Associations between psychological flexibility and daily functioning in endometriosis-related pain.

OBJECTIVES: Processes of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5-10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis. METHODS: This study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning. RESULTS: In general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations. CONCLUSIONS: In this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, but also that careful consideration should be given when selecting instruments.

Brief report: noise reduction in preschool from a self-regulated learning perspective-implementation of a game-based voice regulation training program.

An 8-week voice regulation training program (VRTP) incorporating everyday activities was implemented in an experimental preschool classroom (EG; n = 34), which was compared with a control preschool classroom (CG; n = 31). The VRTP includes songs, games, and conversations aiming to raise children's awareness of noise levels and teach voice modulation skills. Grounded in the theoretical framework of self-regulated learning, the study's objectives were to evaluate the impact of the VRTP on noise levels, children's self-regulation, and pre-literacy skills. Noise levels were assessed weekly using an electronic noise meter before and during the program. The EG preschoolers demonstrated modest but significant improvements over their pre-VRTP levels of voice modulation, behavioral and emotional self-regulated learning, and pre-literacy skills, in contrast with the CG children. The findings provide evidence that young children's self-regulation may be enhanced in preschool, challenging the field of developmental-educational psychology to consider self-regulated learning during early childhood.

How psychedelic-assisted therapy works for depression: expert views and practical implications from an exploratory Delphi study.

As investigations into the efficacy of psychedelic-assisted psychotherapy to treat depression continue, there is a need to study the possible mechanisms of action that may contribute to the treatment's antidepressant effects. Through a two-round Delphi design, the current study investigated experts' opinions on the psychological mechanisms of action associated with the antidepressant effects of psychedelic-assisted psychotherapy and the ways such mechanisms may be promoted through the preparation, dosing, and integration components of treatment. Fourteen and fifteen experts, including both clinical psychedelic researchers and therapists, participated in Round 1 and Round 2 of the study, respectively. Thematic analysis identified nine important or promising 'mechanistic themes' from Round 1 responses: psychological flexibility, self-compassion, mystical experiences, self-transcendence, meaning enhancement, cognitive reframing, awe, memory reconsolidation and ego dissolution. These mechanisms were presented back to experts in Round 2, where they rated 'psychological flexibility' and 'self-compassion' to be the most important psychological mechanisms in psychedelic-assisted psychotherapy for depression. Strategies or interventions recommended to promote identified mechanisms during the preparation, dosing, and integration components of treatment were nonspecific to the endorsed mechanism. The findings from this study provide direction for future confirmatory mechanistic research as well as provisional ideas for how to support these possible therapeutic mechanisms.

Psychological Factors Explaining the COVID-19 Pandemic Impact on Mental Health: The Role of Meaning, Beliefs, and Perceptions of Vulnerability and Mortality.

This study tested an expanded version of the explanatory model of the negative impact of the COVID-19 pandemic on mental health proposed by Milman and colleagues. Participants (N = 680) completed an online survey on demographic variables associated with poor pandemic mental health, COVID-19 stressors, mental health symptoms, and pandemic-related psychological processes we hypothesized as mediating mechanisms explaining the negative mental health effects of the COVID-19 stressors. Results indicated that these psychological processes (core belief violation, meaning made of the pandemic, vulnerability, and mortality perception) explained the severity of mental health symptoms to a far greater extent than COVID-19 stressors and demographics combined. In addition, these psychological processes mediated the impact of COVID-19 stressors on all mental health outcomes. Specifically, COVID-19 stressors were associated with increased core belief violation, decreased meaning making, and more intense perceived vulnerability and mortality. In turn, those whose core beliefs were more violated by the pandemic, who made less meaning of the pandemic, and who perceived a more pronounced vulnerability and mortality experienced a worse mental health condition. This study's results suggest some possible ways of intervention in pandemic-like events useful for limiting such impact at the individual, group, social and political levels.

Assessing Psychological Flexibility and Inflexibility in Chronic Pain Using the Multidimensional Psychological Flexibility Inventory (MPFI).

Psychological flexibility (PF) is a model of well-being and daily functioning that is applied to chronic pain, and is the model behind Acceptance and Commitment Therapy (ACT). However, studies of PF in chronic pain are limited by the lack of a single measure capturing all facets. The Multidimensional Psychological Flexibility Inventory (MPFI) assesses all facets of PF and psychological inflexibility (PI) and could remedy this problem. The current study employs this measure. Adult participants with chronic pain (N = 404) were recruited online and completed the MPFI, other validated measures of PF/PI, and measures of pain, work and social adjustment, and depression, at two time points. The reliability, factor structure, and validity of the MPFI were assessed. Confirmatory factor analysis results demonstrated a good model fit for the proposed factor-and subscale structure. Correlations between MPFI and theoretically similar measures were moderate to strong, and correlations with pain intensity, pain interference, work-and social adjustment, and depression, were small to large. In this first examination of the potential utility of the MPFI within a chronic pain population, we found it to be valid and reliable. It should be noted that the MPFI was less predictive of outcomes compared with more established measures in most cases. Despite this, results from the wide range of variables available from the MPFI highlights the potential importance of aspects of PF and PI not previously emphasized, including the greater predictive utility of the inflexibility facets. Further use and study of the MPFI is recommended. ClinicalTrials.gov ID: NCT05050565 PERSPECTIVE: This article presents a comprehensive examination of a self-report measure assessing all facets of psychological flexibility and inflexibility, in a chronic pain sample. The results support the role of facets not previously emphasized. Comprehensive assessment of PF and PI appears possible and is recommended depending on research questions being asked.

Potential therapeutic effects of an ayahuasca-inspired N,N-DMT and harmine formulation: a controlled trial in healthy subjects.

Background: There is growing scientific evidence for the therapeutic benefits of the Amazonian plant-based psychedelic "ayahuasca" for neuropsychiatric disorders such as depression and anxiety. However, there are certain challenges when incorporating botanical ayahuasca into biomedical research and clinical therapy environments. Formulations inspired by ayahuasca, which contain specific and standardized active components, are a potential remedy. Methods: We investigated subjective acute and persisting effects of a novel formulation containing the reversible monoamine oxidase inhibitor harmine (orodispersible tablet containing 100 mg MAO-I) and N,N-dimethyltryptamine (incremental intranasal dosing of up to 100 mg DMT), compared with two other conditions, namely harmine alone and placebo, in a crossover RCT in 31 healthy male subjects. Results: DMT + harmine, but not harmine alone, induced a psychedelic experience assessed with the 5D-ASC rating scale [global score: F(2,60) = 80.21, p < 0.001] and acute experience sampling items over time, characterized by psychological insights [PIQ, F(2,58.5) = 28.514, p < 0.001], emotional breakthroughs [EBI, F(2,60) = 26.509, p < 0.001], and low scores on the challenging experience questionnaire [CEQ, F(2,60) = 12.84, p < 0.001]. Participants attributed personal and spiritual significance to the experience (GSR) with mainly positive persisting effects (PEQ) at 1- and 4-months follow-up. Acute drug effects correlated positively with persisting effects. We found no changes in trait measures of personality, psychological flexibility, or general well-being, and no increases in psychopathology (SCL-90-R) were reported. Discussion and Conclusion: Our results suggest that the experience induced by the standardized DMT + harmine formulation induces a phenomenologically rich psychedelic experience, demonstrates good psychological safety and tolerability, is well tolerated, and induces beneficial psychological processes that could possibly support psychotherapy. Further studies are required to investigate the psychotherapeutic potential in patients.

Predicting Adherence to Walking from Anxiety, Depression, Disease Impact, Catastrophizing, and Cognitive Fusion in Patients with Fibromyalgia: Does Pain Severity Matter?

AIM: This study analyzed whether the contribution of several factors associated with walking adherence in fibromyalgia (FM) patients varies across pain severity levels. METHODS: Participants were 228 women with FM (mean age 57 years; SD = 8.49). RESULTS: Bivariate analyses replicated the expected association between predictors (FM impact, anxiety, depression, catastrophizing, and cognitive fusion) and poorer adherence to walking. Multivariate analyses showed a negative contribution of FM impact, catastrophizing, and depression on walking adherence after controlling for pain levels (all p < 0.01). A moderation effect of pain severity in the relationship between predictors and adherence to walking was only found for cognitive fusion (B = -0.01, t = -2.02, p = 0.040). Specifically, cognitive fusion only contributed to poor walking adherence at moderate and severe pain levels, but not when pain was mild. The contribution of the remaining predictors was not moderated by pain levels, which means that they contributed to walking adherence irrespective of the pain severity of the patient. Pain severity did not contribute to walking adherence when controlling for the predictors. CONCLUSION: Clinical implications are discussed from the perspective of personalized interventions and preferable target interventions when attempting to increase adherence to walking in this population.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •.

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain.

Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these 2 behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had 2 distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify 3 distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain. PERSPECTIVE: Individuals with chronic pain can be classified with respect to pain acceptance and values-based action and these groups may respond differently to treatment.

The psychological processes of classic psychedelics in the treatment of depression: a systematic review protocol.

BACKGROUND: There is currently renewed interest in the use of psychedelic therapy in the treatment of psychiatric disorders, including depression. The proposed systematic review will aim to identify, evaluate and summarise the psychological processes of change underlying psychedelic therapy for depression in the current literature and consider the implications these processes may have on the psychotherapy component of treatment. METHODS: Scopus, PsycINFO, PubMed and Web of Science databases will be searched using relevant terms. Studies will be included if they discuss the use of a classic psychedelic to treat depression symptomology in an adult population and report or propose psychological processes responsible for depression symptom change. Two authors will independently screen articles, complete quality assessment tools and conduct data extraction. Empirical and non-empirical research will be extracted and synthesised separately. A narrative synthesis approach will be used to report psychological processes identified in the literature. DISCUSSION: This systematic review will be the first to collate available evidence on the psychological processes associated with psychedelic therapy for depression. The preliminary nature of this research field is expected to result in the review having several limitations, namely heterogeneity between studies and the inclusion of limited empirical research. We intend for this review to present the current state of the literature, identify gaps and generate candidate variables that warrant further investigation. SYSTEMATIC REVIEW: PROSPERO CRD42020197202.

Resilience, science, technology, engineering, and mathematics (STEM), and anger: A linguistic inquiry into the psychological processes associated with resilience in secondary school STEM learning.

AIM: To examine resilience in Science, Technology, Engineering, and Mathematics (STEM) learning within an ecological model, identifying the psychological processes associated with resilient, and non-resilient learning to develop a framework for promoting STEM resilience. SAMPLE AND METHOD: From a sample of secondary-school students (n = 4,936), 1,577 students who found their STEM lesson difficult were identified. Students were assessed on three resilience capabilities and asked to write a commentary on how they responded to the lesson. RESULTS: Factor analysis revealed that resilience in STEM learning could be positioned within the ecological systems model, with students' resilience being comprised of three capabilities; the ability to quickly and easily recover (Recovery), remain focussed on goals (Ecological), and naturally adjust (Adaptive capacity). Using a linguistic analysis programme, we identified the prevalence of words within the student commentaries which related to seven psychological processes. Greater ability to recover was negatively related to negative emotional processes. To increase the specificity of this relationship, we identified high and low resilient students and compared their commentaries. Low resilient students used significantly more anger words. Qualitative analysis revealed interpersonal sources of anger (anger at teacher due to lack of support) and intrapersonal sources of anger (including rumination, expression and control, and seeking distraction). CONCLUSIONS: Anger is a key process that distinguishes students who struggle to recover from a difficult STEM lesson. An ecological systems model may prove useful for understanding STEM resilience and developing intervention pathways. Implications for teacher education include the importance of students' perceptions of teacher support.

Psychological Processes in the Social Interaction and Communication Anxiety of University Students: The Role of Self-Compassion and Psychological Flexibility

University students often experience difficulties in social interactions. The current study examinedthe role of self-compassion and psychological flexibility among university students (N= 76) reportinghigh levels of social interaction and communication anxiety. We observed that high social interaction(SIAS) and communication anxiety (PRCA-24) were associated with low levels of self-compassion andpsychological flexibility. Upon further investigating the specific predictors for social interaction andcommunication anxiety, we found that self-judgment, over-identification and openness to experienceswere the key components in self-compassion and psychological flexibility, respectively. However, afterexamining these components together, only self-judgment and over-identification remained crucialpredictors. This suggests that, when training students to manage their anxiety in social situations,attention should be given to promoting skills of self-compassion and psychological flexibility ingeneral. Special attention should be devoted to facilitating a non-critical, accepting and open attitudetowards one’s thoughts, emotions and negative interpretations (AU)

Mindfulness-Based Interventions and Body Awareness.

Body awareness (BA) has long been proposed as a working mechanism of mindfulness-based interventions (MBIs), yet research on the mediating role of BA is scarce. Hence, the present study assesses the impact of an 8-week MBI on self-reported and indirect measures of BA, investigates the potential mediating role of BA in the relationship between an MBI and symptomatology, evaluates the impact of an MBI on important psychological processes (i.e., experiential avoidance, rumination, self-efficacy, and self-discrepancy), and explores whether these variables act alongside BA in mediating the relationship between an MBI and symptomatology. A non-randomized controlled trial was conducted with 148 participants (n = 89 in the MBI group; n = 59 in the control group) who completed questionnaires assessing BA and the above-mentioned psychological processes before and after an MBI. A sub-sample of participants (n = 86) completed a task that evaluates BA indirectly. Results showed a significant effect of MBI on the self-reported BA but not on the indirect measure of BA. The MBI significantly reduced symptomatology, and this effect was mediated by regulatory and belief-related dimensions of BA. Multiple mediator models showed a significant mediation via various pathways involving improved BA and various transdiagnostic psychological processes.

Psychological Processes of Postpartum Mothers with Newborns Admitted to the Intensive Care Unit.

PURPOSE: This research aims to explore the psychological processes of postpartum mothers during the admission of their newborns to the intensive care unit. It is hoped that the findings from this study will serve as a reference for clinical medical staff in providing individual and holistic patient care. METHODS: Using grounded theory methodology, we collected data through semistructured, one-to-one in-depth interviews. When data saturation occurred, 12 participants were involved through the constant comparative analysis process. RESULTS: The psychological processes consisted of a core category and three main categories. The core category was "worrying about the baby and striving to fulfill maternal responsibilities." The three main categories were as follows: "impact on the maternal role," "recognition of the maternal identity," and "exhibition of maternal role." The entire process may be affected by intrinsic and extrinsic factors, such as breast milk supply, timing of skin-to-skin contact, seriousness of the newborn's health conditions, the support system, and the style of postpartum confinement care. CONCLUSION: It is recommended that the neonatal intensive care unit should adopt family-centered care, taking an initiative to empathize and care for the mother, assisting skin-to-skin contact for the mother and baby as soon as possible, maintaining established breastfeeding, providing the correct concept of postpartum care, and encouraging participation in support groups. These activities can reduce the impact of the situation on the maternal role and improve maternal identity recognition.

The role of psychologists in international migration research: Complementing other expertise and an interdisciplinary way forward.

This research note addresses the current and potential future role of psychologists in the study of international migration. We review ways in which psychologists have contributed to the study of migration, as well as ways in which psychological scholarship could be integrated with work from other social science fields. Broadly, we discuss four major contributions that psychology brings to the study of international migration-studying migrants' internal psychological experiences, incorporating a developmental perspective, conducting experimental studies, and integrating across levels of analysis. Given the position of psychology as a 'hub science' connecting more traditional social sciences with health and medical sciences, we argue for a more prominent role for psychologists within the study of international migration. Such a role is intended to complement the roles of other social scientists and to create a more interdisciplinary way forward for the field of migration studies. The research note concludes with an agenda for further scholarship on migration.

Interrelationships Between Psychosocial, Motivational, and Psychological Processes for Effective Learning: A Structural Equation Modeling Study.

We tested a theoretical-conceptual model that introduced our recently developed psychological concept, termed as psychological processes, which is defined as "a person's continuing frame of mind to focus on disposition toward strong resolute, structured thoughts and organization, and aspiration to strive for educational success." This proposition is innovative as it considers the notion that a person's mindset is malleable and, importantly, subjects to social experiences derived from a situated social context. Moreover, from our definition, we contend that psychological processes, as a distinct construct, is "latent," or underlying, with three comparable psychological attributes: personal resolve, effective functioning, and personal striving. Our conceptualization, acknowledging the importance of social contexts and individualized experience and personal belief, proposed that perceived social experiences (i.e., positive versus negative), as a source of information, would shape a student's psychological processes, his/her state of motivation, and engagement in different types of adaptive outcomes. Moreover, from our point of view, psychological processes would act as a predictor as well as a potential mediator of motivation and engagement in different types of adaptive outcomes. In a similar vein, from the positive effect of psychological processes, motivation could act as a predictor as well as a mediator of adaptive outcomes. Structural equation modeling, from Taiwanese university students' (N = 739) responses to various Likert-scale measures, showed support for our original a priori model - for example, the positive effects of perceived social experiences on psychological processes (ß = 0.81, p < 0.001) motivation (ß = 0.61, p < 0.001), and adaptive outcomes (ß = 0.36, p < 0.01), and the positive effect of psychological processes on motivation (ß = 0.31, p < 0.01). Interestingly, we also found some interesting findings with regard to the effects of measured indicators - for example, the positive effect of personal resolve, as a measured indicator, on adaptive outcomes (ß = 0.28, p < 0.001), and the effect of self-efficacy, as a measured indicator, on academic liking experience, also a measured indicator (ß = 0.12, p < 0.01). Overall, the results established have a wide range of implications for consideration - for example, the development of an educational program and/or instructional design that could promote and foster positive learning experiences.

Visual Hallucinations After a Russell's Viper Bite.

Visual hallucinations (VHs) are extremely rare in snakebites. We report a case of Russell's viper bite in an otherwise healthy 55-y-old woman who presented to a hospital in south India with established clinical features of systemic and local envenomation, including coagulation failure, without any neurologic manifestations on admission. She reported simple VH on the third day, which abruptly stopped on the fifth day without any specific medications. Clinical, laboratory, imaging, and electrophysiological studies did not reveal any neuropsychiatric disorders. Including this case, only 5 cases of VH are documented in the literature, 2 following cobra and viper bites and 1 after a sea snake bite. Two cases were reported from Australia and 1 each from the United States, Iran, and India.

Consumer acceptance of genetic-based personalized nutrition in Hungary.

BACKGROUND: Despite the increasing number of personalized nutrition services available on the market, nutrigenomics-based level of personalization is still the exception rather than a mainstream activity. This can be partly explained by various factors of consumer acceptance of the new technology. While consumer attitudes toward genetic tests aiming to reveal the risks of a predisposition to various illnesses have already been examined by several research studies worldwide; consumer acceptance of nutrigenomics-based personalized nutrition has only been examined by a significantly lower number of papers, especially in the Central and Eastern European region. OBJECTIVE: The purpose of this paper is to examine consumer acceptance of genetic-based personalized nutrition in Hungary. Therefore a national representative survey was conducted involving 1000 individuals. The starting point of the model used is the assumption that the consumer acceptance of personalized nutrition is influenced by its consumer perceptions, which are affected by psychological processes that, in a more general sense, determine acceptance of food innovations. RESULTS: The results show that 23.5% of respondents accept genetic test-based personalized nutrition. Women were found to reject the new technology in a significantly smaller proportion than men. The relationship between other demographic variables (i.e. age groups, education and subjective income level) and the perception of genetic-based personalized nutrition is also significant. Our results indicate that it is perceived cost/benefit that is most strongly related to genetically based personalized dietary preferences, followed by perceived risk and subjective norms. Perceived uncertainty and perceived behavioural control, however, have only a weak relationship with genetic-based personalized dietary preferences. CONCLUSIONS: Compared with the magnitude of the effect of socio-demographic criteria, it can be concluded that, on the whole, psychological processes in the individual have a greater influence on the development of preferences for genetic-based personalized nutrition than any socio-demographic factor. This also confirms the trend that there are more and more value-added products or value propositions (where a significant part of the value added is to be found in product innovation), for which psychological characteristics are/should be given more emphasis among the segmentation criteria.

Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis.

Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.

Psychological processes in the experience of hereditary angioedema in adult patients: an observational study.

BACKGROUND: Hereditary angioedema associated to C1 inhibitor deficiency (C1-INH-HAE) is a pathological condition characterized by episodes of subcutaneous swelling and it is frequently associated with discomfort and social impairment of the patients, due to the anxiety experienced for an unpreventable manifestation of an attack during daily life. In children increased level of stress and alexithymia have been associated to C1-INH-HAE, and the latter correlated also with the severity of the disease. We hypothesized that the involvement of psychological issues may impact on the severity of C1-INH-HAE in adult patients as well, interfering with their ability to engage with the management of the disease. METHODS: 28 adult patients with C1-INH-HAE were evaluated for clinical (C1-INH-HAE Severity Score) and psychological factors (alexithymia, emotion regulation, stress, patient health engagement, general severity index) by means of validated questionnaires. RESULTS: Mean age (standard deviation [SD]) was 45 (11) years and time from diagnosis was 20 (12) years. The mean C1-INH-HAE severity score was 6.4. Alexithymia was absent in 22 (78%) patients. Moderate and high stress levels were present in 17 (61%) and 4 (14%) patients, respectively. Moderate-high discomfort was experienced by 9 (36%) patients and a discomfort beyond the clinical attention threshold was shown by 3 (12%) patients. Stress correlated with patient health engagement and with psychological discomfort. CONCLUSIONS: In C1-INH-HAE, patients health engagement and moderate-high psychological discomfort are linked with stress but not with the severity of the disease or alexithymia. A better patient health engagement may be a target for psychological intervention in clinics to ameliorate the stress perceived by C1-INH-HAE patients.