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Treating mental disorders is a critical issue for modern societies due to high costs for the different national healthcare systems. Evidence-based psychological therapies and structured psychotherapies have been recommended for common mental health problems, but real provision of them has not yet achieved significant spread and impact (Mukuria et al., 2013). To improve access to psychological therapies may provide cost-effective solutions, since their positive long-term impact on health has been largely demonstrated (Castelnuovo, 2010a,b; Campbell et al., 2013; Dezetter et al., 2013; Mukuria et al., 2013; Emmelkamp et al., 2014). However, in many developed countries, such as France or Italy, psychotherapies are not enough covered and promoted by the national healthcare systems and health insurance companies (Dezetter et al., 2013). Differently, in the UK, to tackle the huge problem of mental illness, a comprehensive programme of psychological therapy has been launched and watched worldwide. An estimation of its long-term clinical and economic benefits, has, in fact, led to ascertain that “psychological therapy costs nothing” (Layard and Clark, 2014; Clark and Layard, 2015). In order to mimic the positive experience developed in the UK, other countries have now to demonstrate not only the fundamental role and scientific validity of psychological treatments in both clinical and health settings, but also their significant cost-efficacy. As noted by Emmelkamp et al. (2014), “There is little doubt from a scientific perspective that psychotherapy according to this definition is effective, highly beneficial and cost-effective for a wide range of mental disorders and health conditions, such as anxiety, stress and trauma-related disorders, depressive and somatoform and pain disorders, personality disorder, substance use disorders and behavioral addictions, eating disorders and a number of childhood disorders. For all these disorders, various variants of CBT have been established in clinical randomized trials” (pp. 66, 67), but research in psychotherapy lacks of cost-benefit analysis of interventions: “even if a psychological treatment could show strong efficacy and/or effectiveness, due to high costs it might never be assimilated in real clinical practice” (p. 67, Emmelkamp et al., 2014). Unfortunately, most clinical psychologists and psychotherapists are not willing to measure the impact of their clinical practice, even if Beutler (2009) underlined that the gap existing between science and practice could be more imputed to scientists' attitude than to practitioners' intransigence: “scientists were intentionally obscuring many important results because of an unwarranted devotion to a limited number of scientific methods. In fact, I came to believe that they may be using methods and defining psychotherapy and research informed practice in ways that hindered clinicians from being optimally effective” (p. 301, Beutler, 2009). Considering that psychological therapies should be studied not only in the narrow frame of Empirically Supported Treatments (ESTs) approach, but also using different and integrated research and statistical methods (Beutler, 2009), their cost-effectiveness demonstration remains an unaddressed issue in the psychotherapy field. Indeed, as argued by Lilienfeld et al. (2013) with references to how to promote new evidence-based psychological treatments, “organizational support is often tied to the perceived financial viability of a new treatment (Nelson et al., 2006). Consequently, in order to obtain financial support for learning new approaches and techniques within a clinical context, professionals must first estimate and prove the economic gain of training courses to funding organizations. Treatments that have not demonstrated (or treatments whose cost-effectiveness have not been explored) are therefore less viable options for organizations to support” (p. 895, Lilienfeld et al., 2013). More clinical studies aimed at providing cost-offset estimations also measuring additional intangible benefits and showing that psychological treatments could be effective, at both clinical and economic levels, are thus necessary (Wunsch et al., 2014). It is important not to confuse a necessary cost-effective approaches in psychotherapy with dangerous cheap performances provided by the mental health practitioners: “while cost-effective treatments can yield savings in healthcare costs, disability claims, and other societal costs, cost-effective by no means translates to cheap but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses” (p. 423, Lazar, 2014). In clinical psychology, standardized, and internationally recognized psychotherapeutic outcome measures have therefore been developed in order to demonstrate patient improvements (Tarescavage and Ben-Porath, 2014), and an ample set of measurements that are useful to evaluate patients outcomes is currently available considering different criteria (administration time and cost, psychometrics and sensitivity to change, etc.). Among these, the Behavior and Symptom Identification Scale-24 (BASIS-24); the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM); the Depression Anxiety Stress Scales (DASS); the Health Survey Short Form-36 (SF-36); the Outcome Questionnaire-45 (OQ-45); the Patient Reported Outcome Measurement Information System (PROMIS); the Symptom Checklist-90-Revised (SCL-90-R); and the Brief Symptom Inventory (BSI) (Tarescavage and Ben-Porath, 2014) are just a few. However, no agreement has been yet reached over what constitutes relevant ad universal measurements in psychopathology, as requested by the International Consortium for Health Outcomes Measurement (ICHOM) (Porter et al., 2016). Also, clinical psychologists and researchers should strive to develop standardized sets of measures able to estimate savings costs of psychological treatments. In this regard, commonly used analytic approaches to obtain economic evaluations of health care services are: (1) cost-benefit analysis (focusing on the socially desirable outcome achieved by a particular treatment), (2) cost-effectiveness analysis (taking into account the relationship between monetary costs and measures of treatment outcome, evaluating a possible symptoms reduction or a growing work productivity), (3) cost-utility analysis (with similar features of the cost-effectiveness analysis but using a valuing metric for measuring the treatment impact standardized in terms of quality-adjusted life years—QALY). Considering not only the clinical efficacy of ESTs, but also the number of years of life in which an individual would be expected to be completely free of symptoms or disability is a key point to persuade policy makers and administrators that allocation of resources to psychological interventions would lead to both clinical and economic advantages (Hunsley, 2002). Taking into account that the future of the health care systems will be the promising stepped care approach for both chronic care pathologies (Davison, 2000; Richards et al., 2003, 2012; Hermens et al., 2014; Castelnuovo et al., 2015a,b; Delgadillo et al., 2015) and mental disorders (Richards, 2012; Watzke et al., 2014; Gidding et al., 2015; Gureje et al., 2015; Haug et al., 2015; Manber et al., 2015; Oladeji et al., 2015; Palmer et al., 2015; Paris, 2015; Salloum et al., 2015; Edelman et al., 2016), clinical psychologists will play a key role in delivering positive outcomes by continuously revising and progressively intensifying the therapeutic process through the reduction of costs. Despite evidence of the efficacy and effectiveness of the stepped care approach in the clinical field has not been yet reached, positive results have been obtained for preventive treatments aimed at reducing subthreshold depression, which used Internet for individuals who were not able to take part in group interventions (Munoz et al., 1995; Willemse et al., 2004; Van't Veer-Tazelaar et al., 2009; Cuijpers et al., 2010). Instead, another recent study (Van Beljouw et al., 2015) evaluating an outreaching stepped care program on depressive symptoms in older adults failed to demonstrate the utility of the model, while revealing a single (and not stepped) treatment chosen by the participants being sufficient to achieve positive clinical outcomes. Still, further evidence of the cost-benefit, cost-effectiveness, and cost-utility of both single and stepped care approaches in clinical psychology are needed. Useful indications suggesting how to legitimize clinical psychology in health care system are provided in Table ​Table11. Table 1 Steps to legitimize clinical psychology in health care system. Future research in psychology and psychotherapy should, therefore, focus more on cost-effective solutions for the treatment of mental disorders, also considering opportunities provided by new technologies (Castelnuovo et al., 2003, 2014; Cartreine et al., 2010; Castelnuovo and Simpson, 2011; Andrews and Williams, 2014).

Obesity is one of today's most diffused and severe public health problems worldwide. It affects both adults and children with critical physical, social, and psychological consequences. The aim of this review is to appraise the studies that investigated the effects of motivational interviewing techniques in treating overweight and obese children. The electronic databases PubMed and PsychINFO were searched for articles meeting inclusion criteria. The review included studies based on the application of motivational interviewing (MI) components and having the objective of changing body mass index (BMI) in overweight or obese children from age 2 to age 11. Six articles have been selected and included in this review. Three studies reported that MI had a statistically significant positive effect on BMI and on secondary obesity-related behavior outcomes. MI can be applicable in the treatment of overweight and obese children, but its efficacy cannot be proved given the lack of studies carried out on this specific sample.

Psychological issues take on great importance in oncology settings from the communication of the diagnosis to the management of the end-of-life phase (Baider and Surbone, 2014; Chaturvedi et al., 2014; Grassi et al., 2015). When diagnosed with cancer, about 30% of patients can suffer from psychological distress or other important mental health conditions (Singer et al., 2010, 2013; Mitchell et al., 2011; Vehling et al., 2012). The papers of the present research topic give an insight into what taking care of a cancer patient means at the individual, relational, and sociocultural levels. The topics of the papers range from the importance of personality and the psychological distress/psychopathology which cancer patients may experience to the essential role of the caregiver and the relevance of socio-cultural factors. It is now well-proven that psychological distress is a key variable in taking care of cancer patients. A meta-analytic review investigating the longitudinal associations between stress and cancer evidenced in 165 studies that stress-related psychosocial factors are associated with higher cancer incidence in initially healthy populations (Chida et al., 2008). A further 330 studies showed that stress in patients with cancer was related to a poorer rate of survival (Chida et al., 2008). Moreover, individuals with poor social support experienced greater tumor growth and progression, due to increased pro-inflammatory mechanisms (Lutgendorf and Sood, 2011). Poor social support causes an increase of angiogenesis, essential for cancer growth, due to the stress-related production of a cytokine (IL6) acting on the vascular endothelial growth factor. Depression, too, could increase the risk of relapses following cancer treatment and reduce adherence to antineoplastic therapy (Reich, 2008). Moreover, since pain and mood disorders share several pathogenetic mechanisms (Torta and Ieraci, 2013), depression could result in a reduction of the pain threshold (Torta and Munari, 2010). An inflammatory background, mainly due to proinflammatory cytokines, is a central factor that links depression, distress, pain, and cognitive impairment (“chemo-fog”) in cancer patients (Krishnadas and Cavanagh, 2012). The first important step in oncology practice should therefore be screening for psychological distress using well-established clinical instruments, such as the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (Castelli et al., 2011; Grassi et al., 2015). A recent PET study on mixed cancer patients highlighted that the DT scores correlated with the activity of brain areas typically involved in stress response: the higher the DT score, the higher the brain metabolism in brain areas involved in stress, such as the hypothalamus (Castelli et al., 2013). As stressed by Grassi et al. (2015), after the first screening step, patients reporting relevant symptoms should be assessed for more in-depth psychosocial issues. Among these issues, personality traits, coping, attachment style and closeness of personal relationships take on particular importance (Saita et al., 2015). The use of more specific psychological and psychosocial instruments allow the clinician not only to quantify psychological distress but also to better characterize the patients from a psychological standpoint and thus provide a more effective treatment. Civilotti et al. (2015) showed a high percentage of post-traumatic symptomatology (about 60%) in a sample of 92 mixed cancer patients, highlighting how the psychological reaction to cancer may be ascribed to the traumatic spectrum, and can result in dissociative symptoms. The results of the study by Saita et al. (2015) showed that patients who have personality traits of assertiveness and social anxiety tend to use active coping strategies, i.e., Fighting Spirit. Also, the perceived strength of relationships was found to be predictive of using an active coping style (Saita et al., 2015). The clinical relevance of the patient's close relationships was also stressed by Gritti's contribution (Gritti, 2015). The author elucidates the importance of meeting the patient's family, and clearly lists the themes that should be addressed and the conversational strategies to be adopted. The key role played by the caregiver should lead cancer care services to actively include caregiver psychological distress at the core of their health policy. As reported by Baider and Surbone (2014), 40–70% of caregivers have been estimated to have clinically relevant symptoms of depression [National Alliance for Caregiving, (NAC) and AARP, 2008, 2009]. To ignore this evidence would negatively impact on not only the caregiver, but also the care receiver. Healthcare systems can no longer ignore the importance of caring for the caregivers in our endeavors to heal cancer. The universality of cancer and its impact on every aspect of life, highlights the central role of clinical psychology in addressing both social and cultural factors. The papers by Chaturvedi et al. (2014); Baider and Surbone (2014), and Grassi et al. (2015) stressed the key role of the social dimension. As stated by Baider and Surbone (2014), “studies have shown that cultural beliefs and social norms play a part in influencing family emotions and behavior with respect to cancer perception and in their appraisals of illness and health.” Family health-culture norms and beliefs about health and illness, should be taken into account in order to provide appropriate and effective treatment and care to patients and their families (Chaturvedi et al., 2014). Finally, Cormio et al. (2014) investigated posttraumatic growth in caregivers of cancer patients. Once again, the results highlighted that cancer could result in relevant changes not only in the individual, but also in the whole family system. Specifically, they found that both the patient and caregiver may experience posttraumatic growth after the cancer experience. In some cases, patients and caregivers were able to recognize positive elements and growth even in the dramatic experience of a diagnosis of cancer (Cormio et al., 2014). Psycho-oncology does not have a long history, but in more than 30 years it has “produced a model in which the psychological domain has been integrated, as a subspecialty, into the disease-specific specialty of oncology. As such, the field today contributes to the clinical care of patients and families, to the training of staff in psychological management, and to collaborative research” (Holland and Weiss, 2010, p. 3). It is imperative that research and practice in clinical psychology evolves in parallel with medical developments, in order to ensure an integrated and evidence-based approach within this field (Castelnuovo, 2010).

It is highly recommended to promptly assess motivation and readiness to change in individuals who wish to achieve significant lifestyle behavior changes in order to improve their health, overall quality of life and well-being. In particular, motivation should be assessed for those who face the difficult task to maintain weight, which implies a double challenge: weight loss initially and its management subsequently. In fact, weight-control may be as problematic as smoking or drugs-taking cessation, since they all share the commonality of being highly refractory to change behaviors. This paper will examine three well-established tools following the Trans-theoretical Model (TTM), specifically assessing readiness to change in weight management: the URICA, the S-Weight and the P-Weight and the Decisional Balance Inventory. Though their strengths and weaknesses may appear to be rather homogeneous and similar, the S-Weight and P-Weight are more efficient in assessing readiness to change in weight management and control. Assessing motivation and readiness to change may be a crucial step in promptly identifying psychological obstacles or resistance towards weight-management in overweight or obese hospitalised individuals, and it may contribute to provide a more effective weight-control treatment intervention.

Being overweight is a growing problem worldwide, and is becoming an epidemic both in Europe and the United States. Recent reports show that 64% of U.S. adults are overweight, and this a rate continues to rise (Lifshitz and Lifshitz, 2014). In the United States, the economic burden on the healthcare system related to this issue is approximately 100 billion dollars (Cawley et al., 2014; Specchia et al., 2015). The economic burden Europe is similar to that in the United States (Pietrabissa et al., 2012; Lehnert et al., 2014).

Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the “chronic care management” challenge in both traditional and mHealth settings.

Social media, online social networks and apps for smartphones and tablets are changing the way we communicate. According to a recent Pew Research Center survey, 73% of Internet users among US adults engage in social networking to access, create, and share contents (Duggan and Smith, 2013). The number of smartphone users is growing worldwide [56% of American adults are currently smartphone owners (Smith, 2013)], and millions of applications (most of them related to social media or other communication tools) are available on the Google Play or iTunes store. The increased prevalence of chronic (and non-communicable) diseases in high-income countries is today largely attributable to the convergence of an aging population with the persistence of several risk factors, including physical inactivity, use of tobacco and alcohol, high blood pressure and cholesterol, stress, depression, and overweight and obesity. Many of these risk factors can be mitigated by health interventions and education, and communication tools could support healthy lifestyle and behavior change. In the past years there was an increasing interest in the use of digital technologies to support these changes because they contribute to enhance levels of surveillance over behaviors and have the potential to provide acceptable and cost-effective interventions by transferring treatment, rehabilitation and prevention of a condition to self-care in the community (Castelnuovo et al., 2010). Social media and smartphone-based applications are now changing how people interact with the healthcare and public health systems (Santoro, 2013; Santoro and Quintaliani, 2013). The participatory, interactive nature of social media platforms allows for information to be generated and shared in a viral fashion, and provide new mechanisms to foster engagement and partnership with consumers, to change their behaviors and to fight against unhealthy lifestyles. More than 100,000 health related apps are also available in the market allowing people to record, track, and analyze vital signs and physical health data over time, to obtain feedback and general information about the disease they suffer from, and to receive alerts to remind them to take their medications or to measure their blood glucose levels. Due to their possible implications in public health a growing number of scientists suggests to incorporate social media and mobile health in health promotion and healthcare programs (Burke-Garcia and Scally, 2014).

Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives Refereed/Peer-reviewed

The abuse of legal and illegal drugs is a complex and constantly evolving phenomenon. In recent years the polydrug use, term that refers to the use of two or more psychoactive drugs in combination to achieve a particular effect, has been on the rise. In many cases, one drug (amphetamine, cocaine, or heroin) is used as a base, with additional drugs being added to compensate for the side effects of the primary drug and to make the experience more enjoyable. The traditional traffic of drugs, always cheaper and more often available on the Internet, is expanding to include medical prescription drugs that can be ordered without prescription, “smart” drugs (substances legally sold for other uses, such as fertilizers, bath salts, dietary supplements), and synthetic drugs (Cinosi et al., 2014). In Italy, in 2013, the Department of Drug Control Policy (DPA) has identified, made illegal, and seized more than 250 new substances, including synthetic cannabinoids, cathinones, phenethylamines, piperazines, and metossietamine (Dipartimento Politiche Antidroga Relazione annuale al Parlamento, 2013). With the change in substances, the methods of recruitment and their use have also changed. The assumption is that combination of drugs increases the health risk much more compared to a single drug, e.g., alcohol and cocaine increase cardiovascular toxicity (Snenghi et al., 2015); alcohol or depressant drugs, when taken with opioids, lead to an increased risk of overdose; opioids or cocaine taken with ecstasy or amphetamines also result in additional acute toxicity. Benzodiazepines are notorious for causing death when mixed with other depressant substances, such as opioids, alcohol, or barbiturates (Kelly et al., 2015). The unpredictability of the effect, due to the use of several substances randomly mixed, makes the substance use more attractive. Instead of looking for a specific effect, as was the case with the use of a single drug, polyusers seek the maximum alteration of consciousness and loosening of inhibitions (the so-called garbage head syndrome), which makes it much easier to achieve the euphoria. The new phenomenology of the “culture” of the buzz calls for a re-thinking by the therapists and experts in the field in order to promote various forms of integration between professionals and to calibrate new methods of intervention.

Psychological inflexibility refers to the attempt to decrease internal distress even when doing so is inconsistent with life values, and has been identified as a potential barrier to making and maintaining health behavior changes that are consistent with a heart-healthy lifestyle. Disease- and behavior-specific measures of psychological inflexibility have been developed and utilized in treatment research. However, no specific measure has been created for patients with heart disease. Thus, the CardioVascular Disease Acceptance and Action Questionnaire was developed. The present study is aimed to evaluate the psychometric properties of the CardioVascular Disease Acceptance and Action Questionnaire and to explore its association with measures of psychological adjustment and cardiovascular risk factors in an Italian sample of 275 cardiac patients. Exploratory factor analysis showed a structural one-factor solution with satisfactory internal consistency and test-retest reliability. The relation with other measures was in the expected direction with stronger correlations for the theoretically-consistent variables, supporting convergent and divergent validity. CardioVascular Disease Acceptance and Action Questionnaire scores were associated with general psychological inflexibility, anxiety and depression and inversely correlated with psychological well-being. Moreover, the results showed that CardioVascular Disease Acceptance and Action Questionnaire scores are associated with two relevant risk factors for cardiac patients, namely low adherence to medication and being overweight. In sum, results suggest that the CardioVascular Disease Acceptance and Action Questionnaire is a reliable and valid measure of heart disease-specific psychological inflexibility with interesting clinical applications for secondary prevention care.

Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies. Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results. Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL. Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators. Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed. Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed.

Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area. Refereed/Peer-reviewed

In this book a group of independed-minded academics has orchestrated a multi-authored text that represents an update of knowledge concerning how motivation influences Cardiovascular (CV) response. Discussing diverse motivational approaches that are representative of works carried out in several areas of psychology, health implications of the linkages between motivational variables and CV response have been investigated. The volume is divided into two major parts: Part I includes chapters that concern mechanisms of motivational influence on CV response, while in the Part II motivational paths to carry out with the aim of investigate CV response in different life circumstances have been considered. In more detail, 4 subsections organize Part I through 10 chapters, and 3 subsections constitute Part II by means of 9 chapters, each of those preceded by a summary of the key points. The opening chapters discuss the importance of modern neuroimaging techniques in allowing occasions to investigate how the interplay between CV status, cognitive-emotional functioning, and environmental demands are realized within the central and peripheral nervous systems. The relationship between emotional arousal and CV response has been noteworthy argued and enriched by results from recent research findings in various disciplines (Pietrabissa et al., 2012; Compare et al., 2013a). These studies demonstrate stress, motivational intensity, individual personality, self-regulation and mood states being in charge of health damaging CV adjustments, such as heart rate, blood pressure, and heart contraction force (Compare et al., 2011a, 2012, 2013b). Part II mainly contains evidences that CV activity is an indicator or even cause for CV diseases development, also including explanations about the role covered by gender, psychological processes, and social interactions in influencing health outcomes via relevant biological pathway. In addition, a set of considerations that may guide future research on this subject are discussed. Due to the various contributions from different authors of different countries, both style of writing and chapters arrangement widely varies. Some issues are effectively revisited on several occasions in the volume, constituting minor imperfections in an otherwise excellent, comprehensive, and up-to-date overview of mechanisms and applications related to CV disease. In fact, this book, edited by two psychologists and written by an International group of specialists in different fields of medicine, successfully covers the subject. Because of diseases generally display a multifactorial aetiology and symptoms require to be assumed as manifestations of a complex interplay of several factors, the bio-psycho-social approach of illness theorized by Engel (1977) remains in the background. Health and illness are not seen as opposite concepts or distinct entities but extremes of a continuum on which individuals constantly flux depending on the quality of their daily-life experiences, influenced by biological (e.g., genetics, age), psychological (e.g., attitude, stress) (Compare et al., 2011b, 2013c), and social (e.g., interpersonal relationships, socio-economic status) factors (Castelnuovo, 2010; Compare et al., 2013c). Due to this complexity, as well as stated the crucial role of both personal dispositions and intentions in modifying personal attitudes and behaviors, the relevance of setting realistic goal, implementing patient-centered treatments and developing motivational enhancement techniques, is highlighted. Overall, this book represents a well-collated collection of research outcomes, successfully demonstrating the importance of both psychological factors and motivation in the treatment of patients suffering from CV diseases (Manzoni et al., 2011a). In fact, as extensively discussed through the pages of this volume, the individual's level of initial motivation, reflecting the maximum energy spent by a person for goals attainment, represent one the main predictor of success in preventing and managing CV risk factors (Manzoni et al., 2011b) also by modern telecare systems (Villani et al., 2007). However, the text is so densely written than chapters seem to be resources for references rather than flowing text. Despite recent technological changes have made information readily available on the Internet, because of potentially appealing scholars and practitioners from a wide range of areas, together with its acceptable price, this book still constitute a significant source of outcomes and data.

To some extent, all cardiac patients are challenged by their heart disease. Challenging issues concern the adjustment of patients to the cardiovascular disease and involve the physical, psychological, behavioral, and social dimensions of the person. Clearly, heart disease, its physical impact and the clinical sequelae (treatment and rehabilitation procedures) challenge patients at multiple levels by critically upsetting the homeostasis of their bio-psycho-social systems. Challenges may be very easy as well as very hard to accomplish and this variability does not depend only on the seriousness of the cardiac illness or on the impact of the correlated clinical and rehabilitation procedures, but it is also related to the psychosocial characteristics of patients, including personality and coping styles. When patients have difficulties in facing the multi-dimensional challenges of heart disease, they may show high levels of stress, anxiety, and depression as well as problematic behaviors such as resistance and poor adherence to treatment and preventive prescriptions, including behavioral modifications such as smoking cessation and physical exercise improvement. Given the huge amount of empirical evidence supporting the fact that smoking, physical inactivity, unhealthy diet, harmful use of alcohol as well as psychological distress are modifiable risk factors for cardiovascular morbidity and mortality, patients showing difficulties in adjusting to cardiac illness and the correlated clinical demands should be detected and then helped with behavioral and psychological interventions in facing the multi-dimensional challenges they are not able to overcome themselves. This book, edited by an experienced health psychologist in the field of “behavioral cardiology” and written by an international group of outstanding researchers and clinicians working in the expanding area of bio-psycho-social approaches to cardiac patients, covers firstly the psychological challenges and management needs of patients affected by specific cardiovascular conditions. With few exceptions, all chapters in the first part deserve particular consideration for their specialty contents. Clinicians working with cardiac patients affected by specific cardiovascular conditions such as ICD implantation for ventricular fibrillation, atrial fibrillation, heart failure, Takotsubo syndrome, and cardiac transplantation, may find in them extensive information about the unique psychological challenges and difficulties of living with such conditions and they may also acquire specialty knowledge on tailored psychological approaches to specific needs management. In the second and last part of the book, various psychological and behavioral interventions for cardiac patients are described. With the exception of the review chapter about anxiety and depression as risk factors for cardiovascular disease, whose inclusion in this section is questionable, the great part of issues that are covered along the second half of this book were rarely or never addressed in other similar publications. Bright spots are the chapters on computerized therapies and on the management of sleep problems, while a missing issue is the psychological and behavioral management of obese patients with heart disease, for which tailored multi-disciplinary interventions have already been planned and assessed (Manzoni et al., 2010, 2011). The declared purpose of this book is to inform clinicians who practice on the front line of the psychological and behavioral management of cardiac patients on topics where the research findings have not yet caught with practice and, at the same time, to provide them concrete, immediately applicable, translation of clinical research findings into tailored practical approaches (Castelnuovo, 2010a,b). It is noteworthy that clinicians whose this book is addressed will find in it all that was promised.

The discussion about nomothetic and idiographic approaches is one of the main philosophical debates in the field of psychological sciences (Schafer, 1999; Salvatore and Valsiner, 2010). The term “nomothetic” comes from the Greek word “nomos” that means “usage, custom, law” and in psychology is referred to the objective classification under similar conditions, to in establish generalizations, such as diagnoses. The term “idiographic” derives from the Greek word “idios”, meaning “pertaining to self; one's own, private or separate” and is referred to the aspects of subjective experience that makes each person unique. In the clinical psychology, the debate deals about the classification of personality and other taxonomies, as well as the use of diagnosis. At the intervention level, the discussion is about the use of individualistic treatment techniques or treatment derived from research where the focus is a group of people with a similar condition, where (individual) efficacy is tested with aggregated statistics. For example, evidence-based research indicates that the cognitive-behavioral therapy has a positive impact toward the anxiety disorders (Olatunji et al., 2010). As researchers, we look for regularities and repetitive phenomena. However, when the study object is the human being, with all his complexity, we cannot forget that every person is unique. That is even more important in the clinical practice, where clinicians do not have to take care of an “average score,” but they must assist an individual, with his clinical peculiarities, thoughts, emotions and relationships. When dealing with severe and chronic illnesses, such as Amyotrophic Lateral Sclerosis (ALS), this debate is very important and sometimes is at risk of being underestimated. The human tendency toward generalization, together with a superficial approach to research findings, may lead us to stereotypical beliefs about a person living with severe disease. In the case of ALS, an incurable terminal illness with a potentially steep decline in physical function and erosion of independence, it could easily be assumed that “if a person has ALS, than he/she must be depressed and have a low quality of life”(Rabkin et al., 2009). The reaction toward a grave diagnosis such as ALS will vary greatly from person to person. Individual's characteristics will lead to a personal reaction that may include depressive features, despair, hopelessness, but there remains potential for the individual to find hope, and maintain hope in the face of such serious prognosis (McDonald et al., 1994). Therefore, even if we can find out, statistically, the average score of each psychological issue involved, no aggregate research will be able to consider the whole complexity of the individual reaction. The practice of clinical psychology use to be guided by an idiographic approach, with an attention to research results derived from a nomothetic point of view. However, in certain cases, prejudices for a clinical situation may interfere in the process of individual knowledge. In the ALS field, considering the low prevalence of the disease, it is possible that a professional without a good deal of knowledge about such illnesses may overestimate depressive features based on assumption. A similar concept is also important for other types or clinicians, such as the physicians, in particular when they are not used to treat a particular clinical situation. One way of better understanding a patient's world is to complete a quality of life (QoL) questionnaire, though care should be taken when selecting a questionnaire for this purpose. QoL is defined by the World Health Organisation as a “broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment” (WHOQOL Group, 1998). There are two different conceptualizations of QoL, known as health-related Quality of Life (HRQoL), and subjective well-being (SWB). HRQoL largely quantifies QoL based patient self-reported symptoms and ability to carry out activities of daily living. Subjective well-being, otherwise known as “Individual Quality of Life” in ALS research literature (Clarke et al., 2001), refers to a positive state of mind and satisfaction with life in general, and is not contingent on assessment of symptom severity. According to the construct of HRQoL and the manner in which it conceptualizes QoL, patients with ALS must have a lower QoL than the general population, with further decreases as symptom severity increases, in line with disease progression. However, past research has shown that QoL is unrelated to physical strength and the functional capacity (Goldstein et al., 2002; Pagnini, 2012). Therefore, when administering a QoL measure, clinicians must be aware of the subtle, but very important distinction between QoL and the confusingly named HRQoL. Ideally, clinicians should always administer questionnaires that have been shown to work well with the intended illness group. Even questionnaires that are apparently suitable and ostensibly avoid somatic symptoms of depression have been shown to overestimate depressive features for ALS patients (Gibbons et al., 2011). Even if researchers may take advantages from standardized questions and replies, clinicians should also include a patient-based focus. In the assessment of the QoL, for example, there are many questionnaires that are useful to understand how a person feels, with different degrees of sensitivity. One of the most interesting instruments for the assessment of the individual needs, beliefs and emotions, is the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) (Hickey et al., 1996) that asks people to indicate the five most relevant domains for their well-being, to rate them and to classify among each other. Even if the score obtained has been criticized (Felgoise et al., 2009) and has some limitations from the research point of view, the clinical process of domain selection and rating may provide interesting insights about the individual's situation and prove useful in the formulation process, coherently with a SWB approach. The use of a similar approach by clinical psychologists and physicians who work with chronic illnesses may allow assist in understand the patient's individual clinical issues, reducing prejudices and the risk of a blind application of a nomothetic approach.

Starting from the critical review of various motivational frameworks of change that have been applied to the study of eating disorders, the present paper provides an alternative conceptualization of the change in psychotherapy presenting a single-case study. We analyzed six psychotherapeutic conversations with a bulimic patient and found out narratives “for” and “against” change. We read them in terms of tension between dominance and exchange in I-positions, as described by Hermans. These results indicate that the dialogical analysis of clinical discourse may be a useful method to investigate change from the beginning to the end of therapy.

According to systemic-constructivist theory, all psycho-pathological organizations are linked to specific meanings which are developed by the individual within problematic situations in the context of learning, particularly within the family. The aim of this empirical study is to support the theory that eating disorders are linked to the "power semantics," concept developed by Ugazio. The hypothesis that the bipolar construct "winner/loser" and the associated meanings are predominant for obese people, has been verified by interviewing 44 women (22 obese/overweight; 22 controls) using the Repertory Grid Test developed by Kelly. The participants' elicited constructs were classified according to their semantic content and the data compared using statistical techniques. The power semantics were more prevalent and important in the Obese Group than in the Control Group. These results are critically discussed, highlighting possible clinical developments.