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Background Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown). Methods 1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures. Results Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes. Limitations Only 32.7% of participants provided complete responses for both waves. Conclusion The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

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

The Experiences in Close Relationship Scale (ECR) is one of the most commonly used self-report instruments of adult attachment and has been widely adopted in psychotherapy research. Composed of two subscales, namely Attachment Avoidance and Anxiety, the ECR was recently shortened to a 12-items version, called the ECR-12. Given the importance of extending knowledge on its applicability in understudied populations, our aim was to validate the ECR-12 in a large sample of Italian native-speakers. A total of 1197 participants (73.2% females; mean age=28.53±11.37 years) completed the ECR-12. Each participant also completed other measures of attachment, psychopathology, interpersonal distress, coping strategies, and well-being. An Exploratory Structural Equation Modeling analysis showed an excellent fit of the data, providing support for the two-dimensional orthogonal structure of the ECR-12. In addition, the measurement model was invariant across genders. Both attachment anxiety and attachment avoidance subscales demonstrated good internal reliability, with McDonald’s Omegas and Cronbach’s Alphas above the suggested 0.8 cut-off. Finally, the Italian version of ECR-12 showed adequate convergent, concurrent, and divergent validity. Highly anxious individuals reported the highest levels of maladaptive interpersonal functioning and coping strategies, resulting in lower well-being. Interestingly, both attachment insecurity dimensions predicted higher levels of psychopathology, even after controlling for demographic variables and levels of self-reported relational difficulties. Given the good psychometric properties of the ECR-12, researchers and practitioners in Italy are encouraged to adopt the ECR-12 in their future research on adult attachment in psychotherapy.

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n= 14) or a peer mentor (n= 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. Results: WA with peer mentors was slightly higher than WA with students (ES=0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders.

Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals’ quality of life and behaviour change efforts. Increased sensitivity to others’ negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.

The coronavirus disease 2019 (COVID-19) spread several months ago from China and it is now a global pandemic. The experience of lockdown has been an undesirable condition for people with mental health problems, including eating disorders. The present study has the aim of understanding the impact of the first wave of the COVID-19 pandemic on people with selfreported disordered eating behaviours. A linguistic analysis was carried out with regard to the online posts and comments published by 1971 individuals (86% women) in a Facebook online community focusing on EDs during the lockdown. A total of 244 posts and 3603 comments were collected during the 56 days of lockdown (from the 10th of March until the 4th of May 2020) in Italy and were analysed by Linguistic Inquiry and Word Count (LIWC) software. The results showed that words related to peer support decreased in posts over time, and that anxiety and anger increased in the published comments. Moreover, greater feelings of negativity and anxiety were found in posts and comments throughout the COVID-19 pandemic, as well as lesser use of words related to positive emotions. Thematic qualitative analysis revealed eight themes that described the main subjective components of ED symptomatology and distress during the first COVID-19 lockdown. The current findings can help in delivering tailored treatments to people with eating disorders during the COVID-19 pandemic.

The aim of the current study is to examine gender, age. and cross-country differences in fear of COVID-19 and sense of loneliness during the lockdown, by comparing people from those countries with a high rate of infections and deaths (e.g., Spain and Italy) and from countries with a mild spread of infection (e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total of 3876 participants (63% female) completed an online survey on “Everyday life practices in COVID-19 time” in April 2020, including measures of fear of COVID-19 and loneliness. Males and females of all age groups in countries suffering from the powerful impact of the COVID-19 pandemic reported greater fear of COVID-19 and sense of loneliness. In less endangered countries, females and the elderly reported more symptoms than males and the young, in Spanish and Italian samples, the pattern of differences is considerably more complex. Future research should thoroughly examine different age and gender groups. The analysis of emotional well-being in groups at risk of mental health issues may help to lessen the long term social and economic costs due to the COVID-19 outbreak.

Background. A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women’s mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women’s psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women’s psychological distress. Methods. This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. Results. No significant changes were found in women’s psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. Conclusions. Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

The social microcosm is defined as group members replicating their everyday (intersession) interpersonal behaviors in group sessions and new behaviors, learned in the group (in-session), replicating in the members' everyday life. We examined intersession and in-session intimate behaviors, at the within-member (differences in intimate behaviors between weeks/sessions), between-member (average differences in intimate behaviors between group members) and between-groups (group-level differences in intimate behaviors). Participants were 178 graduate students (86% identifying as women and 14% as men) participating in 10 5-session growth groups led by experienced group therapists. Before group sessions, group members completed the Interpersonal Relations Scale Checklist (IRScl; Shadish, 1984) indicating their number of intersession intimate behaviors for the previous week and, at the end of group sessions, they filled in the IRScl to indicate their in-session intimate behaviors. A 3-level HLM analysis (sessions, members, groups) predicting in-session intimate behaviors from previous week intersession intimate behaviors showed significant within-member, between-member, and between-groups effects. A second 3-level HLM analysis (sessions, members, groups), predicting following week intersession intimate behaviors from in-session intimate behaviors, showed significant between-member and between-groups effects. Between-member and within-member in-session intimate behaviors interacted to predict intersession intimate behaviors. Group members who generally had a low number of in-session intimate behaviors engaged in more intersession intimate behaviors in weeks following sessions with higher than average in-session intimate behaviors. These results provide support for the social microcosm proposition that members' trait-like everyday behaviors are replayed in the group. However state-like and other-member everyday behaviors also contribute to members' social microcosm. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The aim of this study is to explore the immediate effects of group counseling ruptures. Group ruptures were defined as discrepancies between (1) the member’s bonding and working ratings in a session and the member’s average bonding and working across all sessions, (2) the member’s bonding and working in a session and the group-as-a-whole’s (across all members and sessions) bonding and working, and (3) the member’s average bonding and working across all sessions and the group-as-a-whole’s bonding and working. Method: Participants were 232 counseling students (199 women and 33 men; age: M = 22.78, SD = 3.51) who participated in one of 13, 7-session, interpersonal process groups. At the end of each group session, group members completed the Group Questionnaire (Burlingame et al., 2016) and the Interpersonal Relations Scale Checklist (Shadish, 1984), an index of intimate behavior. Three-level (members within groups and sessions within members) polynomial regressions and response surface analyses were used to examine discrepancies in ratings of bond and work. Results: Group member’s bonding ruptures were unrelated to the number of intimate behaviors in a session. However, when a member’s perception of positive working in a session was lower than his or her average level of working (across all sessions), that member reported lower level of intimate behaviors. Moreover, when group member’s positive working in the session is lower than the group-as-a-whole’s working, that member’s intimate behaviors were lower. Conclusions: The findings show that group members’ working ruptures have a negative effect on their task engagement and need to be recognized and addressed by the group leader. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Highlights and Implications—•Ruptures in the bonding relationships in group sessions were not related to how many intimate behaviors in which group members engaged. •When a member’s rating of the working relationship in a session was lower than his or her average ratings of working relationships across all sessions, the member showed less involvement in the group task by engaging in fewer behaviors that promote intimate relationships. •When a member’s rating of the working relationships in a session was lower than the group-as-a-whole’s ratings of working relationship, the member showed less involvement in the group task by engaging in fewer behaviors that promote intimate relationships. •Low engagement in intimate behaviors can be a marker for group ruptures in working relationships. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

During the COVID-19 pandemic crisis, the experience of quarantine has been an undesirable condition for people and it can have a negative impact on mental health and psychological wellbeing. Social isolation has led to an increase in time spent on social network sites, with people interacting more frequently with each other, and comparing online the way in which they are experiencing the same state of home confinement. Our study aimed to investigate the role of online social comparison on individuals' psychological distress and life satisfaction during the COVID-19-related quarantine. Specifically, a cross-lagged panel study at three-waves was conducted in Italy in order to examine the change in psychosocial distress levels (e.g. depression, anxiety, stress, loneliness, low life-satisfaction) from before the quarantine for a period of one month, as well as the predictive role of online social comparison to ameliorate individual distress. An online survey was distributed through a social media platform three times after the initial lockdown and at the epidemic's peak two and five weeks later. A total of 113 participants participated in an online survey between the 7th of March and 14th of April 2020. The results showed an increase in the levels of loneliness, depression, stress, anxiety and a decrease in the level of life satisfaction in the pre/post quarantine comparison. Our cross-lagged results also showed that online social comparison at T1 and T2 predicted the individual's improvement in levels of anxiety, stress, loneliness and life satisfaction over time. Overall, the results of the current study underline the positive effects of online social comparison on the reduction of psychological distress during the COVID-19 quarantine.

The Group Questionnaire (GQ) is a measure recently developed by Krogel et al. (2013) for the evaluation of the therapeutic relationship in group. The GQ identifies a three-factor model of the relationship that allows to measure quality (Positive Bonding, Positive Working and Negative Relationship) and structure (member-member, member-leader and member-group), dimensions in group. This work shows the results of a first study on the Italian validation of the GQ. In this study the GQ was administered to 536 subjects from 32 non-clinical groups of undergraduate students. The cross-cultural validity of the GQ in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and scores of the Italian GQ with the original American version. Multilevel confirmatory factor analysis was used to examine both the between- and within-group structures. Data concerning reliability and validity of GQ and the results for different SEM in Multilevel CFA confirm the three factors structure of the GQ. Data from the Italian population have a good fit with the original proposed model. Finally, we discuss the importance of an instrument like GQ, short but consistent, for the evaluation of the therapeutic relationship in clinical and training group.

Background In recent years, the Fear of Missing Out (FoMO) construct has been the object of growing attention in digital technology research with previous studies finding support for the relationship between FoMO and problematic smartphone use (PSU) among adolescents and young adults. However, no previous studies clarified the causal link between FoMO and PSU using a longitudinal design. Methods An auto-regressive, cross-lagged panel design was tested by using a longitudinal dataset with two waves of data collection (T0 and T1, one year apart). Participants included two hundred and forty-two adolescents (109 males and 133 females), with a mean age of 14.16 years, who filled out the Fear of Missing Out scale (FoMOs) and the Smartphone Addiction Scale (SAS). Moreover, participants filled out the Difficulties in Emotion Regulation Scale (DERS), at the first time-point of data collection. Results The findings of the study show that FoMO (both FoMO-Fear and FoMO-Control subscales) and PSU are positively related at both time-points (i.e. at a cross-sectional level). However no cross-lagged associations between them were longitudinally supported. Females and older adolescents show higher FoMO-Fear at T1. Conclusions The findings of the present study suggest caution when causal links between FoMO and PSU are inferred.

Background The extreme social circumstances caused by declared COVID-19 pandemic deeply intervene people’s everyday life and should not be neglected but seen through the view of social reality pinpointing the ‘ordinary’ people. In this article, authors explored basic segments of everyday and their subjective perception to what extent sleeping habits, physical inactivity, physical activity, nutritional habits and smoking have changed. Methods The online survey was conducted in nine European countries (Bosnia and Herzegovina, Croatia, Greece, Kosovo*, Italy, Serbia, Slovakia, Slovenia and Spain) in 4108 participants, aged 15–82 years. The survey took place 30–40 days after World Health Organization declared COVID-19 pandemic state, from 15 April to 3 May 2020. Results The results have shown 30 min longer sleeping time, 50% longer physical inactivity time, 65% longer screen time, 43% shorter walking time, 24% shorter sport time and 37% longer physical work time. Additionally, body mass gains (0.3 kg) could be explained in 20.6% with meals sizes, unhealthy food consumption, screen time and sport time. Further, respondents reported more regular meals (44%) and healthier meals with less alcohol consumption and less smoking, which have been positive outcomes of home confinement. Conclusion The findings draw attention to negative changes in everyday praxis (inactivity, body mass gain) after such a short period. Because of possible risk to population’s health (especially of countries such as Italy and Spain with serious threat and more stringent measures), findings enable development of recommendations for maintaining healthy lifestyle habits with minimal negative health consequences in similar pandemic circumstances.

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

This study examined the measurement invariance of three scales that assessed emotional eating, restrained eating, and intuitive eating across eight countries (Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States) in order to determine their suitability for cross-country body image research. A total of 6272 young adults took part in this study. Participants completed an online survey including the Emotional Eating subscale of the Three Factor Eating Questionnaire-Revised 21, the Restraint subscale of the Eating Disorder Examination Questionnaire, and the Reliance on Hunger and Satiety Cues subscale of The Intuitive Eating Scale-2. Multi-group confirmatory factor analysis was used to evaluate potential cross-country differences in functioning of the measures. Partial invariance for all three scales was found, with only minor levels of non-invariance identified. Multiple indicator multiple cause models identified BMI and gender as potential influences on scores for these measures. Sources of invariance across groups are discussed, as well as implications for further substantive research across countries involving these measures.

We compared each individual group member’s attachment fit with the attachment of the other group members. Participants were 201 members of 20 therapy groups who sought treatment because they were overweight or obese. Group members completed the Attachment Style Questionnaire before commencing treatment and the Group Questionnaire at three points during group treatment. Multilevel polynomial regression followed by response surface analysis was used to examine how the attachment anxiety and avoidance of the individual group member and the aggregated attachment anxiety and avoidance of the group members were related to individual group members’ perceptions of the positive bonding, positive working relationships, and negative relationships in the group. The findings suggested that attachment heterogeneity in group is related to the perception of members’ stronger bonding relationships and lower negative relationships. In addition, positive bonding can be increased when a patient high in attachment avoidance is added to a group whose patients are low in attach- ment avoidance; however, group members reported weaker negative relationships when their attachment anxiety or avoidance became increasingly higher or lower than other group members’ attachment anxiety or avoidance.

A group member’s attachment, anxiety, and avoidance is related to how the group member and the other group members (OGMs) perceive group relationships. In addition, the collective attachment strategies of the OGMs may also be related to how the individual group member and the others perceive the relationships in the group. We extend previous research, using the actor partner interdependence model (APIM), to examine how group members’ and aggregated OGMs’ attachment anxiety and avoid- ance were related to group members’ and OGMs perceptions of positive bonding, positive working, and negative relationships measured early and late in interpersonal growth groups. Three hundred twenty-five Italian graduate students were randomly assigned to 1 of 16 interpersonal growth groups that met for 9 weeks with experienced psychologists. Attachment anxiety and avoidance was assessed with the Attachment Style Questionnaire (ASQ) and the third and eighth session ratings of group relationships were assessed with the Group Questionnaire (GQ). For group members, the relationships between attachment and group relationships were stable across time; for OGMs the relation- ship between attachment and group relationships only emerged late in the group. Group member’s and OGMs attachment anxiety was positively related to positive bonding or working relationships and attachment avoidance was negatively related to positive bonding or working relationships for both group member’s and OGMs’ perceptions of group relationships. The implication of these findings for group composition is discussed.

Although recent research has provided empirical support for the codevelopment of group interaction (defined as development in a common direction of perceptions of group relationships), no studies have yet investigated the "causes" of codevelopment among group members in the long term. The aim of the current study is to examine how the perceptions of an individual group member, and other group members, regarding group relationships influence each other over the course of treatment. We analyzed group data from 168 adult obese patients who participated in (1 of 20) 12-session therapy groups for weight management. Group relationships were measured by the Group Questionnaire (Krogel et al., 2013), which was administered to group members in early, middle and late group sessions. The longitudinal version of the group actor-partner interdependence model was used to analyze the influence among members. Results showed that there is no mutual influence in the codevelopment of both positive bonding and negative relationship. However, positive bonding of other group members in the middle of the group influenced positive bonding of the individual group member in the late group session. Moreover, individual group member negative relationships in early and middle sessions influenced other group member negative relationships in middle and late sessions. Finally, there was evidence of mutual influence in the codevelopment of positive working early in the group. The findings show that the process of influence among members is complex with regard to the specific dimension of the group relationship assessed and the time spent in group treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background A positive relationship between problematic gaming and escapism motivation to play video games has been well established, suggesting that problematic gaming may result from attempts to deal with negative emotions. However, to date, no study has examined how emotion dysregulation affects both escapism motives and problematic gaming patterns. Methods Difficulties in emotion regulation, escapism, and problematic involvement with video games were assessed in a sample of 390 World of Warcraft players. A structural equation modeling framework was used to test the hypothesis that escapism mediates the relationship between emotion dysregulation and problematic gaming. Results Statistical analyses showed that difficulties in emotion regulation predicted both escapism motives and problematic gaming, and that escapism partially mediated this relationship. Conclusion Our findings support the view that problematic players are likely to escape in online games as a maladaptive coping strategy for dealing with adverse emotional experiences.

Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18-30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors - both cross-sectionally and longitudinally - of both ED and higher weight, and how these vary across countries and gender. ispartof: BODY IMAGE vol:31 pages:139-149 ispartof: location:Netherlands status: published

Groups are more effective when positive bonds are established and interpersonal conflicts resolved in early sessions and work is accomplished in later sessions. Previous research has provided mixed support for this group development model. We performed a test of this theoretical perspective using group members' (actors) and aggregated group members' (partners) perceptions of positive bonding, positive working, and negative group relationships measured early and late in interpersonal growth groups. Participants were 325 Italian graduate students randomly (within semester) assigned to 1 of 16 interpersonal growth groups. Groups met for 9 weeks with experienced psychologists using Yalom and Leszcz's (2005) interpersonal process model. Outcome was assessed pre- and posttreatment using the Inventory of Interpersonal Problems, and group relationships were measured at Sessions 3 and 6 using the Group Questionnaire. As hypothesized, early measures of positive bonding and late measures of positive working, for both actors and partners, were positively related to improved interpersonal problems. Also as hypothesized, late measures of positive bonding and early measures of positive working, for both actors and partners, were negatively related to improved interpersonal problems. We also found that early actor and partner positive bonding and negative relationships interacted to predict changes in interpersonal problems. The findings are consistent with group development theory and suggest that group therapists focus on group-as-a-whole positive bonding relationships in early group sessions and on group-as-a-whole positive working relationships in later group sessions. (PsycINFO Database Record

There exists a lack of dyadic research examining how the attachment characteristics of infertile individuals influence their experience of infertility-related distress. The actor partner interdependence model was used to test a theoretical model by examining whether both infertile wives and husbands, who display high levels of attachment avoidance and/or attachment anxiety, will experience infertility-related distress. Seven hundred and seventy individuals (385 couples) completed the experience in close relationships, the fertility problem inventory, and the state-trait anxiety inventory prior to infertility treatment. Wives' distress was predicted by their own and by their husbands' attachment avoidance. Husbands' distress was predicted by wives' attachment anxiety. Moreover, interaction effects between two partners were observed when predicting husbands' distress. The results of the current study support the reciprocal nature of couple's attachment relationships.

Although previous studies investigated the characteristics of therapeutic alliance in group treatments, there is still a dearth of research on group alliance ruptures and repairs. The model by Safran and Muran was originally developed to address therapeutic alliance in individual therapies, and the usefulness of this approach to group intervention needs to be demonstrated. Alliance ruptures are possible at member to therapist, member to member, member to group levels. Moreover, repairs of ruptures in group are quite complex, i.e., because other group members have to process the rupture even if not directly involved. The aim of the current study is to review the empirical research on group alliance, and to examine whether the rupture repair model can be a suitable framework for clinical understanding and research of the complexity of therapeutic alliance in group treatments. We provide clinical vignettes and commentary to illustrate theoretical and research aspects of therapeutic alliance rupture and repair in groups. Our colleague Jeremy Safran made a substantial contribution to research on therapeutic alliance, and the current paper illustrates the enduring legacy of this work and its potential application to the group therapy context.

In the last few decades, particular attention has been paid to the role of personality specific traits that can affect the loss of health, i.e., Type D personality and Alexithymia. They have been conceptualized in a different period, this means that they are different both for their theoretical positions and their empirical studies. Some authors have speculated that there is a potential conceptual overlap between Type D personality and alexithymia constructs but there is a shortcoming in the literature. The aim of the study was to examine the potential overlap between the constructs of type D personality and alexithymia, replicating previous two studies, to extend these findings to Italian population. The participants were 247 Italian adults (males = 43%), recruited in primary health care practices of Palermo. All participants did not have chronic diseases during tests administration. They ranged in age from 35 to 69 years old (M = 52.34 years, SD = 9.76). Participants were administered Type D Personality Scale (DS-14) and Toronto Alexithymia Scale (TAS-20). A series of confirmatory factor analyses was performed to evaluate the factorial structure underlying the TAS-20 and DS-14 items. Globally results showed that alexithymia and type D personality are distinct constructs, but they are also strictly positively related with each other. Negative affectivity (NA) was highly correlated with Difficulties in identifying feelings and Difficulties in describing feelings, while Social inhibition (SI) was highly correlated with Difficulties in describing feelings. These results are consistent with those of other studies conducted in this area. Future research should consider evaluating the relationship between a deficit of affect regulation and type D personality to improve the effectiveness of interventions of health cure.

Background: This study investigated the relationship among negative affect, body image disturbances (BID), and interpersonal problems, and the mediat- ing effect of self-esteem in a group of treatment-seeking obese individuals. Methods: Four hundred twenty-two obese patients (85 males and 337 females) completed standardised measures that assessed negative affect, BID, self-esteem, and interpersonal problems. Results: Structural equation modelling showed that obese individuals with greater negative affect and BID reported higher interpersonal problems and that self-esteem mediated the relationships among negative affect, BID, and interpersonal problems. Conclusions: The mediating role of self-esteem in the relationship between interpersonal functioning and psychological distress needs to be considered when selecting psychologically based interventions that aim to improve the well-being of treatment-seeking obese patients.

California Psychotherapy Alliance Scale-Group (CALPAS-G) data were collected from 1,138 group sessions attended by 248 group members in 16 counseling groups. Hierarchical linear modeling (HLM) was used to derive between-groups, between-member, and between-session variance components and intraclass correlation coefficients (ICCs) for the 12 CALPAS-G items. Using Ledermann and Kenny's (2012) descriptions of variable types, we examined differences in between-groups variance for the 6 CALPAS-G items classified as "Individual" items and the 6 CALPAS-G items classified as "Group" items. A Related-Samples Wilcoxon's Signed Ranked Test showed that the ICCs for the Group items were significantly larger than the ICCs for the Individual items. The results show the importance of how items are worded. If researchers want to accurately examine the between-groups component of the group therapy relationship they should develop measures that ask clients to describe their perceptions of the group, not the members own experience of the group.

International audience; Oncological Genetic Counselling (CGO) allows the identification of a genetic component that increases the risk of developing a cancer. Individuals' psychological reactions are influenced by both the content of the received information and the subjective perception of their own risk of becoming ill or being a carrier of a genetic mutation. This study included 120 participants who underwent genetic counselling for breast and/or ovarian cancer. The aim of the study was to examine the relation between their cancer risk perception and the genetic risk during CGO before receiving genetic test results, considering the influence of some psychological variables, in particular distress, anxiety and depression. Participants completed the following tools during a psychological interview: a socio-demographic form, Cancer Risk Perception (CRP) and Genetic Risk Perception (GRP), Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). The data seem to confirm our hypothesis. Positive and significant correlations were found between the observed variables. Moreover, genetic risk perception determined an increase in depressive symptomatology and cancer risk perception led to an increase in anxious symptomatology, specifically in participants during cancer treatment. The present results suggest the importance of assessing genetic and cancer risk perception in individuals who undergo CGO, to identify those who are at risk of a decrease in psychological well-being and of developing greater psychological distress.

Although several studies have investigated the factor structure of the Rosenberg Self-Esteem Scale (RSES), there are still disagreements about it. The present study assessed: a) the goodness of fit of nine competing factor models for the RSES using data from a clinical sample of 855 women with eating/weight disorders; and b) its measurement invariance across clinical and non-clinical (n = 943) samples. A bifactor model, with a general self-esteem factor, plus positive and negative method factors, provided a better fit with the data than alternative models. However, the results showed the high reliability of the general self-esteem factor, and a low reliability of the two method factors. Furthermore, the full metric invariance of the RSES, as well as a partial scalar invariance and partial strict invariance across clinical and non-clinical groups, was supported by our findings. The factor variances and means differed significantly across groups. Overall, the findings of this study showed that the factor structure of the RSES is contaminated by method effects due to item wording, also with clinical samples, and that respondents from clinical and non-clinical groups interpret the self-esteem construct of the RSES items in a substantially similar way.

Intrapersonal split alliances were defined as discrepancies in how group members perceived their positive bonding relationships with the group leader, the other group members, and the group-as-a-whole, and were related to group members' outcome. Participants were 168 patients (116 women and 52 men) diagnosed as overweight or obese who participated in 1 of 20, 12-session, therapy groups for weight management. Group members completed the Outcome Questionnaire-45 (OQ-45, Lambert et al., 2004) pre- and posttreatment and the Group Questionnaire (GQ, Krogel et al., 2013) at early, middle and late group sessions. Early, middle, and late ratings were aggregated because bond scores were consistent across time. Two-level (members within groups), polynomial regressions and response surface analyses were used to examine congruency and discrepancy in ratings of Positive Bonding Relationships to the leader, group members, and group-as-a-whole. When the discrepancy between positive bonding relationships with the leader and positive bonding relationships with the group members increased, and when the discrepancy between positive bonding relationships with the group members and positive bonding relationships with the group-as-a-whole increased, there was less symptom improvement. The findings show that, like interpersonal split alliances, intrapersonal split alliances are harmful for treatment progress and need to be recognized and addressed by the group leader.

Presently there is a lack of evidence regarding the impact of gender composition of mixed-gender weight management therapy groups on members' posttreatment outcomes. As such, the current study tested the association between the gender composition of mixed-gender narrative therapy groups for weight management and members' posttreatment outcomes. Specifically, we examined the variability in group members' adjusted posttreatment psychological (Outcome Questionnaire-45 [OQ-45]) and obesity-related (Obesity Related Well-Being [ORWELL 97]) symptoms as a function of the quadratic proportion of female members in a group, and the interaction between group member gender and the quadratic proportion of female group members. Pre- and posttreatment OQ-45 and ORWELL 97 data was collected from 32 men and 67 women participating in 15 short-term weight-management therapy groups. Results indicated that the quadratic proportion of female group members was significantly related to adjusted posttreatment OQ-45 scores, such that group members reported fewer psychological symptoms at posttreatment in more proportionally balanced groups of men and women. This relationship was not significant for adjusted posttreatment ORWELL 97 scores. Additionally, in an exploratory analysis we found a significant interaction between group member gender, the proportion of female group members, and group members' adjusted posttreatment OQ-45 scores, indicating that the relationship between gender composition and adjusted posttreatment OQ-45 scores was stronger for men than women. These preliminary findings suggest that the gender composition of weight management groups is an important factor in group members' posttreatment psychological outcomes.

There is a lack of research examining how the proportion of women and men in a group effects both the group member’s perception of group climate and the aggregated perceptions of group climate for the other group members. We adapted the group actor–partner interdependence model (GAPIM; Kenny & Garcia, 2012) to examine how the perception of the group’s climate by a group member and by the other group members are related to the group member’s sex and the sex of the other group members. In addition, we examined how similar the group member’s sex was to the sex of the other group members by analyzing the interaction between the two sex variables. A total of 110 Italian graduate students (96 women, 87%; 14 men, 13%) were studied in six 10-session training groups. Group members filled out the Group Climate Questionnaire–Short Form after the fifth group session. Contrary to hypotheses derived from Kanter’s (Kanter, 2006) theory about the experience of tokens in groups, male group members did not perceive a more therapeutic group climate (i.e., higher engagement and lower conflict) as the proportion of women in a group decreased. There were, however, consistent and large effects for the sex composition of the other group members. Specifically, as the proportion of women in the group increased, both the group member and the other group members perceived the group climate as more engaging and as having less conflict. In addition, a group member’s perception of group climate was positively related to the aggregated climate perceptions of the other group members. Additionally, group size was related to less engagement and more conflict, as rated by the other group members, and less engagement, as rated by the group member. The findings suggest that the GAPIM is a useful approach for examining group composition.

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

We used West and Kenny's (2011) Truth-and-Bias (TB) model to examine how accurately group therapists' judge their group members' alliances, and the effects of therapist-patient congruence in alliance ratings on patient outcomes. Were considered: (a) directional bias - therapists' tendency to over- or underrate their clients' alliances, (b) truth strength - clients' alliance ratings, and (c) bias strength - therapists' tendency to conflate their alliance ratings for a specific group member with the average alliance ratings for the other members of the group. There were 118 obese adult patients with binge-eating disorder that were treated by 8 therapists with Emotionally Focused Group Therapy. Outcomes were operationalized as pre- to postchanges in: health-related quality of life, binge eating, and psychological distress. Patients' and therapists' working alliance were assessed after the 2nd, 10th, and last (20th) group therapy sessions. (a) There was no significant congruence between group therapists' and members' ratings of alliance; (b) therapists' ratings of an individual group member's alliance were significantly related to therapists' ratings of the other group members' alliance in early sessions but unrelated in later sessions; and (c) the relationship between therapists' alliance ratings and bias strength was weaker when patient binge eating outcomes improved. Group therapists adopted a "better safe than sorry" strategy by underestimating the strength of their group members' alliances. Therapists had a tendency to judge each group member's individual alliance based on the aggregated alliance of the other group members. Improvement in patient binge eating outcomes was related to therapists overcoming this tendency. (PsycINFO Database Record

Study question Is the Fertility Quality of Life Questionnaire (FertiQoL)-Relational Scale a valid measure to assess the relational domain regarding quality of life in women and men undergoing infertility treatment? Summary answer The FertiQoL-Relational scale (FertiQoL-REL) showed good psychometric properties and captured core aspects of couple relationships. What is known already FertiQoL has become a gold standard for the assessment of infertility-related quality of life in patients undergoing assisted reproduction treatment (ART). Despite its growing importance, no previous studies have examined the convergent validity of the FertiQoL-REL and its discriminant validity across gender. Study design, size, duration Baseline cross-sectional data as part of a longitudinal study of infertile couples undergoing an ART between February 2013 and January 2015. Participants/materials, setting, methods Five hundred and eighty-nine patients (301 females and 288 males), prior to starting an ART in a private clinic, filled in the Fertility Quality of Life Questionnaire (FertiQoL) and several measures of the marital relationship (Dyadic Adjustment Scale, Marital Commitment Inventory and ENRICH Marital Satisfaction Scale) and infertility-related distress (Fertility Problem Inventory). Main results and the role of chance Confirmatory factor analysis showed that the FertiQoL four-factor solution provided a good fit for the observed data. Reliability of the FertiQoL-REL was higher for women than men. Significant correlations between the FertiQoL-REL scores and all the other measures of marital relationship were found for both women and men. FertiQoL-REL scores did not differ significantly in women and men. The FertiQoL-REL was able to differentiate subjects as regards the Dyadic Adjustment Scale and ENRICH Marital Satisfaction Scale threshold. Limitations, reasons for caution Findings are limited because the data were obtained from only one Italian private clinic. Wider implications of the findings FertiQoL-REL threshold scores are useful for identifying those patients undergoing ART who are more likely to report poor or good relationship quality. Clinicians should tailor their counselling strategies to the positive qualities in a couple's relationship, so as to reinforce the overall quality of life, especially among women, and to support patients in tackling the psychological burden, so that they can either continue treatment or choose discontinuation. Study funding/competing interests This research was supported by funds provided by Centro Andros S.r.l., Palermo, Italy. The authors declare no financial or commercial conflicts of interest in this study. Trial registration number Not necessary.

Background The cognitive interpersonal model predicts that parental caregiving style will impact on the rate of improvement of anorexia nervosa symptoms. The study aims to examine whether the absolute levels and the relative congruence between mothers' and fathers' care giving styles influenced the rate of change of their children's symptoms of anorexia nervosa over 12 months. Methods Triads ( n =54) consisting of patients with anorexia nervosa and both of their parents were included in the study. Caregivers completed the Caregiver Skills scale and the Accommodation and Enabling Scale at intake. Patients completed the Short Evaluation of Eating Disorders at intake and at monthly intervals for one year. Polynomial Hierarchical Linear Modeling was used for the analysis. Results There is a person/dose dependant relationship between accommodation and patients' outcome, i.e. when both mother and father are highly accommodating outcome is poor, if either is highly accommodating outcome is intermediate and if both parents are low on accommodation outcome is good. Outcome is also good if both parents or mother alone have high levels of carer skills and poor if both have low levels of skills. Limitations Including only a sub-sample of an adolescent clinical population; not considering time spent care giving, and reporting patient's self-reported outcome data limits the generalisability of the current findings. Conclusion Accommodating and enabling behaviours by family members can serve to maintain eating disorder behaviours. However, skilful behaviours particularly by mothers, can aid recovery. Clinical interventions to optimise care giving skills and to reduce accommodation by both parents may be an important addition to treatment for anorexia nervosa.

There is a lack of research examining patients' and other group members' agreement about their therapeutic alliance. In the present study, the person-group (P-G) fit model was adopted to predict that the group member symptom reduction will be greater when the group member's and the other group members' perceptions of their alliance to the group-as-a-whole fit and are high. In addition, the effect of disagreement between the group member and the other group members in their perceptions of the group alliance on the individual's outcome was investigated by using response surface analysis. Thirty-two patients from 5 long-term (> 1 year) psychodynamic group treatments were studied. Participants filled out the California Psychotherapy Alliance Scale-Group (CALPAS-G; Gaston & Marmar, 1993) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) monthly over the course of group treatment until termination. As hypothesized, patient's symptom reduction was greater when there was agreement between the group member and the other group members that their alliance to the group as a whole was strong. Contrary to the authors' hypothesis, a lack agreement on alliance to the group as a whole between the patient and the other group members was not related to less symptom reduction, as lack of fit increased, symptom reduction decreased. Also contrary to the authors' hypothesis, when other group members saw their alliance to the group as a whole as stronger than did the patient, there was increased symptom reduction. The findings suggest that the P-G fit model may be a useful strategy to examine group process variables in the psychotherapy context.

In this study, the (a) association of the client- and therapist-rated strength of the real relationship to the outcome of brief psychotherapy, and (b) extent to which the real relationship predicted outcome above and beyond the predictive power of the working alliance were examined. A total of 50 clients at the counseling center of a university in Italy received brief therapy and completed measures before treatment, after the third session, and at the end of treatment. From the clients' perspective, both the Genuineness element of the real relationship and the Bond scale of the working alliance were found to relate significantly to treatment outcome. When we examined the real relationship and working alliance as predictors in a hierarchical regression format, the client-rated real relationship, especially the Genuineness element, did predict outcome and, moreover, added significantly and substantially to the working alliance in predicting outcome. Neither the strength of the real relationship from the therapist's perspective nor the therapist-rated working alliance was found to relate to outcome. The findings are discussed in the context of methodological differences with other investigations of the real relationship.

Recent efforts to improve group psychotherapy have focused on codifying both evidence-based treatments and therapeutic relationships. This chapter reviews the numerous advances in empirical research on group psychotherapy and highlights therapeutic practices ensuing from the evidence. The authors synthesize some of the most crucial development in group psychotherapy research, such as the effectiveness of group treatments, the mechanisms of change of group therapies, the components of group relationship, and issues regarding methodological problems associated with the analysis of group data.

Previous research has not been able to identify a distinct personality style that refers specifically to obese individuals. The purpose of this investigation was to explore whether different personality-based groups can be identified in obese individuals, as has been shown with eating disorder patients. Data were collected from 149 obese patients (BMI = 37.3, ± 6.4; 83% female) seeking dietary treatment and psychological support for their weight problems. Participants completed the Millon Clinical Multiaxial Inventory III (MCMI-III; Millon, 1997) and a battery of eight measures assessing psychological distress, mood states, eating behaviors, obesity-related quality of life, and interpersonal problems. The MCMI-III personality scales were cluster analysed to classify participants into personality subtypes. Three personality clusters were retained (externalizing, internalizing, high-functioning), and several differences in the validating variables emerged across the three personality subtypes. The internalizing group reported the greatest level of personality distress and an increased likelihood of poor psychosocial functioning and high eating behavior symptoms. Findings support the clinical utility of personality subtypes in obesity. Future work is needed to identify causal pathways between personality typologies and eating disorders in obese individuals.

A time-lagged design was used to examine how the perceptions of alliance to the group as a whole by the other group members at an earlier point in the group were related to an individual group member’s perceptions of alliance to the group as a whole at a later point in the group. We also examined how treatment outcome moderated this relationship. Seventy-three patients diagnosed as overweight or obese participating in 10 short-term therapy groups provided data for analyses. Group members completed measures of cohesion to the group and alliance to the group as a whole at the third, sixth, and last session of 12-session groups as well as pre- and posttest ratings on Obesity-Related Well-Being and the Outcome Questionnaire– 45. As hypothesized, earlier ratings of alliance to the group as a whole by the other group members were related to later ratings of alliance to the group as a whole by the group member. Also as hypothesized, when group members had a better outcome, there was a significant positive relationship between perceptions of alliance to the group as a whole by the other group members at an earlier point in the group and an individual group member’s perceptions of alliance to the group as a whole at a later point in time. When members had a worse outcome, there was no relationship between perceptions of alliance to the group as a whole by the other group members at an earlier point in the group and an individual group member’s perceptions of alliance to the group as a whole at a later point in the group.

Introduction We compared the binge eating pathway linking body image dissatisfaction (BID) and psychological distress of obese adults entering and not entering psychological treatment for their weight problems. Method 90 obese participants seeking an integrated treatment (OB-IT) and 87 obese participants seeking only medical treatment (OB-MT) for their weight problems completed questionnaires on BID, binge eating and psychological well-being. Results Only in the OB-IT group, binge eating behaviors mediated the relationship between BID and psychological distress. Conclusions Both BID and binge eating behaviors need to be addressed in the psychological and medical treatment for obesity to enhance psychological well-being.

There is a lack of research examining group members’ attachment styles and group climate perceptions in the context of the attachment styles and group climate perceptions of the other group members. In the current study, the actor–partner interdependence model (APIM) was used to examine the relationships among (a) a group member’s attachment pattern, (b) the aggregated attachment patterns of the other group members, (c) a group member’s perceptions of the group’s climate, and (d) the aggregated group climate perceptions of the other group members. One hundred ten Italian graduate students in six 10-session interpersonal growth groups were studied. Group members filled out the Attachment Style Questionnaire prior to group participation and the Group Climate Questionnaire after the 3rd group session. Contrary to the hypotheses, a group member’s attachment pattern (anxiety and avoidance) was unrelated to her or his perceptions of group climate, and only group member attachment anxiety was positively related to the other group members’ perceptions of conflict in the group’s climate. There was, however, strong support for the hypotheses involving the aggregate attachment of the other group members and group climate perceptions. As hypothesized, aggregated perceptions of attachment anxiety and avoidance were positively related to a member’s perception of group conflict and aggregated perceptions of attachment anxiety and avoidance were negatively related to a member’s perception of group engagement. Both aggregated attachment anxiety and avoidance were related in the expected directions to aggregated perception of group climate. Finally, as hypothesized, a group member’s perception of group climate was positively related to the aggregated climate perceptions of the other group members. The findings suggest that the APIM is a useful approach for examining group process variables in the group counseling context.

Objectives Although disordered eating has been assumed to be associated with interpersonal problems, there is a lack of research regarding the relationship between interpersonal problems and obesity. This study explored associations among self-esteem, binge behaviors, and interpersonal problems in obese individuals, by contrasting obese persons with overweight persons, and to investigate whether body mass index (BMI), binge behaviors, and self-esteem predict interpersonal problems in obese individuals. Methods A group of nonobese overweight people (n = 65; BMI range, 25-29.9 kg/m 2 ) and a group of obese people (n = 78; BMI >35 kg/m 2 ) were selected from 224 people attending a mental health care service specializing in eating disorders in Palermo (Italy). Seventy-eight percent of participants were female. All participants filled in the following measures: the Inventory of Interpersonal problems–short version, the Binge Eating Scale, and the Rosenberg Self-esteem Scale. Results The findings showed that 4 domains of interpersonal problems were associated with binge behaviors and self-esteem in obese participants. Moreover, the relationship between binge behaviors and interpersonal problems was partially mediated by self-esteem. Conclusions Given the poor prognosis for the long-term management of obesity, it could be important for clinicians to carefully assess patients' interpersonal functioning and its relationship to self-esteem and binge behaviors, especially with respect to treatment-seeking obese patients.

Objective: Several studies carried out over the last years show that patients' adjustment is very important to the past experiences of people with cancer. In our study of 96 subjects with cancer, we examined whether patient's working model of attachment anxiety/avoidance and perceptions of social support predicts adjustment to cancer. Methods: All participants filled in a demographic questionnaire, the Relationship Scale Questionnaire (RSQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mental Adjustment to Cancer (MAC). Results: Anxious attachment predicted psychological adjustment: patients with high levels of anxious attachment showed high levels of helplessness/hopelessness and anxious preoccupation (p

Objectives There is a lack of empirical data on the effectiveness and process of group-analytic therapy in eating disorders. This single-group study aimed to explore the effectiveness of such treatment for anorexic and bulimic individuals. Method Eight patients (three anorexic and five bulimic women) entered group-analytic treatment, meeting weekly for 2 years. Eating behaviours, overall psychological distress and group process variables were regularly assessed using quantitative and qualitative measures, with comparisons made at the beginning and end of the therapy. Results Treatment was discontinued in two cases. When outcome was classified on the basis of reliable change and clinical significance for the remaining patients at the end of treatment, four were recovered in terms of overall psychological distress, while one was unchanged and one had deteriorated. In terms of eating disorder symptoms, three patients were recovered, two were unchanged and one had deteriorated. Patients experienced an overall positive group climate and a positive group alliance. Perception of being understood by the therapist appeared to play an important role in the therapeutic process. Conclusions These preliminary results suggest that group-analytic therapy may be effective in helping patients with eating disorders. However, more work is needed before firm conclusions can be drawn. Implications for clinical practice and future research are discussed. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

In this article, the authors study the factorial structure of the Italian translation of the Outcome Questionnaire 45 (OQ-45) in a sample of college students (n = 522) and psychiatric outpatients (n = 301). The relative goodness of fit of six competing models of the OQ-45 was examined using confirmatory factor analysis (CFA). Specifically, the study examined the relative fit of the most frequently presented models in the literature and three alternative models. Results of the CFA provided support for the four factor bi-level solution, suggesting that the OQ-45 is a multidimensional instrument that contains one general factor and multiple unique subscale factors.

The authors report their main findings on the psychological characteristics of Mafia members studied in the past 10 years. Clinical data were collected, such as psychotherapy reports of therapists who treated patients belonging to the Mafia and clinical interviews of important Italian Mafia informers. The psychological profile of a Mafia member and his relatives is described. The importance of the process of identity construction that a mafioso must learn in order to join the Cosa Nostra organization is outlined. The psychological distress mafiosi suffer and the type of psychotherapy they require are reported, including brief excerpts from clinical sessions. Therapists and analysts always feel troubled working with these patients, and supervision is often required. Italian clinical work differs greatly from that represented in American movies, and specific theoretical and clinical training is necessary to treat the particular characteristics of these patients.

The aim of this prospective, longitudinal study was to examine the association between couples' pre-treatment psychological characteristics (state anxiety and infertility-related stress levels of both partners) and ovarian response during assisted reproductive technology treatment in a well-controlled sample. A total of 217 heterosexual couples (434 patients), suffering from primary infertility and undergoing their first assisted reproductive technology treatment at the Reproductive Medicine Unit of ANDROS Day Surgery Clinic in Palermo (Italy), were recruited. Psychological variables were assessed using the State Scale of State-Trait Anxiety Inventory (STAI-S) and the Fertility Problem Inventory (FPI). The number of follicles ≥16 mm in diameter, evaluated by transvaginal ultrasound scan on the eleventh day of the workup, was chosen as the outcome measure. No association between women's level of anxiety and infertility-related stress, and the number of follicles ≥16 mm in diameter was found. Moreover, the male partner's infertility stress and anxiety did not influence the relationship between the woman's infertility-related stress, anxiety level and ovarian response. Fertility staff should reassure couples that the woman's biological response to ovarian stimulation is not influenced by either partner's level of psychological distress.