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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 psy-chopathology, 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.

This study investigated the effects of adolescents’ attachment security and reflective functioning (RF) (assessed by the adult attachment interview [AAI]) in the prediction of well-being in adulthood. Adolescents (N = 79; M = 14.6 years old; SD = 3.5 years) completed the AAI at Time 1 (T1), which was subsequently coded for inferred attachment experiences, narrative coherence, and RF by three nonoverlapping teams of raters. Participants completed the Psychological General Well-being Index at T1 and 8 years later (Time 2, T2). Analyses showed that (a) both adolescent narrative coherence and RF were significant predictors of almost all indices of well-being at T2 in adulthood; (b) both narrative coherence and RF indirectly linked inferred loving parental care and T2 well-being; (c) when included in the same model, RF was a significant indirect effect linking inferred loving parental care and T2 well-being. These findings contribute to theory in suggesting that both RF and narrative coherence are predictive of subsequent psychological well-being and operate as links between inferred parental care and subsequent adjustment. Possible mechanisms underlying these findings are discussed.

The aim of the study was to explore the effects of situational stress and anxiety in a group of healthy elderly, both in terms of psychophysiological correlates and cognitive performance. Eighteen participants (Mage = 70 ± 6.3; range 60–85) were assessed for anxiety and were instructed to perform a computerized math task, under both a stressful and a control condition, while near-infrared spectroscopy (NIRS) signal and electrocardiography (ECG) were recorded. NIRS results evidenced an increased activation of right PFC during the entire procedure, even if effect sizes between left and right channels were larger during the experimental condition. The amount of right activation during the stressful condition was positively correlated with anxiety. Response times (RTs) were slower in more anxious than in less anxious individuals, both during the control and stressful conditions. Accuracy was lower in more anxious than in less anxious individuals, only during the stressful condition. Moreover, heart rate (HR) was not modulated by situational stress, nor by anxiety. Overall, the present study suggests that in healthy elderly, anxiety level has a significant impact on cerebral responses, and both on the amount of cognitive resources and the quality of performance in stressful situations.

Laboratory stress tasks induce strong changes in linear and non-linear indices of heart rate variability (HRV) among healthy adults, due to a task-induced parasympathetic withdrawal. Previous findings suggested that negative affectivity and its correlates (i.e., depressive symptoms, anxiety, hostility, type D personality, and situational stress) could profoundly affect autonomic activity. However, to date no studies considered these psychological dimensions simultaneously while trying to disentangle their acute effects on HRV during a laboratory stress task. A total of 65 healthy participants completed a battery of questionnaires and later underwent a psychosocial stress protocol, which involves a stressful and a non-stressful mental arithmetic task, with the latter serving as a control condition for the former. During the entire procedure, autonomic activity was recorded through a portable ECG device. We analysed longitudinal changes in HRV indices using Mixed Models, taking into account respiration rates and the associations between psychophysiological variables through bivariate Pearson's r (partial) correlation indices. We found significant changes in linear (e.g., HF power, RMSSD) and non-linear (e.g., Poincaré Plot and Correlation Dimension D2) HRV indices during the procedure, with the lowest point reached during the stressful mental arithmetic task. Interestingly, only depressive symptomatology was significantly and positively related to a higher resting-state HRV and to a blunted reactivity to the stress task, even after controlling for baseline values. Results suggest that healthy individuals with higher levels of depressive symptoms could experience atypical cardiovascular responses to stressful events: several speculative interpretations, considering autonomic, behavioral, and motivational dysregulations, are discussed.

Therapeutic alliance and reflective functioning may be important for treatment outcomes for binge-eating disorder (BED). The current study examines: (1) growth in therapeutic alliance over 20 sessions of emotionally focused group therapy (EFGT) for BED, and (2) the association between change in reflective functioning and growth in therapeutic alliance in EFGT for BED, both of which may be important for improving BED outcomes. We hypothesize that: (1) growth in therapeutic alliance will be represented by a quadratic curve (i.e., follow a high-low-high pattern of growth), and (2) a quadratic growth in therapeutic alliance during EFGT will be associated with greater increase in reflective functioning from pre- to six months posttreatment. Italian women and men with BED (N = 118) attended EFGT for BED. They completed the Helping Alliance Questionnaire-II, a measure of therapeutic alliance to the therapist at the end of each session of EFGT, and the Adult Attachment Interview pre- and six months posttreatment. The quadratic model of therapeutic alliance growth was a significantly better fit to the data than the linear model, and the quadratic growth in therapeutic alliance during therapy was associated with greater positive change in reflective functioning at six months posttherapy. The current study provides additional support for the high-low-high pattern of therapeutic growth in short-term process- oriented psychotherapies, and that the growth of alliance to the therapist over the course of group therapy may be important for facilitating improved reflective functioning.

The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists' Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.

Objective: To assess quality of life and psychological differences between infertile women with endometriosis and without endometriosis. To investigate predictive role of perfectionism, mindful awareness and beliefs about parenthood to quality of life in a sample of women with fertility problems. Methods: 43 infertile women (22 with endometriosis; 21 without endometriosis) who recurred to Assisted Reproductive Treatments (ARTs) in the last 12 months took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Fertility Quality of Life, Fertility Problem Inventory – Need of parenthood subscale, Obsessive Beliefs Questionnaire – Perfectionism subscale, and Cognitive and Affective Mindfulness Scale – Revised were used to assess target outcomes. Results: Any difference in quality of life and psychological condition was found between infertile women with and without endometriosis. Importance given to parenthood (beta = −.60, p <.001) and perfectionism (beta = −.30, p <.05) predicted quality of life related to fertility issues, independently of group. Conclusions: Infertility might elicit self-discrepancy between real-self (i.e. being infertile) and ideal-self (being fertile), which in turn has a negative impact on quality of life. Conclusions about the role of psychologist in ART's team are discussed.

Objective The current study examined the role of emotional competences and depression in takotsubo cardiomyopathy (TTC). Methods We compared 37 TTC patients who experienced emotion triggers (TTC-t: M (SD) age = 66.4 (12.8) years, 33 women) with 37 TTC patients who did not experience emotion triggers (TTC-nt: M (SD) age = 65.8 (11.1) years, 33 women) and 37 patients with acute myocardial infarction who experienced an emotion trigger (AMI-t: M (SD) age = 66.1 (10.1) years, 33 women). Three aspects of emotional competence (emotional intelligence, metacognitive beliefs, and emotional processing deficits) were assessed using the Trait Meta-Mood Scale (TMMS), the Meta-Cognitions Questionnaire 30, and the Emotional Processing Scale. Differences between-group means were evaluated using multivariate analysis of covariance, adjusting for depressive symptom (Hamilton Rating Scale for Depression). Results Compared with the TTC-nt and AMI-t comparison groups, TTC-t patients had low scores on emotional intelligence (TMMS Attention: F(2, 184) = 23.10, p <.001; TMMS Repair: F(2, 184) = 11.98, p <.001) and high scores in metacognitive beliefs and emotional processing deficits (e.g., Meta-Cognitions Questionnaire 30 Negative Beliefs about Thoughts: F(2, 184) = 56.93, p <.001), independent of the levels of depressive symptom. TTC-nt patients also had significantly lower scores on the Hamilton Rating Scale for Depression scale compared with AMI-t (p =.021) and TTC-t (p =.004) patients. Conclusions TTC-t patients showed a specific dysfunctional profile of emotional competence, even after adjusting for depressive symptom. These results provided a better understanding of the psychological factors that contribute to TTC.

Objective: Postoperative cognitive decline (POCD) is known to occur quite frequently after a cardiac surgery, especially in older population. Few studies specifically focused on its incidence and characteristics in gynecological setting. Methods: Current opinions and future applications of POCD studies in gynecological setting have been discussed. Result: There are still many questions and issues about POCD in gynecological setting that remain unanswered as well as numerous research fields that have not been still explored. In particular, from this article emerges the need of further studies in gynecological setting focusing on: (a) the evaluation of long-term effect of POCD (e.g. over 3 months after surgery); (b) elderly population; (c) a wide range of cognitive functions (memory, attention, concentration, orientation, etc.); (d) the evaluation of risk and protective factors for subsequent POCD development; (e) the relationships between POCD and previous psychological or neuroendocrine factors; (f) the difference on POCD outcomes between different anaesthesia and disorders. Conclusion: Promoting studies on this topic is significant for the reduction of sociosanitary costs, mortality rates, social dependences and the likelihood of comorbidity.

The current study examines change in attachment variables from pre- to six months post-emotionally focused group therapy (EFGT) for binge eating disorder (BED). A clinical sample of 118 women and men with BED attended 20 sessions of EFGT and completed the Adult Attachment Interview pre- and six months post-treatment. There was a significant increase in secure attachment style classification, significant increases in Coherence of Mind and Reflective Functioning scores, and significant decreases in both unresolved/disorganized attachment style classification and scale scores from pre- to six months post-treatment. Interventions specific to EFGT, common therapeutic factors and group process interventions may have contributed to changes in these attachment variables. The current study demonstrated that EFGT is a promising treatment for facilitating change in attachment in women and men with BED.

Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.

Emotions characterized by opposite valences (positive vs. negative) seem to lead to specific patterns of autonomic and cortical activity. For example, according to valence or approach-withdrawal hypotheses, specific emotions lead to an asymmetrical activation of left or right prefrontal cortex (PFC). The aim of the present study was to explore the psychophysiological underpinnings of emotion experiencing using a paradigm with higher ecological validity than is typically accomplished in neuroimaging research. A total of 28 healthy participants were instructed to recall personally-relevant situations from the past that caused positive (happiness) or negative (anger) emotions, during a 2 min silent preparatory phase and a subsequent 3 min verbal phase. A wearable electrocardiographic (ECG) recording system and a portable 2-channel near-infrared spectroscopy (NIRS) device were used to collect heart rate (HR), high frequencies of heart rate variability (HF-HRV), and the hemodynamic responses of prefrontal cortex during the entire procedure. Results showed that during both anger and happiness recall tasks, HR increased and high frequencies of HRV decreased with respect to the baseline. HR and HF-HRV reached, respectively, their highest and lowest points during the verbal phase of anger recall task. NIRS data evidenced a bilateral increase of oxyhemoglobin concentration changes during both anger and happiness recall tasks, which was highest during the verbal phases. However, no lateralization patterns were found. Overall, present results suggest that the experience of negative emotions, if compared with positive ones, is characterized by a combination of reduced parasympathetic activation and/or increased sympathetic activation. Thus, cardiological data provided partial support to autonomic specificity of emotions. However, the recall paradigm did not evidence an asymmetry of PFC activity during the experience of emotions with opposite valences, probably due to the high nu

Acute psychosocial stress is typically investigated in laboratory settings using protocols with distinctive characteristics. For example, some tasks involve the action of speaking, which seems to alter Heart Rate Variability (HRV) through acute changes in respiration patterns. However, it is still unknown which task induces the strongest subjective and autonomic stress response. The present cross-over randomized trial sought to investigate the differences in perceived stress and in linear and non-linear analyses of HRV between three different verbal (Speech and Stroop) and non-verbal (Montreal Imaging Stress Task; MIST) stress tasks, in a sample of 60 healthy adults (51.7% females; mean age = 25.6 ± 3.83 years). Analyses were run controlling for respiration rates. Participants reported similar levels of perceived stress across the three tasks. However, MIST induced a stronger cardiovascular response than Speech and Stroop tasks, even after controlling for respiration rates. Finally, women reported higher levels of perceived stress and lower HRV both at rest and in response to acute psychosocial stressors, compared to men. Taken together, our results suggest the presence of gender-related differences during psychophysiological experiments on stress. They also suggest that verbal activity masked the vagal withdrawal through altered respiration patterns imposed by speaking. Therefore, our findings support the use of highly-standardized math task, such as MIST, as a valid and reliable alternative to verbal protocols during laboratory studies on stress.

Background: The Italian older adult population is increasing and psychiatric problems, such as anxiety among older adults, represent major challenges for public welfare. A strong need exists for instruments specifically developed to assess anxiety among Italian older adults. The Geriatric Anxiety Scale (GAS) is a 30-item self-report questionnaire that evaluates anxiety among older adults and has demonstrated strong psychometric properties in several languages. Objective: The present study aimed to validate an Italian version of the GAS (GAS-I) and to preliminarily investigate its psychometric properties. Method: The translation was performed using a five-stage procedure, following a forward–back process and paying attention to cultural issues. The GAS-I was administered to 231 community-dwelling older adults with other commonly-used questionnaires of anxiety, depression, and quality of life. Results: Results confirmed good psychometric qualities of the questionnaire. Confirmatory factor analyses evidenced a unidimensional structure of the GAS-I, in accordance with other validated versions. Convergent and discriminant validity were highly satisfactory. The three-factor model also provided an acceptable fit to the data. Receiver operating characteristic curve analyses revealed good discriminatory power of the GAS-I. Conclusion: These findings demonstrate that the GAS-I is a reliable and valid self-report questionnaire to measure anxiety among Italian older adults.

The purpose of this study was to assess the interrelation between cortical, cardiovascular, behavioural, and psychological responses to acute stressors in a large sample of healthy individuals. To date, there are only preliminary evidences for a significant association among these psychophysiological indexes during a stress task. 65 participants completed psychological questionnaires (Beck Depression Inventory and State-Trait Anxiety Inventory) and underwent a psychosocial math stress task, consisting of a control and an experimental (i.e. stressful) condition. Prefrontal and autonomic activities were recorded using respectively a 2-channel near-infrared spectroscopy (NIRS) device and a portable ECG monitoring system. Results evidenced an increased activation of both frontal areas assessed by NIRS, and a positive association between the right NIRS channel and heart rate changes from baseline, during both control and experimental conditions. Subjective stress increased during the procedure, reaching its maximum during the experimental condition. Behavioural performances during the task (e.g. response time) did not correlate with anxiety or depression. Autonomic data evidenced, as expected, an overall reduction of vagal tone during the experimental condition. Finally, severity of depressive and anxious symptoms predicted an increase in parasympathetic activity both at rest and during the task, even when controlling for respiration rate. Results support the hypothesis of an integration between right sectors of frontopolar or dorsolateral PFC and cardiac regulation. Trait anxiety and depression predicted an increase in vagal tone during the entire procedure. The implication of these findings is discussed.

[No abstract available]