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Giorgia Varallo,1 Carlos Suso-Ribera,2 Ada Ghiggia,3 Marco Veneruso,4 Roberto Cattivelli,5 Anna Guerrini Usubini,6,7 Christian Franceschini,1 Alessandro Musetti,8 Giuseppe Plazzi,9,10 Jacopo Maria Fontana,11 Paolo Capodaglio,11,12 Gianluca Castelnuovo6,7 1Department of Medicine and Surgery, University of Parma, Parma, 43121, Italy; 2Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellon de la Plana, 12071, Spain; 3Department of Life Sciences, University of Trieste, Trieste, 34127, Italy; 4Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; 5Department of Psychology, University of Bologna, Bologna, 40127, Italy; 6Department of Psychology, Catholic University of Milan, Milan, 20123, Italy; 7Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, San Giuseppe Hospital, Verbania, 28824, Italy; 8Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, 43125, Italy; 9Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy; 10IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, 40139, Italy; 11Istituto Auxologico Italiano IRCCS, Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, San Giuseppe Hospital, Verbania, 28824, Italy; 12Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, 10121, ItalyCorrespondence: Jacopo Maria Fontana, San Giuseppe Hospital, Strada Cadorna 90, Verbania, 28824, Italy, Tel +39 0323 514 331, Email j.fontana@auxologico.itPurpose: Individuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity.Patients and Methods: In this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed.Results: Pain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning.Conclusion: Pain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning.Keywords: chronic pain, fear-avoidance model, fibromyalgia, functioning, obesity, psychological flexibility model

Background: Narcolepsy type 1 (NT1) is a rare neurological sleep disorder caused by the loss of neurons that produce hypocretin—a peptide that plays a crucial role in addictive behaviors. We aimed to compare, for the first time, levels of problematic online gaming, problematic social media use, and compulsive Internet use between NT1 patients and healthy controls (HC), and to evaluate the association between anxiety, depression, and emotion dysregulation with addictive online behaviors in NT1 patients. Methods: A total of 43 patients with NT1 and 86 sex- and age-matched HC participated in an online cross-sectional survey. Results: NT1 patients did not differ from HC in terms of problematic social media use and compulsive Internet use but displayed higher levels of problematic online gaming compared to HC. Higher levels of emotion dysregulation were significantly associated with higher levels of problematic social media use and compulsive Internet use, while none of the tested factors were associated with problematic online gaming. Conclusion: NT1 patients and HC had similar levels of problematic social media use and compulsive Internet use, but NT1 patients showed higher levels of problematic online gaming. Emotion dysregulation might be an intervention target for reducing compulsive Internet use and problematic social media use.

Pain severity, depression, and sleep disturbances are key targets for FM rehabilitation. Recent evidence suggests that whole-body cryostimulation (WBC) might be an effective add-on treatment in the management of FM. The purpose of this study was to evaluate the effects of an add-on WBC intervention to a multidisciplinary rehabilitation program on pain intensity, depressive symptoms, disease impact, sleep quality, and performance-based physical functioning in a sample of FM patients with obesity. We performed a randomized controlled trial with 43 patients with FM and obesity undergoing a multidisciplinary rehabilitation program with and without the addition of ten 2-min WBC sessions at −110 °C over two weeks. According to our results, the implementation of ten sessions of WBC over two weeks produced additional benefits. Indeed, both groups reported positive changes after the rehabilitation; however, the group that underwent WBC intervention had greater improvements in the severity of pain, depressive symptoms, disease impact, and quality of sleep. On the contrary, with respect to performance-based physical functioning, we found no significant between-group differences. Our findings suggest that WBC could be a promising add-on treatment to improve key aspects of FM, such as pain, depressive symptoms, disease impact and poor sleep quality.

Starting from the idea that dreaming could be considered an index of the psychological health of individuals regarding the COVID-19 outbreak, a major risk of psychological maladjustment has been registered for maladaptive daydreamers (MDers; i.e., people with a compulsive fantasy activity associated with distress and psychological impairment). Nevertheless, there is a gap in literature about dreaming in MDers in general and particularly during the COVID-19 pandemic. The aim of this study was to investigate differences in dreaming and dream content between probable MDers and non-MDers during the COVID19 lockdown in Italy. A total of 3,857 Italian adults (664 probable MDers), completed the Maladaptive Daydreaming Scale (MDS-16) and the Mannheim Dream Questionnaire (MADRE). Among them, 1,095 participants (222 probable MDers) decided to recount their dreams, subsequently analysed through a cluster analysis performed by T-LAB software. Significantly higher levels of dream recall, emotional intensity of dreams, nightmare frequency, nightmare distress, recurring nightmares about daytime, lucid dreams, interest toward dreams, problem solving and creative dreams, and dreams affecting daytime mood emerged in probable MDers compared to non-MDers. No differences were observed in the emotional tone of dreams. From the quali–quantitative analysis of dream narratives, similar themes emerged in probable MDers and non-MDers, except for a cluster named Dreaming the loss of others, where the non-MDers variable is highly represented. Our results highlight some significant differences between probable MDers and non-MDers with respect to dreaming activity. The massive use of dream activity as an affective regulator emerges for both probable MDers and non-MDers during lockdown.

BackgroundAs treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.MethodsA randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m2), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6 months (time 3) and 9 months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device.To assess the effectiveness of the intervention, mixed between-within 3 (conditions) × 4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DiscussionThis study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.Trial registrationClinicalTrials.govNCT04474509. Registered on July 4, 2020

The aim of the current cross-sectional study is to assess the relations between emotion dysregulation, psychological distress, emotional eating, and BMI in a sample of Italian young adults (20-35).A total sample of 600 participants frm the general population, were asked to fill in demographical and physical data, the Difficulties in Emotion Regulation Scale, the Depression Anxiety and Stress Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire via an online anonymous survey. Relations between variables have been inspected using a path model.Results showed that emotion dysregulation was a contributor to higher levels of psychological distress [b= 0.348; SE: 0.020; p=0.001; 95% BC-CI (0.306-0.387)] and emotional eating [b= 0.010; SE: 0.002; p=0.001; 95% BC-CI (0.006-0.014)] which in turn, was related to higher Body Mass Index [b= 0.0574; SE: 0.145; p=0.001; 95% BC-CI (0.286-0.863)].By providing additional evidence concerning the role of emotion dysregulation for physical and psychological outcomes, the current study could inform for improving psychological interventions aimed to promote emotion regulation strategies aimed at fostering physical and psychological well-being.

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIWe found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

Previous evidence about facial emotion recognition capability in obesity is few and not conclusive. We investigated the capability of female individuals affected by obesity to recognize the emotions of fear and anger through a facial emotion recognition task grounded on the implicit redundant target effect. 20 women affected by obesity and 20 healthy-weight women were enrolled. We administered an implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the level of alexithymia was measured through the standard questionnaire. Selective difficulties in recognizing the emotion of fear were observed in participants with obesity, when their performance was contrasted with healthy-weight controls. Instead, they showed the implicit redundant target effect when anger was the target. However, the two groups reported globally similar scores at the standard questionnaire relative to the level of alexithymia. Our result might agree with the hypothesis about affected individuals’ difficulties in being attentive to negative facial emotions, and specifically in the case of fearful expression. This study might encourage future research in which emotional processing will be investigated through subjective judgments and implicit/objective measurements. Experimental study.

This systematic review and meta-analysis aimed at evaluating the role of sleep disturbances and sleep disorders in influencing presence and intensity of chronic postsurgical pain (CPSP). We included cohort studies which enrolled adults, assessed sleep disturbances or disorders before surgery, measured pain intensity, presence of pain, or opioid use at least three months after surgery. Eighteen studies were included in a narrative synthesis and 12 in a meta-analysis. Sleep disturbances and disorders were significantly related to CPSP, with a small effect size, r = 0.13 (95% CI 0.06-0.20). The certainty of evidence was rated low due to risk of bias and heterogeneity. In subgroup analyses the above association was significant in studies that used pain intensity as the outcome, but not in those that used presence of pain; in studies on patients who underwent total knee arthroplasty or other surgeries, but not in those on patients who had breast cancer surgery or total hip arthroplasty; in the single study that assessed insomnia and in studies that assessed sleep disturbances as predictors. A meta-regression showed that the follow-up length was positively associated with the overall estimate. Our findings suggest that presurgical sleep disturbances and disorders should be evaluated to detect patients at risk for CPSP. Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=272654.

STUDY OBJECTIVES: The media are the primary sources of information about health for the public. The media portrayal of narcolepsy might contribute to the stigmatization of people affected by this condition. This study aimed to describe how narcolepsy is portrayed in newspapers. METHODS: We collected 257 newspaper articles from the digital archive of La Stampa published between 1980 and 2020 that mentioned key search terms. The content was assessed using an ad hoc coding schema developed to evaluate the presence of sensationalistic title, negative language, stigmatizing content, stereotypical description, disclosure of a person diagnosed with narcolepsy, person with narcolepsy described as dangerous, presence of an accurate diagnosis, identifiable symptoms, indications about diagnostic and treatment services. Chi-square analysis was performed to identify changes over time in the type of content. RESULTS: In 10.9% of the articles, there was a sensationalistic title; inappropriate, negative, and outdated language appeared in 10.5% of the articles. Stigmatizing and stereotypical content was reported in 19.5% and 14.8% of the articles, respectively. In 62.3% of the articles, it was disclosed that a person had narcolepsy, and in 5.1% of the articles patients with narcolepsy were described as dangerous. The presence of an accurate diagnosis was referred to in 30.4% of the articles, while 16.7% described identifiable symptoms. Services for diagnosis and treatment were mentioned in 24.1% of the articles. Changes over time in the content of articles are discussed. CONCLUSIONS: Our findings highlight areas for improvement in the media portrayal of narcolepsy and could help guide the development of new targeted anti-stigma campaigns. CITATION: Varallo G, Pingani L, Musetti A, et al. Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles. J Clin Sleep Med. 2022;18(7):1769–1778.

Adolescence and emerging adulthood are critical periods for young people with autism spectrum disorder (ASD). However, there is a lack of appropriate and affordable services available.The Il Tortellante® is an Italian project aimed at promoting adaptive behavior and social skills, and at reducing the severity of symptomatology through a culinary group intervention in which young people with ASD learn to make fresh pasta by hand.A longitudinal study was conducted.Before and after the intervention, 20 participants were assessed based on the severity of symptoms, social skills, and adaptive behaviors.According to our findings, severity of symptoms and daily living skills improved significantly.A culinary intervention may be useful for adolescents and young adults with ASD to improve daily living skills and reduce ASD-related symptomatology.Services and associations may consider developing a culinary laboratory for people with ASD to improve group intervention proposals for adolescents and emerging adults. WHAT THIS PAPER ADDS?: This paper offers one of the first investigations of the impact of a culinary laboratory on ASD symptoms, social skills, and adaptive behavior in adolescents and young adults diagnosed with ASD. This group intervention could contribute to expand the range of interventions targeted at adolescents and young adults with ASD, to reduce the severity of symptoms, and to promote adaptive behaviors.

Anna Guerrini Usubini,1,2 Grazia Terrone,3 Giorgia Varallo,1,2 Roberto Cattivelli,4 Giuseppe Plazzi,5,6 Gianluca Castelnuovo,1,2 Adriano Schimmenti,7 Alessandro Musetti,8 Christian Franceschini9 1Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy; 2Department of Psychology, Catholic University of Milan, Milan, Italy; 3Department of History, Cultural Heritage, Education and Society, University of Rome Tor Vergata, Rome, Italy; 4Department of Psychology, University of Bologna, Bologna, 40127, Italy; 5Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, 41125, Italy; 6IRCCS Institute of Neurological Sciences of Bologna (ISNB), Bologna, 40139, Italy; 7Faculty of Human and Social Sciences, UKE—Kore University of Enna, Cittadella Universitaria, Enna, Italy; 8Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy; 9Department of Medicine and Surgery, University of Parma, Parma, ItalyCorrespondence: Alessandro Musetti, Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Borgo Carissimi 10, Parma, 43121, Italy, Tel +39 0521 034820, Email alessandro.musetti@unipr.itPurpose: The present study aimed to explore the mediating role of emotion dysregulation and problematic Internet use in the relationship between negative affect and excessive daytime sleepiness.Methods: This cross-sectional study included 664 Italian adults aged between 18 and 70 years (M = 32.13; SD = 11.71). Participants were asked to complete the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, the Compulsive Internet Use Scale-7, and the Epworth Sleepiness Scale to assess negative affect, emotion dysregulation, problematic internet use, and excessive daytime sleepiness, respectively.Results: According to our results there are significant associations between negative affect, emotion dysregulation, problematic Internet use, and daytime sleepiness. Moreover, the structural equation model showed good fit indices. Emotion dysregulation and problematic Internet use partially mediated the relationship between negative mood and excessive daytime sleepiness.Conclusion: By exploring the role of emotion dysregulation on the association between excessive daytime sleepiness and its possible predictors, our study might represent an important step toward the implementation of psychological intervention for reducing excessive daytime sleepiness. Emotion dysregulation appears to play a significant role in explaining the relationship between negative affect, problematic Internet use, and excessive daytime sleepiness. Thus, it should be considered a treatment target for reducing excessive daytime sleepiness.Keywords: negative affect, psychological distress, excessive daytime sleepiness, emotion dysregulation, problematic Internet use

Individuals affected by chronic lower-back pain and obesity have an increased risk of long-lasting disability. In this study, we aimed to explore the contribution of kinesiophobia and pain catastrophizing in explaining pain intensity and pain-related disability in chronic lower-back pain associated to obesity. A cross-sectional study on 106 participants with obesity and chronic lower-back pain was performed. We assessed pain intensity, pain disability, pain catastrophizing, and kinesiophobia levels through self-reporting questionnaire. Hierarchical regressions were performed to assess the role of pain catastrophizing and kinesiophobia on pain intensity and pain disability. According to the results, kinesiophobia, but not pain catastrophing, significantly explained both pain intensity and pain-related disability. Kinesiophobia might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain and obesity. We encourage future studies in which beliefs and cognition towards pain might be a therapeutic target in interdisciplinary pain management interventions.

The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cog-nitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. 155 over-weight adults (BMI: Kg/m2= 43.8[6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demo-graphical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were ad-ministered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation ef-fects for gender and eating disorders (ED) have been considered. From baseline to dis-charge no significant differences between interventions were found, with the only ex-ception of an improvement in the CORE-OM total score and in the CORE-OM subjective well-being subscale for those in the CBT condition. From discharge to follow-up ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II’s wellbeing, symptoms, and psy-chological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM’ subscale reporting the risk for self-harm or harm others. The pres-ence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-Om’ symptoms and psychological problems sub-scales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time.

This cross-sectional study aims to investigate the impact of psychological distress experienced during the second wave of the COVID-19 pandemic on emotional eating and to assess the mediating role of emotional dysregulation in a sample of Italian young adults (20–35). A total of 437 participants provided demographical data and were assessed using the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire. Correlational analyses were performed to assess the relationship between continuous variables, while ANOVA was conducted to detect differences between males and females for emotional eating. To assess whether demographic and clinical data predicted emotional eating, hierarchical linear regression was performed. Then, a mediation analysis was conducted to assess whether emotional dysregulation was a mediator between psychological distress and emotional eating. Emotional eating was associated with psychological distress and emotional dysregulation. Moreover, higher levels of emotional eating were found in females than in males. Predictors of emotional eating were sex, psychological distress, and emotional dysregulation. Mediation analyses showed that the indirect effect of psychological distress on emotional eating through emotional dysregulation was significant (b = 0.0069, SE = 0.0024, CI = 0.0024–0.0118), confirming that the relationship between psychological distress and emotional eating was mediated by emotional dysregulation, controlling for sex. The model explained 26.8% (R2 = 0.2680) of the variance. These findings may help to plan and develop psychological interventions aimed at addressing emotional eating in young adults by targeting emotional dysregulation.

Individuals suffering from chronic low-back pain and obesity face severe physical and functional limitations. According to the fear-avoidance model, kinesiophobia might play a crucial role in the relationship between pain intensity and disability. Thus, the purpose of this study was to verify the role of kinesiophobia as a mediator in the association between pain intensity and disability in individuals with both chronic low-back pain and obesity. A total of 213 individuals with chronic low-back pain and obesity were included in the study. The level of kinesiophobia, pain intensity and disability were all assessed using self-reported questionnaires. We verified through a simple mediation analysis that kinesiophobia partially mediated the association between pain intensity and disability in our sample. According to our findings, we emphasize the crucial role of kinesiophobia as a psychological factor that should be addressed in chronic low-back pain rehabilitative protocols to reduce disability in individuals with obesity.

Background: Acceptance and Commitment Therapy (ACT) resulted to be efficacious in promoting the core process of Psychological Flexibility, a key ability related to physical and psychological health outcomes. Despite evidence-based ACT protocols were applied successfully in different contexts, including the promotion of long-standing behavioral change, the impact of the single processes in the psychological flexibility model remains unclear. The aim of the present study is to evaluate the efficacy of a Focused-ACT intervention for the maintenance of a healthy lifestyle, by separating and evaluating the impact of single core processes targeted into a modular intervention on the maintenance of healthy lifestyle. Methods: An individually randomized group treatment trial will be conducted. 150 adult obese patients who are attending a four-week medically-based multidisciplinary rehabilitation of weight loss will be randomly allocated into three groups: Module Engage, Module Openness, and Module Awareness. At the beginning (Time 0) and at the end of the intervention (Time 1), at six months (Time2) and one year (Time 3) follow-up weight and height will be recorder and participants will complete the Psychological General Well Being Inventory(PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Acceptance and Action Questionnaire (AAQ II) and the Five Facet Mindfulness Questionnaire (FFMQ). Repeated measures 3 (conditions) x 4 (times) will be assessed to examine differences between three groups within four times on both general outcomes measure of weight, BMI, PGWBI and OQ-45.2, and FACT processes targeted during the interventions.Discussion: By providing additional evidence supporting the relevance of modular transdiagnostic interventions in clinical practice and the use of Process-Based Therapy, this study will contribute toclarify which mechanisms are involved in a generalizable lifestyle behavioral change intervention. Trial registrationClinicalTrials.gov Registration number: NCT04474509 Date: July, 4 2020 https://clinicaltrials.gov/ct2/show/NCT04474509

This Randomized Controlled Trial [(RCT) aims to evaluate the effectiveness of a brief Acceptance and Commitment Therapy (ACT)-based intervention combined with treatment as usual (TAU) compared to TAU only in improving psychological conditions in a sample of adolescents with obesity (body mass index, BMI > 97th percentile for age and sex) within the context of a wider multidisciplinary rehabilitation program for weight loss. Fifty consecutive adolescents (12–17 years) of both genders with obesity will be recruited among the patients hospitalized in a clinical center for obesity rehabilitation and randomly allocated into two experimental conditions: ACT + TAU vs. TAU only. Both groups will attend a three-week in-hospital multidisciplinary rehabilitation program for weight loss. The ACT + TAU condition comprises a psychological intervention based on ACT combined with a standard psychological assessment and support to the hospitalization. The TAU comprises the standard psychological assessment and support to the hospitalization. At pre- to post-psychological intervention, participants will complete the Avoidance and Fusion Questionnaire for Youth, the Psychological Well-Being Scale, the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess psychological well-being as the primary outcome and experiential avoidance, psychological distress, emotional dysregulation, and emotional eating as secondary outcomes. Repeated-measures ANOVAs (2 × 2) will be conducted. The study will assess the effectiveness of a brief ACT-based intervention for adolescents with obesity in improving their psychological conditions by targeting specific core processes of the ACT framework (openness, awareness, and engagement). Future directions of the study will assess whether these psychological processes will contribute to addressing long-term weight loss.

The purpose of this Individually Randomized Group Treatment Trial was to compare an Acceptance and Commitment Therapy-based (ACT) group intervention and a Cognitive Behavioral Therapy-based (CBT) group intervention for weight loss maintenance in a sample of adult patients with obesity seeking treatment for weight loss. One hundred and fifty-five adults (BMI: Kg/m2 = 43.8 [6.8]) attending a multidisciplinary rehabilitation program for weight loss were randomized into two conditions: ACT and CBT. Demographical, physical, and clinical data were assessed at the beginning of the program (t0), at discharge (t1), and at 6-month follow-up (t2). The following measures were administered: The Acceptance and Action Questionnaire-II (AAQ-II) and the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). Generalized linear mixed models were performed to assess differences between groups. Moderation effects for gender and Eating Disorders (ED) have been considered. From baseline to discharge, no significant differences between interventions were found, with the only exception of an improvement in the CORE-OM total score and in the CORE-OM subjective wellbeing subscale for those in the CBT condition. From discharge to follow-up, ACT group participants showed significant results in terms of weight loss maintenance, CORE-OM total score, and CORE-OM and AAQ-II wellbeing, symptoms, and psychological problems subscales. Gender moderated the effects of time and intervention on the CORE-OM subscale reporting the risk for self-harm or harm of others. The presence of an eating disorder moderated the effect of time and intervention on the CORE-OM total score, on the CORE-OM symptoms and psychological problems subscales, and on the AAQ-II. Patients who received the ACT intervention were more likely to achieve a ≥5% weight loss from baseline to follow-up and to maintain the weight loss after discharge. The ACT intervention was thus effective in maintaining weight loss over time.

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performancebased physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.

Obesity management requires a multidisciplinary, integrated treatment composed of medical, nutritional, physical, and psychological interventions. Currently, bariatric surgery is the most suitable treatment available in case of severe obesity, or obesity with comorbid medical conditions. Despite bariatric surgery results in a significant weight loss in most of the cases, a not-inconsiderable portion of patients does not achieve relevant outcomes, in terms of limited weight loss or weight regain due to psychological problems. The pre-operative evaluation of the psychological conditions of the candidates for bariatric interventions and pre/post-surgical psychological support is required in order to achieve the desired post-operative outcomes for a long time. In this chapter, we will elucidate the core components of the psychological assessment of bariatric candidates. Moreover, the main directions for the pre/post-surgery psychological support will be provided.

Prevention and treatment of chronic post-surgical pain should be based on the early identification of patients at risk. The presence of a deficit in executive functions, along with the presence of psychological risk factors, could impair the use of appropriate pain coping strategies and might facilitate the transition to chronic post-surgical pain. A longitudinal cohort study was implemented. Patients listed for orthopaedic surgery were enrolled. Variables measured before surgery were pain intensity, the sensory, affective, cognitive and mixed components of pain, state and trait variables associated with the psychological status of the patient, fear of movement, pain catastrophizing, visual attention and cognitive flexibility. Pain intensity and the components of pain were re-evaluated after surgery and after three months. A linear mixed model was used to assess the predictors of pain intensity, and a multivariate linear mixed model was used to assess the predictors of the pain components. 167 patients were enrolled. Controlling for sex, age, pain duration and surgical procedure, catastrophizing and visual attention were predictors of pain intensity at follow-up. The sensory component of pain was predicted by state anxiety, healthcare-related fears, pain catastrophizing and visual attention. Anxiety and catastrophizing were predictors of the affective and evaluative components of pain. The mixed component of pain was predicted by state anxiety, healthcare-related fears and pain catastrophizing. Executive functions, along with psychological risk factors, shape the course of post-surgical pain. The efficacy of preventive and rehabilitation treatment could be possibly enhanced if these factors are treated.