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The utilization of non-invasive neurostimulation techniques, such as transcranial magnetic stimulation (TMS), is increasingly prevalent in psychiatry due to their efficacy and safety. Although the precise therapeutic mechanisms remain partially unclear, repetitive TMS, particularly high-frequency stimulation, may enhance cognitive functions, contributing to therapeutic benefits. This within-subjects study examined the impact of TMS on cognitive and symptomatic outcomes in patients with obsessive–compulsive disorder (OCD), substance use disorder (SUD), and major depressive disorder (MDD). A total of 44 patients underwent cognitive tests and symptom assessments before and after an intensive four-week TMS treatment phase, followed by a four-week maintenance phase. Cognitive assessments included Raven’s matrices, verbal fluency, and digit span tests, while symptom severity was measured using the Italian version of the SCL-90-R. Decision-making performance was also evaluated by administering a delay discounting (DD) test. Principal component analysis was used to generate a dimensional characterization of subjects along cognitive and symptom-related axes before and after treatment. The results indicated that TMS significantly improved symptom scores, but no significant cognitive enhancement was observed. Statistical analysis based on linear mixed-effects models confirmed these findings, showing a significant fixed effect of TMS treatment on symptoms but not on cognitive performance. DD metrics remained unchanged. These findings suggest that while TMS effectively alleviates clinical symptoms, it does not produce consistent or appreciable enhancement of cognitive functions in these protocols. This study highlights the need for more personalized and combined therapeutic approaches to maximize the benefits of TMS, potentially incorporating cognitive enhancement strategies. Future studies will be useful to explore whether the results we obtained are valid for other pathologies

Objective A two-arm parallel randomised controlled trial was conducted to evaluate the efficacy of a group acceptance-based treatment (ABT) in improving pain acceptance, pain catastrophising, kinesiophobia, pain intensity and physical functioning compared to treatment as usual in patients with fibromyalgia (FM) and comorbid obesity. Methods Female individuals diagnosed with FM and obesity (n = 180) were randomly assigned to either a three-weekly group acceptance-based treatment plus treatment as usual (ABT+TAU) or only TAU. The variables of interest were assessed at baseline (T0) and after the interventions (T1). The treatment protocol for the ABT+TAU condition, designed for an inpatient rehabilitation context, is based on acceptance and commitment therapy but focuses specifically on pain acceptance, a crucial factor in fostering a more functional adaptation to chronic pain. Results Participants in the ABT+TAU group showed significant improvements in pain acceptance (i.e. the primary outcome), but also in pain catastrophising, kinesiophobia, and performance-based physical functioning (i.e. the secondary outcomes) compared to those in the TAU group. However, there were no significant differences in pain intensity between the two groups. Conclusion These findings indicate that a brief group-based ABT intervention is effective in enhancing pain acceptance, reducing pain catastrophising and kinesiophobia, and improving performance-based physical functioning. Furthermore, the observed improvements in kinesiophobia and physical functioning may have particular relevance for individuals with comorbid obesity, as they can facilitate greater adherence to physical activity and promote weight loss.

Cognitive behavioral therapy (CBT) in Italy started to be disseminated in the early 1970s, and from there, it has been continued to develop. This evolution has included integrating a number of different approaches, making CBT in Italy complex and articulate. In the last few decades, CBT in Italy increased thanks to the implementation of research and the major clinical attention given to this approach. Unfortunately, development of research is still limited, and more efforts are necessary to increase funds to support scientific inquiry as the number of people who struggle with a psychological or psychiatric disease is increasing in Italy. As the clinical needs grow, so does the need for an evidence-based approach for mental health in Italy. Related is the importance of having a sufficient number of clinicians who are competent to deliver CBT. As such, the training of students to become a CBT psychotherapist, in order to guarantee highest standards, is important and will be discussed. In this chapter, we discuss the history of CBT in Italy, from the origins to the present, with particular attention for different influences from different theories, Further, the national regulations to become a psychotherapist and how psychotherapy is provided in Italy will be discussed. The current status of CBT organizations and research on CBT in Italy will be reviewed. Finally, we examine CBT with specific populations in Italy.

Background: The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention re-cently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. Methods: Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. Results: Eleven papers met the inclusion criteria, comprising 154 participants as-signed to a stimulation condition and 164 to a sham or control group. We calculated Hedge’s g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. Limitations: Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. Conclusion: Our findings showed that noninvasive brain stimulati

Over the last decade, interest in the clinical field regarding the emotional area of the child has grown. Several studies have confirmed the efficacy of cognitive-behavioural treatment in childhood and adolescence (Sukhodolsky, Kassinove, & Gorman, 2004; Compton et al., 2004), and programmes for the prevention of emotional disorders, such as Rational Emotive Education (Educazione Razionale Emotiva) (Di Pietro, Morosini, & Agostini 1999), have been disseminated in schools. This is a preventive psychoeducational intervention, which derives from the principles of Ellis’s Rational Emotional Behavioural Therapy (1989) and was brought to Italy in 1991 by Mario di Pietro (1992), following its adaptation at the Institute for Rational-Emotive Therapy in New York. In recent years the Italian version has been updated and integrated with the principles of Acceptance and Commitment Therapy, making the intervention more innovative. The purpose of this article is to provide an analysis of the application of Rational Emotional Behavioural Therapy in childhood and adolescence and to deepen the practical aspects of Rational Emotive Education, providing some useful ideas for the realisation of a psychoeducational project in primary schools.

Cognitive-behavioral treatments assume that the mechanisms of change depend on the assessment and questioning of biased beliefs. In contrast, recent developments have emphasized mindful acceptance interventions, in which clients allow thoughts to come and go without questioning them. In order to discuss therapeutic efficacy difference in emotional disorders, we explored the possible normalizing effects of cognitive questioning and mindful acceptance on sympathetic reactivity aroused by recall tasks. We compared the effects of different sequencing of cognitive questioning and mindful acceptance on emotional distress in two groups in which questioning either preceded (group 1) or followed (group 2) acceptance. Thirty-five non-clinical individuals (21 males, 14 females) randomly allocated to either group 1 or 2 participated in the experimental tasks (unpleasant recall, cognitive questioning, and metacognitive acceptance). Sympathetic reactivity levels were measured using galvanic skin response. Results showed that acceptance reduced sympathetic reactivity when compared to questioning. The best sequence was that in which questioning preceded acceptance. By interpreting sympathetic reactivity as a measure of emotional distress and experimental tasks as models for therapeutic approaches, this experiment suggests that acceptance is better than questioning in reducing emotional distress especially when cognitive questioning is followed by mindful acceptance.

Objective: Neuromodulation of regions involved in food processing is increasingly used in studies on eating behaviors, but results are controversial. We assessed the effects of anodal transcranial direct current stimulation (a-tDCS) on food and body implicit preferences in patients with eating disorders (EDs). Method: Thirty-six ED patients and 36 healthy females completed three sessions with a-tDCS applied to the medial-prefrontal cortex (mPFC), the right extrastriate body area (rEBA) or in sham mode. Each participant then completed three Implicit Association Tests (IATs) on tasty/tasteless food, underweight/overweight body images, flowers versus insects as control. Differences in latency between incongruent and congruent blocks were calculated (D score). Results: The tDCS by group interaction was significant for the IAT-food D score, with patients showing weaker preference for tasty food than controls in sham, but not a-tDCS sessions. In particular, rEBA stimulation significantly increased patients' D score compared to sham. Moreover, a-tDCS over mPFC and rEBA selectively increased patients' reaction times in the incongruent blocks of the IAT-food. Discussion: A-tDCS on frontal and occipito-temporal cortices modulated food preferences in ED patients. The effect was specific for food images and selective in patients, but not in healthy participants. These findings suggest that neuromodulation of these regions could affect implicit food attitudes

The study explored the qualitative features of: a) memories of threat to self-esteem, b) grandiose fantasies and c) relaxing scenarios, experimentally induced in a non-clinical participant sample. A group of 103 young university students produced and transcribed personal memories of threat to self-esteem, grandiose fantasies and relaxing scenes. A five point scale was designed ad hoc to enable three independent raters to assess the biological, psychological and relational contents of each of the texts. Inter-rater agreement was satisfactory. Memories of threat to self-esteem and grandiose fantasies were mainly socio- relational, while relaxing scenarios were characterised by both relational and biological elements. With reference to the biological dimension, there was also significant correlation between memories of threat to self-esteem and grandiose fantasies.

BACKGROUND: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. METHODS: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. RESULTS: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. CONCLUSIONS: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.