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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

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

Gianluca Castelnuovo,1,2 Giada Pietrabissa,1,2 Gian Mauro Manzoni,1,3 Roberto Cattivelli,1,2 Alessandro Rossi,1 Margherita Novelli,1 Giorgia Varallo,1 Enrico Molinari1,2 1Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital, Verbania, 2Department of Psychology, Catholic University of Milan, Milan, 3Faculty of Psychology, eCampus University, Novedrate, Italy Abstract: Obesity is a chronic condition associated with risk factors for many medical ­complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care. Keywords: overweight, BED, ACT, BWL, BWLT, mHealth, virtual reality, chronic care management, stepped care

Objective: To assesses the prevalence and co-occurrence of anxiety, depressive symptoms, suicidal thoughts, and hopelessness in patients with narcolepsy type 1 (NT1)., Patients/methods: In this cross-sectional study, 127 patients with NT1 (mean age 38.2 ± 15.5 years, 53.5 % female) and 131 controls (mean age 37.4 ± 14.3 years, 59.5 % female) matched for age, sex, and education, filled in the following validated questionnaires: Beck Depression Inventory-II (BDI), State-Trait Anxiety Inventory (STAI), and Beck Hopelessness Scale (BHS). Comparisons between groups and multivariable logistic regression analyses were performed., Results: Patients with NT1 presented significantly higher scores in BDI, suicidal thoughts (BDI-item-9), STAI-trait, STAI-state, and BHS than controls. Adjusted for age, sex, and educational level, NT1 was significantly associated with depressive symptoms (BDI≥13; OR 3.23, 95%CI 1.71-6.10), trait anxiety symptoms (STAI-trait≥38; OR 1.91, 95%CI 1.14-3.21), co-occurrence of BDI≥13 with STAI-trait≥38 (OR 2.72, 95%CI 1.47-5.05), and with STAI-state≥38 (OR 2.24, 95%CI 1.17-4.30), and moderate to severe hopelessness (BHS≥9; OR 2.95, 95%CI 1.55-5.63)., Conclusions: Patients with NT1 present a multidimensional psychiatric burden and comorbidity between symptoms of depression and anxiety and suicidal thoughts, a concern that deserves tailored interventions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Giuseppe Plazzi reports a relationship with Jazz Pharmaceuticals that includes: board membership. Giuseppe Plazzi reports a relationship with Bioprojet that includes: board membership. Giuseppe Plazzi reports a relationship with Centessa Pharmaceuticals, LLC that includes: board membership. Giuseppe Plazzi reports a relationship with Takeda Pharmaceutical Company Limited that includes: board membership. Giuseppe Plazzi reports a relationship with Idorsia Pharmaceuticals Ltd that includes: board membership. Fabio Pizza reports a relationship with Takeda Pharmaceutical Company Limited that includes: consulting or advisory. Fabio Pizza reports a relationship with Jazz Pharmaceuticals Inc that includes: speaking and lecture fees. Fabio Pizza reports a relationship with Bioprojet that includes: travel reimbursement. Elena Antelmi reports a relationship with Bioprojet that includes: speaking and lecture fees and travel reimbursement. Elena Antelmi reports a relationship with Jazz Pharmaceuticals Inc that includes: speaking and lecture fees and travel reimbursement. Elena Antelmi reports a relationship with Polifarma that includes: speaking and lecture fees. Francesco Biscarini reports a relationship with Bioprojet that includes: travel reimbursement. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Suicide represents a significant problem for healthcare professionals such as veterinarians. Previous studies showed that contextual and individual risk factors can contribute to suicidality among veterinarians. In the present study, self-report measures on exposure to animal euthanasia, substance abuse, reflective functioning, and suicidal ideation were administered to 1556 Italian veterinarians aged 24-74 years old. Structural equation modelling revealed that failures in reflective functioning and substance abuse were associated with suicidal ideation. Prevention programs focusing on improving reflective functioning and decreasing substance abuse might reduce suicide risk among veterinarians., (© 2024. The Author(s).)

Objectives: The main objective of the study is to investigate the short-term efficacy of Acceptance and Commitment Therapy (ACT) on the simultaneous modification of biological indicators of risk and psychological well-being in patients with coronary heart disease attending cardiac rehabilitation (CR)., Design: This was a two-arm randomised controlled trial comparing a brief, manualised, ACT-based intervention with usual care (UC)., Setting: The study was conducted in an outpatient CR unit in Italy. Data collection took place from January 2016 to July 2017., Participants: Ninety-two patients were enrolled and randomised, following an unbalanced randomisation ratio of 2:1 to the ACT group (n=59) and the control group (n=33). Eighty-five patients completed the ACT (n=54) and the UC (n=31) interventions and were analysed., Interventions: The control group received UC, a 6 weeks multidisciplinary outpatient CR programme, encompassing exercise training, educational counselling and medical examinations. The experimental group, in addition to UC, participated in the Acceptance and Commitment Therapy on HEART disease (ACTonHEART) intervention encompassing three group sessions based on ACT., Outcomes: The primary outcomes were Low Density Lipoproteins (LDL)cholesterol, resting systolic blood pressure, body mass index (BMI) and psychological well-being measured by the Psychological General Well-Being Index (PGWBI). Outcome measures were assessed at baseline and at the end of CR., Results: Based on linear mixed models, no significant group × time interaction was observed for either the primary outcomes (β, 95% CI: PGWBI =-1.13, -6.40 to -4.14; LDL cholesterol =-2.13, -11.02 to -6.76; systolic blood pressure =-0.50, -10.76 to -9.76; diastolic blood pressure =-2.73, -10.12 to -4.65; BMI =-0.16, -1.83 to -1.51, all p values >0.05) or the secondary outcomes (all p values >0.05). A significant time effect was found for the PGWBI total (beta=4.72; p=0.03)., Conclusions: Although analyses revealed null findings, the results can inform the design of future ACT-based CR interventions and can help researchers to strike a balance between the idealised implementation of an ACT intervention and the structural limitations of existing CR programmes., Trial Registration Number: NCT01909102., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Narcolepsy type 1 (NT1) is a chronic neurological disorder characterized by symptoms such as excessive daytime sleepiness, sudden sleep episodes, disrupted nocturnal sleep, cataplexy, sleep paralysis, and hypnagogic hallucinations, which significantly impact the overall well-being and quality of life of individuals. While psychological factors have gained attention, there is limited research on the coping strategies employed by patients with NT1 and their association with quality of life. This study aimed to compare coping strategies in patients with NT1 and controls, as well as assess the relationship between coping strategies and quality of life in patients with NT1. A total of 122 individuals diagnosed with NT1 and 138 controls were enrolled in this cross-sectional study. Participants completed questionnaires assessing coping strategies and health-related quality of life. A Mann-Whitney U test was conducted to compare the use of different coping strategies by patients with NT1 and controls. Spearman's rho correlation was performed to examine the association between coping strategies and quality of life in the NT1 group. Results showed that patients with NT1 exhibited differences in the use of coping strategies compared to controls. They reported lower use of active coping, planning, instrumental, and emotional social support, and higher use of behavioral and mental disengagement. Denial and behavioral disengagement were significantly and negatively associated with quality of life. Identifying coping strategies and their association with quality of life may aid in the development of tailored interventions aimed at improving the adoption of effective coping strategies and reducing the use of maladaptive coping strategies., (© 2024. The Author(s).)

Objective: Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation., Methods: In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected., Results: 3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation., Discussion: The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.)

Narcolepsy type 1 is a chronic central disorder of hypersomnolence, and it is frequently accompanied by overweight, but the association between narcolepsy type 1 and eating disorders is controversial. Our study aims to compare patients with narcolepsy type 1 and controls on the symptomatology of eating disorders and to evaluate the association between clinical factors. This is a cross-sectional study, with consecutive recruitment of patients with narcolepsy type 1 attending the Outpatient Clinic for Narcolepsy at the IRCCS Istituto delle Scienze Neurologiche di Bologna (Italy) for routine follow-up visits. Healthy subjects from general populations were recruited as controls. Patients underwent a questionnaire-based assessment using the Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Italian Night Eating Questionnaire (I-NEQ), Epworth Sleepiness Scale (ESS), and Narcolepsy Severity Scale (NSS). One hundred and thirty-eight patients with narcolepsy type 1 and 162 controls were enrolled. This study showed that individuals with narcolepsy type 1 reported higher scores on the EDE-Q, I-NEQ, and a higher body mass index (BMI) than the controls. The logistic regression analysis results, with EDE-Q positivity as a dependent variable, demonstrate a significant association with antidepressant drugs, female sex, and the use of sodium oxybate. We found an association between antidepressant drug consumption, the NSS total score, and female sex with BES positivity as the dependent variable. The logistic regression analysis for I-NEQ positivity found an association with antidepressant drug use. This study shows that patients with narcolepsy type 1 frequently present with comorbid eating disorder symptomatology, mainly night eating syndrome. Investigating the possible presence of eating disorders symptomatology through questionnaires is fundamental during the assessment of patients with narcolepsy type 1., (© 2024 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Objective: The COVID-19 pandemic has contributed to the occurrence of psychological disturbances, such as depressive and anxiety symptomatology, thereby significantly impacting individuals' lifestyles by disrupting sleep patterns. This study aimed to elucidate the interconnections between emotion regulation, depression, anxiety, and daytime sleepiness., Method: We recruited 632 community adults who underwent an online survey of self-report questionnaires, including the Depression Anxiety Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), and the Epworth Sleepiness Scale (ESS).A network analysis was performed to examine and visually represent the pattern of relationships between psychological distress, emotion regulation, and daytime sleepiness., Results: The DERS Strategy dimension showed high values across all centrality indices, indicating it as the most influential node in the network. In addition, the DASS Depression and DERS Goals dimensions exhibited high betweenness values, emerging as points of connection between the other nodes within the network structure., Conclusions: Our primary findings underscore the connection between psychological distress and emotion regulation, specifically between depressive symptoms, a lack of emotional clarity, and difficulty in the flexible use of emotional strategies. These specific constructs hold promising potential as valuable targets for both assessment and the development of effective interventions during highly challenging situations such as the COVID-19 pandemic., Competing Interests: Competing interests: None., (© 2023 Giovanni Fioriti Editore s.r.l.)

Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures., Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords "heart diseases" and "couple-based intervention." A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis., Results: The database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient., Conclusion: The variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients' and partners' outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer VS declared a past co-authorship with the author AG to the handling editor., (Copyright © 2023 Rapelli, Giusti, Tarquinio, Varallo, Franceschini, Musetti, Gorini, Castelnuovo and Pietrabissa.)

Objectives: 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., Conclusions: 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.

Study Objectives: This study aimed to explore resilience and its possible association with sociodemographic and clinical features in patients with narcolepsy type 1 (NT1)., Methods: This was a cross-sectional study involving patients with NT1 and age-/sex-matched controls (comparison group). Sociodemographic and clinical data were collected through semistructured interviews and validated questionnaires, including the Epworth Sleepiness Scale (ESS), State-Trait Anxiety Inventory (STAI)-State Anxiety, Beck Depression Inventory (BDI), 36-item Short Form Survey (SF-36), and the Resilience Scale (RS). Different statistical approaches were used to investigate the relationship between resilience and NT1 and associations with sociodemographic and clinical features., Results: The participants comprised 137 patients (mean age, 38.0 years; 52.6% female) and 149 controls (39.6 years; 55.7% female). Compared with controls, patients had a significantly lower (122.6 vs 135.5) mean RS score and a 2-fold risk of having low/mild-range resilience (adjusted odds ratio = 1.99, 95% confidence interval 1.13-3.52). Patients with high resilience had sociodemographic and narcolepsy characteristics similar to patients with low resilience, but they reported anxiety and depressive symptomatology less frequently (4.2% vs 55.8% and 58.3%, respectively), and their SF-36 scores were comparable to those of the comparison group. In patients, RS score was strongly associated with STAI-State Anxiety and BDI (rho = -0.57 and -0.56, respectively) and weakly with ESS (rho = -20) scores., Conclusions: The results of this study suggest that resilience may play a key role in patients' adaptation to NT1. Furthermore, this study supports interventions aimed at increasing patients' resilience and provides a base for further studies, preferably longitudinal and including objective measures, directed toward understanding the relationship between resilience, depression, and quality of life in patients with narcolepsy., Citation: D'Alterio A, Menchetti M, Zenesini C, et al. Resilience and its correlates in patients with narcolepsy type 1. J Clin Sleep Med . 2023;19(4):719-726., (© 2023 American Academy of Sleep Medicine.)

Narcolepsy type 1 is a central disorder of hypersomnolence characterized by excessive daytime sleepiness, rapid eye movement sleep-related manifestations, and cataplexy. In the current literature there is general agreement regarding neural correlates of Narcolepsy type 1 that appear to be related to anatomical and functional abnormalities in the hypothalamic region. In the last two decades, researchers shed light on the neurological bases of cataplexy by focusing on the neurobiological correlates of emotions. Although the results of these studies differ, they all point to an impairment in the amygdala and hypothalamus functions that are known to be involved in emotional processing, suggesting an impairment in this domain in narcoleptic patients. Indeed, despite heterogeneous results, several studies showed that narcoleptic patients differed from healthy controls in processing emotional stimuli. From a behavioral point of view, these findings suggest that alterations in emotional processing may be driven, at least in part, by compensatory strategies to avoid or reduce the frequency of cataplexy attacks. Surprisingly, the only study exploring in NT1 the behavioural performances in emotional facial recognition found no differences between NT1 adults and controls. We hypothesize that narcoleptic patients may present an alteration in a more complex socio-cognitive ability that is related to emotional processing, namely Theory of Mind. This review aims to investigate the literature supporting this hypothesis and to propose possible future developments on this topic., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Evidence on the relation between binge-watching and sleep quality is still scarce and inconsistent and none has taken into account both the healthy and pathological dimensions of the phenomenon. This study aimed at filling this gap by investigating both aspects in healthy participants with high and low sleep quality. Further, we aimed at identifying sociodemographic, psychological and sleep-related determinants of problematic binge-watching in poor sleepers. We first conducted independent comparisons between good (n = 253) and poor sleepers (n = 209) on different binge-watching symptoms and motives, assessed through 'Binge-watching Engagement and Symptoms' and 'Watching TV Series Motives' questionnaires, respectively. Then, we focused on the problematic aspects of binge-watching in poor sleepers, investigating the role of emotion regulation, loneliness, and sleep-related factors using hierarchical multiple regressions. Comparisons between the two groups revealed a greater extent of binge-watching behaviour (t = -2.80, p = 0.005) and greater use of this practise to cope with negative emotions (t = -4.17, p < 0.001) in poor sleepers. In addition, hierarchical multiple regressions showed that gender (β = -0.166, p = 0.008), alcohol consumption (β = -0.135, p = 0.035), emotional dysregulation (β = 0.260, p = 0.001; β = 0.298, p < 0.001), feelings of loneliness (β = 0.159, p = 0.029; β = 0.199, p = 0.003), and daytime sleepiness (β = 0.149, p = 0.016) are significant determinants of problematic binge-watching in this population. In addition to showing for the first time the relationship between sleep quality and different aspects of binge-watching, our findings indicate that emotional dysregulation, feelings of loneliness, and daytime sleepiness play a key role in determining problematic binge-watching in poor sleepers, possibly due to the existence of a pathological vicious circle between these factors in poor sleepers., (© 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Background/objective: 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)., Methods: 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: 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)]., Conclusions: 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., (© 2022 The Author(s).)

Evidence relative to facial emotion recognition and the role played by alexithymia in fibromyalgia syndrome is rare and heterogeneous. In this work, we investigated this ability in fibromyalgia investigating the implicit behaviour in the facial emotion recognition task, focusing on fear and anger. Twenty women with fibromyalgia and twenty healthy women as controls performed a facial emotion recognition of fearful and angry expressions. Their implicit behaviour was scored in accordance with the redundant target effect. The level of alexithymic traits through a standard psychological questionnaire and its effect on behavioral performance were also assessed. Participants affected by fibromyalgia reported a lower level of accuracy in recognizing fearful and angry expressions, in comparison with the controls. Crucially, such a difference was not explained by the different levels of alexithymic traits between groups. Our results agreed with some previous evidence suggesting an altered recognition of others' emotional facial expressions in fibromyalgia syndrome. Considering the role of emotion recognition on social cognition and psychological well-being in fibromyalgia, we underlined the crucial role of emotional difficulties in the onset and maintenance of the symptoms life-span., (© 2022. The Author(s).)

Objective: 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., Methods: 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., Results: A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQI gen ) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQI gen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality., Conclusions: We 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., (Copyright © 2022 Elsevier B.V. All rights reserved.)

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.

Background: 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., Aims: 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., Methods: A longitudinal study was conducted., Procedure: Before and after the intervention, 20 participants were assessed based on the severity of symptoms, social skills, and adaptive behaviors., Outcome and Results: According to our findings, severity of symptoms and daily living skills improved significantly., Conclusion: A culinary intervention may be useful for adolescents and young adults with ASD to improve daily living skills and reduce ASD-related symptomatology., Implication: 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., (Copyright © 2022. Published by Elsevier Ltd.)

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., (© 2022 American Academy of Sleep Medicine.)

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&#95;record.php?RecordID=272654., Competing Interests: Conflicts of interest The authors have no conflicts of interests to declare, that may be affected by the publication of the paper. Other conflicts of interests are as follows: GP research is supported by Takeda, Jazz Pharmaceuticals, Bioproject, Idorsia., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this cross-sectional study is to investigate the role of psychological inflexibility in the relationship between anxiety and depression and emotional eating in a sample of 123 inpatient Italian adult individuals with obesity. Participants completed the Anxiety and Depression subscales of the Psychological General Well-Being Inventory, the Acceptance and Action Questionnaire, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess anxiety and depression, psychological inflexibility, and emotional eating, respectively. Results showed that the indirect effect of PGWBI-A on DEBQ-EE through AAQ-II was significant [ b = -0.0155; SE = 0.076; 95% BC-CI (-0.0320 to -0.023)]. Similarly, the indirect effect of PGWBI-D on DEBQ-EE through AAQ-II was significant [ b = -0.0383; SE = 0.0207; 95% BC-CI (-0.0810 to -0.0002)]. These findings may help to plan and develop specific psychological interventions aimed at addressing emotional eating through targeting psychological inflexibility to be included in obesity treatment programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Guerrini Usubini, Varallo, Giusti, Cattivelli, Granese, Consoli, Bastoni, Volpi and Castelnuovo.)

Background: The STarT Back Screening Tool (SBST) is a self-report questionnaire developed for prognostic purposes which evaluates risk factors for disability outcomes in patients with chronic low back pain. Previous studies found that its use enables to provide a cost-effective stratified care. However, its dimensionality has been assessed only using exploratory approaches, and reports on its psychometric properties are conflicting. Objective: The objective of this study was to assess the factorial structure and the psychometric properties of the Italian version of the STarT Back Screening Tool (SBST). Materials and Methods: Patients with medical diagnosis of low back pain were enrolled from a rehabilitation unit of a tertiary care hospital specialized in obesity care (Sample 1) and from a clinical internship center of an osteopathic training institute (Sample 2). At baseline and after 7 days patients were asked to fill a battery of self-report questionnaires. The factorial structure, internal consistency, test-retest reliability, and construct validity of the SBST were assessed. Results: One hundred forty-six patients were enrolled (62 from Sample 1 and 84 from Sample 2). The confirmatory factor analysis showed that the fit of the original two-correlated factors model was adequate (CFI = 0.98, TLI = 0.99, RMSEA = 0.03). Cronbach's α of the total scale (α = 0.64) and of the subscales (physical subscale α = 0.55; psychological subscale α = 0.61) was below the cutoffs, partly because of the low correlation of item 2 with the other items. Test-retest reliability was adequate (ICC = 0.84). The SBST had moderate correlations with comparisons questionnaires, except for the Roland-Morris Disability Questionnaire, which had a high correlation ( r = 0.65). Discussion: The SBST has adequate psychometric properties and can be used to assess prognostic factors for disability in low back pain patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Giusti, Varallo, Abenavoli, Manzoni, Aletti, Capodaglio, Castelnuovo and Maggiani.)

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/m 2 = 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 (t 0 ), at discharge (t 1 ), and at 6-month follow-up (t 2 ). 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 performance-based 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., Competing Interests: The authors declare no conflict of interest.

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% ( R 2 = 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.

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.

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: Previous evidence about facial emotion recognition capability in obesity is few and not conclusive., Objective: 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., Methods: 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., Results: 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., Conclusions: 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., Level I: Experimental study.