Agostino Brugnera

Could fNIRS Promote Neuroscience Approach in Clinical Psychology

The purpose of the present commentary is to consider new perspectives of investigation methods used in clinical psychology studies. We propose that functional Near-Infrared Spectroscopy (fNIRS) has several important advantages over currently used methods. This technique opens the opportunity to transfer psychophysiological evidences in clinical settings, for example to evaluate psychophysiological underpinnings of depressive symptomatology. Indeed, fNIRS technology might be promisingly used to find out objective biomarkers of relapse risk of depression after pharmacological and psychotherapeutic treatments.

Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review

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

Psychiatric comorbidity and maternal distress among adolescent eating disorder patients: A comparison with substance use disorder patients

High rates of comorbidity are found among eating disorder (ED) patients, which may negatively affect treatment outcome and prognosis. However, there is a shortage of studies in Spain using clinician administered interviews to assess rates of comorbidity among these patients, particularly in adolescents. This study aimed to evaluate Axis I psychiatric diagnoses in adolescent patients with an ED and to compare them with patients with a distinct disorder with adolescent onset, substance use disorder (SUD) patients. Considering that maternal psychological distress is another factor involved in ED prognosis, a secondary aim was to examine the relationship between patients psychological variables and maternal distress (depression and anxiety). The cross-sectional study included 50 ED patients, 48 SUD patients, and their mothers. More than half of the patients received a diagnosis for a comorbid disorder. Internalizing problems were more common among EDs and externalizing disorders were the most common comorbidities among SUDs, similar to findings from other countries. Maternal distress was associated with higher levels of depression and symptom severity in patients. No differences in distress were found between mothers of patients with a comorbid diagnosis and those without. Elevated anxiety or depression in mothers did not increase the likelihood of patients having a particular primary diagnosis. In short, while both ED and SUD patients presented high rates of comorbidity, the types of comorbid diagnoses were specific to each group. Assessing for the presence of comorbid disorders and targeting maternal psychological distress may guide treatment interventions and improve patient prognosis.

Heart rate variability during acute psychosocial stress: A randomized cross-over trial of verbal and non-verbal laboratory stressors

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

Reflective functioning and growth in therapeutic alliance during emotionally focused group therapy for binge-eating disorder.

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

Cortical and cardiovascular responses to acute stressors and their relations with psychological distress

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

Cortical and Autonomic Patterns of Emotion Experiencing During a Recall Task

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

Psychotherapy for eating disorders: A meta-analysis of direct comparisons

Abstract Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) of bona fide psychotherapy for adults with eating disorders (EDs). Method: Thirty-five RCTs with 54 direct comparisons were included. The majority of RCTs included participants with bulimia nervosa and/or binge-ED, while only two RCTs included participants with anorexia nervosa, and three RCTs included participants with an ED not otherwise specified. Results: There was a clear advantage of bona fide psychotherapy over wait-list controls. Bona fide psychotherapy was superior to non-bona fide treatment; however, the majority of results were not stable. There were no significant differences between bona fide cognitive–behavioral therapy (CBT) and bona fide non-CBT, with the exception of bona fide CBT resulting in greater reductions in ED psychopathology assessed by the ED Examination, which primarily assesses maintenance factors according to the CBT model. Conclusions: Generally, the results indicate that any bona fide psychotherapy will be equally effective. While the number of trials remains modest, we hope that as more research becomes available, treatment guidelines can be updated, and more evidence-based treatment options will be available for treating EDs.

Reciprocal influence of distress and group therapeutic factors in day treatment for eating disorders: A progress and process monitoring study.

Eating disorders (EDs) are chronic mental illnesses with high levels of psychological, social, and health burden. Day treatment programs (DTP) are effective group-based partial hospital models that have been used to treat EDs for several decades. However, few studies have examined the factors associated with reduced distress in ED patients who participate in DTP groups. Related to this is whether change in distress is preceded by change in positive group processes, or vice versa. In this study, we examine the reciprocal relationship between growth of group therapeutic factors and change in distress in an ED sample. Participants were patients with an ED (n = 156) who took part in a 12-week DTP at a tertiary care hospital center. On a weekly basis, patients completed progress- and process-monitoring measures. We hypothesized: (a) positive changes in distress and in group therapeutic factors across weeks of DTP and (b) a bidirectional relationship between change in distress and group therapeutic factors. We found a significant growth of group therapeutic factors and decline in distress over the 12 weeks of DTP. We also found evidence for a reciprocal relationship between change in group therapeutic factors and change in distress. Group therapists working in DTPs for patients with EDs can enhance the benefits of treatment by focusing on group therapeutic processes, which in turn reduces distress, which then acts to enhance the ability of an individual to benefit from group interactions.

Change in Attachment Dimensions and Reflective Functioning Following Emotionally Focused Group Therapy for Binge Eating Disorder

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