Chiara Vari

The development and initial psychometric evaluation of a measure assessing adherence to prescribed exercise: The Exercise Adherence Rating Scale (EARS)

OBJECTIVES There is no gold standard for measuring adherence to prescribed home exercise. Self-report diaries are commonly used however lack of standardisation, inaccurate recall and self-presentation bias limit their validity. A valid and reliable tool to assess exercise adherence behaviour is required. Consequently, this article reports the development and psychometric evaluation of the Exercise Adherence Rating Scale (EARS). DESIGN Development of a questionnaire. SETTING Secondary care in physiotherapy departments of three hospitals. PARTICIPANTS A focus group consisting of 8 patients with chronic low back pain (CLBP) and 2 physiotherapists was conducted to generate qualitative data. Following on from this, a convenience sample of 224 people with CLBP completed the initial 16-item EARS for purposes of subsequent validity and reliability analyses. METHODS Construct validity was explored using exploratory factor analysis and item response theory. Test-retest reliability was assessed 3 weeks later in a sub-sample of patients. RESULTS An item pool consisting of 6 items was found suitable for factor analysis. Examination of the scale structure of these 6 items revealed a one factor solution explaining a total of 71% of the variance in adherence to exercise. The six items formed a unidimensional scale that showed good measurement properties, including acceptable internal consistency and high test-retest reliability. CONCLUSIONS The EARS enables the measurement of adherence to prescribed home exercise. This may facilitate the evaluation of interventions promoting self-management for both the prevention and treatment of chronic conditions.

Sensitivity to Affective Touch Depends on Adult Attachment Style

Affective touch supports affiliative bonds and social cognition. However, it remains unknown whether pre-existing models of social relating influence the perception of affective touch. Here, we present the first study (N=44) to examine how individual differences in attachment styles relate to the perception of affective touch, as well as to a different non-social modality of interoception, namely cardiac perceived accuracy. Using the gold standard assessment of adult attachment (Adult Attachment Interview), we found that insecure attachment was associated with reduced pleasantness discrimination between affective vs. non-affective, neutral touch. Acknowledging the different traditions in measuring attachment, we also used a well-validated self-report questionnaire that pertains to explicit representations of current close relationships. Using this measure, we found that higher scores on an attachment anxiety dimension (but not an attachment avoidance) were associated with reduced pleasantness discrimination between affective vs. non-affective, neutral touch. Attachment patterns (in both measures) were not related to cardiac perception accuracy. These results corroborate and extend previous literature on the affectivity of touch and its relation with affiliative bonds and social cognition. Given that attachment was not related to perceived cardiac accuracy, these findings point to the specificity of the relationship between affective touch and attachment.

Acceptance and Commitment Therapy for MuScle Disease (ACTMuS): Protocol for a two-arm randomised controlled trial of a brief guided self-help ACT programme for improving quality of life in people with Muscle diseases

Introduction In adults, muscle disease (MD) is often a chronic long-term condition with no definitive cure. It causes wasting and weakness of the muscles resulting in a progressive decline in mobility, alongside other symptoms, and is typically associated with reduced quality of life (QoL). Previous research suggests that a psychological intervention, and in particular Acceptance and Commitment Therapy (ACT), may help improve QoL in MD. ACT is a newer type of cognitive behavioural treatment that aims to improve QoL by virtue of improvement in a process called psychological flexibility. The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of a guided self-help ACT programme for improving QoL in people with MD. Main secondary outcomes are mood, symptom impact, work and social adjustment and function at 9-week follow-up. Methods and analysis Acceptance and Commitment Therapy for Muscle Disease is an assessor-blind, multicentre, two-armed, parallel-group RCT to assess the efficacy of ACT plus standard medical care (SMC) compared with SMC alone. Individuals with a diagnosis of one of four specific MDs, with a duration of at least 6 months and with mild to moderate anxiety or depression (Hospital Anxiety and Depression Scale score ≥8) will be recruited from UK-based MD clinics and MD patient support organisations. Participants will be randomised to either ACT plus SMC or SMC alone by an independent randomisation service. Participants will be followed up at 3, 6 and 9 weeks. Analysis will be intention to treat, conducted by the trial statistician who will be blinded to treatment allocation. Ethics and dissemination The study has received full ethical approval. Study results will be disseminated via peer-reviewed publications, conference presentations and journal articles. Data obtained from the trial will enable clinicians and health service providers to make informed decisions regarding the efficacy of ACT for improving QoL for patients with MD. Trial registration number NCT02810028. Protocol version V.11 (4 April 2017).

Investigating Personality and Psychopathology in Patients With Psoriasis

A broad range of literature reported higher rates of psychopathology and personality disorders among patients affected by skin conditions. Specifically, depression, anxiety, and suicidal ideations are more frequently reported by patients affected by skin diseases. This study aimed to examine psychopathology and personality in a group of patients affected by psoriasis by means of a self-report measure (Millon Clinical Multiaxial Inventory – MCMI-III) and a performance-based technique (Wartegg Drawing Completion Test [WDCT], CWS). Study results showed a higher rate of passive-aggressiveness and paranoia among psoriatic patients (MCMI-III). When assessing patients through the performance-based technique (WDCT, CWS), a higher rate of global rejection (GR) – linked by previous literature to suicidal ideation – and a lower affective quality of the drawings emerged. We discuss the clinical importance of detecting psychological issues in dermatology patients by means of a multimethod assessment that goes beyond patients’ self-evaluation of their symptoms and emotions.

Multimethod and Interpersonal Assessment in Medical Settings: A Case Study from the Dermatology Unit

Psoriasis is a chronic skin disease with multifactorial aetiology. The psychological impact of skin diseases is increasingly recognised, but only scant attention has been given to the possible role of couple relationships as protective factors for dermatology patients. This article presents a multimethod assessment conducted along with physical examination at a Dermatology Unit. Specifically, the assessment includes measures of emotion regulation and attachment . The first aim of the article is to support an integrated assessment of dermatological and psychological factors together. The second aim is to highlight the possible role of couple relationships in the management of skin diseases.

EPA-0567 – Does emotion dysregulation enhance rejection sensitivity? a pilot study with inmates

Introduction The propensity to react aggressively seems to be underpinned by rejection sensitivity, namely the disposition to anxiously expect, readily perceive, and intensely react to perceived rejection by significant others (Downey, Feldman, & Ayduk, 2000). The scientific debate has recently turned the attention to the possible contribution of emotion dysregulation toward violent behavior (Roberton, Daffern, & Bucks, 2012). Taken together, these two elements have been scarcely investigated. Objectives On the basis of Gratz and Roemer (2004) conceptualization, we consider emotion regulation as involving: the awareness, understanding and acceptance of emotions; the ability to control impulsive behaviors and pursue desired goals under emotional arousal; the ability to use emotion regulation strategies flexibly. Aims This study sought to examine whether difficulties in any specific domains of emotion regulation were linked to increased rejection sensitivity, which in turn can lead to aggression. Methods A sample of 50 male inmates (mean age=41.04) was recruited and assessed through the Difficulties in Emotion Regulation Scale (DERS; Giromini et al., 2012), and the Rejection Sensitivity Questionnaire-Adult Version (A-RSQ; Berenson et al., 2009). Results Participants shown low scores on both DERS and A-RSQ, if compared with normative data. However, a significant, positive relation was found between difficulties in emotional acceptance and rejection sensitivity (r=0.398; p Conclusions These preliminary results suggest that a reduction in rejection sensitivity could be endorsed by the increased acceptance of emotions, and so the latter may serve as a protective factor toward aggression, and as a potential target for clinical interventions.

EPA-0629 – Investigating mindfulness facets in dermatology patients: a cross-sectional study

Introduction Research data indicate that many dermatological conditions may be related to stress and emotion dysregulation. Increased attention has recently been given also to mindfulness , the ability of attending present experiences in both a non-evaluative and accepting way. In fact, dispositional mindfulness and mindfulness-based interventions have found to influence rates of skin clearance in patients with psoriasis, while reducing pain, and improving the quality of life (QoL). Aims The main aim of the current study was to test differences in the mindfulness ability of individuals affected by psoriasis vs. in absence of any chronic skin condition. Additionally, we also aimed at investigating the link between mindfulness and QoL. Methods Participants were 42 patients with psoriasis and 42 healthy controls. All completed the Five Facets Mindfulness Questionnaire (FFMQ;a self-report measuring five aspects of mindfulness, i.e., Observe, Describe, Act with Awareness, Nonjudge, and Nonreact), and the Dermatology Life Quality Index (DLQI;a self-report assessing the impact of dermatological diseases on the QoL) . The two groups were fairly well balanced in terms of gender and age (all p>.05). Results When compared to the healthy controls, the patients with psoriasis overall showed lower mindfulness scores, although most of the results were only marginally significant. The strongest difference was observed for the Nonjudge mindfulness facet, t (82)=1.97, p =.05, d =.43. No correlation between DLQI and FFMQ was observed. Conclusions This study provides further support for the link between psoriasis and mindfulness, but fails to demonstrate an association between mindfulness and QoL. Accordingly, psoriasis treatment might benefit from a multidisciplinary approach that includes, but is not limited to mindfulness techniques.

EPA-0566 – Differential association between impulsivity and aggression among offenders

Introduction In spite of some adverse opinions (Bushman & Anderson, 2001), at the state of the art pathological aggression is typically depicted as affective/impulsive or predatory (Fonagy, 2004; Meloy, 2006). More recently, some authors argued that different specific facets of impulsivity may predict different types of aggression (Derefinko et al., 2011). Objectives In this study, we focus on three different kinds of impulsivity, namely motor, attention, and non-planning impulsiveness. On the other hand, we consider aggression through four components: verbal aggression, physical aggression, anger, and hostility. Aims We try to highlight if various kinds of aggressiveness may be better understood through different precursor in impulsivity domains. Methods The Barratt Impulsiveness Scale (BIS-11; Patton et al., 1995) encompasses the three types of impulsivity sketched above; the Aggression Questionnaire (AQ; Buss & Perry, 1992) assesses aggression as the sum of the four features before depicted. This preliminary sample consists of 50 incarcerated violent offenders (all males; mean age=41.04). Results The two measures appear to be positively related (r=0.525; p Conclusions In line with our preliminary results, a proper examination of the different aspects of impulsiveness would be helpful in both the care and the custody of violent offenders.