Gianluca Lo Coco

The factorial structure of the outcome questionnaire-45: a study with an Italian sample

In this article, the authors study the factorial structure of the Italian translation of the Outcome Questionnaire 45 (OQ-45) in a sample of college students (n = 522) and psychiatric outpatients (n = 301). The relative goodness of fit of six competing models of the OQ-45 was examined using confirmatory factor analysis (CFA). Specifically, the study examined the relative fit of the most frequently presented models in the literature and three alternative models. Results of the CFA provided support for the four factor bi-level solution, suggesting that the OQ-45 is a multidimensional instrument that contains one general factor and multiple unique subscale factors.

Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis.

OBJECTIVE Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. METHOD The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. RESULTS Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94-8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24-6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38-7.42) and AUC = .71. CONCLUSION Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright

Early and Later Predictors of Outcome in Brief Therapy: The Role of Real Relationship

OBJECTIVES The study examined whether clients who continued longer in brief therapy reported stronger associations of real relationship and working alliance with therapy outcome than clients who received very brief treatment. It also examined whether real relationship and working alliance assessed early in treatment predicted outcome differently from that assessed later in therapy. METHOD Fifty clients (32 women; M(age) = 22.3 years) were recruited from a university counseling center. Thirty-two clients (very brief therapy) completed the post-third session assessment of real relationship and working alliance, and 18 (brief therapy) had both the third and eighth assessment. RESULTS The real relationship scores (both client and therapist rating) were significantly correlated with outcome in the 18 brief therapy clients, but not in the 32 very brief therapy clients. We found significant correlations between outcome and Bond element of the working alliance in the 18 brief therapy clients, and between outcome and working alliance-Task in the 32 very brief therapy clients. CONCLUSIONS These findings suggested that the strength of the early real relationship, as well as later real relationship, are highly associated with outcome for clients who continue brief therapy past its earliest stages.

Group analytic therapy for eating disorders: preliminary results in a single-group study.

OBJECTIVES There is a lack of empirical data on the effectiveness and process of group-analytic therapy in eating disorders. This single-group study aimed to explore the effectiveness of such treatment for anorexic and bulimic individuals. METHOD Eight patients (three anorexic and five bulimic women) entered group-analytic treatment, meeting weekly for 2 years. Eating behaviours, overall psychological distress and group process variables were regularly assessed using quantitative and qualitative measures, with comparisons made at the beginning and end of the therapy. RESULTS Treatment was discontinued in two cases. When outcome was classified on the basis of reliable change and clinical significance for the remaining patients at the end of treatment, four were recovered in terms of overall psychological distress, while one was unchanged and one had deteriorated. In terms of eating disorder symptoms, three patients were recovered, two were unchanged and one had deteriorated. Patients experienced an overall positive group climate and a positive group alliance. Perception of being understood by the therapist appeared to play an important role in the therapeutic process. CONCLUSIONS These preliminary results suggest that group-analytic therapy may be effective in helping patients with eating disorders. However, more work is needed before firm conclusions can be drawn. Implications for clinical practice and future research are discussed.

Binge eating partially mediates the relationship between body image dissatisfaction and psychological distress in obese treatment seeking individuals

INTRODUCTION We compared the binge eating pathway linking body image dissatisfaction (BID) and psychological distress of obese adults entering and not entering psychological treatment for their weight problems. METHOD 90 obese participants seeking an integrated treatment (OB-IT) and 87 obese participants seeking only medical treatment (OB-MT) for their weight problems completed questionnaires on BID, binge eating and psychological well-being. RESULTS Only in the OB-IT group, binge eating behaviors mediated the relationship between BID and psychological distress. CONCLUSIONS Both BID and binge eating behaviors need to be addressed in the psychological and medical treatment for obesity to enhance psychological well-being.

Does the Interpersonal Model Generalize to Obesity Without Binge Eating

The interpersonal model has been validated for binge eating disorder (BED), but it is not yet known if the model applies to individuals who are obese but who do not binge eat. The goal of this study was to compare the validity of the interpersonal model in those with BED versus those with obesity, and normal weight samples. Data from a sample of 93 treatment-seeking women diagnosed with BED, 186 women who were obese without BED, and 100 controls who were normal weight were examined for indirect effects of interpersonal problems on binge eating psychopathology mediated through negative affect. Findings demonstrated the mediating role of negative affect for those with BED and those who were obese without BED. Testing a reverse model suggested that the interpersonal model is specific for BED but that this model may not be specific for those without BED. This is the first study to find support for the interpersonal model in a sample of women with obesity but who do not binge. However, negative affect likely plays a more complex role in determining overeating in those with obesity but who do not binge. Copyright

The Outcome Questionnaire 45.2. Italian validation of an instrument for the assessment of phychological treatments

AIMS The Outcome Questionnaire (OQ-45.2; Lambert et al., 2004) was designed to measure important areas of functioning (symptoms, interpersonal problems and social role functioning) that are of central interest in mental health. The cross-cultural validity of the OQ-45.2 in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and normative scores of the Italian OQ with the original American version. METHOD Data were collected at university (N = 461), in community (N = 61) and in three mental health care organisations (N = 301). RESULTS Results showed that the psychometric properties of the Italian OQ were adequate and similar to the original instrument. The CFA supported the multidimentional construct system of the instrument. Furthermore, normative scores were different for the Italian and American samples and this resulted in different cutoff scores for estimating clinically significant change in the Italian population. CONCLUSIONS The Italian version of the OQ-45.2 appears promising as a measure of general psychological distress, and it could be used to measure the psychotherapy outcome in routine clinical practice.

The Italian version of the Depressive Experiences Questionnaire: psychometric properties and validation in students, community, and clinical groups

The current study evaluated the psychometric properties of the Italian validation of the Depressive Experiences Questionnaire (DEQ), conceived as a measure of self-criticism and dependency, i.e. two personality factors acting, according to Blatt (2004), as risk factors for depression in particular and psychopathology in general. A series of standardized measures [Beck Depression Inventory-II (BDI-II), DEQ, Symptom Checklist-90-R (SCL-90-R), Millon Clinical Multiaxial Inventory, 3rd edition (MCMI-III)] was administered to three samples (i.e., students, community and clinical). Factorial validity was evaluated along with convergent and predictive validity. In order to evaluate the reliability and internal consistency, a specific subgroup of participants was retested on the DEQ and BDI-II. Results showed correlations between DEQ dimensions and some personality traits of the MCMI-III. The traditional three-factor model of the DEQ structure as identified by principal component analysis appears to be as stable factors as typically found in American samples, although some items showed elevated cross-loading or low loadings on any factor. Clinical and diagnostic implications of the findings will be discussed.

The Role of Couples' Attachment Styles in Patients' Adjustment to Cancer

Objective: This study aimed to understand how psychological variables and attachment styles can contribute to improve effective and functional adjustment to the disease and promote better psychological well-being. Methods: A total of 176 participants (88 couples) took part in this research. One member of each couple attended surgery centers at the Oncology Department of the University Hospital of Palermo. Each participant had filled in 5 questionnaires assessing the variables couple relationships, quality of life, anxiety, depression, and psychosocial adjustment to illness. Results: Significant correlations were found among the observed variables. Levels of anxiety and the attachment styles of couples influence adjustment to tumor disease and negatively affect the quality of conjugal relationships. Moreover, the results highlighted the correlation between levels of anxiety and depression in patients and in their respective partners. Finally, we found a correlation between the level of psychological distress of the patient and the level of marital satisfaction perceived by the partner: the latter is lower in couples where the oncological patient has high levels of distress. Conclusions: The results suggest that psychological variables and attachment styles of cancer patients and their partners may be important factors affecting adjustment in multiple domains.

Infertility-related stress, anxiety and ovarian stimulation: can couples be reassured about the effects of psychological factors on biological responses to assisted reproductive technology?

The aim of this prospective, longitudinal study was to examine the association between couples’ pre-treatment psychological characteristics (state anxiety and infertility-related stress levels of both partners) and ovarian response during assisted reproductive technology treatment in a well-controlled sample. A total of 217 heterosexual couples (434 patients), suffering from primary infertility and undergoing their first assisted reproductive technology treatment at the Reproductive Medicine Unit of ANDROS Day Surgery Clinic in Palermo (Italy), were recruited. Psychological variables were assessed using the State Scale of State-Trait Anxiety Inventory (STAI-S) and the Fertility Problem Inventory (FPI). The number of follicles ≥ 16 mm in diameter, evaluated by transvaginal ultrasound scan on the eleventh day of the workup, was chosen as the outcome measure. No association between women’s level of anxiety and infertility-related stress, and the number of follicles ≥ 16 mm in diameter was found. Moreover, the male partner’s infertility stress and anxiety did not influence the relationship between the woman’s infertility-related stress, anxiety level and ovarian response. Fertility staff should reassure couples that the woman’s biological response to ovarian stimulation is not influenced by either partner’s level of psychological distress.