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Mares SHW, Roelofs J, Zinzen J, Béatse M, Elgersma HJ, Drost RMWA, Evers SMAA, Elburg AAV. Clinical effectiveness, cost-effectiveness and process evaluation of group schema therapy for eating disorders: study protocol for a multicenter randomized controlled trial. BMC Psychol 2024; 12:123. [PMID: 38439092 PMCID: PMC10913254 DOI: 10.1186/s40359-024-01624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. METHODS Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. DISCUSSION To our knowledge, this is the first study protocol describing a multicenter RCT to explore the three aforementioned objectives. Related risks in performing the study protocol have been outlined. The expected findings may serve as a guide for healthcare stakeholders to optimize ED care trajectories. TRIAL REGISTRATION clinicaltrials.gov (NCT05812950).
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Affiliation(s)
- Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands.
| | - Jeffrey Roelofs
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Janôt Zinzen
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Manouk Béatse
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hermien J Elgersma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Trimbos Institute, Centre for Economic evaluation and Machine Learning, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
- Co-eur, Utrecht, The Netherlands
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2
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Joshua PR, Lewis V, Simpson S, Kelty SF, Boer DP. What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas. Clin Psychol Psychother 2023. [PMID: 37654072 DOI: 10.1002/cpp.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people. METHOD An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements. RESULTS The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas. CONCLUSIONS Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.
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Affiliation(s)
- Phoebe R Joshua
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Vivienne Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Susan Simpson
- University of South Australia, Adelaide, South Australia, Australia
- NHS Forth Valley, Stirling, UK
| | - Sally F Kelty
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Douglas P Boer
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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3
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Huckstepp TJ, Allen A, Maher AL, Houlihan C, Mason J. Factor structure of the Young Positive Schema Questionnaire in an eating disorder sample. Eat Weight Disord 2023; 28:13. [PMID: 36800100 PMCID: PMC9938060 DOI: 10.1007/s40519-023-01549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The Young Positive Schema Questionnaire (YPSQ) measures early adaptive schemas (EAS) which could be used to develop positive psychology and schema-based interventions to benefit the treatment of eating disorders (EDs). METHODS The present study investigated the factor structure of the YPSQ in a sample of 826 participants (18-73 years; n = 753 women) with ED symptomatology (e.g., restricting, binging, and purging). The sample was randomly split into two groups for exploratory and confirmatory factor analyses. Full sample analysis using Pearson correlations was conducted to explore convergent validity of the new YSPQ factor structure with ED symptomatology, emotional regulation, and cognitive flexibility. RESULTS A nine-factor model was found, demonstrating good fit indices and internal consistency (α = 0.77-0.92). The YPSQ showed an inverse relationship to ED symptomatology and emotional suppression, and a positive relationship with cognitive flexibility and emotion reappraisal. CONCLUSION Further research is needed to explore the clinical benefits of the YPSQ to identify EAS deficits in individuals with EDs to improve treatment outcomes. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Tyrone J Huckstepp
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Allen
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Anthea L Maher
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Catherine Houlihan
- Wandi Nerida, Residential Eating Disorders Facility, Mooloolah Valley, Sunshine Coast, QLD, Australia
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4
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Rossi AA, Manzoni GM, Pietrabissa G, Di Pauli D, Mannarini S, Castelnuovo G. Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ). Eat Weight Disord 2022; 27:2459-2472. [PMID: 35290623 PMCID: PMC9556395 DOI: 10.1007/s40519-022-01385-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/26/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2). METHODS At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital. RESULTS The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable. CONCLUSIONS The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy. .,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
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Mannarini S, Kleinbub JR. Parental-Bonding and Alexithymia in Adolescents with Anorexia Nervosa, Their Parents, and Siblings. Behav Sci (Basel) 2022; 12:123. [PMID: 35621420 PMCID: PMC9137782 DOI: 10.3390/bs12050123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/17/2022] Open
Abstract
Anorexia nervosa (AN) patients and their family-members share alexithymia, anxiety, depression, and other psychological symptoms, in the context of altered attachment. These domains have been individually studied in the context of eating disorders; few attempts have been made to study their interaction, especially including family members. In this study, alexithymia, parental-bonding, and psychopathology were assessed in 32 Italian families consisting of an adolescent AN patient, a sibling, and their parents. We aimed to (a) describe a sample of Italian families with a child affected by AN, notably including siblings; (b) investigate interactions between assessed constructs in patients and their siblings; and (c) investigate possible intergenerational effects. Results showed high alexithymia and psychopathological symptoms in patients but not in siblings, although the latter reported high obsession-compulsion and paranoid ideation scores. Patients' and siblings' alexithymia correlated with psychopathology. Parents reported generally low alexithymia. Perceived parental bonding was found to be suboptimal in most participants, yet no clear relationship was found between specific parenting styles and other measured traits, nor did we find any other relevant intergenerational effect. Anorexia nervosa implies psychological difficulties for all family members. Siblings' psychopathological traits are especially concerning and currently understudied. Implications for future research and clinical interventions are discussed.
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Affiliation(s)
- Stefania Mannarini
- Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy;
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy
| | - Johann Roland Kleinbub
- Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy;
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy
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Oldershaw A, Lavender T, Basra R, Startup H. SPEAKS study: study protocol of a multisite feasibility trial of the Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) intervention for outpatients with anorexia nervosa or otherwise specified feeding and eating disorders, anorexia nervosa type. BMJ Open 2022; 12:e050350. [PMID: 35193902 PMCID: PMC8867350 DOI: 10.1136/bmjopen-2021-050350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a severe mental health condition associated with high mortality rates and significantly impaired quality of life. National guidelines outline psychotherapeutic interventions as treatments of choice for adults with AN, but outcomes are limited and therapy drop-out high, resulting in calls for new innovative treatments. The Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) research programme sought to develop the SPEAKS intervention avoiding some difficulties inherent in development of earlier interventions, such unclear hypotheses about change processes. SPEAKS focuses on a core hypothesised maintaining factor (emotional experience) with clear proposed model of change. The current feasibility trial aims to provide an initial test of SPEAKS and inform design of a full randomised controlled trial protocol. METHODS AND ANALYSIS This study employs a multisite, single-arm, within-group, mixed-methods design. Up to 60 participants (36 therapy completers) meeting inclusion criteria will be offered the SPEAKS intervention instead of treatment-as-usual (TAU). SPEAKS is a weekly psychotherapy lasting nine to 12 months, provided by trained and experienced eating disorders therapists. All other clinical input remains inline with TAU. Acceptability will be assessed using VAS scales and end of therapy interview. Reach and recruitment, such as recruitment yield, will be monitored. To support sample size estimation and economic estimation, data pertaining to eating disorder-related symptoms will be recorded every 3 months, alongside service usage and intervention-specific measures. Videoed therapy sessions will inform model adherence. Additional analyses coding videoed therapy will test SPEAKS change process hypotheses. ETHICS AND DISSEMINATION Ethical approval has been granted by London-Bromley Research Ethics Committee (NHS Rec Reference: 19/LO/1530). Data will be disseminated via high-impact, peer-reviewed journals (Open Access preferred), conferences, service user and charity networks (eg, UK charity BEAT) and through a free open conference hosted by National Health Service Trusts and Higher Education Institutions. TRIAL REGISTRATION NUMBER ISRCTN11778891. TRIAL STATUS Recruitment began on 12 December 2019 and ends on 28 February 2021. All data will be collected and the trial ended by 28 February 2022. PROTOCOL VERSION SPEAKS protocol V.3.0 (30 August 2020). Changes were made to the original protocol due to the COVID-19 pandemic. A further set of changes were made to incorporate the measures of change processes, resulting in this being the third version of the protocol.
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Affiliation(s)
- Anna Oldershaw
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, Kent, UK
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Tony Lavender
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Randeep Basra
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, Kent, UK
| | - Helen Startup
- Brighton and Hove Eating Disorder Service, Sussex Partnership NHS Foundation Trust, Brighton, UK
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Goddard H, Hammersley R, Reid M. Schema Modes, Trauma, and Disordered Eating. J Cogn Psychother 2022; 36:70-95. [PMID: 35121680 DOI: 10.1891/jcpsy-d-20-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.
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Affiliation(s)
| | | | - Marie Reid
- University of Hull, Hull, United Kingdom
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Edwards DJA. Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach. Front Psychol 2022; 12:763670. [PMID: 35126233 PMCID: PMC8813040 DOI: 10.3389/fpsyg.2021.763670] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
This article is situated within the framework of schema therapy and offers a comprehensive and clinically useful list of schema modes that have been identified as being relevant to conceptualizing complex psychological problems, such as those posed by personality disorders, and, in particular, the way that those problems are perpetuated. Drawing on the schema therapy literature, as well as other literature including that of cognitive behavior therapy and metacognitive therapy, over eighty modes are identified altogether, categorized under the widely accepted broad headings of Healthy Adult, Child modes, Parent modes and coping modes which are, in turn, divided into Surrender, Detached/Avoidant, and Overcompensator. An additional category is included: Repetitive Unproductive Thinking. This draws attention to the recognition by metacognitive therapists that such covert behaviors play a significant role in amplifying distress and perpetuating a range of psychological problems and symptoms. In addition to the modes themselves, several concepts are defined that are directly relevant to working with modes in practice. These include: default modes, blended modes, mode suites and mode sequences. Attention is also drawn to the way in which Child modes may be hidden "backstage" behind coping modes, and to the dyadic relationship between Child modes and Parent modes. Also relevant to practice are: (1) the recognition that Critic voices may have different sources and this has implications for treatment, (2) the concept of complex modes in which several submodes work together, and (3) the fact that in imagery work and image of a child may not represent a Vulnerable Child, but a Coping Child. The modes and mode processes described are directly relevant to clinical practice and, in addition to being grounded in the literature, have grown out of and proved to be of practical use in conceptualizing my own cases, and in supervising the cases of other clinicians working within the schema therapy framework.
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Affiliation(s)
- David John Arthur Edwards
- Department of Psychology, Rhodes University, Makhanda, South Africa
- Schema Therapy Institute, Cape Town, South Africa
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19. Behav Sci (Basel) 2021; 11:bs11060087. [PMID: 34198572 PMCID: PMC8231896 DOI: 10.3390/bs11060087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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Panzeri A, Rossi Ferrario S, Cerutti P. Psychological Differences Among Healthcare Workers of a Rehabilitation Institute During the COVID-19 Pandemic: A Two-Step Study. Front Psychol 2021; 12:636129. [PMID: 33868105 PMCID: PMC8045484 DOI: 10.3389/fpsyg.2021.636129] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Healthcare workers facing the threatening COVID-19 can experience severe difficulties. Despite the need to evaluate both the psychological distress and positive protective resources, brief and reliable assessment tools are lacking. Aim: Study 1 aimed at developing a new assessment tool to measure psychological distress and esteem in healthcare workers during the COVID-19 pandemic. Study 2 aimed to explore and compare the psychological reactions of healthcare workers of the COVID-19 and the non-COVID-19 wards. Methods: In Study 1, psychologists created 25 items based on their clinical experience. A preliminary qualitative evaluation selected the best 15 items for the new tool (CPI-HP) assessing the COVID-19 psychological impact with 2 scales: psychological distress and esteem. The CPI-HP was administered to 110 healthcare professionals to study its psychometric properties and the internal structure with exploratory graph analysis and confirmatory factor analysis. Study 2 compared two groups of healthcare professionals of the COVID-19 and non-COVID-19 departments. Results: In Study 1, the CPI-HP showed satisfying psychometric properties, and the two-factor structure was confirmed with good fit indices. In Study 2, the two groups of healthcare workers showed comparable levels of psychological distress and resilient coping, but the COVID-19 group displayed significantly higher esteem and appreciation of the experience. Discussion: All operators showed high psychological distress during the emergency, but the COVID-19 group reported higher resources, probably due to stronger group cohesion and greater esteem, perceived meaning, and own work value. Conclusion: Assessing the psychological distress and resources of healthcare professionals with specific tools is important. Psychological interventions should promote their psychological health.
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Affiliation(s)
- Anna Panzeri
- Department of General Psychology, University of Padua, Padua, Italy
- Unit of Psychology-Neuropsychology, Institute of Veruno, Maugeri Scientific Institutes for Research, Hospitalization and Health Care, Veruno, Italy
| | - Silvia Rossi Ferrario
- Unit of Psychology-Neuropsychology, Institute of Veruno, Maugeri Scientific Institutes for Research, Hospitalization and Health Care, Veruno, Italy
| | - Paola Cerutti
- Unit of Psychology-Neuropsychology, Institute of Veruno, Maugeri Scientific Institutes for Research, Hospitalization and Health Care, Veruno, Italy
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11
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Rossi Ferrario S, Panzeri A, Cerutti P, Sacco D. The Psychological Experience and Intervention in Post-Acute COVID-19 Inpatients. Neuropsychiatr Dis Treat 2021; 17:413-422. [PMID: 33603379 PMCID: PMC7884934 DOI: 10.2147/ndt.s283558] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE COVID-19 patients faced first-hand the life-threatening consequences of the disease, oftentimes involving prolonged hospitalization in isolation from family and friends. This study aimed at describing the psychological intervention to address the psychological difficulties and issues encountered by the hospitalized post-acute COVID-19 patients in a rehabilitation setting. PATIENTS AND METHODS Patients' demographics, medical diagnosis, and neuro-psychological information were collected from March 2nd to May 12th, 2020. The main psychological issues and intervention strategies were collected. RESULTS A total of 181 patients were hospitalized during this period. Among them, the 47.5% underwent psychological assessment (N=86; age: 74.58±13.39; 54.7% females). The most common psychological issues were acute stress disorders (18.6%), anxious and demoralization symptoms (26.7%), depression (10.5%%), and troublesome grief (8.1%). Once recovered from COVID-19, many patients were discharged home (38.4%), some received further rehabilitation in non-COVID-19 wards (41.9%), mostly due to pre-existent diseases (72.2%) rather than to COVID-19 complications (27.8%). CONCLUSION A great number of the hospitalized post-acute COVID-19 patients showed psychological issues requiring psychological intervention, the most common were anxiety, demoralization, acute stress, depression, and grief. The proposed psychological treatment for hospitalized COVID-19 patients was conducted in a Cognitive Behavioral framework. In particular, during the COVID-19 pandemic, psychological intervention is an important part of rehabilitation in the post-acute phase of the illness to reduce distress symptoms and improve psychological health.
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Affiliation(s)
- Silvia Rossi Ferrario
- Psychology and Neuropsychology Unit, Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Anna Panzeri
- Psychology and Neuropsychology Unit, Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Paola Cerutti
- Psychology and Neuropsychology Unit, Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Daniela Sacco
- Psychology and Neuropsychology Unit, Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
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12
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Manzoni GM, Rossi A, Pietrabissa G, Mannarini S, Fabbricatore M, Imperatori C, Innamorati M, Gearhardt AN, Castelnuovo G. Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population. Eat Weight Disord 2021; 26:345-366. [PMID: 32026378 DOI: 10.1007/s40519-020-00858-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To examine the structural validity, measurement invariance, reliability, and some other psychometrical properties of the Italian version of the Yale Food Addiction Scale 2 (I-YFAS 2.0) in patients with severe obesity and the general population. METHODS 704 participants-400 inpatients with severe obesity and 304 participants enrolled from the general population-completed the I-YFAS 2.0 and questionnaires measuring eating disorder symptoms. A first confirmatory factor analysis (CFA) tested a hierarchical structure in which each item of the I-YFAS 2.0 loaded onto one of the twelve latent symptoms/criteria which loaded onto a general dimension of Food Addiction (FA). The second CFA tested a first-order structure in which symptoms/criteria of FA simply loaded onto a latent dimension. Measurement invariance (MI) between the group of inpatients with severe obesity and the sample from the general population was also tested. Finally, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed. RESULTS CFAs confirmed the structure for the I-YFAS 2.0 for both the hierarchical structure and the first-order structure. Configural MI and strong MI were reached for hierarchical and the first-order structure, respectively. Internal consistencies were shown to be acceptable. Prevalence of FA was 24% in the group of inpatients with severe obesity and 3.6% in the sample from the general population. CONCLUSIONS The I-YFAS 2.0 represents a valid and reliable questionnaire for the assessment of FA in both Italian adult inpatients with severe obesity and the general population, and is a psychometrically sound tool for clinical as well as research purposes. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy
- Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Via Venezia 12, Padua, Italy.
- Interdepartmental Center for Family Research, University of Padova, Padua, Italy.
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Via Venezia 12, Padua, Italy
- Interdepartmental Center for Family Research, University of Padova, Padua, Italy
| | | | | | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
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13
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Panzeri A, Komici K, Cerutti P, Sacco D, Pistono M, Rossi Ferrario S. Gender differences and long-term outcome of over 75 elderlies in cardiac rehabilitation: highlighting the role of psychological and physical factors through a secondary analysis of a cohort study. Eur J Phys Rehabil Med 2021; 57:288-297. [PMID: 33448752 DOI: 10.23736/s1973-9087.21.06484-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite cardiac rehabilitation for elder people already showed its usefulness, to date it is still not clear the impact of gender and of psychological constructs in influencing the rehabilitation outcomes. AIM This study aimed at exploring the gender differences of great elders (over 75 years old) in cardiac rehabilitation, with particular attention to the impact of physical and psychological conditions, as depressive symptoms, on long-term post-discharge outcomes. DESIGN A cohort study design was used and a secondary analysis was conducted. SETTING Cardiac rehabilitation unit of a postacute rehabilitation Institute. POPULATION Elderly patients over 75 years old admitted to the cardiac rehabilitation program. METHODS Psychological and functional variables, such as Barthel Index, BMI, quality of life, and depression measured at admission and discharge from CR were matched with mortality information up to 4 years, used as long-term outcomes. RESULTS A total of 523 patients, 228 females and 295 males, with a mean age of 76.27 years±3.46 were progressively enrolled. Barthel index at admission and discharge was higher for males than females, 74.10±17.31 vs. 68.90 SD±16.81 (P<0.001), and 95.45±10.64 vs. 92.95±13.03 (p=0.021), respectively, while the relative change from admission to discharge Δ% of Barthel was higher for females 0.25±0.18 than for males 0.21±0.17 (P<0.05). Compared to males, either at admission or discharge females presented more severe depressive symptoms (5.21±3.46 vs. 3.86±2.79, P<0.001; 4.15±3.21 vs. 2.93±2.45, P<0.001) and a worse quality of life (10.58±2.15 vs. 9.55±2.24, P<0.001; 7.5±1.63 vs. 7.02±1.08, P=0.018). Cox proportional analysis revealed that female gender, depression at discharge, Barthel, and Comorbidity Index were associated with higher hazard and shorter survival time. On the other hand, higher BMI was associated with lower hazard and longer survival time. CONCLUSIONS Elderly women following a CR program present more disability, depression, and a worse QoL than men. Obviously, these characteristics influence the length of hospitalization but with significant improvement. Despite the frail-gender paradox regarding survival, after CR program women have a higher risk of mortality than men. Depression has a significant negative impact on elderly psychophysical health. CLINICAL REHABILITATION IMPACT Gender-specific and individualized rehabilitation programs should be implemented by considering the discussed physical and psychological risk factors. Further insight about gender differences among over 75 elderlies in CR is provided, this knowledge may be useful for clinicians scheduling recovery plans to promote elderlies' psychological and physical health. Psychological interventions should be implemented to relieve the depressive symptoms among elders.
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Affiliation(s)
- Anna Panzeri
- Department of General Psychology, University of Padua, Padua, Italy - .,Unit of Psychology and Neuropsychology, IRCCS Istituti Clinici Scientifici Maugeri, Veruno, Novara, Italy -
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Paola Cerutti
- Unit of Psychology and Neuropsychology, IRCCS Istituti Clinici Scientifici Maugeri, Veruno, Novara, Italy
| | - Daniela Sacco
- Unit of Psychology and Neuropsychology, IRCCS Istituti Clinici Scientifici Maugeri, Veruno, Novara, Italy
| | - Massimo Pistono
- Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Veruno, Novara, Italy
| | - Silvia Rossi Ferrario
- Unit of Psychology and Neuropsychology, IRCCS Istituti Clinici Scientifici Maugeri, Veruno, Novara, Italy
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14
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Consoli S, Rossi A, Thompson LY, Volpi C, Mannarini S, Castelnuovo G, Molinari E. Assessing Psychometric Properties of the Italian Version of the Heartland Forgiveness Scale. Front Psychol 2020; 11:596501. [PMID: 33391116 PMCID: PMC7773814 DOI: 10.3389/fpsyg.2020.596501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Despite increasing popularity and intensive worldwide use, few studies have assessed the validity and factorial structure of the Heartland Forgiveness Scale (HFS). However, scientific literature showed that the original factorial structure of the HFS was not fully replicated and—in addition—the Italian translation is still lacking. To fill this gap, this study aims to extend evidence about the original HFS factorial validity by analyzing the Italian version. The final sample was composed of 523 randomly enrolled participants [139 males (26.6%), 384 females (73.4%)] aged from 18 to 82 years (mean = 42.53, SD = 16.41) who completed the Italian version of the HFS. The confirmatory factor analysis showed good fit indices for the original hierarchical factor solution and a significant decrease in model fit was found for all of the competing models. Also, the Italian version of the HFS revealed good reliability and very good psychometrical properties. Findings suggest that the Italian version of the HFS can be considered a reliable and good psychometrically based instrument for the assessment of dispositional forgiveness of the Self, Other, and Situation.
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Affiliation(s)
- Simone Consoli
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Verbania, Italy
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education and Applied Psychology, Section of Applied Psychology, University of Padua, Padua, Italy.,Interdepartmental Center for Family Research, University of Padova, Padua, Italy
| | | | - Clarissa Volpi
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Verbania, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education and Applied Psychology, Section of Applied Psychology, University of Padua, Padua, Italy.,Interdepartmental Center for Family Research, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Ospedale San Giuseppe, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
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15
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Evaluation of the reliability and validity of the Italian version of the schema mode inventory for eating disorders: short form for adults with dysfunctional eating behaviors. Eat Weight Disord 2020; 25:553-565. [PMID: 30734224 DOI: 10.1007/s40519-019-00644-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To examine the psychometric properties and the factorial structure of the Italian version of the schema mode inventory for eating disorders-short form (SMI-ED-SF) for adults with dysfunctional eating patterns. METHODS 649 participants (72.1% females) completed the 64-item Italian version of the SMI-ED-SF and the eating disorder examination questionnaire (EDE-Q) for measuring eating disorder symptoms. Psychometric testing included confirmatory factor analysis (CFA) and internal consistency. Multivariate analysis of covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED-SF modes, while controlling for possible confounding variables. RESULTS Factorial analysis confirmed the 16-factors structure for the SMI-ED-SF [S-Bχ2 (1832) = 3324.799; p < .001; RMSEA = 0.045; 90% CI 0.043-0.048; CFI = 0.880; SRMR = 0.066; χ2/df = 1.81; < 3]. Internal consistency was acceptable in all scales, with Cronbach's Alpha coefficients ranging from 0.635 to 0.873. CONCLUSIONS The SMI-ED-SF represents a reliable and valid alternative to the long-form SMI-ED for assessment and conceptualization of schema modes in Italian adults with disordered eating habits. Its use is recommended for clinical and research purposes. LEVEL OF EVIDENCE Level V, descriptive study.
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16
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Pietrabissa G, Castelnuovo G, Jackson JB, Rossi A, Manzoni GM, Gibson P. Brief Strategic Therapy for Bulimia Nervosa and Binge Eating Disorder: A Clinical and Research Protocol. Front Psychol 2019; 10:373. [PMID: 30906269 PMCID: PMC6418034 DOI: 10.3389/fpsyg.2019.00373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Although cognitive behavioral therapy is the gold standard treatments for bulimia nervosa (BN) and binge eating disorder (BED), evidence for its long-term efficacy is weak. Empirical research support the efficacy of brief strategic therapy (BST) in treating BN and BED symptoms, but its statistical significance still need to be investigated. Objective: To statistically test the long-term efficacy of the BST treatment protocols for BN and BED through one-year post-treatment. Methods: A two-group longitudinal study will be conducted. Participants will be sequentially recruited for inclusion in a state-funded community psychotherapy clinic. Multilevel growth curve modeling will be used to estimate the average growth trajectories from baseline to one year after treatment termination for the severity of the BN and BED features as measured by the Eating Disorder Examination Questionnaire. Discussion: Findings from this study will clarify the impact of BST in treating BN and BED symptoms. Conclusion: Translating research into practice may inform how to ensure high-quality patient care.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Jeffrey B Jackson
- Department of Human Development and Family Science, Virginia Tech, Falls Church, VA, United States
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padua, Padua, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Padraic Gibson
- Bateson Clinic, Dublin, Ireland.,Hesed House, Dublin, Ireland
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