Cognitive and emotional factors in chronic low-back pain, fibromyalgia, and comorbid obesity

Nella prima parte del progetto, presenteremo gli studi condotti su individui con dolore lombare cronico e obesità. Nel primo studio l'obiettivo era quello di validare un questionario (Start Back Screening Tool) sviluppato per valutare sia le caratteristiche fisiche che psicologiche dell'esperienza del dolore del paziente. Successivamente, abbiamo valutato il contributo della catastrofizzazione del dolore e della kinesiofobia all'intensità del dolore percepito e alla disabilità. Infine, la kinesiofobia è stata poi valutata come mediatore della relazione tra intensità del dolore e disabilità. La seconda parte di questo progetto di tesi si è concentrata sulla fibromialgia. Il primo studio mirava a valutare l'affidabilità e il livello di accordo di un questionario autosomministrato e un intervista clinica condotta da un reumatologo. Abbiamo poi valutato il contributo di catastrofizzazione del dolore e accettazione del dolore, nello spiegare la disabilità self report e performance based. In seguito abbiamo valutato il ruolo della catastrofizzazione del dolore, della kinesiofobia e dell'accettazione come mediatori della relazione tra intensità del dolore e disabilità. Infine abbiamo valutato il ruolo di mediazione della catastrofizzazione, dell'accettazione e della kinesiofobia nell'associazione tra intensità del dolore e disabilità. In particolare, la disabilità è stata valutata utilizzando sia misure self report che misure performance based.In the first part of the project, we will present studies conducted on individuals with chronic low back pain and obesity. In the first study, the objective was to validate a questionnaire (Start Back Screening Tool) developed to assess both physical and psychological characteristics of the patient's pain experience. Next, we assessed the contribution of pain catastrophizing and kinesiophobia to perceived pain intensity and disability. Finally, kinesiophobia was then assessed as a mediator of the relationship between pain intensity and disability. The second part of this thesis project focused on fibromyalgia. The first study aimed to assess the reliability and level of agreement of a self-administered questionnaire and a clinical interview conducted by a rheumatologist. We then assessed the contribution of pain catastrophizing and pain acceptance in explaining self-report and performance-based disability. Next, we evaluated the role of pain catastrophizing, kinesiophobia, and acceptance as mediators of the relationship between pain intensity and disability. Finally, we assessed the mediating role of catastrophizing, acceptance, and kinesiophobia in the association between pain intensity and disability. Specifically, disability was assessed using both self-report and performance-based measures

Correction to: Implicit facial emotion recognition of fear and anger in obesity.

n/

Cognitive-Behavioral Therapy: Current Paths in the Management of Obesity

The treatment of obesity and its related chronic symptoms is one of the major issues that world healthcare systems are facing today. Cognitive-behavioral therapy (CBT) is one of the most effective therapies in the treatment of dysfunctional eating behaviors. In the first part of the chapter, the phenomenon of obesity will be introduced; subsequently, the role of CBT into obesity treatment will be underlined. CBT’s core strategies will be presented and analyzed: goal setting, self-monitoring, stimulus control, problem solving technique, and cognitive restructuring technique. The use of these strategies and related results is a major issue, emphasizing the need for further studies on the phenomenon of obesity, given the excellent results available in the short term, with significant weight loss, but the difficulties in keeping the results achieved in the long run. Since obesity is a chronic condition, CBT treatments must focus on different outcomes, considering weight loss as a consequence of a change in the individual’s eating style rather than as a major and only result to be pursued. Finally, we will take into account the topic of motivation in the psychological treatment of obesity since patient’s motivation assessment seems to be a major prerequisite for successful weight loss therapy

Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain

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

Exploring Addictive Online Behaviors in Patients with Narcolepsy Type 1

Background: Narcolepsy type 1 (NT1) is a rare neurological sleep disorder caused by the loss of neurons that produce hypocretin—a peptide that plays a crucial role in addictive behaviors. We aimed to compare, for the first time, levels of problematic online gaming, problematic social media use, and compulsive Internet use between NT1 patients and healthy controls (HC), and to evaluate the association between anxiety, depression, and emotion dysregulation with addictive online behaviors in NT1 patients. Methods: A total of 43 patients with NT1 and 86 sex- and age-matched HC participated in an online cross-sectional survey. Results: NT1 patients did not differ from HC in terms of problematic social media use and compulsive Internet use but displayed higher levels of problematic online gaming compared to HC. Higher levels of emotion dysregulation were significantly associated with higher levels of problematic social media use and compulsive Internet use, while none of the tested factors were associated with problematic online gaming. Conclusion: NT1 patients and HC had similar levels of problematic social media use and compulsive Internet use, but NT1 patients showed higher levels of problematic online gaming. Emotion dysregulation might be an intervention target for reducing compulsive Internet use and problematic social media use

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performancebased physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity

The ACTyourCHANGE in Teens Study Protocol: An Acceptance and Commitment Therapy-Based Intervention for Adolescents with Obesity: A Randomized Controlled Trial

This Randomized Controlled Trial [(RCT) aims to evaluate the effectiveness of a brief Acceptance and Commitment Therapy (ACT)-based intervention combined with treatment as usual (TAU) compared to TAU only in improving psychological conditions in a sample of adolescents with obesity (body mass index, BMI > 97th percentile for age and sex) within the context of a wider multidisciplinary rehabilitation program for weight loss. Fifty consecutive adolescents (12-17 years) of both genders with obesity will be recruited among the patients hospitalized in a clinical center for obesity rehabilitation and randomly allocated into two experimental conditions: ACT + TAU vs. TAU only. Both groups will attend a three-week in-hospital multidisciplinary rehabilitation program for weight loss. The ACT + TAU condition comprises a psychological intervention based on ACT combined with a standard psychological assessment and support to the hospitalization. The TAU comprises the standard psychological assessment and support to the hospitalization. At pre- to post-psychological intervention, participants will complete the Avoidance and Fusion Questionnaire for Youth, the Psychological Well-Being Scale, the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess psychological well-being as the primary outcome and experiential avoidance, psychological distress, emotional dysregulation, and emotional eating as secondary outcomes. Repeated-measures ANOVAs (2 x 2) will be conducted. The study will assess the effectiveness of a brief ACT-based intervention for adolescents with obesity in improving their psychological conditions by targeting specific core processes of the ACT framework (openness, awareness, and engagement). Future directions of the study will assess whether these psychological processes will contribute to addressing long-term weight loss

Psychological Considerations for Bariatric Surgery

Obesity management requires a multidisciplinary, integrated treatment composed of medical, nutritional, physical, and psychological interventions. Currently, bariatric surgery is the most suitable treatment available in case of severe obesity, or obesity with comorbid medical conditions. Despite bariatric surgery results in a significant weight loss in most of the cases, a not-inconsiderable portion of patients does not achieve relevant outcomes, in terms of limited weight loss or weight regain due to psychological problems. The pre-operative evaluation of the psychological conditions of the candidates for bariatric interventions and pre/post-surgical psychological support is required in order to achieve the desired post-operative outcomes for a long time. In this chapter, we will elucidate the core components of the psychological assessment of bariatric candidates. Moreover, the main directions for the pre/post-surgery psychological support will be provided

The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy-a randomized controlled trial

BackgroundAs treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes.MethodsA randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m(2)), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6months (time 3) and 9months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device.To assess the effectiveness of the intervention, mixed between-within 3 (conditions) x4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups.DiscussionThis study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle.Trial registrationClinicalTrials.govNCT04474509. Registered on July 4, 202