Irrational beliefs and their role in specific and non-specific eating disorder symptomatology and cognitive reappraisal in eating disorders

Background: Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal. Methods: 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal. Results: Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal. Con-clusion: Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive–behavioral treatment is warranted

Mental pain in eating disorders: An exploratory controlled study

Mental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somaticaffective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology

La caratterizzazione della demoralizzazione in un campione di pazienti con disturbi del comportamento alimentare

Obiettivi: La demoralizzazione risulta poco studiata nei disturbi del comportamento alimentare (DCA). La presente ricerca ha l\u2019obiettivo di caratterizzare la demoralizzazione ed esplorare la possibilit\ue0 di differenziala dalla depressione in pazienti con DCA. Inoltre la ricerca mira a valutare se la demoralizzazione subisce riduzioni nel corso del trattamento cognitivo-comportamentale integrato con riabilitazione nutrizionale. Metodi: Il campione \ue8 composto da 83 pazienti femminili con DCA. Le pazienti sono state valutate al baseline tramite: Eating Attitude Test-40 per sintomi DCA, Beck Depression Inventory-II e Clinical Interview for Depression per sintomi depressivi, Diagnostic Criteria for Psychosomatic Research per la demoralizzazione, e le Psychological Well-being Scales per il benessere psicologico. Le sole pazienti ambulatoriali sono state rivalutate a met\ue0 trattamento. Dalle cartelle cliniche sono stati rilevate le diagnosi DCA e di disturbi dell\u2019umore. Risultati e Conclusioni: Al baseline si riscontra un\u2019alta prevalenza di demoralizzazione (65%) e disturbo depressivo (47.7%), un\u2019elevata sovrapposizione tra le sindromi pari al 40% (X2= 11.741, p<0.001), ma la possibilit\ue0 di differenziarle: 25% di pazienti demoralizzati non presentano disturbi depressivi e 7.5% di pazienti con disturbo depressivo non risultano demoralizzati. La demoralizzazione si contraddistingue per specifici sintomi depressivi e compromissione nel benessere psicologico. A met\ue0 trattamento si evidenzia una diminuzione significativa (p<0.001) di prevalenza di depressione e demoralizzazione. Il costrutto di demoralizzazione risulta clinicamente utile per cogliere sintomatologia sottosoglia nei DCA non necessariamente ascrivibile ad un quadro depressivo conclamato

Do metacognitions mediate the relationship between irrational beliefs, eating disorder symptoms and cognitive reappraisal?

Objective: Cognitively oriented therapies, first-line treatment for eating disorders (EDs), still show room for improvement in treatment retention and outcomes. Despite the development of additional cognitive models and therapies, few studies examine the relationship between traditional and third-wave cognitive targets in EDs. The study explores the relationship between irrational beliefs (IBs) and metacognitions and their relationship with ED psychopathology and cognitive reappraisal in ED outpatients. Method: Seventy-seven patients (mean age 27.49 \ub1 12.28 years) were assessed with The Attitudes and Beliefs Scale-ABS-2, Meta-cognitions Questionnaire-MCQ-65, Eating Disorder Inventory 3-EDI-3, Eating Attitudes Test-EAT-40, Emotion Regulation Questionnaire-ERQ. Results: Correlational analyses showed that IBs and metacognitions significantly correlated with each other. Metacognitions partially mediated the relationship between IBs and ED-related general psychological maladjustment and completely mediated the relationship between IBs and ED symptom severity. Cognitive reappraisal was predicted only by IBs and metacognitions were not significant mediators. Conclusions: While IBs are sufficient in explaining ED-related psychopathology and reduced use of cognitive reappraisal, a potential integration of metacognitions about need to control thoughts in CBT models for EDs may offer incremental validity given their contribution to ED severity. Treatment implications include targeting metacognitions concerning need to control thoughts, as a potential maintenance mechanism of ED symptomatology through cognitive restructuring

Irrational Beliefs, Cognitive Distortions, and Depressive Symptomatology in a College-Age Sample: A Mediational Analysis

Dysfunctional cognitions such as irrational beliefs (IBs) of Ellis' rational emotive behavior therapy (REBT) model and cognitive distortions (CDs) or cognitive errors from Beck's cognitive behavioral therapy (CBT) model are known to correlate with depressive symptomatology. However, most studies focus on one cognitive theoretical model in predicting psychopathology. The current study examined the relationship between both IBs and CDs in predicting depression. A college-age sample of 507 participants completed the Attitudes and Beliefs Scale-2, the Cognitive Distortions Scale, and the Beck Depression Inventory-II. Half of the sample showed minimal depression, while the remaining sample exhibited mild-moderate (37.4%) to severe (11.1%) depression symptomatology. Through regression analyses, the study aimed to examine whether IBs accounted for more of the variance in depression symptomatology after the effects of CDs were considered. Moreover, it tested whether CDs served as a moderator or mediator between IBs and depression. Each of Ellis' IBs (demandingness, awfulizing, self-downing, and low frustration tolerance) accounted for significantly more variance in depression after the variance of CDs was entered with the IB of self-downing explaining the most variance in depression severity. Moreover, while no moderation effect was found, CDs partially mediated the effect of IBs on depression. Both IBs and CDs contributed unique variance in predicting depression. Findings support the clinical notion that IBs and CDs are associated as well as highlight the clinical utility of both conceptualizations of dysfunctional cognitions in explaining depressive symptomatology. Clinicians might consider that each dysfunctional cognition might not be subject to change if not directly targeted. Rather than choosing to focus exclusively on IBs or CDs underlying negative automatic thoughts, psychotherapeutic efforts might benefit from identifying and challenging both types of dysfunctional cognitions

An innovative approach for the assessment of mood disturbances in patients with eating disorders

Objective. Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.Methods. Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel's Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.Results. Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.Conclusion. The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed

Fattori psicologici in pazienti affetti da epatite C in fase di pre-trattamento

Obiettivi: Nel presente studio controllato sono stati esplorati i costrutti psicologici di qualit\ue0 della vita (QoL), rabbia e sintomi depressivi in pazienti con epatite C (HCV) prima del trattamento antivirale confrontandoli con un campione della popolazione generale. Metodi: Lo studio comprende un campione sperimentale (56 pazienti HCV positivi) ed un campione di controllo (66 individui sani). Ad entrambi i gruppi sono stati somministrati i seguenti test psicometrici auto-valutativi: Beck Depression Inventory-II (BDI-II; Beck et al., 1996), State-trait Anger Expression Inventory-2 (STAXI-2; Spielberger, 1999), World Health Organization Quality of Life Instruments (WHOQOL-BREF; Whoqol Group, 1995). Risultati e Conclusioni: I pazienti HCV hanno mostrato punteggi significativamente inferiori nelle scale del WHOQOLBREF, superiori nella \u201crabbia di stato\u201d (S-Rab; STAXI-2) e nel BDI-II rispetto ai controlli. Nel gruppo sperimentale S-Rab e T-Rab (rabbia di tratto) correlano negativamente con le scale del WHOQOL-BREF e positivamente con il BDI-II. Inoltre le donne HVC mostravano qualit\ue0 di vita e umore peggiori rispetto ai pazienti maschi e maggiore rabbia di stato. Si pu\uf2 dunque concludere che i pazienti HCV presentano una minore soddisfazione nella propria vita, maggiore rabbia contingente e sintomi depressivi, rispetto agli individui sani