The Italian Version of the Inventory of Interpersonal Problems (IIP-32): Psychometric Properties and Factor Structure in Clinical and Non-clinical Groups

The interplay between emotion regulation, interpersonal problems and eating symptoms in individuals with obesity: A network analysis study

INTRODUCTION

A complex and bidirectional relationship between eating and psychological symptoms in individuals with obesity has been proposed. This study aims to identify the specific processes playing a role in this association, using a data-driven approach.

METHODS

Two hundred ninety-four adults with obesity, including 106 (36 %) with binge-eating disorder, were consecutively admitted to a specialized public center. They completed self-report questionnaires to assess emotion regulation, interpersonal problems, self-esteem, binge-eating symptoms, and expectancies regarding eating behaviors. To assess the interplay among eating and psychological variables, a network analysis was used. The bridge function analysis was also performed to identify the bridge nodes among three communities (eating symptoms, interpersonal and emotional problems).

RESULTS

The network was stable. Limited access to emotion regulation strategies, eating helps manage negative affect, and non-assertiveness were the nodes with the highest strength centrality. Lack of emotional clarity, non-assertiveness, socially inhibition, and binge-eating were the nodes with the highest bridge strength.

LIMITATIONS

The main limitation of the study is the cross-sectional nature of the findings which prevents to infer causality regarding the association between symptoms in the network.

DISCUSSION

An interplay between eating symptoms and affective and interpersonal factors characterizes individuals with obesity. Across the variety of psychological problems associated with obesity, the present study suggests specific psychological variables and their connections that could be addressed to improve treatment outcome.

Exploring the associations between psychodynamic constructs and psychopathology: A network approach

Psychodynamic therapy effectively reduces symptomatology by focusing on underlying (unconscious) processes instead of symptoms. Nevertheless, the exact interrelationship between psychodynamic constructs and psychopathology remains unclear. This study uses network analysis to explore these associations. We computed a cross-sectional partial correlation network between psychodynamic constructs (i.e., personality functioning, interpersonal relations, and active and passive modes of intrapsychic conflicts according to the Operationalized Psychodynamic Diagnostics [OPD] system) and psychopathology (i.e., depression and somatization) in a naturalistic sample of 341 adults registering for psychodynamic outpatient therapy. We estimated node centrality, node predictability, and bridge symptoms and used community detection analysis. Bootstrap methods were applied to assess network stability. Psychodynamic constructs and psychopathology resulted in separate but connected clusters. Personality functioning emerged as the most influential node in the network and was bridging the clusters. The network was found to be highly stable, allowing reliable interpretations. The results offer important insights on how psychodynamic constructs relate to psychopathology, which can be used to inform treatment approaches. The findings suggest that personality functioning may be an important intervention target. However, future research is needed to include a broader range of diagnoses. In addition, longitudinal studies may clarify the direction of causality.

Psychopathology predicts mental but not physical bariatric surgery outcome at 3-year follow-up: a network analysis study

PURPOSE

This study aimed to explore the psychopathological variables that may predict bariatric surgery outcomes after 3 years.

METHODS

One hundred ninety-six candidates for bariatric surgery completed self-report questionnaires to assess eating attitudes, eating disorder (ED)-related psychopathology, affective symptoms, interpersonal and psycho-social functioning. One-hundred patients repeated this assessment 3 years after bariatric surgery. A network analysis was run including the pre-surgical measurements in the network. A composite score derived from the combination of the most central network nodes, as well as clinical and socio-demographical variables, was included in a multivariate regression analysis with weight loss, ED psychopathology and psycho-social functioning as outcomes.

RESULTS

Depression, stress, and shape concerns were the most central network nodes. The composite network score predicted higher ED psychopathology and worse psycho-social functioning at 3-year follow-up, but not weight loss. Higher age, restricting type of bariatric surgery and higher pre-operative BMI were further predictors of reduced weight loss and greater ED psychopathology.

CONCLUSIONS

Affective symptoms and shape concern play a central role in the psychopathology of candidates to bariatric surgery and predict post-surgery ED psychopathology and psycho-social functioning. These variables may allow to identify patients with higher pre-operative risk and in need of further psycho-social interventions.

LEVEL OF EVIDENCE

III, evidence obtained from well-designed cohort study.

Health-related quality of life assessment in eating disorders: adjustment and validation of a specific scale with the inclusion of an interpersonal domain

PURPOSE

Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being.

METHODS

The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool.

RESULTS

The results showed that the IEDQOL has very good psychometric properties with test-retest validity and sensitivity between patients and controls (d = 2.17 for total score). Moreover, the interpersonal domain showed excellent psychometric values (Cronbach's α > 0.70 in all the subgroups) and a robust correlation with other quality of life constructs.

CONCLUSION

Future studies on the Italian population should use IEDQOL as outcome element that can be useful also with other disorder-specific psychopathological constructs and corroborate the reliability of the data. Future research in the ED field should only use this specific tool.

LEVEL OF EVIDENCE

Case-control analytic study, Level III.

Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders

This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.

Psychometric properties of the Inventory of Interpersonal Problems (IIP-C) used with a clinical sample of adolescents: a preliminary study

Background

Interpersonal problems are consistently identified with psychopathology that often has its onset in adolescence. Most of the commonly used instruments in child and adolescent psychiatry target non-interpersonal problems. The Inventory of Interpersonal Problems (IIP) is a widely studied and utilized instrument in the adult mental health field.

Aims

This study aimed to examine the psychometric properties of the IIP (circumplex version) used with a clinical adolescent population. Method: Sixty-two adolescents (13-17 years) who received treatment in a child and adolescent mental health clinic (CAMHS) were included in the study. To establish reliability and validity, we conducted confirmatory factor analyses, internal consistency, and validity analyses.

Results

Confirmatory analyses did not show optimal model fit. However, other indices like CFI and TLI were promising. The reliability of the eight scales was in the same range as previous studies and acceptable. There were expected significant correlations between IIP-C scales and the broadband scales of Youth Self-report (YSR).

Conclusion

The pioneer nature and its clinical focus are strengths however, there is a need for more research. The promising results are encouraging, and future research could also explore how best to bring the instrument into the digital age.

Self-esteem and binge eating: Do patients with binge eating disorder endorse more negatively worded items of the Rosenberg Self-Esteem Scale?

OBJECTIVE

Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms.

METHOD

Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms.

RESULTS

Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating.

CONCLUSIONS

Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression

OBJECTIVES

Interpersonal problems were examined as moderators of depression outcomes between mindfulness-based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression.

METHODS

Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed.

RESULTS

Higher scores on the "vindictive/self-centered" subscale were associated with a better outcome in MBCT than in CBASP (HAM-D: p < .01; BDI-II: p < .01). Higher scores on the "nonassertive" subscale were associated with a better outcome in CBASP than in MBCT (HAM-D: p < .01; BDI-II: p < .01).

CONCLUSIONS

If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self-centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.

The Effect of Shyness on Adolescent Network Problem Behavior: The Role of Gender and Loneliness

With the latest, rapid developments of the Internet, young people have become the main group in the online world. Congruently, Internet problem behaviors have shown a significant growth trend among adolescents. The present paper explores the factors affecting adolescents' problem network behavior from the perspective of their shyness, gender, and loneliness, and provides suggestions for guiding these young people toward using the network rationally. The study surveyed 5,130 teenagers from Shandong province in China to investigate the moderating effect of gender on the relationship between shyness and problem network behavior, and the mediating effect of loneliness on the moderating effect. The results indicated that the level of shyness among girls was significantly higher than that among boys, whereas the prevalence of cyberbullying, pathological Internet use, and Internet gaming disorder was significantly lower for girls than for boys. The relationship among shyness, cyberbullying, and Internet gaming disorder was found to be moderated by gender, and the problems of cyberbullying and Internet gaming disorder faced by shy boys were greater than those faced by shy girls. In addition, the moderating effect of gender on cyberbullying and Internet gaming disorder was found to occur through the mediating factor of loneliness. The paper concludes with a discussion of the theoretical significance and generalizability of our research results.

Challenges, Coping and Resources: A Thematic Analysis of Foreign Teachers' Experience of Cultural Adaptation in China

The aim of this study was to explore foreign teachers’ experience of cultural and life adaptation in China, including the difficulties, emotional stress, and challenges they confronted, as well as the useful coping strategies and resources that facilitated their cultural adaptation. Ten foreign professors who taught in China were recruited from three Chinese universities. Semi-structured interviews on the participants’ experience of cross-cultural adaptation in China were conducted. Thematic analysis of the transcribed dialogs was performed, and five core themes emerged: multiple challenges, mixed negative emotions, active coping and insulation, rich supportive resources, and personal traits. In the cross-cultural adaptation process in China, the main challenges for foreign teachers were language barriers; a lack of supportive relationships; and conflicts in perceptions related to teaching, privacy, and boundaries. Useful coping strategies included seeking interpersonal interactions that provided emotional and instrumental support, developing localized teaching models, and maintaining connections with the culture of origin. Under circumstances with convenient living facilities and supportive interpersonal relationships, these strategies promoted the adaptation of foreign teachers with functional personality traits. The potential correlations among these different themes and the influence of their interactions on foreign teachers’ adaptation experience were also discussed. The themes that emerged in our study can help clinicians and university administrators develop therapy methods and support systems for foreign teachers who work in Chinese universities.

Psychometric properties of the Italian version of the Experience in Close Relationship Scale 12 (ECR-12): an exploratory structural equation modeling study

The Experiences in Close Relationship Scale (ECR) is one of the most commonly used self-report instruments of adult attachment and has been widely adopted in psychotherapy research. Composed of two subscales, namely Attachment Avoidance and Anxiety, the ECR was recently shortened to a 12-items version, called the ECR-12. Given the importance of extending knowledge on its applicability in understudied populations, our aim was to validate the ECR-12 in a large sample of Italian native-speakers. A total of 1197 participants (73.2% females; mean age=28.53±11.37 years) completed the ECR-12. Each participant also completed other measures of attachment, psychopathology, interpersonal distress, coping strategies, and well-being. An Exploratory Structural Equation Modeling analysis showed an excellent fit of the data, providing support for the two-dimensional orthogonal structure of the ECR-12. In addition, the measurement model was invariant across genders. Both attachment anxiety and attachment avoidance subscales demonstrated good internal reliability, with McDonald’s Omegas and Cronbach’s Alphas above the suggested 0.8 cut-off. Finally, the Italian version of ECR-12 showed adequate convergent, concurrent, and divergent validity. Highly anxious individuals reported the highest levels of maladaptive interpersonal functioning and coping strategies, resulting in lower well-being. Interestingly, both attachment insecurity dimensions predicted higher levels of psychopathology, even after controlling for demographic variables and levels of self-reported relational difficulties. Given the good psychometric properties of the ECR-12, researchers and practitioners in Italy are encouraged to adopt the ECR-12 in their future research on adult attachment in psychotherapy.

Metacognitive Interpersonal Mindfulness-Based Training for Worry About Interpersonal Events: A Pilot Feasibility and Acceptability Study

Individuals with personality disorders experience worry and repetitive thoughts regarding interpersonal scenarios. Mainstream mindfulness-based approaches may be insufficient to soothe these individual's distress due to difficulties in letting thoughts go and refocusing attention to the present moment. For this reason, we devised an adapted form of mindfulness-based program called Metacognitive Interpersonal Mindfulness-Based Training (MIMBT) for personality disorders. In this pilot study, 28 individuals attended nine weekly sessions to evaluate the feasibility and acceptability, and to establish preliminary outcomes. All individuals completed the program. Attendance was very high (96%). Significant changes were observed on the primary outcome of reduction in repetitive thinking, measured using the Metacognition Questionnaire-30. We also observed a decrease in depression severity. Despite important limitations, this pilot study suggests that MIMBT has the potential to be a viable and well-accepted option for increasing positive outcomes in the treatment of personality disorders. Clinical considerations and directions for future research are discussed.

Eye Tracking the Feedback Assigned to Undergraduate Students in a Digital Assessment Game

High-quality feedback exerts a crucial influence on learning new skills and it is one of the most common psychological interventions. However, knowing how to deliver feedback effectively is challenging for educators in both traditional and online classroom environments. This study uses psychophysiological methodology to investigate attention allocation to different feedback valences (i.e., positive and negative feedback), as the eye tracker provides accurate information about individuals' locus of attention when they process feedback. We collected learning analytics via a behavioral assessment game and eye-movement measures via an eye tracker to infer undergraduate students' cognitive processing of feedback that is assigned to them after completing a task. The eye movements of n = 30 undergraduates at a university in Western Canada were tracked by the EyeLink 1000 Plus eye tracker while they played Posterlet, a digital game-based assessment. In Posterlet, students designed three posters and received critical (negative) or confirmatory (positive) feedback from virtual characters in the game after completing each poster. Analyses showed that, overall, students attended to critical feedback more than to confirmatory feedback, as measured by the time spent on feedback in total, per word, and per letter, and by the number of feedback fixations and revisits. However, there was no difference in dwell time between valences prior to any feedback revisits, suggesting that returning to read critical feedback more often than confirmatory feedback accounts for the overall dwell time difference between valences when feedback is assigned to students. The study summarizes the eye movement record on critical and confirmatory feedback, respectively. Implications of this research include enhancing our understanding of the differential temporal cognitive processing of feedback valences that may ultimately improve the delivery of feedback.

Emotion Regulation in Participants Diagnosed With Attention Deficit Hyperactivity Disorder, Before and After an Emotion Regulation Intervention

The study of Attention Deficit Hyperactivity Disorder (ADHD) addresses variables related to three core symptoms: inattention, hyperactivity, and impulsivity. However, it has been suggested that in recent years emotional difficulties and subsequent social challenges have not received sufficient attention. This study had two objectives: (1) to compare the performance of participants (age range: 8-14 years) on facial emotion recognition tasks using the Affect Recognition subtest of the Children Neuropsychological Battery II; and (2) to assess the perceptions of family members in relation to variables associated with emotional problems, difficulty in regulating emotions, and anger management using the Spanish Assessment System for Children and Adolescents. Assessments were conducted before and after applying an emotion regulation intervention designed for this study. Following the intervention, there was a significant decrease in scores associated with emotional regulation, and an improvement in the identification of affect on facial recognition tasks. The results suggest that despite ADHD children and adolescents having social and emotional deficits secondary to the core symptom triad, emotional regulation in this group can be improved by the application of socio-emotional intervention programs.

Influence of Maternal and Paternal Parenting Style and Behavior Problems on Academic Outcomes in Primary School

Parents and teachers are concerned about the academic outcomes of children. Among the variables that play an important role in school success, parenting styles and behavior problems are some of the most studied. Literature shows that presence of behavioral problem and parenting styles based on physical punishment, lack of consistency and ineffective limit setting are related to poor academic achievement. The present study examined the influence of maternal and paternal parenting styles and behavior problems on the academic outcomes of primary-school children. Measures used in this study included the Inventory of Parenting Guide, the Child Behavior Checklist and information on academic outcomes (n = 78 families). The range age of the students was 6 to 13 years old (mean = 8.08; SD = 1.6; 38 girls). The participation rate was 90.7%. The results showed that behavior problems and sensitive parenting style were related to academic outcomes. Specifically, attentional problems and maternal sensitive parenting styles appeared to be significant predictors of academic outcomes in this study. These data suggest the relevance of attention and maternal sensitive parenting styles in understanding processes that promote academic outcomes.

Effect of Narcissism, Psychopathy, and Machiavellianism on Entrepreneurial Intention-The Mediating of Entrepreneurial Self-Efficacy

The driving factors behind the exploration and search for entrepreneurial intention (EI) are critical to entrepreneurship education and entrepreneurial practice. To reveal in depth the influence of personality traits on EI, our study introduces the opposite of proactive personality-the dark triad that consists of narcissism, psychopathy and Machiavellianism. Our study used the MBA students of Tianjin University as a sample to analyze the relationship between the dark triad, entrepreneurial self-efficacy (ESE) and EI. A total of 334 MBA students aged 24-47 years participated and the participation rate is 95.71%. The data collection was largely concentrated in the period from May 15 to June 5, 2018. From the overall perspective of the dark triad, the results show that the dark triad positively predicts EI, and ESE has a partial mediating effect on the dark triad and EI. From the perspective of the three members of the dark triad, the study found that narcissism/psychopathy has a negative effect on ESE and EI; narcissism/psychopathy has a non-linear effect on EI; Machiavellianism has a positive effect on ESE and EI; and ESE has a mediating effect on the three members of the dark triad and EI. In short, our research reveals that the three members of the dark triad have different effects on EI in different cultural contexts, and the research findings have certain reference value for further improvement of entrepreneurship education and entrepreneurial practice.