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The integration of digital tools into psychotherapy has gained increasing attention, particularly for practices such as routine outcome monitoring (ROM), which involves the regular collection of patient-reported data to inform treatment decisions. However, despite the potential benefits, the adoption of digital platforms remains limited, partly due to usability concerns and workflow misalignment. This study aimed to assess the usability of a digital platform, Mindy, designed to support psychotherapists in implementing ROM and to explore broader challenges associated with the integration of digital tools into psychotherapeutic practice. This study adopted a qualitative, 2-stage approach. Sixteen psychotherapists participated in semistructured interviews, which included task-based usability testing and reflective discussions. Participants interacted with Mindy by performing typical clinical tasks, such as creating patient profiles, managing session data, and sending questionnaires. The first stage of analysis used a deductive thematic approach focused on predefined platform functionalities. The second stage followed an inductive methodology to identify broader themes related to the integration of digital tools in psychotherapy. The usability assessment identified strengths in the platform's appointment scheduling, questionnaire delivery, and dashboard functionalities, which were perceived as intuitive and supportive of ROM practices. However, limitations were reported in areas such as documentation flexibility, interoperability with other systems, and control over information sharing with patients. Broader thematic analysis revealed three main challenges: (1) the tension between standardized documentation and the need for narrative and implicit information; (2) difficulties in embedding digital platforms into existing therapeutic workflows, especially for clinicians less familiar with technology; and (3) concerns about confidentiality and the potential for misinterpretation when sharing therapeutic notes with patients. These findings underscore the importance of considering both technical and contextual dimensions when developing and implementing digital platforms in mental health care. Tailoring digital tools to the needs and practices of psychotherapists may improve adoption and ultimately enhance the quality of care.

The aim of the study was to assess the predictive value of dyspareunia, general chronic pain, and metacognitive beliefs to sexual distress in a sample of women with endometriosis. Ninety-six women (mean age = 34.60 ± 6.44 years) with a diagnosis of endometriosis took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Metacognitive beliefs and sexual distress were assessed by means of the Metacognitions Questionnaire (MCQ30) and the Female Sexual Distress Scale-R (FSDS-r). General chronic pain intensity was collected by means of a Numeric Rating Scale. Data were subjected to Hierarchical logistic regression. We found high percentages of dyspareunia and sexual distress (i.e., 66% and 76%). Findings suggested that dyspareunia and chronic pain did not predict sexual distress, while negative beliefs about worries predicted sexual distress over and above them (p = .040, odd ratio 1.159). In the target population, metacognitive beliefs may have more influence on sexual distress than pain symptomatology.

Aim Healthy lifestyle behaviors and a good adherence to pharmacological treatments are important predictors of lower recurrence rates and better overall outcomes among patients with an established acute coronary syndrome (ACS). The present study sought to investigate the longitudinal trajectories of these behaviors years after the onset of an ACS. Subject and methods We recruited a sample of 275 newly diagnosed consecutive patients at their first ACS event (mean age: 57.1 ± 7.87 years; 84% males) admitted to a cardiac rehabilitation program from three large public hospitals in Northern Italy. Patients completed a battery of sociodemographic questionnaires, which evaluated healthy lifestyles (smoking status, alcohol intake, diet, and physical activity) and adherence to pharmacological treatments, at five time-points (pre-event, 6-, 12-, 24-, and 36-month follow-ups). Longitudinal trajectories were examined through hierarchical (generalized) linear models, controlling for several demographic and clinical variables. Results We found significant changes in all healthy lifestyles from pre-event to the 6-month follow-up, suggesting the adoption of healthier behaviors soon after the cardiac event. However, from the 6-month up to the 3-year follow-up, patients experienced small but significant declines in their self-reported levels of healthy dietary behaviors and physical activity. Further, we found that the odds of being at medium risk of non-adherence to the pharmacological treatments significantly increased over the course of 3 years. Conclusion Given the negative long-term trajectories in specific lifestyles and adherence to pharmacological treatments, cardiac rehabilitation programs are suggested to provide repeated psychological interventions aimed at fostering patients’ capabilities to self-regulate their habitual behaviors.

Routine outcome monitoring (ROM) is an evidence-based methodology in psychotherapy that supports clinical decision-making through the standardized and systematic collection of patient-reported outcome data. Although its benefits are well established, ROM remains poorly integrated into routine psychotherapeutic practice in many countries, including Italy. Structural fragmentation of services, limited digital infrastructure, and cultural resistance within the profession hinder the adoption of data-informed clinical practices. This study aims to investigate the implementation of a digital platform designed to support ROM in Italian psychotherapy, with a focus on individual, organizational, and contextual factors influencing adoption and integration into everyday clinical practice. This is a longitudinal, mixed methods implementation study embedded within the OutProFeed project, the first randomized controlled trial in Italy focused on ROM in psychotherapy. The study is guided by the Consolidated Framework for Implementation Research, which informed the selection of constructs through a structured expert consensus process. Approximately 30 psychotherapists are included across diverse practice settings, therapeutic orientations, and geographic areas. Data will be collected at three time points (T0 baseline, T1 midimplementation at ~6 mo, and T2 final follow-up at ~12 mo). Qualitative data will be generated through semistructured interviews, while quantitative data will be collected using the Evidence-Based Practice Attitude Scale-36 (EBPAS-36). Qualitative and quantitative data will be linked at the individual level to support integrated interpretation of implementation trajectories. The study received ethical approval from the Ethics Committee of the University of Bergamo in April 2024. Technical setup of the digital platform and preimplementation engagement with participating psychotherapists were conducted between May and November 2025. Baseline (T0) implementation data collection started on a rolling basis in December 2025 and is planned to continue through March 2026. The midimplementation follow-up (T1; approximately 6 mo after individual baseline) is expected to occur between June and October 2026, with the final follow-up (T2; approximately 12 mo after baseline) planned between December 2026 and April 2027. Data analysis will begin after completion of follow-up assessments, with initial findings expected to be submitted for publication in 2027. This protocol outlines a theory-informed and context-sensitive approach to studying the implementation of digitally supported ROM in psychotherapy. By combining qualitative and quantitative data within a longitudinal design, the study aims to generate insights into the conditions under which digital outcome monitoring may be integrated into routine psychotherapeutic work in fragmented and professionally autonomous health care systems.

Psychological variables may be crucial in favoring or discouraging health-related behaviors, including vaccine acceptance. This study aimed to extend the previous literature by outlining the psychological profile associated with COVID-19 vaccine hesitancy in a sample of Italian citizens. Between April and May 2021, 1122 Italian volunteers completed a web survey on COVID-19 vaccine acceptance, also including several self-reported psychological measures. A multiple hierarchical logistic regression analysis was performed to identify the psychological variables associated with vaccine hesitancy. Low confidence in COVID-19 vaccine efficacy and safety, low collective responsibility, high complacency, and high calculation (i.e., extensive information searching, and costs–benefit estimates) predicted higher hesitancy. Our results suggest that to be effective, vaccine-related communications should be as clear, understandable, and sound as possible, preventing the spreading of misunderstandings, or even fake information, that may foster people’s insecurities and distrust. Furthermore, the advantages and necessity of vaccination, both at the individual and community-level, should be clearly emphasized. Efficacious vaccine-related communications may be crucial, not only to maintain an adequate immunity rate for COVID-19, but also to inform policymakers and public authorities in the case of possible future infectious outbreaks.

Background The prevalence of anxiety and depression disorders is surging worldwide, prompting a pressing demand for psychological interventions, especially in less severe cases. Responding to this need, the Italian government implemented the “Psychological Bonus” (PB) policy, allotting 25 million euros for mental health support. This policy entitles individuals to a minimum of four to twelve psychological sessions. In collaboration with the National Board of Italian Psychologists, our study assesses this policy’s effectiveness. Indeed, the PsyCARE study aims to examine the utilization of the Psychological Bonus, evaluate its impact on adult and adolescent participants’ psychological well-being through pre- and post-intervention assessments and six-month follow-up, and conduct a longitudinal cost-effectiveness analysis of this policy. A secondary aim is to investigate the influence of these interventions on transdiagnostic factors, including emotion regulation and epistemic trust. Methods The study involves licensed psychotherapists and their patients, both adults and adolescents, benefiting from the Psychological Bonus. Data collection is underway and set to conclude in December 2023. Psychotherapists will provide diagnostic information and assess patient functioning. In addition, patients will be evaluated on mental health aspects such as clinical symptoms, emotion regulation, epistemic trust, and quality of life. We will employ linear mixed-effects models to analyze the outcomes, accounting for both fixed and random effects to capture the hierarchical structure of the data. Discussion We anticipate the study’s findings will highlight reduced psychological distress and improved quality of life for participants and demonstrate the Psychological Bonus policy’s cost-effectiveness. The study will gather data on the role of specific versus nonspecific therapeutic factors in psychotherapy while adopting a patient-tailored approach to identify effective therapeutic elements and examine transdiagnostic factors. Overall, this study’s findings will guide future measures within the Italian healthcare system, fostering a psychological health culture and providing valuable insights to the broader public. Study registration https://osf.io/6zk2j

Cardiovascular diseases (CVDs) reflect a huge and diversified condition that influences patient quality of life (QoL) both in the physical and mental aspects, especially in older adults who often present comorbidities and may be affected by cognitive decline. The concept of cognitive reserve (CR), which is built through life course experiences, has widely been considered a protective factor against cognitive decline, while the results of QoL in the field of CVDs are still controversial. In particular, there is a lack of evidence that explicitly explores the effects of CR on the QoL in CVD cases since studies have considered only single CR proxies (e.g., education) or specific cardiovascular conditions. Moreover, none of them have considered the motor reserve (MR), another recent concept that considers the amount of physical activity carried out during a lifespan. Its potential role in preventing age-related diseases has been observed, but more clarification is needed given the importance of the physical component in CVDs. The present state-of-the-art review aims to (i) examine how the literature conceives CR and its proxies in CVDs relating to QoL and (ii) integrate the concept of MR in this framework. Implications for clinical practice will also be discussed.

The etiologies and causal beliefs of heart disease are considered one of the 5 dimensions of health self-regulatory model. Thus, the present study aimed to review the literature and screen the appropriate tools for evaluating the causal beliefs and perceived heart risk factors (PHRFs). The review samples encompassed all published articles from 1992 to March 2017. A systematic search was conducted across 6 databases: the Web of Science, Scopus, Medline, EBSCO, ProQuest, PsycINFO, and Google Scholar. The qualitative evaluation of the articles was examined using the checklists of the Critical Appraisal Skills Programme (CASP) by 2 independent investigators. After the application of the criteria for inclusion in the study, 22 studies were obtained according to the PRISMA guidelines. A total of 10 504 (50.5% male) patients at an average age of 57.85±10.75 years participated in 22 studies under review. The results of the systematic review showed that 22 tools were available to measure PHRFs. The instruments were categorized into 4 groups of valid scales (6 studies), invalid questionnaires (6 studies), checklists (3 studies), and open-ended single items (7 studies). Only 23.2% of the measuring instruments were sufficiently valid. The results of this systematic review showed that a limited number of valid tools were available to measure PHRFs. Considering the importance of studying cardiac patients' perception of the etiology of disease and the paucity of standards and valid grading scales, it seems necessary to design and provide tools with broader content that can cover all aspects of patients' beliefs.

Objective The metabolic syndrome (MS) is a multifactorial disorder associated with a higher risk of developing cardiovascular diseases and type 2 diabetes. However, its pathophysiology and risk factors are still poorly understood. In this study, we investigated the associations among gender, psychosocial variables, job-related stress and the presence of MS in a cohort of obese Caucasian workers. Methods A total of 210 outpatients (142 women, 68 men) from an occupational medicine service was enrolled in the study. Age, BMI, waist circumference, fasting glucose, blood pressure, triglycerides and HDL cholesterol were collected to define MS. In addition, we evaluated eating behaviors, depressive symptoms, and work-related stress. Data analyses were performed with an artificial neural network algorithm called Auto Semantic Connectivity Map (AutoCM), using all available variables. Results MS was diagnosed in 54.4 and 33.1% of the men and women, respectively. AutoCM evidenced gender-specific clusters associated with the presence or absence of MS. Men with a moderate occupational physical activity, obesity, older age and higher levels of decision-making freedom at work were more likely to have a diagnosis of MS than women. Women with lower levels of decision-making freedom, and higher levels of psychological demands and social support at work had a lower incidence of MS but showed higher levels of binge eating and depressive symptomatology. Conclusion We found a complex gender-related association between MS, psychosocial risk factors and occupational determinants. The use of these information in surveillance workplace programs might prevent the onset of MS and decrease the chance of negative long-term outcomes. Level of evidence Level V, observational study.