ObjectiveThis study aims to evaluate the effectiveness of the MotivAir program—a phone-based intervention based on Motivational Interviewing principles and techniques—in enhancing adherence to Continuous Positive Airway Pressure therapy among patients with Obstructive Sleep Apnea Syndrome.MethodsA multicenter randomized controlled trial design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A minimum sample (...) of 80 participants will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary and secondary outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation.DiscussionParticipants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition. (shrink)

ObjectiveThis study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome and comorbid obesity following after continuous positive airway pressure therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management.MethodsQualitative research was conducted using three focus groups with a representative sample of 32 inpatients undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, Verbania, (...) Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes.ResultsSix main themes were extracted: Living the diagnosis as a shock; You should not sleep on it: the importance of prevention; The adjustment to CPAP; Barriers and facilitators to the use of CPAP; Three in a bed; and The relationship with the healthcare system.ConclusionResults of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program. (shrink)

Managing cardiac illness is not easy because it dramatically disrupts people’s daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (...) plays in moderating the link between patient and partner cardiac illness-related distress and partner support. The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple’s cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support. With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping. (shrink)

Objective: to develop and test the factorial structure of a new self-determination theory-based measure of behavioral regulation in children. Method: 590 (F = 51.7%) children aged 7-11 years completed the Motivation to Exercise and Diet (MED-C) questionnaire, which comprises 16 items (8 for exercise and 8 for diet) grouped into eight-factors (5 motivations and 3 needs). Psychometric testing included confirmatory factor analysis and internal consistency. Measurement invariance analyses were also performed to evaluate whether the factorial structure of the MED-C was (...) equivalent for gender (male vs. female), age ( 10yo) and the perception of having at least one parent with overweight or obesity (yes vs. no). Results: factorial analysis confirmed an acceptable factors solution for the MED-C and a good fit to the data for both the exercise and the diet subscales assessed independently. The Maximal Reliability coefficient revealed good reliability for the exercise and the diet subscales. Moreover, the MED-C factor structure was invariant across group comparisons. Discussion: findings support the construct validity and reliability of the MED-C. Therefore, it represents the first validated instrument simultaneously measuring motivational regulation and psychological need satisfaction in the context of children’s exercise and diet. Considering the goodness of these results, scale percentile ranks of the total score distribution as well as the z-score and the T-score were provided for clinical and research purposes. Conclusion: The MED-C might support the understanding of motivations and needs of children with weight problems and assist their process of behavioural change in primary and secondary prevention programs. Psychological factors represent, in fact, potential targets for interventions to increase children’s motivation to exercise and diet. (shrink)

Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population. Method: 573 participants with disordered eating patterns as measured by the Eating Disorder Examination Questionnaire (EDE-Q) completed the 190-item adapted version of the Schema Mode Inventory (SMI). The new SMI-ED was developed by clinicians/researchers specializing in the treatment of eating disorders, through combining items from the original SMI with a set of (...) additional questions specifically representative of the eating disorder population. Psychometric testing included Confirmatory Factor Analysis (CFA) and internal consistency (Cronbach’s α). Multivariate Analyses of Covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED modes, while controlling for possible confounding variables. Results: Factorial analysis confirmed an acceptable sixteen-related-factors solution for the SMI-ED, thus providing preliminary evidence for the adequate validity of the new measure based on internal structure. Concurrent validity was also established through moderate to high correlations on the modes most relevant to eating disorders with EDE-Q subscales. This study represents the first step in creating a psychometrically sound instrument for measuring schema modes in eating disorders, and provides greater insight into the relevant schema modes within this population. Conclusion: This research represents an important preliminary step toward understanding and labeling the schema mode model for this clinical group. Findings from the psychometric evaluation of SMI-ED suggest that this is a useful tool which may further assist in the measurement and conceptualization of schema modes in this population. (shrink)

Background: although cognitive behavioural 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 symtoms. Conclusions: translating research into practice may inform how to ensure high-quality patient care. (shrink)

An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role it (...) has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to exploration of subjective feelings and experiences that influence the individuals' expression, communication and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression–and related methodological recommendations–are needed to improve the validity and generalizability of research findings. It will allow the development (...) of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression, this contribution is aimed to provide practical suggestions for the design of research able to incorporate first- and third-person accounts. It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression. Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind. (shrink)

According to the ‘Evidential Internalists’, one’s evidence supervenes on one’s non-factive mental states. ‘Evidential Externalists’ deny that, and allow for external factors to determine what evidence one has. After clarifying what Evidential Internalism and Evidential Externalism entail, and what they are silent on, this chapter provides an opinionated overview of the main arguments and motivations behind Evidential Internalism and Evidential Externalism. It concludes that Evidential Externalism is a more promising view.

Why can testimony alone be enough for findings of liability? Why statistical evidence alone can’t? These questions underpin the “Proof Paradox” (Redmayne 2008, Enoch et al. 2012). Many epistemologists have attempted to explain this paradox from a purely epistemic perspective. I call it the “Epistemic Project”. In this paper, I take a step back from this recent trend. Stemming from considerations about the nature and role of standards of proof, I define three requirements that any successful account in line with (...) the Epistemic Project should meet. I then consider three recent epistemic accounts on which the standard is met when the evidence rules out modal risk (Pritchard 2018), normic risk (Ebert et al. 2020), or relevant alternatives (Gardiner 2019 2020). I argue that none of these accounts meets all the requirements. Finally, I offer reasons to be pessimistic about the prospects of having a successful epistemic explanation of the paradox. I suggest the discussion on the proof paradox would benefit from undergoing a ‘value-turn’. (shrink)

At the core of evidentialism lies a very plausible claim: rational thinkers follow their evidence. While this seems to be a very intuitive, almost trivial, claim, providing a full and complete evidentialist theory is complicated. In this entry, I begin with elucidating what kind of theory evidentialists aim to provide us with. I will show that, in order to provide a complete evidentialist theory, we have to provide a lot of details on what evidence is and how it relates to (...) the proposition it’s evidence for, as well as the agent possessing such evidence. I then consider objections arising for the most popular answers one can give to such questions. I conclude by considering old and new challenges that arise for evidentialism, regardless of the specific version one endorses. (shrink)

Can epistemic paternalistic practices make us better epistemic agents? While a satisfying answer to this question will ultimately rest at least partly on empirical findings, considering the epistemological discussion on evidence, knowledge, and epistemic virtues can be insightful. In this paper, Giada Fratantonio argues that we have theoretical reasons to believe that strong epistemic paternalistic practices may be effective at mitigating some evidential mistakes, in fostering true belief, and even for allowing the subject of the intervention to gain knowledge. (...) However, we have reasons to expect that these practices will not be able to make the subject of the intervention an overall better epistemic agent at the dispositional level. She then considers weak epistemic paternalistic practices, e.g., epistemic nudging, and provides some reasons for optimism. Finally, Fratantonio considers the implications that these theoretical considerations have for education. (shrink)

According to Probability 1 Infallibilism (henceforth, Infallibilism), if one knows that p, then the probability of p given one’s evidence is 1. Jessica Brown (2018, 2013) has recently argued that Infallibilism leads to scepticism unless the infallibilist also endorses the claim that if one knows that p, then p is part of one’s evidence for p. By doing that, however, the infalliblist has to explain why it is infelicitous to cite p as evidence for itself. And yet, the infallibilist doesn’t (...) seem to have a satisfying explanation available. Call this the Infelicity Challenge for Probability 1 Infallibilism. By exploiting the distinction between the justifying and the motivating role of evidence, in this paper, I argue that, contrary to first appearances, the Infelicity Challenge doesn’t arise for Probability 1 Infallibilism. However, after anticipating and resisting two objections to my argument, I show that we can identify a different version of infallibilism which seems to face a problem that is even more serious than the Infelicity Challenge. (shrink)

In this paper, I focus on the Armchair Access Problem for E=K as presented by Nicholas Silins (2005), and I argue, contra Silins, that it does not represent a real threat to E=K. More precisely, I put forward two lines of response, both of which put pressure on the main assumption of the argument, namely, the Armchair Access thesis. The first line of response focuses on its scope, while the second line of response focuses on its nature. The second line (...) of response is the most interesting one, for it represents the framework within which I develop a novel account of second-order knowledge, one that involves evaluation of counterfactual conditionals and the employment of our imaginative capacities, i.e., an imagination-based account of second-order knowledge. The two lines of response are shown to be jointly compatible and mutually supportive. I then conclude that the Armchair Access Problem is not a challenge for E=K, yet it relies on the ambiguity of the notion of armchair knowledge underpinning the Armchair Access thesis. (shrink)

This paper reassesses the case against Evidential Externalism, the thesis that one's evidence fails to supervene on one's non-factive mental states, focusing on two objections to Externalism due by Nicholas Silins: the armchair access argument and the supervenience argument. It also examines Silins's attempt to undermine the force of one major source of motivation for Externalism, namely that the rival Internalist picture of evidence is implicated in some central arguments for scepticism. While Silins concludes that the case against Evidential Externalism (...) is surprisingly strong, reassessing the arguments supports the opposite conclusion; the objections to Externalism are weak, and for all Silins has shown it may well have unmatched advantages when it comes to resisting scepticism. (shrink)

In this paper, I consider the so-called Access Problem for Duncan Pritchard’s Epistemological Disjunctivism (2012). After reconstructing Pritchard’s own response to the Access Problem, I argue that in order to assess whether Pritchard’s response is a satisfying one, we first need an account of the notion of ‘Reflective Access’ that underpins Pritchard’s Epistemological Disjunctivism. I provide three interpretations of the notion of Reflective Access: a metaphysical interpretation, a folk interpretation, and an epistemic interpretation. I argue that none of these three (...) interpretations comes without problems. I conclude that, until we have a clear and unproblematic account of Reflective Access, the Access Problem remains a challenge for Pritchard’s Epistemological Disjunctivism. (shrink)

Earthquakes, which can cause widespread territorial and socio-economic destruction, are life-threatening, unexpected, unpredictable and uncontrollable events caused by the shaking of the surface of the earth. The psychological consequences, such as PTSD, anxiety, depression, and suicidal ideation, are well-known to clinicians and researchers. This study was conducted with the aim of evaluating the use of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (IGTP) on a sample of adolescents, after the earthquake in Central Italy on 24 August (...) 2016. The objective of the EMDR intervention was to reduce PTSD symptoms. Before and after EMDR, specific assessment to find changes in PTSD symptoms was made using the IES-R (Impact of Event Scale Revised) and through the analyses of the Subjective Units of Disturbance (SUD). The EMDR treatment was given in three sessions (T1, T2, T3), each lasting 90 minutes, and the results at follow-up phase (T4) were also monitored. The results are very encouraging, showing significantly reduced PTSD symptoms in the majority of the subjects. The clinical implications and limitations will be discussed. (shrink)

What is the relationship between syntax and logic? Is the former autonomous and independent of the latter? If it is not, what kind of logic syntax interfaces with? These questions are not unheard of, having been around for quite some time, along with different answers. In the generative tradition, for example, logic cannot provide a model for linguistic behaviour. Conversely, according to the logicality of language hypothesis logical considerations are relevant to syntactic formation and explain the ungrammaticality of certain constructions. (...) This note offers a brief overview of the logicality of language hypothesis and proposes new evidence that seems to indicate that accepting the said hypothesis does not necessarily require assuming a “natural” logic. (shrink)

Wars and armed conflicts have a devastating impact at the economic, social, and individual level. Millions of children and adolescents are forced to bear their disastrous consequences, also in terms of mental health. Their effects are even more complicated when intertwined with those of other disasters such as the current COVID-19 pandemic. To help them face such adverse events, lay adults can be supported by psychoeducational interventions involving simple tools to assist children and adolescents emotionally. Hence, we planned and implemented (...) two public communication campaigns concerning wars to support adult carers such as parents, teachers, educators, psychologists, first responders, and others interested in young people’s wellbeing. We developed psychoeducational materials to help children and adolescents cope with negative emotions related to indirect and direct exposure to wars. This study had the objective to identify the content for two pamphlets, testing their comprehensibility, usability, and utility, and monitoring their dissemination. First, based on classifications of coping strategies and on a previous campaign about COVID-19 pandemic, we decided to include in the psychoeducational materials basic information on news about wars and common reactions to wars, respectively; on emotions that might be experienced; and on coping strategies for dealing with negative emotions. For the first pamphlet, we identified the strategies involving 141 adults. They completed an online survey with open-ended questions concerning ways to help children and adolescents cope with negative emotions associated with the Russia-Ukraine war. For the second pamphlet, we selected the contents based on Psychological First Aid manuals. Through content analyses, we chose 24 strategies. Second, data gathered with 108 adults who had consulted the psychoeducational materials supported their comprehensibility, usability, and utility. Third, we monitored the visibility of the campaigns after the release of the pamphlets, using Google Analytics™ data from the HEMOT® website through which we disseminated them. To conclude, our findings supported the comprehensibility, the usability, and the utility of the two pamphlets, to be disseminated as psychoeducational materials in the early phase of a disaster. (shrink)

The book is an accurate and accessible introduction to the complex and dynamic field of transitional and post-conflict justice, providing an overview of its recurring concepts and debated issues. Particular attention is reserved to how these concepts and issues have been addressed, both theoretically and literally, by lawyers, policy-makers, international bodies, and other actors informing the practice. By presenting significant, if undeniably disputable, alternatives to mainstream theories and past methods of addressing past injustice and (re)building a democratic state, the work (...) aims to illustrate some foundational themes of transitional justice that have emerged from a diverse set of discussions. The author's position thus arrives from a careful analysis of the advantages and disadvantages of answers to the question: how, after a traumatic social experience, is justice restored? (shrink)

The new Coronavirus has been declared a global pandemic by the World Health Organization. The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people’s quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add (...) specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship, with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people. (shrink)

According to a version of Infallibilism, if one knows that p, then one’s evidence for p entails p. In her Fallibilism: Evidence and Knowledge, Jessica Brown has recently developed two arguments against Infalliblism, which can both be presented in the form of a dilemma. According to the first dilemma, the infallibilist can avoid scepticism only if she endorses the claim that if one knows that p then p is part of one’s evidence for p. But this seems to come at (...) the cost of making infelicitous claims. According to the second dilemma, the infallibilist cannot make sense of the phenomenon of defeat unless she rejects closure. In this paper, we argue that the infallibilist has the conceptual tools to resist both dilemmas. (shrink)

After centuries of symbolic and political oppression, Galicia has been recognized by the Spanish constitution as a historic nationality. However, despite a certain degree of political autonomy, Galician identity is threatened by increasing homogenization in the economic, social, cultural and linguistic fields. In the early 1990s the aesthetic movement Bravú constructed an aesthetic community, sustained by an ideological project, and with the aim to, on the one hand, prevent Galician culture from becoming folklore stuck in a time warp and, on (...) the other hand, to validate Galician identity. The Bravú artists refused the historically inherited outsider position and contributed to a reinvention of Galician identity and of a political ideal within a cosmopolitan, internationalist framework and by reversing social stigmas through their works and performances. (shrink)

Background: The recent COVID-19 pandemic has highlighted the deficiencies that characterize the functioning of the Italian national health system. Prisons have always mirrored the most radical expressions of these weaknesses. During the early stages of the pandemic, prison facilities across Italy underwent a series of changes dictated by the need to ensure the safety of the prisoners and staff. The adoption of these rules contributed to a total or partial redefinition of many central facets of life in prison, such as (...) intake procedures for new arrivals and the ways prisoners were allowed to communicate with their families.Objectives: The aim of this qualitative study was to analyze the testimony of penitentiary healthcare workers in prisons throughout Italy to determine the impact of COVID-19 on their professional and personal lives.Participants: Thirty-eight participants were contacted and 20 decided to participate in the interview. The sample was made up of 10 women and 10 men. All the participants were members of the healthcare staff of a penitentiary facility. All were recruited through an Italian association whose mission is the development, promotion, and implementation of social solidarity projects including prisoners' social and health care. This study was facilitated through representatives serving in nine different regions of Italy. The participants were divided according to their professional roles in prisons.Method: In-depth interviews were conducted by telephone or online using telecommunication platforms. The transcribed texts underwent thematic analysis using the Atlas.ti software to identify patterns of meaning across the dataset.Results: Four main themes emerged from the analysis: Interpersonal difficulties, management and operational difficulties, the personal distress and bereavement of healthcare workers, and the distress of inmates. The importance of relationship management skills when interacting with prisoners emerged as a key topic in many interviews, and the participants highlighted the need for adequate training. The increase in prisoners' anxiety made communication more difficult.Conclusions: The findings suggest that healthcare workers in jails need emergency-oriented training. Participants described their feeling of loneliness and quasi-abandonment when carrying out their duties during the pandemic. In particular, they underscored the need for psychological guidance to better manage altered reactions with prisoners and colleagues as a result of heightened death anxiety and isolation. (shrink)