State rumination is a temporary activation of repetitive, negative, self-focused thinking in response to specific situational triggers or mood states. We present the results of two studies that examined the psychometric properties and measurement invariance of the Italian version of the Brief State Rumination Inventory (BSRI). Study 1 tested its unidimensionality and measurement invariance across administration methods (paper-and-pencil, N = 216, vs. online, N = 222) and national samples. Study 2 (N = 675) tested its measurement invariance across sex and its construct validity. Results supported the BSRI's unidimensional structure. Configural and weak (metric) invariance were supported across administration methods and national samples, whereas partial strong invariance was established across sex. The Italian BSRI showed construct-validity evidence consistent with theoretical expectations, correlating more strongly with brooding than reflection and more strongly with depression than anxiety or stress. Neuroticism and limited access to emotion regulation strategies emerged as other significant correlates. These findings support the Italian BSRI as a robust tool for assessing state rumination.

Substance use disorders (SUDs) are among the leading causes of morbidity and mortality globally. Identification of aetiological factors related to the severity of substance use can offer targets for therapeutic interventions. Role of impulsivity and emotion dysregulation in SUDs is well established. Based on the evidence that the adverse effects of impulsivity on behavioural and mental health outcomes can be mediated by emotion dysregulation, this study explored the possible mediating role of emotion dysregulation in the association between impulsivity and the severity of substance dependence. One hundred treatment-seeking substance users (monosubstance users and polysubstance users) were enrolled. Impulsivity, emotion dysregulation and severity of substance dependence were assessed using the Barratt Impulsiveness Scale-11, the Difficulties Emotion Regulation Scale and the Severity Dependence Scale, respectively. Correlation, mediation and 95% bias-corrected and accelerated (BCa CI) bootstrapped analyses were run. Emotion dysregulation was found to mediate the association between attention impulsivity (indirect effect [BCa CI]: 0.22 [0.11-0.36]), motor impulsivity (indirect effect [BCa CI]: 0.15 [0.08-0.24]), non-planning impulsivity (indirect effect [BCa CI]: 0.11 [0.04-0.18]) and severity of substance dependence. The direct effect of different facets of impulsivity on dependence severity was not significant after accounting for emotion dysregulation. Impulsivity was found to have a significant indirect effect on the severity of substance use through emotion dysregulation. Among substance users, emotion dysregulation may be involved in the association between impulsivity and severity of substance dependence. Emotion dysregulation could be considered a possible therapeutic target to reduce the severity of substance dependence among substance users with impulsive tendencies.

The study aimed to investigate the dynamic associations among meaning in life (MIL), metacognitions about mobile phone use, and adolescents’ problematic mobile phone use (PMPU). A longitudinal design with a 6-month interval was adopted, involving a total of 831 adolescents who completed questionnaires assessing MIL, metacognitions about mobile phone use, and PMPU. The results indicated a significant bidirectional relationship between MIL and the severity of adolescents’ PMPU. In addition, both positive and negative metacognitions about mobile phone use were positively and reciprocally associated with PMPU. Furthermore, MIL negatively influenced both forms of metacognitions over time. This study highlights the potential roles of metacognitions and MIL in the prevention and intervention of PMPU among adolescents, suggesting that both fostering MIL and modifying dysfunctional metacognitions may be effective targets.

This exploratory qualitative study investigates ChatGPT-4’s capacity to apply the LIBETcase formulation model by analyzing its feedback on anonymized interview transcripts. The study aimed to assess whether ChatGPT-4’s outputs reflectedaccurate identification and interpretation of two key psychological constructs—lifethemes and semi-adaptive plans—while adhering to theoretical principles, and toexplore recurring errors and limitations in its clinical reasoning. Ten non-clinicalparticipants underwent semi-structured interviews, and a custom-configured versionof ChatGPT-4 was provided with structured instructions and theoretical material.Reflexive thematic analysis revealed four overarching themes: (1) limitations inabstraction and interpretative barriers, (2) consistent structure and contentorganization, (3) hypothesis-driven reasoning with cautious language, and (4) partialadherence to LIBET theory through appropriate terminology. While ChatGPT’sstructured reasoning and alignment with theoretical vocabulary suggest its potentialas a reflective support tool—particularly in training or supervision—it also showeddifficulties in distinguishing emotional vulnerabilities from coping strategies, and ininterpreting abstract, relational constructs such as life themes. Findings support theimportance of improving prompt design, expanding training on psychologicalconstructs, and developing rigorous validation pipelines. Future research shouldaddress these limitations before deploying LLMs as assistive tools in clinical reasoningand decision-making.

The present study aimed to examine the metacognitive model in explaining adolescent problematic mobile phone use (PMPU). A total of 1469 Chinese adolescents participated in the study, completing a series of self-report questionnaires designed to assess metacognitions about desire thinking, desire thinking, craving, and PMPU. Structural equation modeling revealed that desire thinking and craving partially mediated the relationship between positive metacognitions about desire thinking and PMPU; negative metacognitions about desire thinking partially mediated this relationship. Additionally, desire thinking and negative metacognitions about desire thinking jointly partially mediated the relationship between positive metacognitions about desire thinking and PMPU. The study’s findings highlight the significant role of metacognitions in influencing PMPU, providing valuable insights for both research and practice in understanding and intervening in adolescent PMPU.

INTRODUCTION:Using the metacognitive model of emotion dysregulation as a basis, this study explored whether metacognitive beliefs are associated with positive emotion dysregulation. METHOD:A total of 436 participants from the general population and 133 outpatients seeking psychological treatment were recruited. Positive emotion dysregulation, metacognitive beliefs, and affective symptoms were assessed. Tt test, chi-square test, correlation, and hierarchical multiple linear regression analyses were run. RESULTS:In the general population, over and above age, sex, and affective symptoms, a higher endorsement on positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, and beliefs about the need to control thoughts were associated with a poor acceptance of positive emotions (F = 13.66, p < 0.001), with difficulties in engaging in goal-directed behavior (F = 9.06, p < 0.001), and with difficulties in controlling behaviors when experiencing positive emotions (F = 10.61, p < 0.001). In the clinical sample, over and above age, sex, and affective symptoms, a higher endorsement of negative beliefs about thoughts concerning uncontrollability and danger and lack of cognitive confidence were associated with difficulties in engaging in goal-directed behavior (F = 5.74, p < 0.001) and with difficulties in controlling behaviors when experiencing positive emotions (F = 6.54, p < 0.001). Outpatients seeking psychological treatment also reported more severe positive emotion dysregulation and higher endorsement of metacognitive beliefs when compared with the general population (p < 0.001). CONCLUSION:Positive emotion dysregulation appears to be associated with the tendency to endorse metacognitive beliefs. Metacognitive beliefs could be a potential therapeutic target for reducing difficulties in the regulation of positive emotions. SUMMARY:Among participants from the general population, the tendency to endorse metacognitive beliefs is associated with greater positive emotion dysregulation. Among outpatients seeking psychological treatment, the tendency to endorse metacognitive beliefs is associated with greater positive emotion dysregulation. Assessing metacognitive beliefs may allow clinicians to gain a clearer understanding of treatment trajectories to reduce difficulties in the regulation of positive emotions. Metacognitive beliefs could be the potential therapeutic target to reduce positive emotion dysregulation. Metacognitive Therapy techniques could be suitable approaches to reduce positive emotion dysregulation.

Problematic mobile phone use (PMPU) among adolescents is increasingly recognized as a significant behavioral health concern. Previous studies have found general metacognitive beliefs can positively predict PMPU. However, the longitudinal relationship between specific metacognitive beliefs and addictive behaviors has not been fully explored. This study aimed to explore the longitudinal relationship between metacognitions about mobile phone use, metacognitions about desire thinking, and PMPU among adolescents using cross-lagged panel network analysis. A sample of 993 adolescents were surveyed at two points over six months. Findings indicated that negative metacognitions about mobile phone use and positive metacognitions about desire thinking emerged as two prominent bridge nodes. Negative metacognitions about mobile phone use were strongly associated with withdrawal and relapse symptoms, while positive metacognitions about desire thinking correlated with tolerance and relapse. These results suggest that interventions aimed at addressing PMPU should consider the distinct impacts of different metacognitive beliefs and tailor their approaches accordingly.

This study aimed to evaluate the factor structure, internal consistency and concurrent validity of the Italian version of the Metacognitions about Smoking Questionnaire (MSQ), utilizing the framework of the Self-Regulation Executive Function model. A total of 532 smokers completed the Italian-translated version of the MSQ, the Fagerstrom Test for Nicotine Dependence, the Severity Dependence Scale, the Depression Anxiety and Stress Scale-21. To test the factorial structure of the MSQ, a series of confirmatory factor analyses (CFAs) were run; correlational analyses and structural equation modelling (SEMs) approaches were undertaken to evaluate the concurrent validity. The 12-item MSQ with four factors was confirmed: positive metacognitions about cognitive regulation (PM-CR), positive metacognitions about emotional regulation (PM-ER), negative metacognitions about uncontrollability (NM-U) and negative metacognitions about cognitive interference (NM-CI). The MSQ showed an overall satisfactory fit index (TLI = 0.949, CFI = 0.963, RMSEA = 0.082 [0.064-0.101]). Internal consistency was satisfactory. MSQ factors are associated with higher nicotine/cigarette dependence and emotional distress, supporting the concurrent validity of the tool. Specific metacognitions about smoking were associated with different clinical outcomes related to smoking. A higher engagement on PM-CR and on NM-U was positively associated with nicotine/cigarette dependence. A higher engagement on PM-ER and NM-CI was associated with greater emotional distress. The 12-item Italian version of the MSQ could be a promising tool to assess specific metacognitions about smoking in both research and clinical contexts. Metacognitions about smoking may be a suitable therapeutic target to reduce the levels of nicotine/cigarette dependence and emotional distress among smokers.

INTRODUCTION:Emotional Disorders (EDs) with and without comorbid personality disorder (ED-PD vs. ED-noPD) show distinct symptom patterns. ED-PDs involve pervasive, ego-syntonic traits, whereas ED-noPD conditions are more ego-dystonic. This study examined whether these differences extend to the interplay between metacognitive processes, repetitive negative thinking, and symptoms. METHODS:962 Italian-speaking adults (mean age = 36.9; 336 males, 626 females) seeking treatment at our outpatients' service (inTHERAPY) participated. Of these, 653 had a primary ED (mainly depressive or anxiety disorders), and 309 had a comorbid PD. Participants completed assessments of repetitive negative thinking styles, metacognitive beliefs, symptoms, and psychosocial functioning. A network analysis was conducted on the total sample and by subgroup, assessing Bridge Expected Influence and network invariance. RESULTS:Negative metacognitive beliefs about danger and uncontrollability of thoughts, depressive symptoms and depressive rumination were central in both groups. In the ED-noPD group, Negative metacognitive beliefs about danger and uncontrollability of worry exerted the strongest influence, whereas in the ED-PD group, depressive rumination emerged as the most central feature. Bridge connections revealed that depressive rumination and cognitive self-consciousness acted as key links in ED-PD, possibly reinforcing ego-syntonicity. However, no significant structural differences emerged between networks. CONCLUSION:Findings indicate that the structure linking symptoms, repetitive negative thinking, and metacognitive beliefs is broadly similar in ED-PD and ED-noPD. Yet, the specific bridge patterns in ED-PD may reflect stronger ego-syntonicity, underscoring the importance of interventions targeting self-focused attention and metacognitive awareness in this subgroup.

Case conceptualization in psychotherapy allows clinicians to hypothesize the origins of patients’ difficulties and to plan interventions. The LIBET model (Life and Themes Implication Biased: Elicitation and Treatment, Sassaroli et al., 2022) is a cognitive-behavioral framework designed to construct a case conceptualization. The present study aims to investigate differences in the dimensions assessed by the LIBET model among individuals without a diagnosis, those with symptomatic disorders, and those with comorbid personality disorders. A total of 738 participants completed a psychological assessment, which included semi-structured interviews, LIBET-Questionnaire, and self-report instruments. Findings revealed group differences in the selection of strategies used to manage psychological distress, as well as significant differences across three out of the four metacognitive axes included in the LIBET model. Metacognitive axes were found to be correlated with personality rigidity and potential predictors of psychosocial wellbeing, supporting the model’s sensitivity. The study presents limitations primarily related to participant recruitment and research design. Further studies will be required to enhance the validation of the LIBET model. Nonetheless, the LIBET-Questionnaire appears to be a promising tool for assessment purposes and for monitoring therapeutic progress. It can help identify phases of improvement or lack of progress and guide adjustments to the treatment plan within a shared therapeutic framework.

Background: Maladaptive personality traits are transdiagnostic risk factors associated with functional impairment, lower treatment efficacy, and poor mental health outcomes. These traits, encompassing domains such as Negative Affectivity, Detachment, Antagonism, Disinhibition, Psychoticism, and Anankastia, contribute to difficulties in emotional regulation, interpersonal relationships, and occupational functioning. While increasing evidence suggests that personality traits can change over time, longitudinal research examining within-person fluctuations in maladaptive traits during psychotherapy remains limited. Methods: This preregistered longitudinal study investigates the dynamic interplay between maladaptive personality domains and treatment outcomes in patients undergoing Cognitive Behavioral Therapy (CBT). A total of 200 participants will be recruited from an Italian outpatient psychotherapy service and assessed across five time points over one year (baseline, 3, 6, 9, and 12 months). At each point, participants will complete validated self-report measures of personality domains and clinical symptoms (anxiety, depression, psychosocial functioning). The study will use Random Intercept Cross-Lagged Panel Models to examine reciprocal relationships between personality traits and clinical outcomes while distinguishing between within-person fluctuations and between-person differences. Latent Growth Curve Models will be used to assess mean-level change in personality traits over time. An exploratory analysis will examine whether patients show the greatest change in the trait domain most elevated at baseline. Discussion: This study will provide novel insights into the temporal dynamics of maladaptive personality traits during CBT and their association with therapeutic change. Identifying which traits change most significantly - and whether these changes predict symptom improvement - may inform the development of more personalized interventions. The findings may also guide clinical decision-making by highlighting which personality factors influence treatment trajectories, ultimately supporting better planning and outcomes for patients with elevated maladaptive traits.

Background:Metacognitive beliefs, as proposed in the Self-Regulatory Executive Function (S-REF) model, are considered to play a central role in the development and maintenance of psychological disorders; however the intergenerational dimension of these beliefs remains poorly understood. Existing studies suggest potential associations between parental and offspring metacognitive beliefs, while preliminary genetic evidence indicates that some domains may be more strongly influenced by biological predispositions. Methods:A systematic search of PubMed, EBSCOhost, and SCOPUS was conducted between January and April 2025, examining studies assessing the association between parental and offspring metacognitive beliefs, as described in the S-REF model, and studies exploring links with genotype. Effect sizes were pooled for domains assessed in at least three studies, and moderator analyses considered age, study quality, and the number of covariates included. Results:Nine studies met inclusion criteria, eight focusing on parent-child associations and one on genotype. Meta-analytic results indicated small-to-moderate associations for positive metacognitive beliefs (r = .24) and negative beliefs about danger and uncontrollability of thoughts (r = .17), whereas Cognitive self consciousness did not show significant associations. Limited molecular genetic evidence suggested that Cognitive confidence and Need to control thoughts may be more strongly linked to biological predisposition. Heterogeneity was observed across studies, and moderator analyses did not reveal significant effects. Conclusion:The intergenerational dimension of metacognitive beliefs is an underexplored area with heterogeneous findings. Associations between parental and offspring beliefs are evident, particularly for Positive and Negative metacognitive beliefs, while some domains may reflect biological influences. Future research should employ longitudinal designs, comprehensive assessment across all metacognitive domains, and integrate both genetic and environmental factors to clarify the mechanisms underlying these associations. Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD420251020891.

The current progressive adoption of online platforms and web-based interventions, within the context of Cognitive Behavioral Therapy (CBT) services, offers a novel opportunity to scale evidence-based psychotherapy. In the present work, we depict the development of a web and native application within the Italian landscape, GRETA (Graphic Robotic Engine for Therapy Automation). GRETA provides the following functions: (a) Management of therapy appointments and payments; (b) Clinical data, therapy progress, and sessions summary between professionals; (c) Production of the medical report and notes for external institutions; (d) Homework, materials, psychometric measures, progress reports, and therapy notes; (e) Systematic monitoring of the therapeutic process and outcomes; (f) Ensuring confidentiality, security, and integrity of patient information; (g) Collection, aggregation, and analysis of anonymized patient data through statistical reports and graphical dashboards. Beyond the technological implementation, this study also assesses the effectiveness of therapy delivered through GRETA. Pre-post treatment comparisons were conducted on a sample of 442 patients discharged for any reason by the CBT service, categorized into three diagnostic groups: anxiety disorder, depressive disorder, and comorbid anxiety and depressive disorder. Results revealed significant improvements in symptom severity and functional adjustment across all groups. Future developments of GRETA will involve integrating Artificial Intelligence-based features, such as predictions of clinical outcomes.

Body awareness consists of aesthetic body image, functional body image, and interoception. Previous studies indicated a link between these components of body awareness and mental health. This study aims to clarify the relationship among these variables during the period of pubertal body changes. As puberty progresses, individuals’ perceptions of their bodies shift, which has been associated with a decline in mental health, according to the existing literature. To investigate this issue, a sample of 294 post-pubertal adolescents assigned female at birth completed assessments related to body awareness, mental health, psychosomatic symptoms, gender congruence, and eating disorders. A network analysis was conducted to illustrate the intricate interactions among the observed variables, and a mediation model was utilised to explore how body image influences overall health, with interoception and functional body image acting as mediators. The study identifies three key variables—body image, mental health, and interoception—as central within the network. Additionally, functional body image was significantly associated with other variables in the study. Ultimately, both direct and indirect effects of body image on mental health were found, mediated through interoception and functional body image. The clinical implications emphasise the importance of enhancing awareness of bodily sensations and functions to support psychological well-being, particularly during a developmental stage characterised by challenges related to body image due to rapid changes in puberty.

BACKGROUND:Using the metacognitive model of emotion dysregulation as a basis, this study explored whether, among participants with substance use disorders (SUDs), metacognitive beliefs and repetitive negative thinking were associated with emotion dysregulation. METHODS:127 participants with SUDs and 127 controls without SUDs were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, and depression were assessed. t-tests, Mann-Whitney tests, logistic regression, correlation, and hierarchal regression analyses were run. RESULTS:Participants with SUDs reported significantly higher levels of emotion dysregulation, positive beliefs about worry, beliefs about the need to control thoughts, rumination, and worry, compared to controls without SUDs. Among participants with SUDs negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, beliefs about the need to control thoughts, rumination, and worry were significantly associated with an increase of emotion dysregulation. LIMITATIONS:The cross-sectional design. CONCLUSION:Emotion dysregulation, metacognitive beliefs, and repetitive negative thinking may contribute to increase the risk of substance use. Among participants with SUDs emotion dysregulation is associated with the tendency to endorse dysfunctional metacognitive beliefs and report repetitive negative thinking. Metacognitive beliefs and repetitive negative thinking could be a suitable therapeutic target to reduce emotion dysregulation among participants with SUDs.

INTRODUCTION:This study explored the possible mediating role of emotion dysregulation in the association between perfectionism and eating psychopathology symptoms. METHOD:One hundred forty-two outpatients with eating disorders (EDs) were enrolled. Perfectionism, emotion dysregulation, ED psychopathology, anxious and depressive symptoms were assessed. Correlation, mediation and 95% bias corrected and accelerated (BCa CI) bootstrapped analyses were run. RESULTS:Emotion dysregulation was found to mediate the association between concern over mistakes perfectionism and restraint (indirect effect: 0.093, BCa CI: 0.001-0.02, adjusted R2 = 0.3324, p < 0.001), shape concern (indirect effect: 0.0130, BCa CI: 0.004-0.03, adjusted R2 = p < 0.001) and weight concern (indirect effect: 0.0142, BCa CI: 0.004-0.03, adjusted R2 = 0.2986, p < 0.001). CONCLUSION:Among ED outpatients, emotion dysregulation may be involved in the association between concern over mistakes perfectionism and persistence of eating psychopathology symptoms. Emotion dysregulation could be considered as possible therapeutic target to reduce the persistence, and severity, of eating psychopathology symptoms among ED patients with concern over mistakes perfectionism.

INTRODUCTION:Using the self-regulatory executive function model as a basis, this study explored whether, among substance users, metacognitive beliefs and repetitive negative thinking were associated with impulsiveness. METHODS:A total of 100 substance users were recruited. Impulsiveness, metacognitive beliefs, rumination and worry were assessed. Correlation and hierarchal regression analyses were run. RESULTS:Beliefs about the need to control thoughts, lower cognitive self-consciousness and brooding rumination were found to be independent predictors of the total score on impulsiveness in the hierarchical regression analysis. Further regression analyses indicated that motor impulsiveness was predicted by a combination of beliefs about the need to control thoughts and brooding rumination, while non-planning impulsiveness was predicted by beliefs about the need to control thoughts and lower cognitive self-consciousness. CONCLUSION:Among substance users, higher impulsiveness is associated with the tendency to endorse beliefs about the need to control thoughts and brooding rumination. Among substance users, beliefs about the need to control thoughts and brooding rumination (and potentially cognitive self-consciousness) could be a suitable therapeutic targets to mitigate particularly motor impulsiveness and non-planning impulsiveness.

Using the Elaborated Intrusion Theory of Desire and the Self-Regulatory Executive Function model of psychopathology as bases, this study explored whether metacognitive beliefs and desire thinking (DT) are associated with higher levels of Compulsive Sexual Behavior (CSB). A total of 1185 participants from the general population were included in the study (mean ± SD age = 25.32 years ± 5.58; age range = 18-19 years; females = 76.7 %). Metacognitive beliefs, DT, CSB, anxiety and depressive symptoms were assessed. Correlation analyses and path analyses were run. Results of the path analysis showed that positive metacognitive beliefs about DT were associated with DT-Imaginal Prefiguration (DT-IP), which in turn was positively associated with DT-Verbal Perseveration (DT-VP). The latter was strongly and positively associated with negative metacognitive beliefs about DT, which in turn was linked to CSB. Moreover, DT-VP was also found to be directly linked to the outcome variable and positive metacognitive beliefs about DT were also directly linked to DT-VP and negative metacognitive beliefs about DT. The total Coefficient of Determination (0.45) indicated a good fit to the observed data. Metacognitive beliefs and DT may be potential maintenance factors in CSB. Metacognitive beliefs and DT could also be considered as potential therapeutic targets in clinical interventions aimed at reducing the severity of CSB.