Search Results (919)

The postnatal period involves significant emotional and relational shifts that can challenge early mother–infant interactions, particularly under conditions of psychosocial vulnerability (e.g., maternal anxiety/depression) or infant-related risk (e.g., preterm birth). Maternal mentalization, operationalized as Parental Reflective Functioning (PRF), is a key protective factor for sensitive caregiving and dyadic regulation. Objectives: This protocol describes a multicenter, open-label, single-arm feasibility study evaluating a brief, fully online, mentalization-based video-feedback intervention (VFI-RF). The study is designed to assess the feasibility and acceptability of the intervention, rather than its efficacy. We aim to recruit 48 mothers, 24 in each of two risk groups, through socio-health services and neonatal intensive care units. Risk Group 1 will include mothers with clinically significant depressive and/or anxiety symptoms, defined as EPDS > 9 and/or GAD-7 ≥ 10, whereas Risk Group 2 will include mothers of preterm infants, defined as infants born before 37 weeks of gestation. Methods: The intervention consists of 8 + 2 synchronous online sessions over approximately 5 months. Mothers record brief everyday caregiving interactions (~5 min) to review with a trained clinician, focusing on the infant’s internal states and reflective meaning-making. Assessments occur at baseline (T0, infant age ~3 months), post-intervention (T1, ~8 months), and follow-up (T2, ~12 months). Primary feasibility outcomes include recruitment/referral metrics, uptake, retention, assessment completion, missing data, and participant-reported acceptability. Secondary exploratory clinical outcomes include maternal PRF, symptoms, parenting stress, social support, and mother–infant attachment, evaluated via validated self-report questionnaires. Results: The study is designed to evaluate referral and recruitment patterns, intervention uptake, and participant retention, as well as the acceptability and suitability of study procedures and outcome measures for a future controlled trial. Preliminary trajectories of change in maternal reflective functioning and early relational indicators will be examined descriptively and exploratorily. Conclusions: Findings will inform the feasibility and refinement of a brief online mentalization-based video-feedback intervention to support at-risk mother–infant dyads during the first postnatal year. Trial registration: Registered on Open Science Framework, osf.io/6g9ja, date of registration 4th March 2026. Full article

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women’s nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women’s experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women’s experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating “good motherhood”; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support. Full article

School Attendance Problems (SAPs) are multidimensional phenomena with significant short- and long-term effects not only for students’ socio-emotional and cognitive development but also for the broader social welfare of the country. Grounded in Self-Determination Theory (SDT), this study examined the associations between self-perceived competence and distinct non-attendance motivations among adolescents at risk for SAPs. In Study 1, Exploratory and Confirmatory Factor Analyses (EFA: n = 391; CFA: n = 593) supported a refined 13-item four-factor structure of the Italian version of the Adolescent Reasons for School Non-Attendance Scale (ARSNA), with satisfactory fit indices (CFI = 0.90; TLI = 0.87; RMSEA = 0.07), demonstrating its suitability for use with Italian adolescents. In Study 2 (n = 183 at-risk adolescents), hierarchical regression analyses, controlling age, gender, academic achievement, and failed subjects, revealed that lower self-perceived academic competence was associated with Truancy-related reasons (β = −0.27, p < 0.01), whereas School Refusal-related reasons were associated with lower self-perceived general (β = −0.23, p < 0.01) and academic competence (β = −0.18, p < 0.05). These findings provide the first Italian validation of the ARSNA and highlight competence-related processes as central mechanisms underlying Truancy and School refusal in at-risk adolescents, with direct implications for early identification and targeted intervention. Full article

Objective: This study examined the prospective association between self-reported physical exercise and depressive symptoms among older adults, and further tested whether loneliness statistically accounted for this association and whether baseline cognitive emotion regulation strategies moderated the exercise–loneliness pathway. Methods: A two-wave prospective survey with a six-month interval was conducted among 980 community-dwelling older adults in Zhengzhou, China. Baseline data were collected in September 2024, and follow-up data were collected in March 2025. Physical exercise was assessed using the Physical Activity Rating Scale-3, depressive symptoms using the 10-item Center for Epidemiologic Studies Depression Scale, loneliness using the 8-item UCLA Loneliness Scale, and cognitive emotion regulation strategies using the short version of the Cognitive Emotion Regulation Questionnaire. Cross-lagged models were used to examine the residual prospective association between physical exercise and depressive symptoms. A two-wave prospective explanatory model was then tested to examine the role of follow-up loneliness, and moderated explanatory (half-longitudinal) analyses were conducted using baseline adaptive and maladaptive cognitive emotion regulation strategies as moderators. Results: Baseline physical exercise was significantly associated with lower depressive symptoms at follow-up after controlling for baseline depressive symptoms and covariates (β = −0.182, p < 0.001). In contrast, baseline depressive symptoms were not significantly associated with follow-up physical exercise (β = −0.016, p = 0.633). Baseline physical exercise was negatively associated with follow-up loneliness (β = −0.267, p < 0.001), and follow-up loneliness was positively associated with follow-up depressive symptoms (β = 0.324, p < 0.001). The indirect association through follow-up loneliness was significant (indirect effect = −0.087, 95% CI [−0.112, −0.065]). Baseline adaptive cognitive emotion regulation strategies strengthened the association between physical exercise and lower loneliness (interaction β = −0.076, p < 0.001), whereas baseline maladaptive strategies weakened this association (interaction β = 0.059, p = 0.004). Conclusions: Self-reported physical exercise was prospectively associated with fewer depressive symptoms among older adults six months later. This association was statistically accounted for, in part, by lower follow-up loneliness, and baseline cognitive emotion regulation strategies were associated with the strength of the exercise–loneliness association. Because this study used a two-wave observational design with the explanatory variable and outcome measured at the same follow-up wave, the findings should be interpreted as prospective associations rather than evidence of causal or temporal mediation. Full article

This systematic review, following PRISMA 2020 guidelines, analyzes scientific literature on bullying and cyberbullying among adolescents (aged 12–16) in educational settings, focusing on ICT, smartphone hyperconnectivity, and emotional education. An exhaustive search across Web of Science, Scopus, PubMed, Dialnet, CSIC, SciELO, and Google Scholar identified 34 empirical studies. A narrative synthesis was performed due to methodological heterogeneity. The synthesized evidence suggests that cyberbullying frequently acts as a persistent extension of school violence, where continuous digital exposure makes it difficult for victims to emotionally disconnect. Empirical data indicate a concerning correlation between prolonged bullying and psychosocial distress, including self-harming behaviors and suicidal ideation. Furthermore, results highlight systemic gaps: heightened vulnerability is reported among girls and LGBTQ+ students, alongside disparities between public and state-subsidized schools regarding institutional involvement and emotional support resources. Educational implications suggest reactive protocols are insufficient. Evidence supports that systematic emotional education, enhancing socio-emotional skills like impulse control, empathy, self-esteem and emotional regulation, acts as a key protective factor. Consequently, fostering “digital emotional intelligence” emerges as a promising preventive educational strategy to protect adolescents’ well-being in hyperconnected environments. Full article

As livestreaming e-commerce rapidly expands, impulsive buying has become increasingly prominent in online consumption. However, although prior studies have examined impulsive buying in general e-commerce contexts, little attention has been paid to impulsive buying in sports livestreaming e-commerce. Drawing on the stimulus-organism-response framework and Dual-System Theory, this study examined the associations among consumer herding tendency, perceived scarcity, hedonic benefits of sales promotion tools, pleasure emotion, trust in seller, and impulsive buying. A cross-sectional self-report survey was conducted with 775 university students in eastern China with prior purchase experience in sports livestreaming e-commerce, and the model was analyzed using partial least squares structural equation modeling. The results showed that consumer herding tendency, perceived scarcity, and hedonic benefits of sales promotion tools were positively associated with pleasure emotion and trust in seller. Perceived scarcity showed the strongest path coefficient with trust in seller. Trust in seller and pleasure emotion were positively associated with impulsive buying, whereas self-control was negatively associated with impulsive buying. Specific indirect associations through trust in seller were generally stronger than those through pleasure emotion. The moderating effect of self-control was not significant, and the gender-based multi-group analysis revealed no significant differences between male and female consumers. Given the cross-sectional self-report design, these findings should be interpreted as associations rather than causal effects. Full article

Background/Objectives: Borderline personality disorder (BPD) is a severe mental disorder characterised by emotion dysregulation, impulsivity and interpersonal hypersensitivity. Its prevalence ranges from 0.5% to 6.4%. Eye tracking and pupillometry provide objective indices of social attention and inhibitory control, but the BPD literature using these techniques has not been systematically reviewed. The aim of this work was to synthesise the empirical evidence on visuo-attentional and pupillary alterations in BPD. Methods: Following the PRISMA 2020 statement, Web of Science, Scopus and PubMed were searched up to 13 March 2026, with no date or language restrictions. Search terms combined borderline personality disorder and eye-tracking constructs. Two reviewers independently screened records with complete inter-rater agreement at the title-and-abstract stage (Cohen’s κ = 1.00); two generative artificial-intelligence assistants (ChatGPT, NotebookLM) were additionally consulted as a non-systematic plausibility check and returned no eligible studies beyond the database search. Risk of bias was appraised with the framework appropriate to each study design (RoB 2 for randomised trials and Newcastle–Ottawa Scale logic for observational studies, with ROBINS-I held in reserve for non-randomised intervention designs). Results: Seventeen studies met the inclusion criteria, with sample sizes ranging from 19 to 164 participants and predominantly adult female samples. Designs included antisaccade and oculomotor tasks, free-viewing, dot-probe, affective priming and pharmacological challenge. Four findings recurred across studies. First, patients with BPD showed an early reflexive vigilance to the eye region of emotional and neutral faces, followed by reduced time on positive stimuli during longer presentations. Second, self-reported impulsivity was elevated, but laboratory inhibition was largely preserved; the deficits that did emerge were limited to preparatory control and were greater in patients with comorbid ADHD or under induced negative affect. Third, autonomic dysregulation was indexed by lower heart-rate variability and a larger baseline pupil size; in a single longitudinal study, pupillary reactivity was prospectively associated with subsequent symptom change. Finally, intranasal oxytocin reduced amygdala-driven vigilance. Conclusions: Eye-tracking and pupillometric measures appear to capture meaningful aspects of the BPD clinical picture. The two-stage profile of early vigilance followed by reduced sustained engagement is most parsimoniously described as a vigilance–avoidance pattern, which is compatible with, but not uniquely explained by, the hypersensitivity hypothesis of emotion dysregulation. Because thirteen of the seventeen studies recruited women only, these conclusions apply primarily to adult women with BPD. Methodological heterogeneity, the predominance of female samples and the scarcity of longitudinal data justify the need for standardised protocols, transdiagnostic comparisons and the inclusion of male and gender-diverse populations in future research. Full article

Background/Objective: Emotion regulation (ER) is closely linked to decision-making (DM). Although executive functions (EF) are often suggested as a key mechanism underlying this relationship, evidence from different clinical conditions remains fragmented. This scoping review aims to map the literature on the relationship between ER and DM in clinical populations, with a specific focus on the interaction between EF and ER in shaping adaptive DM processes, particularly in populations characterised by cognitive impairment and emotional dysregulation. Methods: A search of electronic databases was conducted to identify empirical studies examining ER, EF and DM in clinical populations. Sixteen studies involving patients with dementia, traumatic brain injury, autism spectrum disorder, substance and behavioural addictions were included. Results: Difficulties in ER were associated with altered DM. EF, particularly inhibitory control, working memory, and cognitive flexibility, were found to be key processes linking emotional states to decision outcomes. Clinical groups consistently showed a tendency to prefer immediate rewards despite potential long-term negative consequences and experienced difficulties integrating emotional and cognitive information. Conclusions: This scoping review emphasises the importance of moving beyond reductionist explanations of DM and to adopt an integrative approach. ER and EF should be conceptualised as interacting components of a broader self-regulatory system shaping decision behaviour. Developing this framework will be crucial to enable targeted clinical and neurorehabilitation interventions for individuals experiencing impaired DM. Full article

Objective: Disorders of gut–brain interaction (DGBIs) are characterized by functional impairments without identifiable organic causes, with their prevalence increasing with age. Emerging evidence suggests that selective serotonin reuptake inhibitors (SSRIs), such as escitalopram oxalate, may influence DGBIs through the brain–gut axis, though the precise mechanisms driving their therapeutic effects remain unclear. This study investigated the impact of escitalopram oxalate on elderly patients with DGBIs in an outpatient department to elucidate these mechanisms. Methods: This study was an observational cohort study. We recruited elderly patients diagnosed with DGBIs. Patients receiving standard treatment alone were assigned to the control group, while patients receiving standard treatment plus 10 mg of escitalopram oxalate daily were assigned to the exposure group. Emotional and gastrointestinal symptoms were assessed at baseline and after 12 weeks of treatment using validated symptom scales. Additionally, stool samples were collected at both time points and analyzed via 16S amplicon sequencing to evaluate the changes in gut microbiota. Results: A total of 83 elderly patients with DGBIs were included in the study, comprising 40 patients in the control group and 43 in the exposure group. After 12 weeks, the exposure group showed significantly greater reductions in their scores on the Gastrointestinal Symptom Rating Scale (GSRS), Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) compared with the control group (e.g., GSRS: 17.00 ± 0.85 vs. 22.58 ± 3.18, p < 0.001; p < 0.01 for all other scale comparisons), with higher effective and recovery rates. Notably, the exposure group showed significant alterations in the abundance of four genus-level taxa (Blautia, Butyricicoccus, Prevotellaceae UCG-003, and Streptococcus) and two species-level taxa (Eubacterium-hallii-group and Parabacteroides-merdae). Conclusions: The escitalopram oxalate treatment was associated with significant improvements in both emotional and gastrointestinal symptoms in elderly patients with DGBIs. These improvements may be linked to alterations in specific gut microbiota taxa, offering a preliminary hypothesis for further investigating the underlying mechanisms of the gut–brain axis. Full article

Purpose: This study examined the relationships among attention-deficit/hyperactivity disorder (ADHD) symptoms, emotion dysregulation, and reflective functioning (RF) in adults. Specifically, it explored whether reflective functioning uncertainty—defined as difficulties in understanding one’s own and others’ mental states—was associated with the relationship between ADHD symptom severity and emotion dysregulation. Methods: In this case–control observational study, 40 adults with ADHD and 40 healthy controls completed the Adult ADHD Self-Report Scale (ASRS), the Difficulties in Emotion Regulation Scale (DERS), and the Reflective Functioning Questionnaire (RFQ). Analyses included group comparisons, correlation analyses, linear regression models, and adjusted mediation analysis. Results: Compared with controls, adults with ADHD showed significantly greater emotion dysregulation and higher reflective functioning uncertainty. ADHD symptom severity was positively associated with both emotion dysregulation and reflective functioning uncertainty. Mediation analysis supported a significant indirect effect, whereas the direct effect was not statistically significant, a pattern consistent with a possible indirect pathway. Conclusions: These findings suggest that difficulties in reflective functioning may be associated with the relationship between ADHD symptoms and emotion dysregulation in adults with ADHD. Assessing emotion dysregulation and reflective functioning may improve the clinical characterization of adult ADHD. Further studies with larger samples, longitudinal designs, and multimethod assessment are needed to clarify the directionality and clinical implications of these relationships. Full article

Background/Objectives: Parkinson’s disease (PD) is increasingly recognized as a multisystem disorder affecting perceptual, emotional, and reward-related processes. While arts-based interventions in PD have primarily focused on active creative arts engagement, it remains unclear whether receptive arts engagement with visual art—how artworks are perceived and evaluated—is altered. Our objective is to determine whether aesthetic evaluation of visual artworks differs in individuals with PD compared to age-matched healthy controls. We further examine whether emotional interpretation, color-emotion associations, and experiential responses to art viewing are altered. Methods: In a cross-sectional case–control study, individuals with PD (n = 87) and age-matched healthy controls (n = 49) completed two online assessments. Participants evaluated 36 artworks from the Vienna Art Picture System in terms of liking, beauty, and subjective art attributes. Objective image-derived features were computed for each artwork. Interpretable machine learning models were used to test whether evaluation patterns predicted diagnostic group and to identify determinants of aesthetic judgments. Participants further completed a color-emotion association task using ambiguous expressive portraits and reported perceived changes in cognitive, emotional, motivational, and physical states following art viewing. Results: Aesthetic evaluation patterns did not support reliable classification of PD status, indicating no systematic group differences in liking, beauty, or attribute-based judgments between PD and controls. Instead, aesthetic judgments were robustly predicted by individual differences and objective artwork properties, including art-historical style, symmetry, complexity, and color-related features, whereas diagnostic group, gender, and age did not contribute to predictions. Emotional interpretation and color-emotion associations were largely comparable between groups, with a single specific deviation in color-emotion mapping. Positive emotions were less frequently associated with pink in people with PD. Self-reported experiential responses to art viewing did not differ significantly between groups. Conclusions: Aesthetic evaluation of visual artworks appears largely preserved in people with PD. These findings suggest that, in digital viewing contexts, substantial adaptation of visual content to make it accessible for people with PD may not be necessary, although subtle perceptual and emotional differences may still be relevant. Efforts may instead be better directed toward addressing practical barriers to visual art engagement. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

Background: In the context of population aging and the growing burden of chronic conditions, promoting exercise participation has become an important strategy for supporting healthy aging. However, older adults with chronic conditions often face multiple constraints related to symptom burden, risk perception, and everyday life. A theory-informed understanding of the determinants of exercise participation in this population is therefore needed. Methods: This study adopted a theory-informed qualitative descriptive design and conducted face-to-face semi-structured interviews with 30 community-dwelling older adults with chronic conditions. Purposive sampling was used to ensure variation in age, sex, chronic condition type, and exercise participation. Data were analyzed using the framework method guided by the Theoretical Domains Framework (TDF), and the resulting themes were subsequently mapped onto the Capability, Opportunity, Motivation–Behavior (COM-B) model. Results: Participants were aged 60–86 years, and most were women, had low educational attainment, came from rural backgrounds, and lived with multimorbidity. Participants described exercise participation as a day-to-day process of negotiating symptoms, risk, functional boundaries, and everyday responsibilities rather than as a simple matter of willingness. Although most participants recognized the value of exercise, many lacked disease-specific knowledge about suitable exercise types, safe intensity, progression, and warning signs. Symptom burden and functional limitations constrained exercise, but many participants used symptom-based self-regulation strategies, such as resting, slowing down, or modifying activity when discomfort occurred. Family members, peers, health professionals, and community resources could either facilitate exercise or restrict it, depending on their accessibility, continuity, specificity, and practical relevance. Continued participation was closely linked to perceived benefits, controllable risk, self-efficacy, positive emotional experience, and immediate bodily feedback. Conclusions: Exercise promotion for older adults with chronic conditions should move beyond general advice and provide disease-adapted exercise education, symptom-based self-regulation strategies, family and peer support, professional guidance, age-friendly community resources, and feedback mechanisms that support long-term maintenance. Full article

Problematic smartphone use (PSU) has become an increasingly important public health concern among adolescents, yet the potential protective role of restorative environmental experiences (nature exposure) remains insufficiently understood. Under the perspective of Stress Reduction Theory (SRT) and Attention Restoration Theory (ART), this cross-sectional study examined the association between nature exposure and adolescent PSU, with anxiety and self-control tested as potential mediators. The sample comprised 700 high school students recruited from several high schools in Qinghai Province, China (52.00% female; M age = 17.01 years, SD = 0.78). Nature exposure, anxiety, self-control, and PSU were assessed using self-report measures. The results showed that nature exposure was negatively associated with PSU; anxiety and self-control significantly mediated this association both independently and sequentially. Specifically, more nature exposure was associated with lower anxiety and higher self-control, which, in turn, were associated with lower PSU. These findings suggest that restorative environmental experiences may be associated with reduced vulnerability to PSU through interconnected affective and self-regulatory processes. The present study extends existing literature by integrating emotional and attentional restoration perspectives within a unified framework linking nature exposure to adolescent PSU, and provides implications for the prevention and intervention of PSU. Full article

Background/Objectives: Dental anxiety (DA) is a well-known obstacle affecting dental care in children. Children living in orphanages are a special population with healthcare needs. The aim of the study was to assess DA among children living in orphanages compared to those living with both biological parents. Methods: This frequency-matched case–control study included 61 children living in orphanages in Jeddah city and 122 age- and gender-matched peers living with both parents in Jeddah, Saudi Arabia. Demographic and background data, including medical history, dental visit history, and Adverse Family Experiences (AFEs), were completed by the caregiver. Dental anxiety was assessed subjectively using the self-reported Abeer Children Dental Anxiety Scale (ACDAS) and objectively by the Venham Clinical Anxiety Rating Scale (VCARS). Results: The prevalence of children with DA in the study sample among those living in orphanages was 18%. AFEs were significantly higher among children living in orphanages (96.7% vs. 32%, p < 0.001). ACDAS and VCARS showed fewer children with DA living in orphanages compared to children living with both parents. Logistic regression showed that living in orphanages decreased the adjusted odds ratio (AOR) of dental anxiety according to ACDAS (AOR = 0.36; p = 0.06) and VCARS (AOR = 0.43, p = 0.040). Conclusions: Although children living in orphanages presented with lower DA than those living with both parents, this may point to differences in emotional expression rather than true emotional state. Clinicians should not rely only on behavioral observations when treating institutionalized children. Full article