Antonino Carcione

• MD
• Associate Professor at Marconi University

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology an...

Introduction: Borderline personality disorder (BPD) is marked by emotional instability, interpersonal dysfunction, and high comorbidity, posing significant treatment challenges. Metacognitive Interpersonal Therapy (MIT) targets core features of BPD, including metacognitive impairments and emotional dysregulation. This study uses Latent Transition A...

Background Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional dysregulation, impulsive behaviors, and difficulties in interpersonal relationships. Despite the poor understanding of the underlying biological processes, the oxytocin (OXT) system may be involved in and mediate some of BPD’s symptomatic and beh...

The therapist’s self-disclosure (TSD) interventions are considered beneficial and often used by psychotherapists. However, their use remains controversial for several reasons, including the use of broad definitions neglecting the distinction between the TSD and the therapist's self-involving (TSI) interventions. The TSD interventions involve the re...

Background Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). Method A total of 395 patients with a DSM-5 diagnosi...

Background: Routine outcome monitoring with immediate clinical feedback can improve the effectiveness of psychotherapy. This protocol study represents the first Italian randomized controlled trial (RCT) to evaluate the effectiveness of Feedback Informed Therapy (FIT) to improve patient mental health outcomes and processes. In it, we test a state-of...

Treating patients with Personality Disorders (PDs) means dealing with what are often referred to as complex cases. The complexity of cases stems from several variables and in particular: the high percentage of diagnostic co-occurrences, patients' difficulty in reflecting on their own and others' mental states (i.e., metacognitive impairments), and...

Different psychotherapeutic approaches demonstrated their efficacy but the possible neurobiological mechanism underlying the effect of psychotherapy in borderline personality disorder (BPD) patients is poorly investigated. We assessed the effects of metacognitive interpersonal therapy (MIT) on BPD features and other dimensions compared to structure...

In the context of sleep disturbances, increasing evidence suggests a critical role of sleep-related dysfunctional metacognitive activity, including metacognitive control of intrusive thoughts in the pre-sleep period. Although the relationship between sleep-related thought-control strategies and poor sleep quality is well recognized, the possible co...

Introduction: The present study aimed to adapt the 25-item Hikikomori Questionnaire to the Italian context (HQ-25-I) and to test its psychometric properties in two samples, particularly a sample of residents with psychiatric conditions (n = 117) and a sample of individuals from the community (n = 209). Methods: We tested the fit of the original...

Background: Core symptoms of Borderline Personality Disorder (BPD) are associated to aberrant connectivity of the triple network system (salience network [SN], default mode network [DMN], executive control network [ECN]). While functional abnormalities are widely reported, structural connectivity (SC) and anatomical changes have not yet been inves...

Within the field of cognitive therapy, the importance of the therapist’s emotions in the context of the therapeutic relationship is increasingly recognised. Feelings such as tension, fatigue, and irritation in the therapist are of particular concern during the initial sessions. The pilot study described here found that such feelings may arise when...

Psychotic-like experiences (PLEs) are a phenomenon that occurs in the general population experiencing delusional thoughts and hallucinations without being in a clinical condition. PLEs involve erroneous attributions of inner cognitive events to the external environment and the presence of intrusive thoughts influenced by dysfunctional beliefs; for...

The role of metacognition in gambling disorder (GD) is underexplored. To date, only two studies have investigated the role of metacognitive functioning, but among the adolescent population. The first aim of the current research was to assess and compare adult male gamblers with healthy controls (HCs) in relation to metacognition, impulsivity and em...

For a long time dreamwork in cognitive-behavioural therapy (CBT) was considered useless and as a technique specific to psychodynamic approaches, consequently overlooked in the treatment course. In the last twenty years, thanks to the contribution of neuroscience studies on sleep and dreams, dreams joined the attention and interest of authors belong...

Sommario Il disturbo narcisistico di personalità negli ultimi anni sta assumendo sempre più rile-vanza al di là della diagnosi categoriale espressa dalle correnti classificazioni come il DSM-5. Infatti, mentre la diagnosi categoriale pone in primo piano la grandiosità, trattare il narcisismo come dimensione permette di tener conto della sua eteroge...

In this chapter, we present the case of Enrico, which has all the characteristics of what we can call “complex cases.” The difficulties that the therapist faces in both diagnosis and treatment planning are illustrated. Enrico has a rather varied symptomatology that does not fit into a specific diagnostic framework, and giving multiple categorical d...

This chapter discusses the state of the art of pharmacological treatment of personality disorders from a clinical perspective. Although it is important always to remember that no drug has yet been officially approved for the treatment of personality disorders, the chapter proposes a model of reasoned management of psychopathological and behavioral...

Patients with PD are excessively preoccupied with or excessively detached in their human relationships, and the relationships are unstable, conflictual, hostile, detached. These ways of relating also repeat themselves in the therapeutic relationship, suffusing the therapy with obstacles, more or less predictable disruptions, and possible iatrogenic...

In this chapter, the characteristics of metacognitive interpersonal therapy (MIT) are summarized, and some questions that may be a useful guide, following the conceptualization of the case, in structuring the treatment, establishing priorities, and deciding the proper timing of the interventions are indicated. To explain the specific principles of...

Human beings think, imagine, remember, fantasize, and predict future scenarios. In each of these activities, they create mental representations. Moreover, humans seem to be able to observe these representations, reflect on them, and modify them. We define the abilities that allow us to “think about thinking” using the term "metacognition", but they...

Metacognitive therapy proposes to enhance skills for knowing one’s mind with an eye to a better regulation of problematic mental states. Promoting metacognition and mastery of mental states are, therefore, the main strategic goals of our treatment. The promotion of metacognition is carried out through a set of procedures that break down metacogniti...

This chapter describes the problems caused by impairments in two metacognitive subfunctions, monitoring and integration, and suggests ways to improve them. Monitoring is the ability to identify and label the components of a mental state in terms of emotions, thoughts, motivations, and desires. Impairments of this function compromise both the indivi...

In treating complex cases, it is useful to have a team composed of psychotherapists experienced in the use of different techniques, so as to encourage multidisciplinarity and integration of the different procedures and techniques that modern psychotherapy offers us, in order to face each specific aspect of psychopathology. This chapter illustrates...

MIT is a treatment specific to relatively difficult patients with complex personality and psychotic disorders. Owing to their relational difficulties, these patients can activate problematic interpersonal cycles during treatment, in which the therapist is involved. In turn, relational difficulties are related to reduced metacognitive skills. MIT ai...

Background This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods A total of 155 patients with BED complete...

This book proposes an integrated model of treatment for Personality Disorders (PDs) that goes beyond outdated categorical diagnoses, aiming to treat the general factors underlying the pathology of personality. The authors emphasize the development of metacognitive functions and the integration of procedures and techniques of different psychotherapi...

Background: This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA), in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods: One hundred and fifty-five patients wit...

Objective The Interpersonal Needs Questionnaire (INQ‐15) is a self‐report measure of thwarted belongingness and perceived burdensomeness, two constructs associated with suicidal ideation. The objective of the current study was to translate the INQ‐15 from English to Italian (INQ‐15‐I) and to test its factor structure, reliability, and validity in I...

Mindreading is contingent upon interpersonal context. Little is known about how competitive contexts influence mindreading skills. The idea was that the capacity to think about mental states would decline when individuals experiencing failure in competition. This study aims to assess effects of a competitive experience (a computer competitive PC ga...

Background: Metacognitive functions play a key role in understanding which psychological variables underlying the personality might lead a person with a severe mental disorder to commit violent acts against others. The aims of this study were to: (a) investigate the differences between patients with poor metacognitive functioning (PM group) and pa...

Supporting Information of: Iliceto P, D'Antuono L, Fino E, et al. Psychometric properties of the Italian version of the Interpersonal Needs Questionnaire‐15 (INQ‐15‐I). J Clin Psychol. 2020;1–18. https://doi.org/10.1002/jclp.23026

Objective: This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dys-regulation in patients with binge eating disorder (BED). Method: Forty non-BED-obese and 46 BED-obese patients completed...

Objectives Several studies provided evidences that Personality Disorders (PDs) are characterized by an impairment in the abilities to reflect on one's and others' mental state. These abilities have been often named as metacognition or mentalization. There are also evidences that adverse experiences in childhood (ACE) (abuse, neglect, maltreatment)...

In quest'articolo si discutono i cicli interpersonali problematici che insorgono tra terapeuta e paziente nel trattamento dei disturbi di personalità. I cicli interpersonali vengono affrontati da tre livelli teorici. In primo luogo presentiamo i costrutti che ci permettono di cogliere e descrivere il fenomeno e chiamiamo questo livello teorico: teo...

Traumatic experiences are a risk factor for suicide and non-suicide self-injury. However, it has been hypothesized that the relation between trauma and self-harm is not a direct one, rather it is mediated by dissociation. The scope of this work is to review advances in psychopathology and pathophysiology of dissociation and its role in the context...

Background: Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The "gold standard" treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to asse...

Introduction: Both clinical observations and empirical data suggest that the ability to think about the mental states of themselves and others (i.e., metacognition) is a crucial factor strongly associated to the outcome of individual psychotherapies. Although it has been hypothesized that the activation of cooperation between patient and psychothe...

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a...

Background Grandiose narcissism has been associated with poor ability to understand one’s own mental states and the mental states of others. In particular, two manifestations of Narcissistic Personality Disorder (NPD) can be explained by poor mindreading abilities: absence of symptomatic subjective distress and lack of empathy. Methods We conducte...

Database file. All the variables described in the reported studies are included in the database. (SAV)

Social sharing capacities have attracted attention from a number of fields of social cognition and have been variously defined and analyzed in numerous studies. Social sharing consists in the subjective awareness that aspects of the self’s experience are held in common with other individuals. The definition of social sharing must take a variety of...

Objective: Avoidant personality disorder (AvPD) is closely related to and partially overlaps with social phobia (SP). There is an ongoing debate as to whether AvPD and SP can be classified as separate and distinct disorders or whether these diagnoses rather reflect different degrees of severity of social anxiety. The hypothesis of this study is tha...

Objective: Metacognition is a multi-component psychological construct, characterized by the ability to identify and describe one’s own mental states and those of others. Evidence has been found for an association between impairments in metacognitive abilities and poor social functioning, low quality of life, severity of psychopathology in Personali...

Objective: Metacognition is a multi-component psychological construct, characterized by the ability to identify and describe one's own mental states and those of others. Evidence has been found for an association between impairments in metacognitive abilities and poor social functioning, low quality of life, severity of psychopathology in Personali...

The ability to reflect on one's own states of mind and those of others (metacognition or mindreading) is strongly implicated in personality disorders (PDs). Metacognition involves different abilities, and there is evidence that specific abilities can be selectively impaired in different PDs. The purposes of this study were to compare metacognitive...

Objective: Metacognition is a multi-component psychological construct, characterised by the ability to identify and describe one’s own mental states and those of others. Evidence has been found for an association between deficits in metacognitive abilities and poor social functioning, low quality of life, psychopathology, and symptoms in Personalit...

The aim of this study was to explore the relationships among empathy processes in terms of self-report empathy evaluation and recognition of emotional cues and Theory of Mind components. We used the Empathy Quotient - short form (EQ-s), the Pictures of Facial Affect (POFA) system, a (ToM) Irony appreciation task and the Wisconsin Card Sorting Test...

The capacity of understanding mental states is a complex function which involves several components. Single components can be selectively impaired in specific clinical populations. It has been suggested that impairments in mindreading are central for borderline personality disorder (BPD). However, empirical findings are inconsistent, and it is deba...

Maladaptive perfectionism is a common factor in many disorders and is correlated with some personality dysfunctions. Less clear is how dimensions, such as concern over mistakes, doubts about actions, and parental criticism, are linked to overall suffering. Additionally, correlations between perfectionism and personality disorders are poorly explore...

Significant metacognitive impairments are observed in first episode psychosis (FEP) and chronic psychosis samples. There is evidence of associations between metacognition and presentation in FEP, but the relative contribution of metacognitive understanding of the self and the other is as yet unclear. The current study is a secondary analysis of dat...

Il presente lavoro ha come scopo di utilizzare le tecniche di scaling per rappresentare in uno spazio tridimensionale le dissimilarità (o similarità) tra le dimensioni della metacognizione in soggetti clinici. La metacognizione viene descritta nei termini di una funzione composta da abilità distinte, ipotesi confortata anche dagli ultimi dati prove...

Metacognitive impairment is crucial to explaining difficulties in life tasks of patients with personality disorders (PDs). However, several issues remain open. There is a lack of evidence that metacognitive impairments are more severe in patients with PDs. The relationship between severity of PD pathology and the extent of metacognitive impairment...

Abstract Personality Disorders (PDs) can reasonably hope to gain benefit from psychotherapy. Nevertheless many patients do not fully respond. Research therefore has to be done into which variables need to be targeted in psychotherapy, in order to tailor treatment to the needs of the majority of PD patients. These have to date been understudied, in...

Significant metacognitive impairments are observed in chronic psychosis samples but metacognition is less understood in first episode psychosis (FEP). The current study explored correlations between metacognition, symptoms and premorbid functioning in an FEP sample. In a cross-sectional cohort study, individuals in the first 12months of treatment m...

Personality disorders are better understood as entities that vary according to severity along specific domains rather than a phenomenon separate from and unrelated to Axis I disorders. This study explores whether patients who were rated as having greater numbers of personality disorder traits reported greater levels of interpersonal problems, psych...

Background: Metacognition is a multi-facet psychological construct; deficits in metacognitive abilities are associated to low social functioning, low quality of life, psychopathology, and symptoms. The aim of this study was to describe and develop a valid and reliable interview for assessing metacognition. Methods: The semi-structured interview,...

Research indicates that many with schizophrenia experience deficits in metacognitive capacity or the ability to form complex representations of themselves and others. Previous work has found that metacognitive capacity in schizophrenia is correlated with symptoms, insight, and neurocognitive deficits. We sought to replicate these results in a sampl...

Research indicates that many with schizophrenia experience deficits in metacognitive capacity or the ability to form complex representations of themselves and others. Previous work has found that metacognitive capacity in schizophrenia is correlated with symptoms, insight, and neurocognitive defi-cits. We sought to replicate these results in a samp...

Psychotherapists need to perform tasks such as being empathetic, performing an ongoing assessment of cases, self-disclosing, making explicit treatment contracts, validating patients' experiences and promoting awareness of psychological experience, if they are to be effective in treating personality disorder (PD). Successful therapy also requires a...

Metacognition has been shown to be impaired in people diagnosed with schizophrenia, and related to poorer social functioning. To date, no research has looked at the relationship between a particularly rare – but problematic – social functioning outcome (violence) and metacognition. The present study explored patterns of metacognition in people diag...

Poor awareness of one's own emotions and theory of mind appears to be a feature of many adult psychiatric conditions. In this study, we explored whether alexithymia and poor understanding of irony, both elements of the metacognitive system, were impaired in a clinical sample (n = 20) when compared to a non-clinical group (n = 35). We expected that...

Impairment in the ability to recognize and make sense of emotions has been hypothesized to be present in a sub-sample of people suffering from personality disorder (PD). In particular it is possible that difficulty recognizing and expressing feelings, or alexithymia, is related to many of the symptoms and problems in making sense of social interact...

Objectives. Deficits in metacognition, or the ability to think about thinking, are common in schizophrenia and associated with functional impairment. Unknown are what elements of function are affected by what aspects of metacognition. Design. This study explored whether participants with differing capacities for Mastery, a domain of metacognition t...

Individuals with personality disorders (PDs) have difficulties in modulating mental states and in coping with interpersonal problems according to a mentalistic formulation of the problem. In this article we analyzed the first 16 psychotherapy sessions of 14 PD patients in order to explore whether their abilities to master distress and interpersonal...

It remains unclear what processes lead to the establishment of persecutory delusions in acute phases of schizophrenia. Recently, it has been argued that persecutory delusions arise from an interaction among a range of emotional, cognitive and social factors. In this work, we explored this possibility by first discussing the relevant aspects of rece...

Many persons with schizophrenia experience poor insight or reflexive unawareness of the symptoms and consequences of their illness and, as a result, are at risk for treatment nonadherence and a range of negative outcomes. One recent theory regarding the origins of poor insight in schizophrenia has suggested that it may result, in part, from deficit...

RIASSUNTO Questo studio misura l'alessitimia nei disturbi di personalità (DP), correlandola con i tratti di personalità, i sintomi e i problemi interpersonali, in un campione di 388 sog-getti afferenti ad un centro di psicoterapia cognitiva. I soggetti sono stati valutati con la Toronto Alexithymia Scale (TAS-20), l'Intervista Clinica Strutturata p...

Recognition that recovery from schizophrenia may involve a deepening of the experience of being in the world has led to the possibility that psychotherapy may play a key role in treatment by enhancing metacognition, or the capacity to think about thinking. While the potential of psychotherapy to enhance metacognition in non-psychotic disorders has...

Many persons with personality disorders (PD) have problems contemplating mental states and using psychological knowledge to cope with their suffering and solve social problems, the skill termed metacognition in this article. Therapists can focus on metacognitive dysfunctions in order to tailor PD treatment to clients' metacognitive skills. To brief...

It remains unclear what processes lead to the establishment of persecutory delusions in acute phases of schizophrenia. Recently, it has been argued that persecutory delusions arise from an interaction among a range of emotional, cognitive and social factors. In this work, we explored this possibility by first discussing the relevant aspects of rece...

Dagli anni '90, il III Centro di Psicoterapia Cognitiva di Roma si è impegnato nell'attività clinica e di ricerca sul trattamento di pazienti gravi e difficili da trattare. In questo lavoro verranno analizzati alcuni tra i più importanti lavori pubblicati dal Gruppo in questo ambito. Si tratta di ricerche sul processo terapeutico condotte a partire...

Individuals with personality disorders (PDs) have difficulties in modulating mental states and in coping with interpersonal problems according to a mentalistic formulation of the problem. In this article we analyzed the first 16 psychotherapy sessions of 14 PD patients in order to explore whether their abilities to master distress and interpersonal...

There is an emerging empirical evidence that patients with eating disorders have severe metacognitive concerns, i.e. ability to reflect on mental states. This single-case study aims to explore the relationship between limited metacognition and eating symptoms in six patients who attended a long-term group treatment. This study also aims at analysin...

Impairments in metacognition are believed to be closely linked with functional impairments among persons with schizophrenia. Recently, we proposed a method for assessing multiple domains of metacognition by rating a narrative generated by a semi-structured interview with an abbreviated form of the Metacognition Assessment Scale (MAS). Less is known...

Background: The therapeutic relationship plays a key role in personality disorder (PD) psychotherapy. Some aspects of therapeutic relationship regulation appear important for treatment of PD clients, including those with constricted relational schemas, poor metacognition, and over-regulation of affects described here. AIM.: To propose a rational m...

Research has indicated that many with schizophrenia experience deficits in metacognitive capacity, defined as impairments in the ability to think about thinking. These difficulties are related to, but not reducible to symptoms and have been hypothesized to function as an independent impediment to psychosocial function. To explore the possibility th...

Since mid 90's the Third Centre of Cognitive Psychotherapy in Rome has been interested in the research and treatment of severe and difficult to treat patients;. In this work we analyze some of the most important publications on this issue. These are researches on the therapeutic process led by the clinical observation which suggests that some speci...

Sommario Dagli anni '90, il III Centro di Psicoterapia Cognitiva di Roma si è impegnato nell'attività clinica e di ricerca sul trattamento di pazienti gravi e difficili da trattare. In questo lavoro verranno analizzati alcuni tra i più importanti lavori pubblicati dal Gruppo in questo ambito. Si tratta di ricerche sul processo terapeutico condotte...

Deficits in the ability to make sense of mental states both of oneself and others, which we term metacognition, is a key difficulty in persons with schizophrenia and psychotherapy needs to address this deficit in order to be effective. We describe here the steps in the treatment of a young woman meeting the criteria for paranoid schizophrenia. Trea...