Reading of ingroup politicians' smiles triggers smiling in the corner of one's eyes.

Spontaneous smiles in response to politicians can serve as an implicit barometer for gauging electorate preferences. However, it is unclear whether a subtle Duchenne smile-an authentic expression involving the coactivation of the zygomaticus major (ZM) and orbicularis oculi (OO) muscles-would be elicited while reading about a favored politician smiling, indicating a more positive disposition and political endorsement. From an embodied simulation perspective, we investigated whether written descriptions of a politician's smile would trigger morphologically different smiles in readers depending on shared or opposing political orientation. In a controlled reading task in the laboratory, participants were presented with subject-verb phrases describing left and right-wing politicians smiling or frowning. Concurrently, their facial muscular reactions were measured via electromyography (EMG) recording at three facial muscles: the ZM and OO, coactive during Duchenne smiles, and the corrugator supercilii (CS) involved in frowning. We found that participants responded with a Duchenne smile detected at the ZM and OO facial muscles when exposed to portrayals of smiling politicians of same political orientation and reported more positive emotions towards these latter. In contrast, when reading about outgroup politicians smiling, there was a weaker activation of the ZM muscle and no activation of the OO muscle, suggesting a weak non-Duchenne smile, while emotions reported towards outgroup politicians were significantly more negative. Also, a more enhanced frown response in the CS was found for ingroup compared to outgroup politicians' frown expressions. Present findings suggest that a politician's smile may go a long way to influence electorates through both non-verbal and verbal pathways. They add another layer to our understanding of how language and social information shape embodied effects in a highly nuanced manner. Implications for verbal communication in the political context are discussed.

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The Italian validation of the MIES adapted to the healthcare setting yielded a three-factor structure: (a) 'perceived transgressions by self'; (b) 'perceived transgressions by others'; (c) 'perceived betrayals by others'.Findings suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency.Future research should consider the role of individualising and social binding moral principles in shaping moral injury experiences among healthcare professionals across different socio-cultural settings.

Attachment anxiety and depressive symptoms in undergraduate medical students : The mediating role of emotion regulation strategies.

INTRODUCTION: Several studies report that medical students are at high risk of depression. Despite the variability in students' vulnerability to depression, the role of individual differences in depression risk among medical students has hardly been investigated. Studies outside of medical student populations have shown that individual differences in attachment style and emotion regulation participate in vulnerability to depression. OBJECTIVES: This study investigates to what extent medical students' depressive symptoms are related to differences in students' insecure attachment styles and their perception of reduced access to emotion regulation strategies. METHODS: In a cross-sectional quantitative study, undergraduate medical students at the beginning of their second academic year completed online questionnaires measuring their attachment style, difficulties in emotion regulation, and depressive symptoms. RESULTS: Out of the 390 medical students invited, 267 participated in the survey. Higher secure attachment was associated with fewer depressive symptoms. Medical students' insecure attachment style and emotion dysregulation were significantly related to depressive symptoms. Difficulties in employing strategies to disengage from one's own negative affect partly mediated the effects of two dimensions of insecure anxious attachment-need for approval and preoccupation with relationships-on depressive symptoms. DISCUSSION: Anxious attachment style and limited access to emotion regulation strategies participate in medical students' depressive symptoms. These findings highlight the need for acknowledging medical students' attachment style and students' perceived access to emotion regulation strategies for the early identification of and intervention programs for the risk of depression.

COVID-19 fear, post-traumatic stress, growth, and the role of resilience.

Understanding the factors through which pandemic fear may be associated not just with distress, but also with growth outcomes is crucial to informing interventions across population groups and cultural settings. To achieve this aim, in a cross-sectional study, we examined the relationship between the fear of COVID-19, post-traumatic stress and post-traumatic growth while assessing the moderating role of trait resilience. Findings showed that fear of COVID-19 was associated with both stress and growth outcomes and that resilience was a significant moderator of these effects. Specifically, trait resilience acted as a buffer against post-traumatic stress and as a booster factor for appreciation for life. Given the imbalance between needs and resources in times of global pandemic, interventions promoting psychological wellbeing should leverage existing resources and consider psychological resilience as a valuable target to protect against negative and optimise positive outcomes.

The Interpersonal Dimension of Pandemic Fear and the Dual-Factor Model of Mental Health: The Role of Coping Strategies.

(1) Background: Current COVID-19 research has mainly focused on negative outcomes associated with fear of the pandemic with the examination of potentially positive outcomes remaining underexplored. Based on the dual-factor model of mental health, which postulates positive and negative dimensions, we assessed the influence of COVID-19 fear on both negative and positive mental health outcomes and examined the mediational role of coping strategies. (2) Methods: A convenience sample of 231 respondents participated in an online survey reporting on measures of pandemic fear (SFS), distress (HADS), post-traumatic growth (PTGI) and individual differences in terms of coping strategies (CSI-SF). (3) Results: Respondents' main concerns related with the pandemic highlighted the interpersonal and social dimensions implicated in fear of COVID-19. As expected, fear of the pandemic was associated not just with negative but also positive outcomes, while different coping strategies played a role in determining such effects. More specifically, disengagement coping mediated the effects of fear on anxiety and depression, whereas engagement coping was the only mediator of the relationship between COVID-19 fear and post-traumatic growth. (4) Conclusions: Approaches to promote psychological wellbeing in the context of the COVID-19 pandemic should on the one hand be sensitive to the needs of the more vulnerable population groups, while on the other leverage existing resources to harness the potential for growth. Strengthening engagement coping in the context of fears triggered by the pandemic may constitute a valuable target to protect against negative and optimize positive mental health outcomes in the general population.

Nail surgery: the effect of clinical and psychological characteristics on post-surgical quality of life and pain severity

Background: Nail disease and nail surgery are commonly perceived as painful and distressful experiences that can significantly affect patient health-related quality of life. A comprehensive management of patients undergoing dermatological surgery could improve their emotional experience, influence quality of life and, hopefully, improve their adaptation to the intervention. Objectives: This study aimed to investigate whether patient psychological characteristics may relate to nail intervention procedures and influence post-surgical quality of life and pain severity. Materials & Methods: This prospective observational monocentric cohort study was conducted in the Dermatology Nail Unit of Bologna. Patient candidates for nail surgery, meeting the inclusion criteria, were invited to participate in the study which consisted of completion of a self-report questionnaire before (Time 1) and one month after (Time 2) surgery. Results: Nail surgery was performed for 102 patients: 46 underwent highly invasive and 56 mildly invasive nail procedures. In total, 46 nail tumours were excised which were shown to be benign in 36 cases and malignant in 10 cases. Patients with a high level of pain sensitivity and trait of anxiety reported significantly lower levels of quality of life and high levels of pain intensity one month after surgery (p < 0.001). Conclusion: Our findings highlight the need for clinicians to consider the psychological characteristics of patients following dermatological surgery care in order to balance the negative impact of trait anxiety, pain sensitivity and negative treatment expectations regarding post-surgery quality of life and pain severity.

Burnout, Attachment and Mentalization in Nursing Students and Nurse Professionals.

(1) Background. In caretaking professions, attachment style and mentalization capacities are essential factors for establishing an effective caretaker-patient relationship and for buffering burnout. While attachment avoidance and dependency are considered risk factors for burnout, impairment in mentalization capacity is associated with psychological distress and ineffective emotion regulation. (2) Objective: Evaluating the attachment style and mentalization capacity in nurse professionals and nursing students. We further investigated the impact of these factors on burnout in professional nurses. (3) Method: 94 nursing students and 94 controls and 34 professional nurses completed the Attachment Style Questionnaire (ASQ) and the Reflective Functioning Questionnaire (RFQ). For professional nurses, the Maslach's Burnout Inventory (MBI) was also administered. (4) Results: Nursing students exhibited lower scores in secure attachment and higher scores in anxiety over relationships compared to controls while no difference in mentalization capacity was found between both groups. Importantly, attachment anxiety resulted a significant predictor of burnout in professional nurses. (5) Conclusions: Nursing students might compensate their attachment insecurity with high mentalization. Attachment security may play a protective role against burnout in the professional nurses. Education programs aimed at enhancing mentalizing abilities might facilitate nursing students' entrance in the forthcoming clinical environment and practice. Implementing training strategies based on attachment theory may contribute to burnout prevention in nurse professionals.

Individual Differences in Emotion Dysregulation and Social Anxiety Discriminate between High vs. Low Quality of Life in Patients with Mild Psoriasis.

A deeper understanding of how health-related quality of life relates to the clinical and individual characteristics of patients is essential for the delivery of patient-centered dermatological care. The current study aimed to examine the role of individual differences in emotion dysregulation and social anxiety in modulating quality of life in psoriatic patients. A total of 130 patients affected by psoriasis were consecutively enrolled in the study as they approached the Dermatology Unit of Sant'Orsola-Malpighi Hospital of Bologna. Clinical information gathered included illness severity, assessed with the Psoriasis Area and Severity Index (PASI) and the Body Surface Area (BSA); illness onset; familiarity; and prescribed treatment. The patient-reported outcome measures were the Dermatology Life Quality Index (DLQI), measuring the patient's quality of life; the Psoriasis Skin Appearance Bothersomeness scale (PSAB), measuring patient's perception of illness severity; the Difficulties in Emotion Regulation Scale (DERS), assessing emotion dysregulation traits; and the Social Interaction Anxiety Scale (SIAS), measuring anxiety about social interactions. Patients with moderate-to-severe psoriasis reported significantly lower quality of life compared to mildly affected patients. In addition, of the patients affected by mild psoriasis, those characterized by emotion dysregulation and social anxiety traits showed significantly lower levels of quality of life. Our findings suggest that individual differences in emotion dysregulation and social anxiety contribute to health-related quality of life in addition to illness severity. Therapeutic approaches that combine dermatological care with psychological support, especially focused on emotional regulation skills, may be useful to improve clinical outcomes in patients with psoriasis.

Helping patients connect remotely with their loved ones modulates distress in healthcare workers: a tend-and-befriend hypothesis for COVID-19 front liners.

The no-visitor policies endorsed by healthcare organizations to limit COVID-19 virus risk exposure have unfortunately contributed to the isolation of patients further exacerbating distress in relatives and frontline healthcare workers. To contrast such effects, many healthcare institutions have adopted technology-based solutions helping patients and families communicate online through the aid of virtual devices. To date, no study has investigated whether facilitating patient-family videocalls would mitigate distress levels in frontline healthcare professionals. Caring for emotional needs of patients by re-establishing affiliative connections interrupted by the pandemic through patient-family videocalls is expected to mitigate distress in engaged healthcare workers as an example of a tend-and-befriend response to stress caused by the pandemic. We tested this hypothesis in a cross-sectional study conducted during 1-30 June 2020, involving 209 healthcare workers (nurses = 146; physicians = 63) engaged in the COVID-19 frontline in Italy. Half of participants in our sample (n = 107) had assisted efforts aimed at connecting patients remotely with families through videocalls. Psychological distress measures included symptoms of burnout, post-traumatic stress, anxiety, depression, and difficulty in sleep and wakefulness. Partially in line with our expectations we found a modulation effect specific for professional category: nurses assisting patient-family videocalls reported significantly lower levels of distress and a better quality of wakefulness compared to those who did not, whereas physicians reported higher levels of distress during such virtual communications. We interpret these findings from the perspective of patient-family communication and differences in skills and training between nurses and physicians. These findings highlight that technology-based solutions aimed at reducing barriers and alleviating distress in healthcare settings should be promoted in concert with skill enhancement training for healthcare professionals especially in terms of communicating online and communicating difficult topics with patients and families.

La política de no recibir visitas que ha sido legitimada por organizaciones de atención de salud para limitar el riesgo de la exposición al virus COVID-19 ha contribuido en forma desafortunada al aislamiento de los pacientes, lo que aumenta el malestar/angustia en familiares y en trabajadores de salud de la primera línea. Para contrastar tales efectos, muchas instituciones de salud han adoptado soluciones basadas en la tecnología para ayudar a pacientes y familiares a comunicarse en línea a través de la ayuda de dispositivos virtuales. Hasta la fecha, ningún estudio ha investigado si es que la facilitación de video llamadas paciente-familiares pudiese mitigar el nivel de angustia en profesionales de salud de primera línea. Se espera que el cuidado de las necesidades emocionales de los pacientes mediante el restablecimiento de conexiones afilativas interrumpidas por la pandemia a través de video llamadas entre el paciente y la familia ayude a mitigar la angustia en los trabajadores de la salud como un ejemplo de una respuesta de "cuidar y hacer amigos" a la angustia causada por la pandemia. Probamos esta hipótesis en un estudio transversal realizado entre el 01 y el 30 de junio del 2020, en la que participaron 209 trabajadores de la salud (enfermeras=146; médicos=63) involucrados en la atención de la primera línea del COVID-19 en Italia. La mitad de los participantes en nuestra muestra (n=107) habían asistido a esfuerzos destinados a conectar a los pacientes en forma remota con sus familias a través de video-llamadas. Las medidas de angustia psicológica incluyeron síntomas de burnout, estrés postraumático, ansiedad, depresión, dificultad para dormir y estar despiertos. Parcialmente en línea con nuestras expectativas, encontramos un efecto modulador específico para la categoría profesional: Las enfermeras que asistían las video llamadas de los pacientes con sus familias reportaron significativamente menor nivel de angustia y una mejor calidad de vigilia en comparación con las que no lo hicieron, mientras los médicos reportaron mayores niveles de angustia durante tales comunicaciones virtuales. Interpretamos estos hallazgos desde la perspectiva de la comunicación paciente-familia y las diferencias en las habilidades y formación entre las enfermeras y los médicos. Estos hallazgos destacan que las soluciones basadas en la tecnología destinadas a reducir las barreras y aliviar la angustia en los entornos de atención de salud deben promoverse junto con la capacitación para la mejora de habilidades para profesionales de la salud especialmente en términos de comunicarse en línea y comunicar temáticas difíciles a pacientes y familiares.

Professional framing and emotional stability modulate facial appearance biases in nursing students.

AIM: Providing the same standard of care to all patients alike, regardless of race, gender, age or any other irrelevant characteristic is imperative in the healthcare profession. In this study we examined whether and to what extent unintentional evaluations based on facial appearance of others affect nursing students' readiness to approach them and provide nursing care. METHOD: A cross-sectional study was conducted from November 2018 to July 2019. Nursing students (N = 160) enrolled in the Nursing Degree Course of School of Medicine of Bologna University, completed a self-report questionnaire assessing personality traits and evaluated photographs of trustworthy, untrustworthy and neutral-looking male and female faces, while indicating their own approach behavior in a series of social interaction and caretaking scenarios. RESULTS: Trustworthy faces elicited a higher approach readiness than untrustworthy and neutral ones across scenarios. Nonetheless, the nursing care scenario facilitated the approach toward others perceived as untrustworthy. Emotional stability trait further enhanced the approach of untrustworthy-looking others and provision of impartial care. CONCLUSION: Present findings suggest that facial appearance bias among nursing students may be downregulated by activating cognitive representations of their professional role as future caretakers and their caretaking motivation. This speaks of the need to integrate as early as possible into existing nursing education programs simulation scenarios aimed to increase emotional awareness and model nursing students' future relational and caring skills.

Tending and mending: Affiliative responses to the COVID-19 pandemic by healthcare professionals in Italy.

The physical and social isolation measures associated with the 2019 novel coronavirus (COVID-19) outbreak, although certainly necessary to contain the spread of the virus, represent a particularly distressing aspect that might accentuate the fears and pain associated with the disease, especially for patients, their family members, and health-care professionals. Affiliative responses to the crises are emerging as ad hoc or formally endorsed practices within COVID-19 facilities in Italy, aimed at establishing links of communication between patients and family members by using new communication technologies. Tending to the emotional needs of patients and mending the affiliative connections interrupted by the disease are good examples of interdisciplinary cohesion and affiliative responses to the COVID-19 emergency. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Author Correction: Unfolding political attitudes through the face: facial expressions when reading emotion language of left- and right-wing political leaders.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

(Not so) Smart sleep tracking through the phone: Findings from a polysomnography study testing the reliability of four sleep applications.

An increasing number of sleep applications are currently available and are being widely used for in-home sleep tracking. The present study assessed four smartphone applications (Sleep Cycle-Accelerometer, SCa; Sleep Cycle-Microphone, SCm; Sense, Se; Smart Alarm, SA) designed for sleep-wake detection through sound and movement sensors, by comparing their performance with polysomnography. Twenty-one healthy participants (six males, 15 females) used the four sleep applications running on iPhone (provided by the experimenter) simultaneously with portable polysomnography recording at home, while sleeping alone for two consecutive nights. Whereas all apps showed a significant correlation with polysomnography-time in bed, only SA offered significant correlations for sleep efficacy. Furthermore, SA seemed to be quite effective in reliable detection of total sleep time and also light sleep; however, it underestimated wake and partially overestimated deep sleep. None of the apps resulted capable of detecting and scoring rapid eye movement sleep. To sum up, SC (functioning through both accelerometer and microphone) and Se did not result sufficiently reliable in sleep-wake detection compared with polysomnography. SA, the only application offering the possibility of an epoch-by-epoch analysis, showed higher accuracy than the other apps in comparison with polysomnography, but it still shows some limitations, particularly regarding wake and deep sleep detection. Developing scoring algorithms specific for smartphone sleep detection and adding external sensors to record other physiological parameters may overcome the present limits of sleep tracking through smart phone apps.

The Role Of Effective Radiation Therapist-Patient Communication In Alleviating Treatment-Related Pain And Procedural Discomfort During Radiotherapy.

PURPOSE: Managing radiotherapy (RT)-induced pain is essential for reducing the likelihood of treatment interruption and improving the chance of tumor control. The current study aimed to examine the role of radiation therapist (RTTs) interaction and effective information communication in modulating patients' experiences of pain and discomfort during RT. METHODS: Participants were 91 cancer patients undergoing RT for the first time referred to the Radiotherapy Unit of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Patient-reported outcome measures included patient satisfaction with the quality of the relationship and the information received by the RTTs, assessed by the Communication with RTTs - Shortened, scale, and pain and discomfort experienced during RT, assessed through two VAS scales. Attitudes toward RT were also assessed. All measures were collected as patients were approximately halfway through the overall RT duration (on average at the end of the 12th session). RESULTS: Patient satisfaction with RTT relationships and treatment-information communication was significantly related to RT-induced pain intensity and patient attitudes toward RT. The more satisfied patients were with RTT interactions and communication, the more positive their attitudes were toward RT and the lower the pain intensity experienced during treatment. CONCLUSION: Clinical implications can be drawn in terms of highlighting the need for RTTs to be mindful of their technical and supportive role in delivery of patient care and in structuring treatment information content in a way that contrasts potential nocebo effects related to patients' negative expectations about RT. The findings support the idea that RTTs may benefit from training interventions and structured education sessions with a focus on interpersonal skills and patient-centered communication.

Unfolding political attitudes through the face: facial expressions when reading emotion language of left- and right-wing political leaders.

Spontaneous emotionally congruent facial responses (ECFR) to others' emotional expressions can occur by simply observing others' faces (i.e., smiling) or by reading emotion related words (i.e., to smile). The goal of the present study was to examine whether language describing political leaders' emotions affects voters by inducing emotionally congruent facial reactions as a function of readers' and politicians' shared political orientation. Participants read sentences describing politicians' emotional expressions, while their facial muscle activation was measured by means of electromyography (EMG). Results showed that reading sentences describing left and right-wing politicians "smiling" or "frowning" elicits ECFR for ingroup but not outgroup members. Remarkably, ECFR were sensitive to attitudes toward individual leaders beyond the ingroup vs. outgroup political divide. Through integrating behavioral and physiological methods we were able to consistently tap on a 'favored political leader effect' thus capturing political attitudes towards an individual politician at a given moment of time, at multiple levels (explicit responses and automatic ECFR) and across political party membership lines. Our findings highlight the role of verbal behavior of politicians in affecting voters' facial expressions with important implications for social judgment and behavioral outcomes.

There Is a Limit to Your Openness: Mental Illness Stigma Mediates Effects of Individual Traits on Preference for Psychiatry Specialty.

Objective: The widening gap between the need for mental health professionals and the low percentages of medical students pursuing a psychiatric career urges an examination of how individual traits, stigma attitudes, and related intended behaviors interact to better explain the variance in preferences for psychiatry as a specialty choice. Methods: Participants were second-year, preclinical medical students at Bologna University, Italy. The study consisted in completion of an online questionnaire evaluating preferences for the psychiatry specialty (one single item and a scenario-based response), personality traits (the Big Five Questionnaire), attitudes (Mental Illness for Clinicians' Attitude scale), behaviors (Reported and Intended Behavior Scale), and fears toward mental illness (questionnaire created ad hoc). Sociodemographic data were also collected. Results: A total of 284 medical students [58.8% female, mean (SD) age 20.47 ± 1.90] completed the questionnaire. Preference for the psychiatry specialty was significantly and positively associated with openness to experience and negatively related with Mental Illness for Clinicians' Attitude scale and Reported and Intended Behavior Scale. The full-mediation model provided good indices explaining 18% of the variance. Mental illness stigma was strongly and negatively associated with both openness to experience and preference for psychiatry, and the mediation results evidenced a positive and significant effect. Conclusions: Mental illness stigma influences medical students' choice of psychiatry as a specialty, accounting for the effects of the openness to experience trait. Stigma awareness and reduction programs should be introduced as early as possible in medical education.