Emotional competencies and psychological distress: Is loneliness a mediating factor?

Emotional competencies, such as emotion regulation and empathy, are essential for social interaction. Impairment of these skills has been associated with increased rates of anxiety/depressive symptoms and loneliness, which has been defined as the discrepancy between the desired and actual quality and quantity of social relationships a person maintains. The aim of the present study was to shed light on the associations between these constructs and to examine the possible mediating role of loneliness in the relationship between emotional competencies and anxiety/depressive symptoms in a sample of non-clinical individuals. A total of 298 participants were recruited for this study and were asked to complete a series of measures assessing difficulties in emotion regulation, empathy, loneliness, and anxiety/depressive symptoms. Regression and mediation models were tested to analyze the associations between these variables. Results showed that reduced emotional competencies in emotion regulation and empathy were both directly and indirectly associated with increased anxiety/depressive symptoms and emotional loneliness, which in turn was related to higher levels of psychological distress (with a partial mediation of loneliness). Overall, the present findings seem to indicate that emotional competencies play a key role in the experience of loneliness and psychological distress. Therefore, individuals reporting high levels of loneliness in combination with anxious/depressive symptoms should receive appropriate assessment and treatment of emotion regulation and empathic skills.

Alexithymia and Hypertension: Does Personality Matter? A Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: Personality characteristics, such as alexithymia, may lead to alterations in the autonomic nervous system functionality, predisposing individuals to an increased risk of hypertension (HTN). The present meta-analysis aimed to quantify the presence of alexithymia in people with HTN and to assess for potential sources of heterogeneity between studies. PubMed, PsycINFO and Scopus databases were systematically searched, using the following strings: ("alexithymia" OR "alexithymic") AND ("hypertension" OR "hypertensive"). Data were meta-analyzed with random-effects models. RECENT FINDINGS: A total of 13 studies met the inclusion criteria. The prevalence of alexithymia in people with and without HTN were obtained from 5 studies (26.3% vs 15.0%; pooling of odd ratios, 3.15 [95% CI, 1.14;8.74]), whereas the mean level of alexithymia between people with and without HTN was obtained from 7 studies Hedges g, 1.39 [95% CI, -0.39;3.16]). There was a significant association between alexithymia prevalence and year of article publication (g = -0.04; 95% CI, -0.07;-0.01), whereas no significant relationship was detected between the former and both sex and age. Findings revealed a greater prevalence of alexithymia in people with HTN than in participants without HTN. These findings suggest that alexithymia may contribute to both the onset and persistence of HTN symptomatology. However, future research is needed to clarify this association.

Adherence to oral chemotherapy: Evidence from a randomised clinical trial.

OBJECTIVE: To evaluate the efficacy of a reinforcement message (RM) administered by a hospital pharmacist on adherence, through a randomised study involving patients undergoing oral chemotherapy from which an objective outcome measure and patients' subjective opinions were collected. A secondary aim was to detect which psychological or clinical factors influence adherence. METHODS: Forty patients were enrolled and randomised to an experimental group (EG) or a control group (CG). The EG received a 10-minute RM provided by a hospital pharmacist with a doctor and a nurse. The CG received the standard of care. To measure adherence, plasma drug concentration and subjective evaluation were taken during the visits, in addition to a psychological assessment (coping strategies, psychological distress and personality traits). RESULTS: The EG reported higher drug levels and a statistically significant higher mean score on the subjective evaluation. A linear regression model highlighted statistically significant differences in the plasma drug concentration, after considering toxicity and dose reduction and controlling for the Reward Dependence Scale of the Temperament and Character Inventory between the EG and the CG. CONCLUSION: Adequate information and education on the therapy, using an RM strategy provided by a hospital pharmacist, seems to positively influence adherence to the treatment.

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis.

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients' quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia.

Fibromyalgia (FM) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self-awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem-focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally-oriented thinking factor of alexithymia significantly explained both problem- and emotion-focused coping, while the difficulty-describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.

Psychosomatic syndromes in fibromyalgia.

OBJECTIVES: The aim of this study was to compare the prevalence of psychosomatic symptoms in patients with fibromyalgia (FM) or rheumatoid arthritis (RA). METHODS: Seventy-six consecutive women with FM and 80 with RA without concomitant FM were assessed using the Diagnostic Criteria for Psychosomatic Research (DCPR) interview to evaluate the presence of psychosomatic syndromes. Beck Depression Inventory - II (BDI-II) and Form Y of the State-Trait Anxiety Inventory (STAI-Y) were administered in order to assess the symptoms of anxiety and depression. RESULTS: Significantly higher levels of anxiety and depression were found in the FM patients (p<0.001), and each FM patient (as against 79% of the RA patients) presented at least one DCPR syndrome. Comparisons of psychological distress between the FM patients with and without each of the psychosomatic syndromes revealed high levels of anxiety and depression in the patients with the psychosomatic condition. CONCLUSIONS: The findings of this study highlight the greater presence of psychological distress and psychosomatic syndromes in patients with FM than in RA patients. The FM patients with psychosomatic symptoms also showed high levels of psychological distress. A better understanding of the psychosomatic manifestations of FM syndrome could allow clinicians to structure tailored interventions that take more account of the emotional distress associated with the physical complaints.

Psychological distress and coping in nasopharyngeal cancer: an explorative study in Western Europe.

Nasopharyngeal carcinoma (NPC) is the head and neck cancer with the greatest impact on patients' quality of life. The aim of this explorative study is to investigate the psychological distress, coping strategies and quality of life of NPC patients in the post-treatment observation period. Twenty-one patients disease-free for at least two years were assessed with a medical and a psycho-oncological evaluation. Clinically relevant depressive symptoms (CRD) were present in 23.8% of patients and 33.3% reported clinically relevant anxiety symptoms (CRA). Patients with CRD and CRA showed a significantly higher score in the use of hopelessness/helplessness and anxious preoccupation coping strategies and a worse quality of life. Even in the post-treatment period, about a quarter of patients showed CRD and CRA. Results showed that patients with high anxiety or depressive symptoms seem to use dysfunctional coping strategies, such as hopelessness and anxious preoccupation, more than patients with lower levels of anxiety and depression. The use of these styles of coping thus seems to be associated to a higher presence of CRA or CRD symptomatology and to a worse quality of life.

Post-traumatic growth, distress and attachment style among women with breast cancer.

Identifying factors fostering post-traumatic growth (PTG) is very important to promote PTG itself through specific psychological interventions. To this end, we investigated PTG and its relationship with clinical and psychological variables in a sample of 108 female breast cancer survivors. Results showed that women with higher depressive symptoms presented lower levels of PTG than women without. Moreover, women who had undergone combined treatment presented higher levels of PTG than women who had not. The results highlighted the resulting importance of psychological intervention focusing on depressive symptoms, which negatively interfere with the patients' psychological growth.

Alexithymia in Chronic Pain Disorders.

This review proposes a critical discussion of the recent studies investigating the presence of alexithymia in patients suffering from different chronic pain (CP) conditions. The term CP refers to pain that persists or progresses over time, while alexithymia is an affective dysregulation, largely observed in psychosomatic diseases. Overall, the examined studies showed a high prevalence of alexithymia, especially difficulties in identifying feelings, in all the different CP conditions considered. However, the association between alexithymia and pain intensity was not always clear and in some studies this relationship appeared to be mediated by negative effect, especially depression. The role of alexithymia in CP should be clarified by future studies, paying particular attention to two aspects: the use of additional measures, in addition to the Toronto Alexithymia Scale, to assess alexithymia, and the analysis of the potential differences in the evolution of different CP conditions with reference to the presence or absence of alexithymia.

A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data.

OBJECTIVES: Fibromyalgia syndrome (FMS) is a chronic disorder characterised by widespread musculoskeletal pain, troubled sleep, disturbed mood, and fatigue. Recently published reviews have demonstrated that it is influenced by various psychological aspects, and antidepressants are now considered the treatment of choice for most patients. The aim of this randomised controlled trial was to compare the effects of duloxetine and acetyl L-carnitine on pain, depression, anxiety and well-being in FMS patients. METHODS: Sixty-five female outpatients with FMS diagnosed by a rheumatologist were recruited between January 2011 and May 2012, and randomised to receive duloxetine 60 mg/day or acetyl L-carnitine 1500 mg/day (500 mg t.i.d.). Drug efficacy and side effects were assessed by the same psychiatrist at baseline, and four and 12 weeks later. RESULTS: Both drugs led to a general clinical improvement, with positive effects on pain and depressive symptoms; but neither induced a significant improvement in anxiety. Both drugs had a positive effect on the physical component of the quality of life, but only duloxetine improved the psychological component. CONCLUSIONS: Although they need to be confirmed by further studies, these preliminary findings confirm the efficacy of duloxetine, and suggest that acetyl L-carnitine is also efficacious in improving depressive symptoms, pain, and the quality of life of FMS patients.

Confirmatory factor analysis of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) among Italian medical students.

OBJECTIVE: A steady increase in the number of patients requiring end-of-life care has been observed during the last decades. The assessment of healthcare students' attitudes toward end-of-life care is an important step in their curriculum, as it provides information about their disposition to practice palliative medicine. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B) was developed to detect such a disposition, but its psychometric properties are yet to be clearly defined. METHOD: A convenience sample of 608 second-year medical students participated in our study in the 2012/2013 and 2013/2014 academic years. All participants completed the FATCOD-B. The sample was randomly divided in two subsamples. In the item analysis, reliability (Cronbach's α), internal consistency (item-total correlations), and an exploratory factor analysis (EFA) were conducted using the first subsample (n = 300). Using the second subsample (n = 308), confirmatory factor analysis (CFA) was performed using the robust ML method in the Lisrel program. RESULTS: Reliability for all items was 0.699. Item-total correlations, ranging from 0.03 to 0.39, were weak. EFA identified a two-dimensional orthogonal solution, explaining 20% of total variance. CFA upheld the two-dimensional model, but the loadings on the dimensions and their respective indicators were weak and equal to zero for certain items. SIGNIFICANCE OF RESULTS: The findings of the present study suggest that the FATCOD-B measures a two-dimensional construct and that several items seem in need of revision. Future research oriented toward building a revised version of the scale should pay attention to item ambiguity and take particular care to distinguish among items that concern emotions and beliefs related to end-of-life care, as well as their subjects (e.g., the healthcare provider, the patient, his family).

Psychological Preparedness of Psychologists during the COVID-19 Emergency: Are There Any Individual Differences?

The COVID-19 outbreak has posed an unprecedented global challenge. However, despite the large amount of evidence on the psychological consequences of the pandemic, very few studies have focused on psychologists themselves. (1) Background: The present study aimed to characterise the professional and clinical profile of psychologists facing the COVID-19 outbreak and to investigate the relationship between psychological preparedness and a series of potential predictors (e.g., sociodemographic and professional variables and psychological distress). (2) Methods: A total of 1115 psychologists fully completed an online survey. The data collection period started with the first wave of the pandemic. Participants were asked to provide sociodemographic and professional data and to complete three questionnaires assessing psychological preparedness, worry, and anxiety symptoms. (3) Results: Descriptive results showed that the COVID-19 outbreak did not cause an interruption to the psychological practice of professionals (both in the public and in private sectors) and that psychologists accepted the introduction of technological devices within their regime of work in order to guarantee their service to clients. Only a minority of participants reported clinically significant levels of symptoms of anxiety and worry. Regression analyses revealed that being older, having taken part in training courses on the COVID-19 emergency, and experiencing lower levels of worry and anxiety were all significant predictors of both cognitive and affective psychological preparedness. (4) Conclusions: Taken together, these findings seem to highlight that specific factors can enhance psychological preparedness among psychologists. Therefore, it is vital to inform authorities about the importance of providing emergency programmes to train healthcare workers, especially psychologists, on how to develop psychological preparedness when facing the negative consequences of critical incidents at a universal level, given their crucial role in promoting mental health.

On the Relationship Between Alexithymia and Social Cognition: A Systematic Review.

Objective: This systematic review summarises the studies that have investigated the relationship between dimensions of social cognition (i.e., Theory of Mind - ToM, emotion recognition, and empathy) and alexithymia in the general adult non-clinical population. Method: PubMed, PsycINFO, and Scopus databases were screened, using the following strings: ("alexithymi*") AND ("theory of mind" OR "ToM"); ("alexithymi*") AND ("empath*"); ("alexithymi*") AND ("emotion recognition"); ("alexithymi*") AND ("social cognition"). Results: A total of 117 studies met the inclusion criteria and were included in this review. The total number of participants included in the reviewed studies was 40,231. Mixed results were found for alexithymia and ToM, while the relationship between emotion recognition or empathy and alexithymia was more homogeneous. Alexithymia was found to be significantly associated with both a reduced ability to recognise emotions and empathy. Conclusions: These results support the existence of significant relationships between alexithymia and altered social cognitive abilities. Future research is needed to confirm the present findings and further elucidate the complex relationship between these processes. Suggestions are made on how to overcome some of the theoretical and methodological problems in the literature.

Intimate Partner Violence and Alexithymia: Do Emotions Matter? A Systematic Review and Meta-Analysis.

Intimate partner violence (IPV) encompasses physical, sexual, or psychological abuse. Recent evidence suggests that victims and perpetrators might share some common psychological characteristics. Particularly, high levels of alexithymia, a difficulty in identifying and expressing emotions, and an externally oriented thinking style were found in both victims and perpetrators when compared to the general population. This systematic review and meta-analysis aimed to quantify the levels of alexithymia in victims and perpetrators of IPV and compare these levels to controls. We systematically searched PubMed, PsycINFO, Web of Science, and Scopus databases, using the following strings: ("intimate partner violence" OR "IPV" OR "partner abuse") AND ("alexithymia" OR "alexithymic"). The inclusion criteria were: adult perpetrators or victims of IPV; with or without a rehabilitation program; having or not a comparison group from the general population; alexithymia as outcome; all types of study design. Seventeen studies met the inclusion criteria. Data were meta-analyzed with random-effects models. Results showed comparable levels of alexithymia in victims and perpetrators of IPV (mean = 55.92 vs. 55.15, respectively). Furthermore, we found increased alexithymia in victims (Hedges' g, 0.87 [95% CI 0.43, 1.31]) and perpetrators (Hedges' g, 0.94 [95% CI 0.77, 1.12]) compared to controls. These results highlight that both perpetrators and victims exhibited high levels of alexithymia. A deeper understanding of this psychological dimension can help professionals to plan better-tailored interventions, in which all relevant factors associated with IPV are considered.

The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment.

Background and purpose: This exploratory prospective observational study investigated the changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points. Materials and methods: We assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3). Results: The data showed that HRQoL decreased during active treatments, especially between T1 and T2 (p = 0.005), before increasing again at follow-up (p = 0.002).Baseline intestinal symptoms (p < 0.001) and negative affectivity trait (p = 0.03) significantly predicted HRQoL at T0. Baseline pain (p < 0.001), intestinal (p = 0.003) and urinary (p = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 (p = 0.013), psychological distress (p = 0.003), mouth symptoms (p = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 (p = 0.006), psychological distress (p = 0.004), mouth (p = 0.002) and pain symptoms (p = 0.002) at T3 significantly predicted HRQoL at T3. Conclusion: Several physical and psychological factors are involved in the changes occurring after diagnosis in RCPs' HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.

Inflammatory Bowel Disease and Irritable Bowel Syndrome: What Differences in Mentalization Abilities? A Scoping Review.

Mentalization is a psychological process that enables individuals to understand the self and others in terms of intentional mental states. The aim of this scoping review was to provide an overview of the findings on mentalization in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). A literature search, in line with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols extension for Scoping Review guidelines, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Scopus. Databases were queried using the following strings (with Boolean operators): ("mentaliz*" OR "metacogniti*" OR "theory of mind" OR "ToM" OR "reflective function*") AND ("irritable bowel syndrome" OR "IBS" OR "inflammatory bowel disease" OR "IBD"). In line with the eligibility criteria, seven articles were included. Results showed that no significant differences in metacognitive ability were found between patients in the IBD and IBS groups. This review revealed the mentalizing difficulties for patients with IBD and IBS. These results should be interpreted with caution since they are based on a few studies that used different instruments to assess mentalizing processes. Future studies are needed to clarify the role of mentalization in patients with these gastrointestinal conditions.

Expanded version of the Posttraumatic Growth and Depreciation Inventory: Scale validation and refinement among Italian adults.

OBJECTIVE: The main aim of this study was to investigate the psychometric properties of the Italian version of the newly-developed Posttraumatic Growth and Depreciation Inventory (PTGDI-X) in a heterogeneous sample of Italian adults who had experienced a traumatic event. METHOD: The instrument was translated following the forward-backward method and completed by 601 participants who met the inclusion criteria. The factorial structure of the PTGDI-X was assessed by means of multiple confirmatory factor analyses (CFA). Convergent and discriminant validity and reliability were also evaluated. RESULTS: The results of the CFA revealed that the original 5-factor model was the best fit for the growth (PTG) dimension of the PTGDI-X, whereas it poorly fit the data with respect to the depreciation (PTD) component. With regard to convergent and divergent validity, positive correlations were found between the PTG scores and the core belief disruption and rumination scores, whereas the PTG factors correlated negatively with depressive and posttraumatic symptom measures. Conversely, positive correlations were identified between the PTD total score and all the other investigated constructs. Finally, the total scales and subscales of the PTG/PTD dimensions revealed good to excellent internal consistency. CONCLUSIONS: The current findings indicate that the Italian version of the PTGDI-X appears to be a valid assessment tool for the multidimensional structure of the PTG component. Future research is needed, on the other hand, to confirm the validity of the PTD dimension in the Italian population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alexithymia and psychological distress in fibromyalgia: prevalence and relation with quality of life.

OBJECTIVES: Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with other symptoms like fatigue, stiffness, non-restorative sleep and psychological distress that strongly affects the quality of life in FM patients. While the psychological distress has been widely explored in FM, only a few studies investigated alexithymia, an emotional dysregulation trait. AIMS: Evaluate the prevalence of alexithymia and psychological distress and their impact on patients quality of life. METHODS: A battery of tests assessing alexithymia, depression, anxiety, emotional distress symptoms and the health related quality of life (HRQoL) was filled out by 55 female FM patients. After having analysed their prevalence, two regression analyses were performed in order to evaluate the role that alexithymia, depression, anxiety, emotional distress and pain characteristics have on quality of life of FM patients. RESULTS: Results showed that a clinically relevant level of psychological distress was present in more than half of our sample, whereas alexithymic traits were present in 20% of the patients. Regression analyses showed that pain intensity, depression and current pain were the variables that best contribute to explain the physical component of the HRQoL while anxiety, depression and pain intensity were the variables that mainly contributed to explain the mental component of quality of life. CONCLUSIONS: These results underline the high prevalence of alexithymia in FM patients and the great impact of psychological symptoms on FM patients HRQoL. Wholistic care of FM patients which addresses both physical and psychological symptoms is needed.

Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: a pilot study.

OBJECTIVES: This study aimed to compare the tolerability and efficacy of two different titrations of paroxetine (slow and standard) in a population of cancer patients with depression. METHODS: This randomized open trial included 30 cancer patients with depression (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and aimed to compare the safety of slow up-titration (arm A) versus standard up-titration (arm B) of paroxetine chlorhydrate. In both arms, the maximum final dose was 20 mg/day. Patients were evaluated at baseline and after 2, 4, and 8 weeks with rating scales for depression and anxiety (MADRS, HADS, HAM-A, CGI), quality of life (EORTC-QLQ-30), and side effects (DOTES, SIDE). RESULTS: Thirty consecutive cancer patients (F = 21; M = 9) meeting DSM-IV TR criteria for mood disorders (MD) were enrolled in the study and randomly assigned to slow or standard paroxetine titration. Both treatment groups showed a significant mood improvement (change in MADRS total score) from baseline to end point (arm A-F(2,18) = 33.68 p < 0.001; arm B-F(2,12) = 6.97 p < 0.005). A significantly higher rate of patients in arm A compared with arm B showed no side effects after 2 weeks (40% vs. 6.7%, respectively). A multinomial logistic regression confirmed such differences between arms (chi square = 20.89 p = 0.004). The self-evaluating scale (SIDE) confirmed this difference: 60% of subjects in arm B perceived side effects compared to only 11.1% of patients in arm A. CONCLUSIONS: The results of this study suggest that slow paroxetine up-titration is better tolerated and at least as effective as the standard paroxetine up-titration in cancer patients with depression.