Improving Purpose in Life in School Settings.

Background and aim: The dimension of purpose in life (PiL) is one of the core features of eudaimonia and plays a crucial role in developmental settings. However, few studies have examined purpose in life in younger generations and verified if it is amenable to improvements following a wellbeing-promoting intervention. The aim of the present investigation is to explore correlates and predictors of purpose in life in school children and to test if it can be ameliorated after school-based wellbeing interventions. Methods: A total of 614 students were recruited in various schools in Northern Italy. Of these, 456 belonged to junior high and high schools and were randomly assigned to receive a protocol of School Well-Being Therapy (WBT) or a psychoeducational intervention (controls). A total of 158 students were enrolled in elementary schools and received a positive narrative intervention based on fairytales or were randomly assigned to controlled conditions. All students were assessed pre- and post- intervention with Ryff scales of eudaimonic wellbeing (short version) and with other self-report measures of anxiety, depression and somatization. Additionally, the Strengths and Difficulties Questionnaire (SDQ) was administered to their schoolteachers as observed-rated evaluation. Results: In both elementary and high schools, purpose in life after the intervention was predicted by initial depressive symptoms and by group assignment (positive interventions vs. controls). In older students, PiL was predicted by female gender and anxiety levels, while no specific strengths identified by teachers were associated with PiL. Conclusions: PiL plays an important and strategic role in developmental settings, where students can develop skills and capacities to set meaningful goals in life. Depressive symptoms and anxiety can be obstacles to developing PiL in students, while positive school-based interventions can promote this core dimension of eudaimonia.

The use of narrative strategies based on fairytales as a novel, integrative ingredient in CBT: a case report.

Even though cognitive behavioral therapy (CBT) is often the recommended treatment for mental health problems, it may present limitations when dealing with existential or moral issues. The aim of this case report is to describe the introduction of narrative techniques based on traditional fairytales in the process of CBT, in order to overcome treatment resistances and to help the patient in dealing with major life crises. In the case presented, the joint use of these two techniques helped the patient to achieve the right self-distance from her problems, allowing her to reach a new, wider perspective and a subjective self-maturation.

Positive Narrative Group Psychotherapy: the use of traditional fairy tales to enhance psychological well-being and growth.

BACKGROUND: Oral narrative strategies have rarely been applied in the positive psychology domain. Traditional folk and fairy tales are concerned with several concepts that are now scientifically investigated by research on positive psychology, such as resilience, self-realization, personal growth and meaning in life. The aim of this pilot study was to apply a new narrative approach based on fairy tales (Märchen, tales of magic, rise tales) told, discussed, and written in a group context for the purpose of promoting psychological well-being and growth. METHODS: A group intervention consisting of 7 sessions was delivered to 21 women who reported adjustment disorder. The group was conducted by a folklorist and a clinical psychologist. Each session consisted of an introduction to a number of themes recurring in fairy tales as well as references to the social uses of narratives, followed by a discussion with the participants. In two concluding workshops, participants were asked to work as a group to write their own original fairy tale. Assessment pre- and post-intervention was performed with the Ryff Psychological Well-being Scale, the Kellner Symptom Questionnaire and 2 subscales of the Posttraumatic Growth Inventory (Appreciation of Life and personal strengths). RESULTS: Participants reported increased personal growth, self-acceptance, and an enhanced sense of appreciation of life and personal strengths, together with decreased levels of anxiety. CONCLUSIONS: This pilot investigation suggests the feasibility and positive effect of a group intervention based on narrative strategies for promoting well-being and growth in stressed women. Considering its promising results, clinical implications and possible further applications are discussed.

Alexithymia in the medically ill. Analysis of 1190 patients in gastroenterology, cardiology, oncology and dermatology.

OBJECTIVE: To use the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing alexithymia in a large and heterogeneous medical population, in conjunction with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and other DCPR criteria. METHOD: Of 1305 patients recruited from 4 medical centers in the Italian Health System, 1190 agreed to participate. They all underwent an assessment with DSM-IV and DCPR structured interviews. A total of 188 patients (15.8%) were defined as alexithymic by using the DCPR criteria. Data were submitted to cluster analysis. RESULTS: Five clusters of patients with alexithymia were identified: (1) alexithymia with no psychiatric comorbidity (29.3% of cases); (2) depressed somatization with alexithymic features (23.4%); (3) alexithymic illness behavior (17.6%); (4) alexithymic somatization (17%) and (5) alexithymic anxiety (12.8%). CONCLUSIONS: The results indicate that DCPR alexithymia is associated with a comorbid mood or anxiety disorder in about one third of cases; it is related to various forms of somatization and abnormal illness behavior in another third and may occur without psychiatric comorbidity in another subgroup. Identification of alexithymic features may entail major prognostic and therapeutic differences among medical patients who otherwise seem to be deceptively similar since they share the same psychiatric and/or medical diagnosis.

[Promoting psychosocial well-being in adolescence. A controlled study]. / La promozione del benessere psicologico nell'adolescenza. Uno studio controllato.

INTRODUCTION: In the recent years a large body of literature has focused its attention to the study of the positive aspects of adolescence, in particular quality of life, happiness and social functioning. The school is an ideal setting for promoting learning abilities, educational processes and also optimal human and social development. AIM: A new school program for the promotion of psychological well-being has been tested and compared to an attention-placebo intervention in a high school setting. METHODS: Nine classes (227 students) were enrolled in the study and randomized to: a) School Well-Being Therapy intervention (5 classes); b)attention-placebo (4 classes). 1) Symptom Questionnaire (SQ); 2) Psychological Well-Being Scales (PWB); 3) Revised Children's Manifest Anxiety Scale (RCMAS) were administered at pre- and post-intervention, and after six months. RESULTS: WBT school intervention was associated to an improved Personal Growth (PWB), and to decreased distress (Somatization (SQ), Physical Well-being (SQ), Anxiety (SQ), and RCMAS Physiological Anxiety). DISCUSSION AND CONCLUSIONS: A school intervention focused on the promotion of positive emotions and psychological well-being has resulted to be effective not only in increasing these dimensions in high school students, but also in decreasing distress, in particular anxiety and somatization.

[Italian validation of Multiple Visual Analogue Scales for Bipolarity (MVAS-BP) of Ahearn and Carroll]. / Validazione italiana delle scale visive analogiche multiple per la bipolarità (Multiple Visual Analogue Scales for Bipolarity, MVAS-BP) di Ahearn e Carroll.

AIM: The aim of the present study was to validate the Italian version and to assess the clinimetric properties of Ahearn and Carroll's Visual Analogue Scales for Bipolarity (MVAS-BP), a self-rating questionnaire measuring affective state. METHOD: MVAS-BP consist of 26 items: 1 item assesses overall mood, 2 items anger and 23 items are based on the Carroll model of bipolar disorder (Consummatory Reward, Incentive Reward, Central Pain, Psychomotor Regulation). MVAS-BP have been translated into Italian and administered with Kellner's Symptom Questionnaire (SQ), Ryff's Psychological Well-Being Scales (PWB), and Cloninger's Tridimensional Personality Questionnaire (TPQ) to a normative sample of 450 people. The assessment was repeated after one month. Test-retest reliability, means scores, differences according to sociodemographic variables and correlations among the scales of MVAS-BP, SQ, PWB and TPQ were performed in order to assess clinimetric properties. RESULTS: Test-retest coefficients were highly significant. Significant sex differences were found in the scales of consummatory reward, central pain, psychomotor regulation and anger. MVAS-BP scales were significantly related with symptom and well-being scales, but with very low correlation coefficients, and only with one personality dimension, TPQ Harm Avoidance. DISCUSSION: MVAS-BP has been found to possess clinimetric properties and to record specific and different information from those investigated by other questionnaires.

The pregnant uterus as a psycho-endocrine organ.

The pathogenesis of preterm birth (PTB) is largely unknown and the endocrine stress pathway is likely to participate in the mechanisms allowing onset of labor. However, the vast majority of the studies evaluating psychosocial distress denied an association with PTB. Uterine contractility rather than PTB seems associated with distress in pregnancy.

[The use of Well-Being Therapy in childhood: clinical cases]. / L'applicazione della Well-Being Therapy nell'infanzia: esemplificazioni cliniche.

Anxiety, mood and somatoform disorders are among the most prevalent forms of psychological suffering during childhood and adolescence. If untreated, these problems can be predictors of more severe disorders in adulthood. New trends in clinical psychology suggest the relevance of focusing on child's competencies and developing optimal functioning in youth. A specific psychotherapeutic strategy for enhancing well-being (Well-Being Therapy; WBT) has been developed for adult patients and it was found to be effective in determining remission from affective symptoms, in improving psychological well-being and in preventing relapses. In this article we describe a modified form of WBT which has been applied for the first time to children suffering from emotional and behavioral disorders in order to test its feasibility and potential effects in reducing symptoms and in improving new skills. Four cases particularly interesting by a clinical point of view are reported. This new therapeutic approach, based on the promotion of psychological well-being seems to be a very promising intervention: children improved at post treatment and during 1 year follow-up, both in symptomatology and in social skills. The promotion of psychological well-being and optimal functioning is an innovative and relevant ingredient and could play an important role in the treatment of somatic and psychosocial symptoms in paediatric settings.

Differential effects of well-being promoting and anxiety-management strategies in a non-clinical school setting.

The aim of the present study was to examine the differential effects of strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non-clinical school setting.162 students attending middle schools in Northern Italy were randomly assigned to: (a) a protocol derived from WBT; (b) an anxiety-management protocol (AM). The students were assessed immediately before and after the interventions, and after 6 months using: Psychological Well-Being Scales (PWB), Symptom Questionnaire (SQ) and the Revised Children's Manifest Anxiety Scale (RCMAS). In school children, well-being and symptom focused interventions produced slightly different effects on psychological dimensions. WBT, by facilitating progression toward positive and optimal functioning, may integrate symptom-centered strategies.

[What are the differences between well-being therapy and anxiety management in the school setting?]. / La well-being therapy e le tecniche di gestione dell'ansia in ambito scolastico: quali differenze?

BACKGROUND: In the last decade there has been increasing interest in the potential of early preventive interventions capable of promoting psychological well being in order to reduce the risk of childhood psychological distress. This study analyzes the differential effects of strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non clinical school setting. METHODS: Our sample consisted of eight classes (N=162 students) attending middle schools in Northern Italy which were randomly assigned to a protocol derived from WBT (4 classes) and to an anxiety-management protocol (AM) (4 classes). Immediately before and after both school interventions students were assessed using the Psychological Well-Being Scales (PWB), Kellner's Symptom Questionnaire (SQ) and the Revised Children's Manifest Anxiety Scale (R-CMAS). A six month follow-up was performed in the following school year, and students were re-assessed with the same psychometric instruments. RESULTS: Our results lend support to the possibility to change attitudes to psychological well-being and distress with brief interventions in school (both well-being improving and distress removing). CONCLUSIONS: Further investigations should determine whether the combined and sequential integration of well-being and symptom oriented strategies may yield more complete and lasting effects that each strategy alone.

School intervention for promoting psychological well-being in adolescence.

OBJECTIVE: to test the efficacy of a new school program for the promotion of psychological well-being. In this study a school program for promoting psychological well-being has been compared to an attention-placebo intervention in a high school setting. METHODS: Nine classes (227 students) were randomly assigned to: a) Well-Being intervention (5 classes); b)attention-placebo (4 classes). Assessment was performed at pre and post-intervention, and after six months using: 1) Symptom Questionnaire (SQ); 2) Psychological Well-Being Scales (PWB); 3) Revised Children's Manifest Anxiety Scale (RCMAS). RESULTS: A significant effect of WB school intervention in improving Personal Growth (PWB), and in decreasing distress (Somatization (SQ), Physical Well-being (SQ), Anxiety (SQ), and RCMAS Physiological Anxiety) emerged. CONCLUSIONS: A school intervention based on promoting positive emotions and well-being was effective not only in increasing psychological well-being among adolescents, but also in decreasing distress, in particular anxiety and somatization.

Assessing somatization with various diagnostic criteria.

BACKGROUND: Somatization is a widespread clinical phenomenon that cuts across diagnostic categories, both psychiatric and medical. OBJECTIVE: This study investigates whether somatization can be assessed with a comprehensive diagnostic system, the Diagnostic Criteria for Psychosomatic Research (DCPR) in gastroenterology and cardiology (myocardial infarction) patients. METHOD: Authors assessed a group of 343 outpatients, 190 gastroenterology and 153 cardiology outpatients, with functional gastrointestinal disorders and recent first myocardial infarction. RESULTS: A total of 146 patients were diagnosed by the DCPR Somatization cluster and 106 by the DCPR Abnormal Illness Behavior cluster; 27 patients who met DSM-IV criteria for somatoform disorders were not classified with any DCPR somatization syndromes, whereas 120 with DCPR Somatization cluster did not satisfy the criteria for DSM-IV somatoform disorders. CONCLUSION: Findings suggest that the DCPR is able to identify clinical and subthreshold psychosomatic syndromes and that it can used jointly with the DSM-IV.

Psychosocial factors associated with preterm uterine contractions.

BACKGROUND: The aim of our study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. METHODS: In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled. The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care. They were matched for parity and gestational age. RESULTS: Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls. They also displayed a reduced environmental mastery. CONCLUSION: Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.

Psychological factors affecting cardiologic conditions.

There are substantial data supporting a strong relationship between cardiovascular diseases and psychological conditions. However, the criteria for scientific validation of the entities currently subsumed under the DSM-IV category of 'Psychological factors affecting a medical condition' have never been clearly enumerated and the terms 'psychological symptoms' and 'personality traits' that do not satisfy traditional psychiatric criteria are not well defined; moreover, it is difficult to measure these subtypes of distress and there is always the need for a clinical judgment. In recent years psychosomatic research has focused increasing attention on these clinical and methodological issues. Psychosocial variables that were derived from psychosomatic research were then translated into operational tools, such as Diagnostic Criteria for Psychosomatic Research; among these, demoralization, irritable mood, type A behavior are frequently detected in cardiac patients. The joint use of DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research allow then to identify psychological factors that seem to affect cardiologic condition. There remains the need to further investigate if treating both clinical and subsyndromal psychological conditions can improve quality of life and reduce the risk of morbidity and mortality in these patients.

Psychosocial impairment in patients treated for pituitary disease: a controlled study.

OBJECTIVE: To verify whether patients with pituitary disorders in remission and on appropriate treatment display significant differences in psychological distress compared to healthy controls and other patients treated for nonpituitary endocrine disorders. DESIGN: A single-centred, controlled study. PATIENTS: Eighty-six outpatients cured or in remission for at least 9 months following appropriate treatment by surgery, irradiation and/or pharmacological interventions for pituitary disease were compared with 86 healthy subjects. A sample comprising 60 outpatients cured or in remission from nonpituitary endocrine disorders was also compared. MEASUREMENTS: (1) A modified version of the Structural Clinical Interview for DSM-IV; (2) a shortened version of the structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR); (3) the Psychosocial Index (PSI); and (4) the Medical Outcomes Study (MOS) short form General Health Survey (SF-20) were employed. RESULTS: Patients with pituitary disease displayed a higher prevalence of psychiatric disease (P < 0.001) compared to controls, but not when compared to nonpituitary endocrine patients. They also showed a higher prevalence of DCPR clusters compared to controls (P < 0.001), but not when compared to nonpituitary endocrine patients. At PSI and MOS (SF-20), patients with endocrine disease, whether pituitary or not, reported more psychological distress, and less well-being (P < 0.001) compared to controls. CONCLUSIONS: At follow-up after appropriate treatment, we documented a high prevalence of psychopathology in patients with pituitary disease, which was however, similar to that found in nonpituitary endocrine patients. This is consistent with an increasing body of literature that reports difficulties in obtaining full recovery in patients treated for endocrine disorders.

Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V.

BACKGROUND: Adjustment disorders have been found to be the most frequent psychiatric diagnosis in the medically ill. Problems have been raised, however, as to their clinical value. The aim of the study was to characterize the psychosomatic features of adjustment disorders. METHODS: One hundred patients with medical illness and a diagnosis of adjustment disorder according to DSM-IV criteria were interviewed according to the Diagnostic Criteria for Psychosomatic Research (DCPR) system, consisting of 12 clusters. RESULTS: A considerable overlap was shown between adjustment disorders and DCPR clusters related to abnormal illness behavior (health anxiety, tanatophobia, nosophobia and illness denial) (54%), somatization (functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction) (37%) and demoralization (33%). Only 13 of the patients with adjustment disorders did not present any DCPR syndromes. LIMITATIONS: The study is cross-sectional and does not allow to determine the prognostic features of DCPR categorization. CONCLUSION: The clinical information which derives from the concomitant application of the DCPR might improve and make more specific the treatment of patients with adjustment disorders.

Irritable mood in Italian patients with medical disease.

Irritability may be a mood state independent of other moods and anxiety disorders, even though it may be symptomatic of several psychiatric disorders, such as major depression. The aims of this exploratory study were to verify the presence of irritable mood in a group of medical outpatients with a variety of clinical conditions (functional gastrointestinal disorders, cardiovascular disorders, endocrine diseases and cancer) and to examine its relationship with major depression. A total of 609 consecutive outpatients recruited from different medical settings were assessed according to DSM-IV and Diagnostic Criteria for Psychosomatic Research using semistructured research interviews. Irritable mood was identified in 163 (27%) patients, while major depression was present in 113 (19%) patients. Even though there was a considerable overlap between the two diagnoses, 76 (67%) patients with major depression were not classified as irritable, and 126 (77%) patients with irritable mood did not satisfy the criteria for major depression. The findings suggest a high prevalence of irritability in the medically ill, which in most cases is independent of mood disorder. Further research may determine whether irritability, alone or in association with major depression, entails prognostic and clinical implications.

Prodromal symptoms in myocardial infarction.

BACKGROUND: Little is known about the prodromal phase of myocardial infarction (MI). The aim of this study was to explore this phase with methodologies which have been standardized in affective disorders. The psychological evaluation of patients with MI diagnosis is currently based on DSM-IV criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. In this study, we are going to compare these new criteria, i.e. the Diagnostic Criteria for Psychosomatic Research (DCPR), with DSM-IV in a population where a high prevalence of psychological problems is expected. METHODS: A semistructured research interview based on Paykel's Clinical Interview for Depression for eliciting prodromal symptoms was administered to a consecutive series of 92 patients with a first episode MI diagnosis. Two interviews for the evaluation of psychological problems were administered according to DSM-IV and DCPR criteria. RESULTS: Most of the patients reported prodromal symptoms. Irritability, depressed mood and somatic anxiety were the most common prodromal symptoms. The results also show that the number of DCPR diagnoses was higher than the number of DSM-IV diagnoses. At least one DCPR diagnosis was found in all patients, whereas at least one DSM-IV diagnosis was present in 42 (46%) patients. CONCLUSIONS: The prodromal phase of MI was found to be characterized by prodromal symptoms of affective type. The joint use of DSM-IV and DCPR criteria was found to improve the identification of psychological factors which could affect this phase. The results should alert the physician to the fact that patients presenting with irritability, depressed mood (including demoralization), anxiety and insomnia may be at risk of developing coronary artery disease.

Assessing demoralization and depression in the setting of medical disease.

OBJECTIVE: The aim of this study was to assess the presence of demoralization and major depression in the setting of medical disease. METHOD: 807 consecutive outpatients recruited from different medical settings (gastroenterology, cardiology, endocrinology, and oncology) were assessed according to DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research, using semistructured research interviews. RESULTS: Demoralization was identified in 245 patients (30.4%), while major depression was present in 135 patients (16.7%). Even though there was a considerable overlap between the 2 diagnoses, 59 patients (43.7%) with major depression were not classified as demoralized, and 169 patients (69.0%) with demoralization did not satisfy the criteria for major depression. CONCLUSIONS: The findings suggest a high prevalence of demoralization in the medically ill and the feasibility of a differentiation between demoralization and depression. Further research may determine whether demoralization, alone or in association with major depression, entails prognostic and clinical implications.