Adjustment Processes After the First Wave of the COVID-19 Pandemic: A Grounded Theory Study Based on Clinical Psychologists' Experience.

Background: Anxiety, depression, and post-traumatic stress have been reported among the general population during the first wave of the COVID-19 pandemic. However, the adjustment after the emergency phase remains under-investigated. This study aims to understand the adjustment processes of the population after the emergency phase of the pandemic. Methods: We conducted a grounded theory based on the experience of 24 clinical psychologists who provided extensive support to the population during the pandemic in different Italian regions. Three online focus groups were conducted. The transcripts of the focus groups were analyzed through a process of open, axial, and selective coding. Data collection terminated once thematic saturation was reached. Results: Repositioning emerged as the evolutionary task people were confronted with in the face of a New Reality. Repositioning meant dealing with and integrating unpleasant Emotional Experiences deriving from the lockdown and reopening (i.e., unsafety, emotional exhaustion, loneliness, uncertainty, loss, and disconnection) through different Coping Strategies. Repositioning was facilitated or hindered by contextual and individual Intervening Conditions and led to two Adjustment Outcomes: growth or block. Conclusion: Results suggest that repositioning was the core task people had to face after the emergency phase of COVID-19. Proactive psychological interventions may support the population in repositioning in order to prevent maladjustment and encourage post-traumatic growth.

Metacognitive interpersonal therapy in group versus TAU + waiting list for young adults with personality disorders: Randomized clinical trial.

Young adults presenting with personality disorders (PDs) featuring overcontrol and social inhibition urgently require effective psychological interventions to help them navigate important life transitions. metacognitive interpersonal therapy-group (MIT-G) is a time-limited group program designed to enable individuals to find adaptive solutions to their social difficulties. A small randomized clinical trial (RCT) of MIT-G versus treatment as usual (TAU) was conducted with the primary outcomes of improvements in social and interpersonal functioning and global psychological symptoms. Secondary outcomes were specific symptoms of anxiety and depression and changes in alexithymia and emotion dysregulation. From 40 participants, 20 were randomized to 16 weekly sessions of MIT-G, plus 3 individual sessions and 20 to TAU + waiting list. All 20 patients allocated to MIT-G completed treatments, while 2 dropped-out in the TAU arm. Patients in the MIT-G arm reported significant improvements on primary outcomes of functioning, interpersonal problems and global symptoms of medium magnitude, medium effect sizes for changes in depression and anxiety, and large magnitude changes for alexithymia. However, other than alexithymia no significant differences were observed between groups at treatment end. A Time × Condition interaction, indicated that MIT-G was associated with more rapid and larger magnitude improvements in functioning and alexithymia. MIT-G is a well-tolerated treatment option for young adults with overcontrolled PD. Further effectiveness studies in larger samples are underway. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploration of psychometric properties of the Italian version of the Core Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE).

There is an increasing need of outcome measures for young people suitable to evaluate treatments and routine settings. However, measures must show suitable psychometric characteristics for such use. This is the first psychometric evaluation of the Italian version of the Core Young Person Clinical Outcomes in Routine Evaluation (YP-CORE). Data are reported for a clinical sample, aged 11-17 (n=175) and non-clinical sample, aged 11-17 (n=206). Analyses included acceptability, confirmatory factor analysis, internal reliability, influence of gender and age on cutoff scores and reliable change. The YP-CORE acceptability was good, with a very high completion rate (98.7% fully completed). Internal consistency was good: the overall Cronbach's alpha value (α) equal to 0.75 (95% confidence interval=0.69-0.80). The measure was sensitive to change (Cohen dz=1.35). The Italian version of the YP-CORE showed acceptable psychometric properties is suitable for use in services for young people as a change/outcome measure.

Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial.

Young adults with personality disorders (PD) other than borderline are in urgent need of validated treatments to help them in managing important life transitions. Therapeutic interventions focused upon social and interpersonal difficulties may facilitate these individuals in maximizing opportunities for employment, forming stable romantic relationships, and belong to social groups. It is also important that they are offered evidence-based, first-line time-limited treatments in order to maximize effectiveness and reduce costs. We developed a 16-session programme of group-based Metacognitive Interpersonal Therapy (MIT-G) including psychoeducation on the main interpersonal motives, an experiential component enabling practice of awareness of mental states; and use of mentalistic knowledge for purposeful problem-solving. We report a feasibility, acceptability, and clinical significance randomized clinical trial. Participants meeting inclusion criteria were randomized to receive MIT-G (n = 10) or waiting list+TAU (n = 10). Dropout rate was low and session attendance high (92.19%). Participants in the MIT-G arm had symptomatic and functional improvements consistent with large effect sizes. In the MIT-G arm similarly large effects were noted for increased capacity to understand mental states and regulate social interactions using mentalistic knowledge. Results were sustained at follow-up. Our findings suggest potential for applying MIT-G in larger samples to further test its effectiveness in reducing PD-related symptoms and problematic social functioning.

Early Eye Movement Desensitisation and Reprocessing (EMDR) intervention in a disaster mental health care context.

'Early psychological intervention' is defined as commencing treatment within three months of the traumatic event, with the aim to prevent or treat posttraumatic stress disorder, ongoing distress or acute stress disorder. In natural disaster situations, specific issues may limit the amount of time available for treatment and the possibility of interventions. Eye Movement Desensitisation and Reprocessing (EMDR) can be used without regard to these limits. The aim of the study is to evaluate the effects of EMDR, Recent Traumatic Episode Protocol (R-TEP) provided within three months of the traumatic event to a large sample of individuals exposed to the earthquake that hit Emilia Romagna Region (Northern Italy) in 2012. This study is based on a retrospective review of medical records collected during the activities of psychological and psychosocial unit in the immediate aftermath of earthquake. In total, 529 participants completed the Impact of Event Scale Revised (IES-R) (pre e post treatment). In order to provide a comparison similar to a waitlist-like control group, a method of cohort analysis was applied. In addition, possible time dependent effect was tested. ET (early-treated sample, participants treated within one month after the earthquake) and LT (late-treated sample, participants treated after the first month from the earthquake) reported at post-treatment an improvement to a level below the IES-R cutoff (65.8% of the ET sample and 64.02% of the LT sample). Control group analogue and time-outcome correlation suggest that positive changes in symptoms were likely due to the treatment provided and not merely to the time lapse from the traumatic event. The results of this study suggest that EMDR is a viable treatment option in response to a disaster crisis and in reducing psychological distress of acutely traumatized individuals within the context of a natural disaster.

Metacognitive interpersonal therapy in group: a feasibility study.

Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.

Cognitive Attentional Syndrome and Metacognitive Beliefs in Male Sexual Dysfunction: An Exploratory Study.

Erectile dysfunction (ED) and premature ejaculation (PE) are two forms of male sexual disorder with both psychological and physical features. While their cognitive, attentional, and affective components have been investigated separately, there is a lack of knowledge about the role played by cognitive attentional syndrome in their onset and maintenance. The aim of the present study was to investigate the possible contribution of perseverative thinking styles and thought control strategies to the development and maintenance of ED and PE. The authors hypothesized that such modes of processing might constitute a cognitive attentional syndrome specific to these disorders and sustained by particular metacognitive beliefs. A semistructured interview was administered to 11 participants with ED and 10 with PE in order to assess their metacognitive beliefs and cognitive attentional processes. The results suggest that individuals with ED and PE adopt a range of cognitive attentional strategies aimed at improving their sexual performance, and endorse both positive and negative metacognitive beliefs about these thinking responses. Overall, their cognitive and attentional patterns worsened negative internal states, reduced sexual excitement, detached them from their bodily sensations, and hindered sexual functioning. These preliminary findings suggest that perseverative thinking, thought control strategies, and metacognitive beliefs may play a key role in the onset and maintenance of male sexual dysfunction.

Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers.

The cognitive avoidance model of worry assumes that worry has the adaptive function to keep under control the physiological arousal associated with anxiety. This study aimed to test this model by the use of a fear induction paradigm in both pathological and healthy individuals. Thirty-one pathological worriers and 36 healthy controls accepted to be exposed to a fear induction paradigm (white noise) during three experimental conditions: worry, distraction, and reappraisal. Skin conductance (SCR) and heart rate variability (HRV) were measured as indices of sympathetic and parasympathetic nervous system functioning. Worriers showed increased sympathetic and decreased parasympathetic activation during the worry condition compared to non-worriers. There were no differences between groups for the distraction and reappraisal conditions. SCRs to the white noises during worry were higher in worriers versus controls throughout the entire worry period. Intolerance of uncertainty - but not metacognitive beliefs about worry - was a significant moderator of the relationship between worry and LF/HF-HRV in pathological worriers. Results support the cognitive avoidance model in healthy controls, suggesting that worry is no longer a functional attitude when it becomes the default/automatic and pathological response.

Self-discrepancy monitoring and its impact on negative mood: an experimental investigation.

BACKGROUND: The perception of self-discrepancies between the actual self and the ideal self has been defined as a cognitive risk factor for depression (Higgins, 1987). In this view, self-discrepancy monitoring (SDM) refers to the voluntary re-orientation of attention towards detecting discrepancies between ideal and actual selves, even in a positive situation. AIMS: The goal of this study was to explore the impact of SDM on levels of mood in the face of positive stimuli. METHOD: Two clinical and two non-clinical samples were recruited from two different European countries (Italy and Romania). All participants were asked to focus on a past positive experience, and were then randomly allocated to one of two induction tasks. The experimental condition consisted of monitoring discrepancies between personal goals and the recalled positive experience, while the control condition consisted of observing what the participant was feeling. RESULTS: The findings show that, after recalling a positive memory, SDM leads to a significant decrease in mood over a short period independent of the severity of depressive symptoms. This effect is partially mediated by the concurrent change in levels of brooding. CONCLUSIONS: Self-discrepancy monitoring in response to positive stimuli tends to lower current mood independent of the initial level of depressive symptoms, and seems to be a global trigger of emotional distress that does not refer only to a depressed cognitive style.

The effect of rumination on craving across the continuum of drinking behaviour.

BACKGROUND: Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems. AIMS: The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour. METHODS: Participants of three groups of alcohol-dependent drinkers (N=26), problem drinkers (N=26) and social drinkers (N=29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase. RESULTS: Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. CONCLUSIONS: Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.

Parental overprotection and metacognitions as predictors of worry and anxiety.

BACKGROUND: Parental overprotection may have a direct effect on worry through hindering children's exploration experiences and preventing the learning of action-oriented coping strategies (Cheron, Ehrenreich and Pincus, 2009; Nolen-Hoeksema, Wolfson, Mumme and Guskin, 1995) and an indirect effect through fostering the development of maladaptive metacognitions that are associated with the activation of worry and the escalation of anxiety (Wells, 2000). AIM: The aim was to investigate the relative contribution of recalled parental overprotection in childhood and metacognitions in predicting current levels of worry. METHOD: A community sample (n = 301) was administered four self-report instruments to assess parental overprotection, metacognitions, anxiety and worry. RESULTS: Metacognitions were found to predict levels of worry independently of gender, anxiety and parental overprotection. They were also found to predict anxiety independently of gender, worry and parental overprotection. CONCLUSIONS: The combination of a family environment perceived to be characterized by overprotection and high levels of maladaptive metacognitions are a risk factor for the development of worry.

Rumination as a predictor of drinking behaviour in alcohol abusers: a prospective study.

AIMS: To investigate the role of depression and rumination in predicting drinking status (absence or presence of alcohol use) and level of alcohol use at 3, 6 and 12 months following a brief course of cognitive-behavioural therapy for alcohol abuse. METHODS: A total of 80 out-patients with a diagnosis of alcohol abuse completed measures of depression (Beck Depression Inventory), rumination (Ruminative Responses Scale) and alcohol use (Quantity-Frequency Scale). RESULTS: These indicated that rumination predicted drinking status and level of alcohol use at 3-, 6- and 12-month follow-up. The contribution of rumination was independent of depression and initial level of alcohol use. CONCLUSIONS: The results confirm that rumination is an important prospective predictor of drinking status and level of alcohol use in alcohol abusers and highlight the potential relevance of targeting rumination in the treatment of alcohol abuse.