Relational Sequelae of Fetal Death During the First Pregnancy: A Qualitative Study on the Subjective Perceptions of the Relationship Between Mothers and Their Adult Subsequent Firstborn Children.

Perinatal loss may deeply affect the attachment relationships of mothers and their next-born children. The aim was to explore the subjective perceptions of mothers, who had fetal death during the first pregnancy, and their adult subsequent firstborn children regarding the impact of the perinatal loss on the mother-child relationship and children's self-perception. Fifteen mothers who experienced a fetal death during the first pregnancy and their adult subsequent firstborn children were interviewed. A Grounded Theory approach was used. Five main themes were identified: fetal death as a real loss producing prolonged grief; the importance of the communication about the dead sibling; creating and maintaining a relationship with the lost sibling; the mother-subsequent child relationship: between detachment and overprotection; significant effects of fetal death on adult subsequent children's self-perception. Results highlighted a deep impact of fetal death on the subsequent mother-child relationship, as perceived by both mothers and adult children.

Attachment-security prime effect on skin-conductance synchronization in psychotherapists: An empirical study.

Physiological synchronization (PS) is a phenomenon of simultaneous activity between two persons' physiological signals. It has been associated with empathy, shared affectivity, and efficacious therapeutic relationships. The aim of the present study was to explore the possible connections between PS and the attachment system, seeking preliminary evidence of this link by means of an experimental manipulation of the sense of attachment security in psychotherapists according to a protocol by Mikulincer and Shaver (2001), which has been proven to elicit empathetic behavior. We compared the synchronization of skin-conductance signals in brief psychological interviews between 18 psychodynamic therapists and 18 healthy volunteers. A sense of attachment-security priming was administered to half of the therapists, whereas the other half received a positive-affect control prime. Lag analysis was performed to investigate the "leading" or "following" attitudes of the participants in the two conditions. Mixed-model regressions and evidence-ratio model comparisons were used to investigate the effects of the manipulation on PS. Therapist attachment anxiety and avoidance traits were considered covariates. The attachment-security prime showed a significant effect on PS lag dynamics, but not on overall PS amount. Lag analysis showed that the therapists in the attachment-security condition were significantly more prone to assume a leading attitude in the physiological coupling than the therapists in the control condition. Therapist attachment anxiety and avoidance had no apparent effect. Our result paves the way for further exploration of the clinical relationship from a physiological standpoint. (PsycINFO Database Record

Attachment orientations and psychological adjustment of parents of children with cancer: A matched-group comparison.

OBJECTIVE: To investigate the impact of childhood cancer on parents' adult attachment, social support, marital adjustment, anxiety, and depression. METHODS: 30 parents of children with childhood cancer and 30 matched controls completed the following questionnaires: Experiences in Close Relationships-Revised, Dyadic Adjustment Scale-4, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory - form Y, and Beck Depression Inventory. RESULTS: Parents of children with childhood cancer had a significantly lower dyadic adjustment than controls, and higher levels of insecure-avoidant attachment, state anxiety, and depression. CONCLUSION: It is important for health-care personnel to take into account these parents' propensity to show increased levels of avoidant attachment during children's treatment to foster effective communication and supportive relationships between clinicians, pediatric patients, and parents.

Female gender doubles executive dysfunction risk in ALS: a case-control study in 165 patients.

BACKGROUND: Cognitive impairment, mainly characterised by executive dysfunction, occurs in about half of cases in amyotrophic lateral sclerosis (ALS). There is evidence that gender influences some clinical features of the disease, but its influence on the cognitive spectrum is unknown. Our objective was to investigate the impact of gender on cognitive profiles of patients with ALS. METHODS: A retrospective study based on an exhaustive neuropsychological battery was performed in a group of 165 (70 females, 95 males) sporadic, non-demented patients with ALS compared with 134 healthy control participants. This assessment primarily focused on executive, memory and language functions. RESULTS: 47 (29%) patients revealed impairment in executive function and 30 (18%) patients revealed cognitive non-executive impairment. Independent from mood tone and clinical variables, a significantly greater executive impairment was determined in female patients than in male patients and control participants. The relative risk for ALS females having impairment in executive function compared with male patients was 2.6 (95% CI 1.6 to 4.4; p=0.0003). ALS females scored lower in Phonemic Fluency, Trial Making, and Wisconsin Card Sorting test. CONCLUSIONS: Results highlight a significant vulnerability of ALS female patients to develop cognitive dysfunctions peculiar to the disease, independently of bulbar onset. The explicative hypotheses of the data are focused on two interpretative lines not mutually exclusive: the role of gonadal hormones and gender-related brain asymmetry pre-existing to the disease. These findings, never reported before in the literature, can have important implications for models of ALS pathogenesis and for future clinical trial designs.

Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style.

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion.

Somatic underpinnings of perceived empathy: the importance of psychotherapy training.

This study investigated the somatic underpinning of empathy using an interpersonal physiology approach. Thirty-nine dyads were formed by a "pseudo-patient" and a "listener" (a therapist, a psychologist, or a non-therapist). Dyadic physiological concordance in electrodermal responses and listeners' empathy were evaluated during simulations of clinical sessions. A significant positive correlation between empathy as perceived by pseudo-patients and physiological concordance was found, providing empirical evidence of a somatic underpinning of empathy. Moreover, therapists showed higher levels of physiological concordance and empathy, confirming the importance of psychotherapy training in managing clinical interactions.

'I feel like I was born for something that my body can't do': a qualitative study on women's bodies within medicalized infertility in Italy.

OBJECTIVE: In the context of infertility, women's bodies have a central physical, psychological, and social role. Medically assisted reproduction (MAR) treatment includes highly intrusive procedures targeting women's bodies. This study aimed to develop a preliminary understanding of women's core meanings around their bodies within their experiences of medicalized infertility in Italy. DESIGN: 104 Italian women dealing with infertility and MAR treatments answered open-ended questions, which were part of a broader online survey. A reflexive thematic analysis was performed. RESULTS: Three themes were identified: (a) the paradox of the body: 'I feel like I was born for something that my body can't do'; (b) 'Something only mothers can do': meanings attributed to the physical body; (c) Internalized 'clinical gaze': medicalized body representations. CONCLUSIONS: This work provides insights into the meanings assigned to their bodies by Italian women dealing with MAR. This study outlined women's ambivalence towards their bodies, describing them as 'fragmented' into parts and as 'deposits' of their reproductive hopes. Results suggest that Italian pronatalist culture may have potential fallouts for women's gendered sense of self and the integration between their biological and psychosocial body experiences. Study limitations, future research directions, and clinical implications are presented.

Attachment orientations and emotion regulation: new insights from the study of interpersonal emotion regulation strategies.

A crucial point for the understanding of the link between attachment and emotion regulation concerns the individual tendency in turning to others to alleviate distress. Most previous studies in this field have considered almost exclusively intra-personal forms of emotion regulation, neglecting the role of social interaction in emotion regulation processes. In the present study, instead, we focused on interpersonal emotion regulation. 630 adults were assessed for their attachment orientations, general difficulties in emotion regulation, and habitual intra-personal and interpersonal emotion regulation strategies. Results showed that the imbalance between the hyper-activation and deactivation of the attachment system, which characterize unsecure attachment, reflects a correspondent imbalance in the use of emotion regulation strategies, with an exaggerated dependence on other associated with attachment anxiety and pseudo-autonomy associated to attachment avoidance.

Strengths and Weaknesses of Children Witnessing Relatives with Amyotrophic Lateral Sclerosis.

Research on minors who have a close family member with amyotrophic lateral sclerosis (ALS) is scarce. This study aims to analyze the relationships between reflective function and wellbeing among such children, considering their reflective function, representations of death, and behavioral problems with the following instruments: Reflective Functioning Questionnaire, Testoni Death Representation Scale for Children, Positive and Negative Affect Schedule for Children, and Strengths and Difficulties Questionnaire. Participants were 248 minors divided into the target group (38 children-16 females, 22 males-7-18 years old (M = 11.61, SD = 2.97)) and the control group (210 students-120 females, 90 males 9-14 years old (M = 11.17, SD = 1.33)). Results showed that the target group exhibited more negative affect and hyperactivity. However, they also showed less uncertainty in their mental states. The opportunity to support these minors is discussed.

Eudaimonic Well-Being of Italian Young Adults during the COVID-19 Pandemic: Predictive and Mediating Roles of Fear of Death and Psychological Inflexibility.

The literature has widely acknowledged the impact of the COVID-19 pandemic on the mental health of young adults. Despite extensive research, eudaimonic well-being, which focuses on self-knowledge and self-realization, has been scarcely investigated. This cross-sectional study aimed to add knowledge on the eudaimonic well-being of young adults one year after the outbreak of the COVID-19 pandemic, verifying its potential linkages with fear of death and psychological inflexibility. A total of 317 young Italian adults (18-34 years), recruited through a chain sampling method, completed measures of psychological inflexibility, fear of death, and eudaimonic well-being included in an online survey. The study's hypotheses were tested with multivariate multiple regression and mediational analyses. Results showed that psychological inflexibility was negatively associated with all the dimensions of well-being, while fear of the death of others was associated with autonomy, environmental mastery, and self-acceptance. Furthermore, in the association between fear of death and well-being, the mediation role of psychological inflexibility was verified. These results contribute to the extant literature on the factors associated with eudaimonic well-being, providing clinical insights into the work with young adults within challenging times.

Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT-IPA questionnaire).

AIMS: The aim of the study was to adapt the German version of the insulin pump therapy (IPA) questionnaire to Italian (IT-IPA) and to evaluate its psychometric properties in adults with type 1 diabetes. METHODS: We conducted a cross-sectional study, data were collected through an online survey. In addition to IT-IPA, questionnaires evaluating depression, anxiety, diabetes distress, self-efficacy, and treatment satisfaction were administered. The six factors identified in the IPA German version were assessed using confirmatory factor analysis; psychometric testing included construct validity and internal consistency. RESULTS: The online survey was compiled by 182 individuals with type 1 diabetes: 45.6% continuous subcutaneous insulin infusion (CSII) users and 54.4% multiple daily insulin injection users. The six-factor model had a very good fit in our sample. The internal consistency was acceptable (Cronbach's α = 0.75; 95% IC [0.65-0.81]). Diabetes treatment satisfaction was positively correlated with a positive attitude towards CSII therapy (Spearman's rho = 0.31; p < 0.01), less Technology Dependency, higher Ease of Use, and less Impaired Body Image. Furthermore, less Technology Dependency was associated with lower diabetes distress and depressive symptoms. CONCLUSIONS: The IT-IPA is a valid and reliable questionnaire evaluating attitudes towards insulin pump therapy. The questionnaire can be used for clinical practice during consultations for shared decision-making to CSII therapy.

Romantic attachment, infertility-related stress, and positive body image of women dealing with infertility.

Introduction: Infertility is a condition that can affect the physical, emotional, social, and relational well-being of women. Women's bodies seem to assume a crucial relevance as part of the experience of infertility and its treatments. An extended body of literature supports the role of romantic attachment orientations in facing infertility-related stress. However, the association between romantic attachment orientations, infertility-related stress, and women's body image has not been explored. Methods: This cross-sectional study aimed to investigate the role of romantic attachment and infertility-related stress concerning positive body image in 113 women dealing with infertility. Data were analyzed with correlation and mediation path analyses. Results: Results showed that high levels of attachment anxiety, attachment avoidance, and infertility-related stress were negatively associated with positive body image. Path analyses indicated that positive body image may be directly associated with romantic attachment anxiety. The negative association of attachment avoidance with body image appeared to be mediated by infertility-related stress. Discussion: Findings suggest that romantic attachment insecurities and infertility-related stress are significantly associated with a worsened body image in infertile women. Implications for future research are discussed.

The extended unconscious group field and metabolization of pandemic experience: dreaming together to keep cohesion alive.

Working with dreams in groups allows an understanding of phenomena that characterise the unconscious as a total unity. The dreamer becomes the vehicle of emotions, fantasies, and anxieties that dominate the group at a given moment, allowing them to be understood and processed. The analysis of shared dreams can further our understanding of emotional concerns related to the COVID-19 pandemic and its psychological repercussions. Six sessions of social dreaming were conducted during the COVID-19 pandemic period. Our aim was not to investigate differences between and within groups: the analysis was performed by identifying the core themes encompassing the contents of dreaming sessions, as products constructed by and within groups that are informative of society's collective unconscious more broadly. The narratives were transcribed and thematic analysis was performed with the support of Atlas.ti software. Three main themes were identified: i) nightmares' descriptions and the links with the COVID-19 pandemic; ii) loss of control within the unexpected outbreak: the pandemic as a learned helplessness context and environmental mastery as an emergent psychological issue; and iii) recalls of the child-past as continuity-makers within the continuity-breaking pandemic present. Through the qualitative analysis of dream narratives, we identified the links between individuals and the shared field. It is arguable that, by sharing dreams, the members of the group develop meanings useful to process the painful experience that unites them, as the three main themes show.

Assessment of socio-relational self-efficacy in breast cancer patients: Italian validation of the social relationship coping efficacy scale (SRCE-I).

BACKGROUND: Social relationship coping efficacy (SRCE) represents the ability to maintain or enhance social relationships in the context of serious illness. The purpose of the current study was to confirm the factor structure, psychometric properties, and utility of the Italian version of the SRCE scale. METHODS: 181 breast cancer patients completed the SRCE-Italian (SRCE-I), the Cancer Behavior Inventory-Brief/Italian (CBI-B/I), quality of life (QOL) measures (EORTC QLQ-C30; EORTC QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The SRCE-I was internally consistent (Cronbach alpha = .95) and factor analysis confirmed that the SRCE-I was a unidimensional construct. In terms of validity, the SRCE-I was correlated with QOL (EORTC QLQ-30, Social Functioning, r = .33, Emotional Functioning, r = .57, and Global Health/Quality of Life; r = .54) and scales of the EORTC QLQ-BR23 (e.g., Future Perspective, r = .38; Breast Symptoms, -.31). SRCE-I was also correlated negatively with the HADS (r = -.72) and positively with the CBI-B/I (r = .79), a measure of coping efficacy (all ps < .001). Mediation analyses confirmed the utility of the SRCE-I scale as a mediating mechanism in enhancing social functioning and QOL. CONCLUSIONS: The SRCE-I is a structurally sound, reliable, and valid measure that assesses the ability to maintain or enhance social support and mitigate the loss of social support. The SRCE-I can be used as a screening measure to assess low efficacy for maintaining social support or as a measure to detect the change in efficacy for enhancing social support in interventions to improve the QOL of patients.

Perceived Social Support Mediates the Negative Impact of Insecure Attachment Orientations on Internalized Homophobia in Gay Men.

The mediating effect of perceived social support on the influence of insecure attachment orientations on internalized homophobia was assessed in a group of 70 Italian gay men (mean age = 28.8, SD = 6.2, range: 19-46 years). Participants completed self-report measures of adult attachment (Experiences in Close Relationships-Revised), perceived social support (Multidimensional Scale of Perceived Social Support), and internalized homophobia (Measure of Internalized Sexual Stigma for Lesbians and Gay). Higher levels of attachment anxiety and avoidance, and perceptions of lower social support were correlated with higher levels of internalized homophobia. The mediation analyses showed that only attachment anxiety, but not avoidance, may have a direct link with internalized homophobia, while both anxiety and avoidance may have an indirect influence on internalized homophobia mediated by perceived social support. Improving social support can reduce the negative effects of homophobia on gay men, thus mitigating the detrimental fallout of any insecure attachment orientations.

Interpersonal Emotion Regulation: From Research to Group Therapy.

The concept of interpersonal emotion regulation (IER) refers to a variety of processes in which emotion regulation occurs as part of live social interactions and includes, among others, also those interpersonal interactions in which individuals turn to others to be helped or to help the others in managing emotions. Although IER may be a concept of interest in group therapy, specific theoretical insights in this field appear to be missed. In this article, we firstly provide a review of IER definitions, of classifications of IER strategies, and of IER clinical conceptualizations. Afterwards, we discuss the relevance of considering IER for group therapy, both in terms of non-specific group therapeutic factors and of group therapy techniques promoting adaptive emotion regulation, underlining the potentially relevant role of IER behaviors as intrinsically involved in group experience.

Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders.

This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.

Depressive symptoms and glycaemic control in adults with type 1 diabetes: an exploratory study on the role of family functioning.

AIMS: Psychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D. METHODS: In a cross-sectional study design, we consecutively enrolled 90 adults with T1D diagnosis from at least 1 year and currently living in their family of origin or conjugal family from at least 1 year before the enrolment. Questionnaires were administered to assess family functioning and depressive symptoms. The SMBG frequency over the past 3 months and the most recent HbA1c measurement were also collected in each individual. Correlation and mediation analyses were carried out. RESULTS: Glycaemic control showed a positive relationship with depressive symptoms and family balanced cohesion, while SMBG frequency was correlated with family balanced flexibility and rigidity, but not with depressive symptoms. Mediation analyses showed that family rigidity mediates the effect of depressive symptoms on glycaemic control. CONCLUSIONS: This exploratory study highlighted the significance of a cohesive family context to facilitate the achievement of individual glycaemic goals in individuals with T1D. These observations, if confirmed in larger data sets, would timely call for a comprehensive family care assessment as part of the evaluations routinely carried out in the ambulatory care of these individuals.

Is Narcissism Associated with Heavy Work Investment? The Moderating Role of Workload in the Relationship between Narcissism, Workaholism, and Work Engagement.

This study aimed to investigate the association between narcissism and two forms of heavy work investment, namely, workaholism and work engagement. More specifically, it was hypothesized that narcissism is positively associated with both workaholism and work engagement, with workload moderating these relationships, which are expected to be stronger when the workload is high. Overall, 217 workers completed a self-report questionnaire, and the hypothesized relationships were tested using moderated multiple regression. Results partially supported our predictions. Narcissism was positively associated with workaholism and its dimensions of working excessively and working compulsively only in individuals facing a high workload. Furthermore, narcissism was positively associated with work engagement and its dimensions of vigor and dedication (but no absorption) in employees with average levels of workload. Finally, the workload exacerbated the relationship between narcissism and work engagement and its dimensions so that these associations were stronger when the workload was high. Overall, our study suggested that in a work environment characterized by moderate levels of demand, individuals with strong narcissistic components might inherently feel energetic and dedicated (i.e., engaged) at work. Differently, in a demanding work environment, workers with high narcissism might experience higher work engagement, but they could also be at risk of workaholism.