Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial.

OBJECTIVES: This single-centre prospective randomised controlled study aimed to investigate the effectiveness of dignity therapy on spiritual well-being, demoralisation and dignity-related distress compared with standard palliative care. METHODS: A total of 111 terminally ill hospice patients were randomly allocated to one of two groups: dignity therapy plus standard palliative care (intervention group) or standard palliative care alone (control group). The main outcomes were meaning, peace, faith, loss of meaning and purpose, distress and coping ability, existential distress, psychological distress and physical distress. Assessments were conducted at baseline, 7-10 and 15-20 days. RESULTS: Following randomisation, 11 dropped out before baseline assessment and 33 after post-treatment assessment. A total of 67 patients completed the study, 35 in the experimental group and 32 in the control group. Repeated measures general linear model showed significant differences between groups on peace and psychological distress over time, but not on existential distress, physical distress, meaning and purpose, distress and coping ability, meaning and faith. Specifically, patients in the dignity therapy intervention maintained similar levels of peace from baseline to follow-up, whereas patients in the control group significantly declined in peace during the same time period. Moreover, psychological distress significantly decreased from pretreatment to post-treatment in the intervention group and increased in the control group. CONCLUSIONS: Dignity therapy may be an effective intervention in maintaining sense of peace for terminally ill patients. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of this psychological intervention.

Promoting well-being in early adolescents through mindfulness: A cluster randomized controlled trial.

OBJECTIVES: The Gaia program is a 12-week mindfulness intervention based on cultivating body, emotional, and ecological self-awareness, which has been shown to be effective in reducing children's and adolescents' internalizing problems at school. This paper presents the results of a cluster randomized controlled trial aimed at assessing the effectiveness of this program on improving psychological well-being, subjective well-being, and psychological distress in early adolescents. METHODS: A sample of 195 early adolescent students (boys, n = 99; girls, n = 96) with a mean age of 11.49 years (standard deviation = 0.80) attending 12 middle school classes participated in the study. Seven Gaia instructors belonging to six schools led the program. Measures were administered at three time points, approximately every 3 months: 1 week before treatment, 1 week after treatment, and 3 months after treatment. We used a multilevel regression model to test whether treatment was effective in increasing psychological well-being and subjective well-being, and reducing psychological distress, as compared to a waiting-list control group. RESULTS: The results showed that the Gaia program improved psychological well-being but not subjective well-being and psychological distress. Specifically, the Gaia program was effective in increasing personal growth and purpose in life, the key eudaimonic components of psychological well-being, in the experimental group whereas they decreased in the control group. CONCLUSIONS: Findings from this study provide preliminary evidence that the Gaia program for early adolescents may improve the core eudaimonic components of psychological well-being from pretest to follow-up that, conversely, decrease in the control group.

Meaning in Life and the Acceptance of Cancer: A Systematic Review.

Meaning in life and acceptance of cancer are critical for patients to adjust to a cancer diagnosis and to improve psychological wellbeing. Little is known about the relationship between meaning in life and the acceptance of cancer. This study provides a systematic review of the associations between meaning in life and the acceptance of cancer in cancer patients. CINAHL, MEDLINE, PsycINFO, and SCOPUS databases were searched until 15 March 2021. Studies were included if they quantitatively examined the association between meaning in life and the acceptance of cancer in adult cancer patients/survivors and if they were published in peer-reviewed journals or in books. The study quality was assessed using Joanna Briggs Institute critical appraisal tools. Of the 4907 records identified through database searches, only 3 studies quantitatively examined the associations between meaning in life and the acceptance of cancer. The total sample involved 464 women with cancer. All three studies reported positive correlations between meaning in life and the acceptance of cancer (ranging from r = 0.19 to r = 0.38), whereas meaning in life did not predict the acceptance of cancer. Overall, the meaning in life-acceptance relationship has not been sufficiently investigated, though it has relevant theoretical and clinical implications for coping with cancer. High-quality studies are needed to better understand the relationship between meaning in life and the acceptance of cancer.

Does Guided Written Disclosure Reduce Distress and Improve Psychological Functioning in Patients with Skin Diseases?

Background. Skin diseases (e.g., psoriasis and systemic sclerosis) are generally associated with negative psychosocial outcomes. Although different psychological interventions have been used to improve the quality of life of dermatological patients, the effects of the guided written disclosure (GWD) protocol have not been previously examined in these patients. Moreover, little attention has been paid to positive psychology constructs. Methods. This study investigates the effectiveness of GWD on positive and negative functioning in dermatological patients. Pre- and 1-month post-intervention measures included emotion regulation, sense of inner peace, skin-related symptoms and functioning, sense of coherence, and psychological distress. Results. A total of 196 consecutive outpatients were randomly assigned to GWD and active control groups, of whom 60 (30.6%) completed the study and 45 (GWD: n = 24; AC: n = 21) provided complete data. Our results did not show any significant difference between the experimental and control groups in the outcome variables, whereas non-completers reported higher levels of distress, unpleasant skin-related emotions, and lower cognitive reappraisal compared to completers. Conclusions. These findings show a poor compliance, and suggest that expressive writing is not well accepted by patients and is not effective in improving positive and negative psychological functioning in dermatological patients.

The Relationship between Alexithymia and Mental Health Is Fully Mediated by Anxiety and Depression in Patients with Psoriasis.

BACKGROUND: Psoriasis is a common skin disease that affects quality of life, especially mental health. Alexithymia has been considered a relevant feature in psoriasis patients. Moreover, psoriasis was found to be associated with negative psychological health, including anxiety and depression. As the pathways linking alexithymia and mental health remain unclear among patients with psoriasis, we aimed to examine the mediating role of anxiety and depression in the relationship between alexithymia and mental health in these patients. METHODS: To explore our variables of interest, we used the Toronto Alexithymia Scale (TAS-20), the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Forty-four percent of patients were alexithymic and reported higher anxiety and depression, and lower quality of life compared to non-alexithymic patients. Alexithymic patients also had lower educational attainment. A correlation analysis showed positive associations between alexithymia and both anxiety and depression, whereas mental and physical health were negatively associated with alexithymia. Moreover, anxiety and depression fully mediated the relationship between alexithymia and mental health. CONCLUSIONS: Our findings highlight the importance of assessing alexithymia and psychological distress in clinical practice to identify vulnerable patients and to implement interventions aimed at improving negative emotional states.

Sexuality in Persons With Hidradenitis Suppurativa: Factors Associated With Sexual Desire and Functioning Impairment.

Hidradenitis Suppurativa (HS) is a chronic skin disease involving intimate and sensitive areas and affecting physical and mental health. We investigated the prevalence of sexual desire and functioning impairment, and their associations with quality of life, anxiety, depression, minor psychiatric disorders (MPD), and clinical features (e.g., disease severity) in 77 patients with HS who completed self-report measures and answered to questions assessing socio-demographic characteristics, lifestyle habits, and hindered sexuality due to HS. The majority of patients reported hindered sexuality, and poor sexual functioning, while showing good levels of dyadic and solitary sexual desire. No associations were found between clinical severity and sexuality measures. Multivariate analyses showed significant associations of sexual outcome measures with alcohol consumption, low Body Mass Index, family history of HS, and severe skin symptoms. Moreover, we found that the presence of negative psychological factors (i.e., MPD, anxiety, poor mental status) increased the risk of sexual impairment. These findings underline the important role of psychological and sexual aspects in HS patients and suggest that physicians should consider the effect of disease burden on patients' sexual health.

Alexithymia, Psychological Distress, and Social Impairment in Patients with Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a rare, chronic, inflammatory skin disease characterized by deep-seated nodules, abscesses, and draining fistulas. HS has a substantial adverse impact on patients' lives. Only a few studies investigated the relationship between health-related quality of life, psychological distress, and emotional dysregulation in patients with HS. Alexithymia, namely the difficulty in describing or recognizing emotions, has been associated with various psychological disorders, such as anxiety, depression, and psychological distress. OBJECTIVE: The aim of this study was to examine the prevalence of alexithymia in patients with HS and its association with demographic and clinical variables, quality of life indices, and psychological distress. METHODS: Ninety outpatients with HS completed the 20-item Toronto Alexithymia Scale, the 12-item General Health Questionnaire (GHQ-12), the Dermatology Life Quality Index, the Skindex-17, and the 36-Item Short-Form Health Survey. Information on sociodemographic and clinical variables was retrieved from clinical records. RESULTS: Alexithymia or borderline alexithymia was observed in 44.4% of patients with HS, with a higher prevalence of the alexithymic trait in women than in men (51.7 vs. 31.2%). We did not find any association between alexithymia and clinical variables. Of the entire sample analyzed, 46.1% reported high psychological distress; among them, 78% reported alexithymia or borderline alexithymia compared to 16.7% among GHQ noncases. Furthermore, HS patients with alexithymia or borderline alexithymia showed significantly higher scores on the Skindex-17 psychosocial scale and the Dermatology Life Quality Index, and a lower score on the mental component of the 36-item Short-Form Health Survey, than nonalexithymic patients. CONCLUSIONS: Dermatologists should consider alexithymia in the diagnosis and treatment of HS patients, given its important role in psychological and psychosocial distress.

Positive Psychological Factors Are Associated With Better Spiritual Well-Being and Lower Distress in Individuals With Skin Diseases.

In this study we examined whether aspects of positive functioning [reappraisal, sense of coherence (SOC), and positivity] were associated with spiritual well-being and psychological distress after controlling for negative functioning (skin-related symptoms, type of disease, and expressive suppression) in individuals with skin diseases. We also examined whether negative functioning aspects were linked to spiritual well-being and distress when controlling for aspects of positive functioning. The study used a cross-sectional design with a sample of 192 individuals with psoriasis and systemic sclerosis (SSc) (M age = 51.6 years, SD = 16.5). Two hierarchical multiple regressions were conducted to determine whether spiritual well-being and psychological distress were accounted for by skin-related symptoms, type of disease, emotion regulation strategies, SOC, and positivity. Positivity was the most important contributor to better spiritual well-being, followed by both the comprehensibility/manageability and meaningfulness SOC subscales, after controlling for the other variables. High skin-related symptoms and expressive suppression were associated with lower psychological distress, whereas high SOC and reappraisal correlated with higher psychological distress. The findings of this study pave the way for further research on how SOC and positivity may reduce the effects of both skin-related symptoms and emotion dysregulation and facilitate spiritual well-being of individuals with skin diseases. Interventions aimed to enhance inner resources of these individuals and help them to find a meaning in their experience of skin disease might reduce psychological distress and improve spiritual well-being. Our findings suggest that healthcare professionals should consider positive functioning aspects in future interventions for individuals with skin diseases.

Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning.

BACKGROUND: Whether mindfulness and emotional intelligence may counteract psychological symptoms and whether brooding and worry may be linked to decreased psychological well-being (PWB) in individuals with generalized anxiety disorder (GAD) is still an issue. METHODS: The study used a cross-sectional design on a sample of 66 consecutive individuals with a diagnosis of GAD. Two hierarchical multiple regressions were conducted to determine whether PWB and anxiety symptoms were accounted for by mindfulness and emotional intelligence skills, brooding, and worry. RESULTS: Worry was negatively related to PWB and showed a tendency to be positively associated with anxiety symptoms after controlling for the other variables. Brooding was uniquely and positively related to anxiety symptoms. Different mindfulness (i.e., describing and nonjudging) and emotional intelligence (i.e., attention and repair) skills were particularly important for PWB. Repair was also negatively related to anxiety symptoms. CONCLUSIONS: Repair was the variable that played a key role in the association with both PWB and GAD symptoms. Worry was the second most important variable, although it approached significance in the relationship with anxiety symptoms. Brooding was more strongly positively associated with anxiety than worry. In sum, the results suggest that an integrated and balanced focus on both positive and negative functioning will be useful in future clinical psychology research to predict, understand, and treat anxiety as well as to examine the antecedents and characteristics of positivity in individuals with GAD and promote their PWB.