Cognitive and Relational Processes Associated to Mental Health in Italian High School Students during COVID-19 and Russian-Ukrainian War Outbreaks.

The negative impact of the COVID-19 pandemic on mental health has been widely demonstrated; however, few studies have investigated the psychological processes involved in this impact, including core beliefs violation, meaning-making disruption, interpersonal support, or one's relational functioning. This study explored the mental health of 215 Italian adolescents during the COVID-19 pandemic and the subsequent outbreak of the Russian-Ukrainian war. By administering a set of questionnaires, several cognitive and emotional variables were investigated, including core belief violation, meaning attribution to the pandemic and war, attachment, and emotion regulation, social media addiction, and relationships with significant others and teachers. We conducted some descriptive, mean difference, correlational, and predictive analyses that revealed a significant association between core belief violation caused by war and pandemic, ability to integrate war and pandemic within personal meaning universe, the relational support received, and mental health. The relationship with teachers during these challenging periods improved significantly according to the respondents' opinion, becoming both more authoritative and empathic. This study offers insights into what cognitive and relational processes are useful to intervene on to reduce the distress of adolescents who are facing significant moments of crisis due to events that challenge their cognitive and emotional balance.

Exploring Factors Influencing COVID-19 Vaccine Hesitancy and Refusal: A Study in Italy during the Vaccine Rollout.

The availability of an effective vaccine against COVID-19 virus marked a crucial moment in the fight against its pandemic spread. Although distribution of the vaccine began in December 2020, high acceptance rates and repeated administrations are needed to achieve widespread immunization, but hesitation toward the vaccine persists to this day. To identify psychological variables and other factors associated with vaccine hesitancy, we conducted a study from August 2021 to October 2022. An Internet-based survey gathered data from 137 Italian adults, exploring attitudes, sociodemographic characteristics, psychological variables, and immunization behavior. The results analysis showed that gender (69.2% of vaccine-adverse people were males), education (years of education was negatively correlated with vaccine hesitancy), and religion (not declaring oneself religious or atheist was more likely to be associated with hesitancy toward the vaccine) were the variables influencing attitudes toward the vaccine. Other psychological variables differentiated people with opposite attitudes toward the vaccine: high scores on the Conspiracy Mentality Questionnaire (CMQ) and Core Belief Inventory (CBI) were positively correlated with vaccine hesitancy, indicating that individuals with more pronounced core belief violation, due to the pandemic, tend to express higher levels of vaccine hesitancy. Finally, a linear regression analysis confirmed the role of participants' conspiracy mentality as a valid predictor for vaccine hesitancy.

A Single Case Multimethod Assessment to Detect Significant Changes in the Psychoanalytic Treatment of Psychosomatic Disorders.

Mental disorders with body-centered symptoms, such as somatic, eating, and body dysmorphic disorders, present difficulties in psychotherapy because psychological suffering is manifested in the body rather than expressed verbally. The present study illustrates a single case multi-method investigation sensitive to detecting characteristic change manifestations in the treatment of these disorders. We investigated a treatment of a patient with body dysmorphic disorder. Computerized linguistic measures were applied to 86 sessions to assess changes in symbolic processing; out of the 86 sessions, 40 were analyzed to calculate the proportion of speech focused on bodily symptoms versus on relationships. Changes in personality were assessed using the SWAP-200 on nine sessions from different treatment stages. Measures of linguistic style, speech content, and personality showed marked changes over the treatment. The patient manifested schizoid and schizotypal personality traits that decreased over time, along with an increase in personality high-functioning dimension. The patient's ability to translate his emotional experience into words steadily increased, switching the primary focus of narratives from bodily symptoms to relationships. A multimethod assessment of the treatment of body dysmorphic disorder shows that improvement in personality functioning is accompanied by a shift from a focus on bodily experiences to a focus on relationships.

[Twelve tips for a good medical consultation in primary care.] / Dodici suggerimenti per una buona consultazione medica nelle cure primarie.

BACKGROUND: The recent pandemic has brought into sharper focus the need, long emphasised in the scientific literature, for a change in primary care that goes beyond the limits of the hyper-specialisation constitutive of Western health systems. While the direction of the cultural and organisational change that needs to be developed is well outlined, little is written about the competencies and values that physicians must acquire in order to shape a new and coherent organisation of services. The patient encounter is the frame in which these competencies take shape, and it is from this perspective that these competencies are examined here. OBJECTIVES: The aim of this narrative review of empirical studies and the multisciplinary literature is to provide primary care physicians with some tips for a good management of the medical consultation. These tips outline the competencies needed in general practice, rethought within the paradigm of complexity of care. RESULTS: The concepts, practices and values on which the 12 tips are based are: a) an attitude of attention to the complexity of care in which the patient's subjectivity can only be understood through an encounter with one's own subjectivity; b) the peculiar method of clinical reasoning in general practice, which includes the early generation of diagnostic hypotheses to be verified using simple and inexpensive tests, such as history taking and physical examination; these tests should have a high negative predictive value to rule out more serious conditions; c) the contextualisation of the working diagnosis (opposed to a definitive diagnosis) as a tool for dealing with complexity; d) the analysis of the evolution of scenarios as a tool for planning and choosing courses of action; e) the assessment of uncertainty in addition to that of measurable risk; f) the involvement of the patient and the use of the test of time as tools for managing uncertainty; g) the centrality of sharing the decision with the patient.

[The methodological and relational core competencies of General practice/Family medicine in Primary Care.] / Le competenze distintive metodologiche e relazionali del medico di medicina generale nelle cure primarie.

In this article, we examine three out of the seven distinctive values of General practice/family medicine (Gpfm), as proposed by World Organization of Family Doctors (Wonca) and recently translated into Italian: patient-centered care, continuity of care, and evidence-based care. We believe that these values can contribute to the ongoing debate on the reorganization of the primary care model and the reform of the core curriculum of Italian Gpfm. These three values are the basis of the distinctive methodological and relational competencies of Gpfm. In this contribution, we analyze them through the lens of epistemology of complexity, aiming to highlight the unique aspects of this method and relationship, thus identifying the necessary competencies for Gpfm. The thought and method of care - the first and third values - are analyzed considering that the framework in which Gpfm operates leads to significant modifications of the clinical method. While it certainly encompasses elements of the traditional clinical method, they are executed at different paces and with different objectives, employing distinct strategies. For instance, the epidemiological context with a high prevalence of symptomatic distress but low prevalence of "true" disease needs the early generation of diagnostic hypotheses. These hypotheses are then tested using verbal and physical examinations as exclusion tests with high predictive power. The aim is to arrive at diagnoses that are not exhaustive, yet operational and contextualized. Furthermore, the uncertainty inherent in Gpfm requires the utilization of contextual knowledge related to the patient's environment, negotiation with the patient about the tolerable threshold of decisional uncertainty, their involvement - which increases with greater uncertainty - and the use of the test of time within an organizational and relational protective network. Complex thinking enables reflection on the second value - the relationship - by assigning the physician's subjectivity a place as precious as that of the patient, which is already historically established. Thus, both the physician and patient, as subjects, exist on the same ontological plane but differ methodologically due to their distinct roles. Adopting an epistemology of complexity in Gpfm allows each variable of the system - subjects, context, method, clinical aspects - to regain significance. This approach favours a genuine science in service of humanity.

The Up-Side of the COVID-19 Pandemic: Are Core Belief Violation and Meaning Making Associated with Post-Traumatic Growth?

The negative impact of the COVID-19 pandemic on mental health has been extensively documented, while its possible positive impact on the individual, defined as Post-Traumatic Growth (PTG), has been much less investigated. The present study examines the association between PTG and socio-demographic aspects, pre-pandemic psychological adjustment, stressors directly linked to COVID-19 and four psychological factors theoretically implicated in the change processes (core belief violation, meaning-making, vulnerability and mortality perception). During the second wave of the pandemic 680 medical patients completed an online survey on direct and indirect COVID-19 stressors, health and demographic information, post-traumatic growth, core belief violation, meaning-making capacity, feelings of vulnerability and perceptions of personal mortality. Violation of core beliefs, feelings of vulnerability and mortality, and pre-pandemic mental illness positively correlated with post-traumatic growth. Moreover, the diagnosis of COVID-19, stronger violation of core beliefs, greater meaning-making ability, and lower pre-existing mental illness predicted greater PTG. Finally, a moderating effect of meaning-making ability was found. The clinical implications were discussed.

Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic.

COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.

Mother and father interaction with their 3-month-old infants: Similarities and differences in parenting behaviour in well-resourced parents.

Infancy is characterized by intensive parenting which may affect later child development. However, little is known about similarities and differences in maternal and paternal parenting behaviour, as the majority of the studies have mainly focused on mothers. The present study investigated similarities and differences in mothers' and fathers' parenting behaviour during parent-infant interaction in 56 mothers and 56 fathers of 3-months-old infants in a good-resourced sample. Parent-child interactions were videotaped and coded by the Global Rating Scales. Results suggested similar parenting behaviour in terms of maternal and paternal sensitivity, intrusiveness and remoteness. Moreover, regardless of sex infant's behaviour was similar during interactions with mothers and fathers. The low-risk and non-clinical nature of our sample may have had a positive influence on mother-child and father-child dyadic exchanges. These findings suggest including family system models in research and clinical practice.

Psychological Factors Explaining the COVID-19 Pandemic Impact on Mental Health: The Role of Meaning, Beliefs, and Perceptions of Vulnerability and Mortality.

This study tested an expanded version of the explanatory model of the negative impact of the COVID-19 pandemic on mental health proposed by Milman and colleagues. Participants (N = 680) completed an online survey on demographic variables associated with poor pandemic mental health, COVID-19 stressors, mental health symptoms, and pandemic-related psychological processes we hypothesized as mediating mechanisms explaining the negative mental health effects of the COVID-19 stressors. Results indicated that these psychological processes (core belief violation, meaning made of the pandemic, vulnerability, and mortality perception) explained the severity of mental health symptoms to a far greater extent than COVID-19 stressors and demographics combined. In addition, these psychological processes mediated the impact of COVID-19 stressors on all mental health outcomes. Specifically, COVID-19 stressors were associated with increased core belief violation, decreased meaning making, and more intense perceived vulnerability and mortality. In turn, those whose core beliefs were more violated by the pandemic, who made less meaning of the pandemic, and who perceived a more pronounced vulnerability and mortality experienced a worse mental health condition. This study's results suggest some possible ways of intervention in pandemic-like events useful for limiting such impact at the individual, group, social and political levels.

Changes in Clinical Process as a Result of Online Therapy: Findings from a Single Case Study.

Introduction: This study examined changes in the clinical interaction in a single clinical dyad between sessions conducted in person and sessions conducted remotely, applying linguistic indicators based on multiple code and referential process theory. Methods: Sessions from an ongoing psychotherapy of a male patient in his late 30s were audio-recorded and transcribed. Linguistic indicators, including the Weighted Referential Activity Dictionary (WRAD), were scored, and graphed using the Discourse Attributes Analysis Program (DAAP). The sessions included 8 sessions immediately before online work, 10 sessions immediately following the implementation of online work, and 12 sessions collected several months after the clinical dyad had been working remotely. Results: A comparison of in-person sessions to telehealth sessions shows that the patient spoke more in post-telehealth sessions but with decreased emotional engagement, as evidenced by a decrease in WRAD. The therapist appeared to be working harder to communicate that he was listening as evidenced by an increase in the measure of non-turn vocalizations (interjections such as hmm). Discussion: It appears that both patient and therapist were working harder to remain connected and communicate that they were present but with limited emotional engagement. This pattern remained unaltered at a 2-month followup. The findings address empirically the subjective experience of many clinicians who have switched to remote treatment. Implications for the future of remote therapy are discussed.

Language and Intelligence: A Relationship Supporting the Embodied Cognition Hypothesis.

Cognitive science has gathered robust evidence supporting the hypothesis that cognitive processes do not occur in an amodal format but take shape through the activation of the sensorimotor systems of the agent body, which works as simulation system upon which concepts, words, and thought are based. However, studies that have investigated the relationship between language and cognitive processes, as both embedded processes, are very rare. In this study, we investigated the hypothesis that intelligence is associated with referential competence, conceived as the ability to find words to refer to our subjective and perceptual experience, and to evoke understanding of this experience in the listener. We administered the WAIS-IV test to 32 nonclinical subjects and collected autobiographical narratives from them through the Relationship Anecdotes Paradigm Interview. The narratives were analyzed linguistically by applying computerized measures of referential competence. Intelligence scores were found to correlate with the use in narratives of words related to somatic and sensory sensations, while they were not associated with other measures of referential competence related to more abstract domains of experience or based on vivid or reflective dimensions of language style. The results support the hypothesis that sensorimotor schemas have an intrinsic role in language and cognition.

Analysis of General Practitioners' Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care.

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist's profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.

The relationship between self-observed and other-observed countertransference and session outcome.

For the psychodynamic approach, being aware of and managing countertransference is a core therapeutic competency. Research has demonstrated the negative effect of unmanaged countertransference on the outcomes of all kinds of psychotherapy. In this study, we focused on the relationship between countertransference when measured by therapists and external observers and its impact on session quality. We analyzed 69 counseling sessions, held by 23 in-training psychotherapists with 23 patients. We used the Therapist Response Questionnaire and three external observers (who used the Countertransference Behavior Measure) to measure psychotherapists' countertransference. We rated the session impact perceived by patients and psychotherapists using the Session Evaluation Questionnaire and by patients through the Session Impact Scale. Psychotherapists' and observers' ratings of countertransference correlated though on different dimensions. These results indicate that comparing external and internal evaluations can help to understand various aspects of countertransference since they have different associations with the session outcome. From a methodological point of view, it is necessary to adopt various perspectives to investigate countertransference. Future research should confirm these results on a sample of experienced psychotherapists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing Key Linguistic Dimensions of Ruptures in the Therapeutic Alliance.

Over the past two decades, therapeutic alliance research has increasingly focused on understanding the process by which the alliance is ruptured and repaired. This paper is the first to explore how alliance rupture segments from psychotherapy sessions differ from non-rupture segments on key dimensions of the referential process. A sample of 27 psychotherapy sessions were scored using a measure designed to identify rupture from non-rupture segments. These segments were then scored for key linguistic dimensions of the referential process. During ruptures patients manifested a referential process marked by a decrease in emotional engagement, an increase in a measure of distancing, and an increase in negation as compared to non-rupture segments. Therapists show similar patterns but, in addition, manifest a language pattern that suggests that during ruptures, therapists are attempting to make sense of, and self-disclose, aspects of their inner experience. Implications for research and clinical work are explored.

Stimulus Features of the Object Relations Technique Affecting the Linguistic Qualities of Individuals' Narratives.

Previous studies on projective techniques have investigated the effects of variation in stimulus features on individuals' response behavior. In particular, the influence of chromatic colors and form definition on the images elicited by the stimuli has been tested. Most studies have focused on the Rorschach and TAT and have examined effects in terms of variables such as reality testing and reactions to perceptual details. This is the first study to examine the effects of variation in visual stimuli as represented in features of the Object Relations Technique (ORT) cards on linguistic indicators of connection to emotional experience using measures of the referential process. The ORT was administered to 207 Italian non-clinical participants to explore effects of color, form and content variation on language style. The sample was stratified by age, gender, marital status and education to be representative of the Italian population. The stories told in response to the card images were rated using computerized linguistic measures, including the Weighted Referential Activity Dictionary-Italian version (IWRAD) which indicates the degree to which language is connected to nonverbal experience, and the Weighted Reflection/Reorganization List-Italian version (IWRRL) which detects a linguistic style of personal re-elaboration of emotional experience. The results provide support for the color-affect and form-reality testing hypotheses. Cards with better form definition, including color definition, and with fewer silhouettes of people elicited responses that were higher in IWRAD and lower in IWRRL, and also higher in the degree to which the two measures varied together. Implications of the results for use of ORT in clinical assessment and intervention are discussed.

Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak.

The expressive writing method has rarely been proposed in contexts of large-scale upheavals that affect large populations. In this study this method was applied as an intervention and tool of investigation during the confinement period in the Lombardy region, the Italian Epicenter of COVID-19 outbreak. Sixty-four participants took part in an online expressive writing project, and a total of 167 writings were collected together with some self-report evaluations on emotions and physical sensations. A linguistic analysis through two different sets of computerized linguistic measures was conducted on the collected writings in order to study the linguistic markers of emotion regulation and elaboration. Results indicated that online expressive writing has helped respondents to get more in touch with the intense emotions that were experienced following the upheavals they witnessed. Writing even only once or twice helped, particularly those respondents who had at least one COVID-19 patient among close friends or relatives. Their writings showed an intense emotional involvement together with the ability to reflect and reorganize the personal meaning of the events and emotions experienced. This study shows that expressive writing can be used in the context of a psychological emergency, both as a powerful instrument to investigate and detect the complex psychodynamic processes underpinning the distress, and as a useful intervention to reduce the negative impact of traumatic events.

First Validation of the Referential Process Post-Session Scale - Therapist Version (RPPS-T).

OBJECTIVE: Bucci's multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. METHOD: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale - Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. RESULTS: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the four-factor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. CONCLUSIONS: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.

Linguistic features of the therapeutic alliance in the first session: a psychotherapy process study.

Critical aspects of the therapeutic alliance appear to be established as early as the first session. Specifically, the affective bond between the therapeutic dyad appears to develop early in treatment and tends to remain stable over time, while agreements on goals and tasks tend to fluctuate over the course of treatment. Are there distinguishable early signs of a strong therapeutic alliance? In this study, we examined how some linguistic measures indicative of joint emotional elaboration correlated with a measure of the therapeutic alliance assessed within a single session. Initial intake sessions with 40 patients with varying diagnoses were videotaped, transcribed, and analyzed using linguistic measures of referential process and then scored with the Segmented Working Alliance Inventory-Observer form. Results showed that patients who were rated as more emotionally engaged in relating their experiences and then reflecting on them by mid-session also had higher scores in the therapeutic alliance by the final part of that same session. An implication of this study is that the interpersonal factors facilitating elaboration of inner experience, including elements of warmth, safety, and analytic trust, are related to the development of early therapeutic alliance. These findings did not appear to be dependent on the patient's psychopathology. This study is one in a growing line of research exploring how patients speak rather than just the content of what they say.

Psychotherapy trainees' epistemological assumptions influencing research-practice integration.

Over the last few decades a growing number of psychotherapy scholars as well as psychotherapy researchers have joined a paradigm shift, moving from a reductionist to a complexity-oriented epistemology. Many authors recognize that when human subjectivity is the object of intervention and study, it is appropriate to resist simplification and to assume a more complex approach. While this paradigm shift is taking place not only in psychology but also in other disciplines, many psychotherapists still share the assumption that psychotherapy practice and psychotherapy research have opposite values; hence, they are worlds that cannot be reconciled. Considering this as one of the main reasons preventing a useful integration of evidence-based practice and clinical training in psychotherapy, we conducted an online survey of 126 Italian trainees from three differently-oriented psychotherapy institutes (cognitive-behavioral, relational-psychoanalytic and relational-systemic) to explore the epistemology underling the clinical and research practices. After presenting a clinical vignette, we asked questions about diagnostic considerations, case formulations, and treatment plans; we also asked questions about participants' involvement in research projects or in research methodology courses and about willingness to be involved in future research studies in their clinical practice. We found some significant differences among trainees with different orientations, but in general most of the responses reflected a positivistic epistemology underlying both clinical and research activities. These findings suggest that a deeper awareness of one's own epistemological assumptions could help trainees foster a more theory-coherent and research-informed clinical practice.