Path analysis from COVID-19 perceptions to psychological health: The roles of critical distance and mastery.

OBJECTIVE: The Coronavirus disease 2019 (COVID-19) pandemic was previously associated with psychopathological symptoms. However, the psychological mechanisms underlying these associations are largely unexplored. Previous studies suggested associations between metacognitive abilities (e.g., mastery) and symptomatology, which may have impacts on COVID-19 perceptions. This study aims to explore, using path analysis, the mediational role of Critical Distance (differentiation and decentration abilities) and Mastery on the relationships between COVID-19 perceptions and psychological well-being and distress. METHODS: In a cross-sectional design, 227 participants (M = 34.21, SD = 10.9) filled self-report questionnaires. RESULTS: Metacognitive abilities were negatively correlated with psychopathological symptoms. Both Critical Distance and Mastery mediated the path from COVID-19 perceived severity and anxiety to psychological distress and well-being. Critical Distance seems to augment Mastery which tends to increase psychological well-being and limited psychological distress. CONCLUSIONS: Metacognition seems to play a mediational role on the relationship between COVID-19 perceptions and mental health. Clinical psychologists and psychotherapists may enhance psychological interventions regarding COVID-19 psychopathological symptomatology by working on metacognitive Critical Distance and Mastery abilities.

Early maladaptive schemas and COVID-19 anxiety: The mediational role of mistrustfulness and vulnerability to harm and illness.

BACKGROUND: Early maladaptive schemas (EMS), as lifelong psychological structures, tend to be associated with psychopathological symptomatology. Previous research has suggested that schemas act as psychological vulnerabilities to stressful life situations, such as the present worldwide COVID-19 pandemic. In this context, anxiety and psychological distress have been documented as two of the main psychological symptoms associated with the COVID-19 pandemic. However, the associations between specific EMS and COVID-19 anxiety remain unexplored. Therefore, this study aims to explore the relationships between EMS, COVID-19 anxiety as well as other mental health variables such as psychological well-being, distress and life satisfaction. METHODS: In a cross-sectional design, 249 individuals (M = 34.2, SD = 12.0) completed several self-report measures. RESULTS: EMS from different schematic domains were positively associated with COVID-19 anxiety and psychological distress and negatively associated with psychological well-being and life satisfaction. An EMS hierarchical regression model predicted COVID-19 anxiety. Mistrustfulness and vulnerability to harm and illness mediated the relationships between COVID-19 anxiety, psychological distress and life satisfaction. CONCLUSIONS: According to these results, mistrustfulness and vulnerability to harm and illness can act as underlying variables for the decrease in mental health associated with the COVID-19 pandemic.

COVID-19 Inventory and Mental Health: Preliminary Analysis.

OBJECTIVE: The COVID-19 pandemic imposed a set of drastic worldwide changes to and restrictions on daily life. Despite predictions of the harmful impacts of the pandemic on mental health, empirical data are lacking. This study sought to examine the relationship between individuals' perceptions about COVID-19 and scores on mental health indexes. METHODS: In this cross-sectional study, 183 individuals answered self-report questionnaires. A new inventory based on the health belief model (HBM) developed in Portugal was explored with a factor analysis, which revealed two significant factors: COVID-19 anxiety and perceived severity of the disease. RESULTS: Results showed that anxiety about COVID-19 was positively correlated with psychological distress, somatization, and paranoid ideation and was negatively correlated with psychological well-being. COVID-19 anxiety mediated the relationship between symptomatology and mental health. CONCLUSIONS: Perceptions about COVID-19 seem to play pivotal roles in mental health. These results may inform interventions focused on reducing psychological distress and symptomatology and on increasing psychological well-being.

Relationships between Emotional Schemas, Mindfulness, Self-Compassion and Unconditional Self-Acceptance on the Regulation of Psychological Needs.

Emotional schemas are pervasive mental structures associated with a wide array of psychological symptoms, while mindfulness, self-compassion, and self-acceptance are viewed as adaptive psychological constructs. Psychological needs may be described as the cornerstone of mental health and well-being. However, a study of the relationships between emotional schemas, mindfulness, self-compassion, and self-acceptance with psychological needs was not performed. For this purpose, 250 subjects (M=20.67, SD=4.88, Male=33, Female=217), were evaluated through self-report questionnaires, in a cross-sectional design. Negative correlations were found between emotional schemas, mindfulness, self-compassion, unconditional self-acceptance, and psychological needs. Symptomatology was positively correlated with emotional schemas. Mindfulness, self-compassion, and unconditional self-acceptance predicted the regulation of psychological needs and mediated the relationship between emotional schemas and psychological needs. Emotional schemas may be associated with a tendency for experiential avoidance of internal reality, self-rejection/shame and self-criticism which may impair the regulation of psychological needs. These variables may be targets of integrative case conceptualization and clinical decision making focused on patient's timings, styles of communication and needs.

Relationships between emotional processing difficulties and early maladaptive schemas on the regulation of psychological needs.

Emotional processing difficulties may be viewed as dysfunctional emotional states emerging from non-adequately processed emotional experience while early maladaptive schemas are experienced-based dysfunctional mental structures associated with chronic and recurrent psychological disorders. Schemas and emotional difficulties were previously associated with impairments on the regulation of psychological needs. However, clarifications about the relationships between these constructs are lacking. In a cross-sectional study, a clinical sample of 66 participants (M = 46.4, SD = 13.1) completed self-report questionnaires. Emotional processing difficulties correlated positively with schemas and negatively with the regulation of psychological needs. Disconnection and rejection, lack of autonomy and impaired limits schema domains mediated the relationship between emotional processing difficulties and psychological needs. Emotional processing difficulties may be associated with impairments on the regulation of psychological needs, due to activation of early maladaptive schemas, which, in turn, prompts symptomatology. Transtheoretical intervention regarding marker-guided interventions and phase-by-phase schema restructuring may be used to promote the regulation of psychological needs.

Self-assessment of patterns of subjective experience: development and psychometric study of the States of Mind Questionnaire.

States of mind are forms of subjective experience that involve cognitions, emotions, needs, desires and physical sensations, subjectively, some charged with emotional suffering and some charged with well-being. This study presents a new questionnaire designed of States of Mind Questionnaire (SMQ), focused on the self-assessment of recurring patterns of subjective experience. We first review the literature leading to the development of SMQ and then we investigate its psychometric properties. We conducted an exploratory factor analysis (EFA), internal reliability, inter-correlations between subscales, test-retest reliability, convergent and divergent validity. Finally, we explored the relationship between states of mind and symptoms. The sample was composed of 427 individuals (M age=32; SD=11.49). EFA did not showed a theoretically coherent structure. Internal consistency was good for the 24 subscales (Cronbach's α of 0.62 to 0.96) and test-retest reliability was adequate. States of mind converged and diverged with maladaptive schemas and predicted symptomatology. Overall results indicate that SMQ may be a valuable tool to help clinicians and patients to assess different and diverse states of mind. However, more research it is required to explore and enhance SMQ psychometric properties in non-clinical clinical groups and in psychotherapy outcomes.

The Alliance Negotiation Scale: Portuguese adaptation.

The transtheoretical conceptualization of the working alliance and the ensuing evaluation tools tend to overestimate the collaboration between therapist and patient and to disregard the negotiation. The degree to which therapists and patients are able to negotiate their disagreements between goals and tasks is an important variable for establishing and maintaining the alliance. The purpose of this study was to adapt the Alliance Negotiation Scale - which operationalizes the theoretical construct of negotiation - to the Portuguese population. A translation and study of the psychometric traits of the scale are presented. After a backward-translation of the scale it was distributed, with the help of therapists, to a sample of 120 participants, all patients in therapeutic process. The scale showed a similar structure to its previous versions, and adequate levels of internal consistency (α=.82). These results reinforce the quality of the scale, construct's relevance and its transtheoretical nature. These results are a step forward for Portuguese therapists' and researchers' ability to evaluate the bond between patient and therapist and to compare results from different countries.

Alexithymia and emotional processing: a longitudinal mixed methods research.

Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients processing emotions and engaging in emotional tasks. The possibility of alexithymia being modified by psychotherapy remains a topic of great debate but with little empirical research. In this study a mixed methods longitudinal design was used to better understand alexithymia, emotional processing and change process in psychotherapy. Twelve clients, five with alexithymia, were studied considering the development of alexithymia, emotional awareness, differentiation, regulation and severity of symptoms. The reliable change index was used to interpret the evolution of those emotional variables' scores for each case and thematic analysis was used to analyze individual interviews. Thematic analysis generated several themes, organized in two broad domains: i) perception of emotions and ii) description of change. The three alexithymic patients that changed in alexithymia also changed in at least one of the emotional variables - lack of emotional awareness, emotion differentiation or emotion regulation. Generally, alexithymic patients were able to accomplish change in psychotherapy although they had a tendency to focus on physical complaints, describe changes in a more rational rather than emotional way and present vaguer descriptions of their problems. These results point that alexithymia may change through therapy and reinforces that those changes are associated with improved emotional processing.

Alexithymia and therapeutic alliance: a multiple case study comparing good and poor outcome cases.

Alexithymia has been associated with poor outcomes in psychotherapy. This association has been attributed to a difficulty in patients expressing emotions, engaging in emotional tasks and also poor therapeutic alliances. This study aims to better understand alexithymic patients in psychotherapy. A multiple case study design was used. Cases were selected from a larger research project considering their alexithymia level and outcome status, based on the reliable change index and the client perspective on change. Four cases are presented: with and without alexithymia with good and poor outcome. The therapeutic alliance was included as a process measure, evaluated from both client and therapist. At the end a semi structured interview was conducted with both participants, individually. The analysis concerned the integration and triangulation of the therapist and client experience for each case. Each patient was briefly presented and then a focus was made regarding the perception of both participants on the therapeutic alliance and the emotional processing and change process of the client. Both alexithymic cases and the non-alexithymic poor outcome case showed difficulties in the therapeutic alliance, especially from the perspective of the therapist. In these cases, emotional impairments may have contributed to a poor therapeutic alliance, impacting on the outcome. We suggest that a great focus on the therapeutic alliance with alexithymic patients may increase the quality of treatment and it may be more useful for case conceptualization to consider each feature of the alexithymia construct individual.

Alexithymia and Emotional Processing: A Mediation Model.

OBJECTIVE: Although alexithymia has been associated with difficulties in emotional regulation, both constructs are complex and this association remains unclear. This research attempts to study the relation between both constructs to identify better ways to guide clinical intervention. METHOD: Emotion awareness, differentiation, and regulation were tested as mediators of the associations between alexithymia and severity of symptoms. The model was tested in a clinical (121 participants) and a nonclinical sample (188 participants). RESULTS: Mediation effects were found in both samples with respect to different alexithymia factors, with the effects being higher in the clinical sample. CONCLUSION: Emotional awareness and emotional differentiation mediate the relationship between alexithymia and emotion regulation. The similarities between samples suggest that emotional processing may be better thought of as being on a continuum. Being aware of the differential effect each alexithymia factor has on emotional processing may be helpful to guide intervention.

Del encapsulamiento a la complementariedad paradigmática: Estilos terapéuticos y epistémicos de los psicoterapeutas / From encapsulation to paradigmatic complementarity. Psychotherapists' epistemic and therapeutic styles

Desde el momento en que los estilos epistémicos determinan lo que cuenta como realidad y conocimiento válido, es posible que los mismos sean, al menos parcialmente, responsables de los estilos terapéuticos de los terapeutas. En realidad, hay estudios previos que prueban que, independientemente de la orientación teórica, los diferentes estilos epistémicos parecen estar relacionados con diferentes estilos terapéuticos. Este estudio fue diseñado con el propósito de verificar la hipótesis de que los terapeutas que utilizan una variedad mayor de estilos epistémicos diferentes son, a su vez, más flexibles en términos de estilos terapéuticos. Los resultados parecen confirmar tal hipótesis. Esta habilidad para usar diferentes estilos epistémicos es una manera de superar el encapsulamiento, y se lo llama "complementariedad paradigmática". Se obtienen conclusiones sobre la implicancia que esto tiene para la integración en psicoterapia.

Del encapsulamiento a la complementariedad paradigmática: Estilos terapéuticos y epistémicos de los psicoterapeutas / From encapsulation to paradigmatic complementarity. Psychotherapists epistemic and therapeutic styles

Desde el momento en que los estilos epistémicos determinan lo que cuenta como realidad y conocimiento válido, es posible que los mismos sean, al menos parcialmente, responsables de los estilos terapéuticos de los terapeutas. En realidad, hay estudios previos que prueban que, independientemente de la orientación teórica, los diferentes estilos epistémicos parecen estar relacionados con diferentes estilos terapéuticos. Este estudio fue diseñado con el propósito de verificar la hipótesis de que los terapeutas que utilizan una variedad mayor de estilos epistémicos diferentes son, a su vez, más flexibles en términos de estilos terapéuticos. Los resultados parecen confirmar tal hipótesis. Esta habilidad para usar diferentes estilos epistémicos es una manera de superar el encapsulamiento, y se lo llama "complementariedad paradigmática". Se obtienen conclusiones sobre la implicancia que esto tiene para la integración en psicoterapia.(AU)