Defense mechanisms and alexithymia in Inflammatory bowel disease and Irritable bowel disease

Objectives: This study aimed to examine the differential contribution of demographic and medical characteristics on severity of gastrointestinal symptoms in a sample of patients with IBS or IBD. In a sample of outpatients with gastrointestinal disorders. In addition this study aimed to explore the role of alexithymia and defense style on gastrointestinal symptoms. Methods: The participants consisted of 65 outpatients with an IBS or IBD diagnosis who completed a demographic questionnaire, the Toronto Alexithymia Scale – 20 (TAS-20), the Defense Style Questionnaire (DSQ), and the Gastrointestinal Symptom Rating Scale (GSR). Results: ANOVA showed no significant effect of specific diagnosis on the severity of gastrointestinal symptoms. Results of MANCOVA showed that there was a significant multivariate effect of gender with female scoring significantly higher than males on severity of intestinal symptoms. Other variables such as age, level of education, years since diagnosis did not reach a significance on the dependent variables. In addition the defense style defined “maladaptive” had a significant effect on dyspeptic symptoms. Conclusions: Our results have shown the influence of the maladaptive defense style on the severity of symptoms with no differences for the three considered diagnosis. Moreover they are coherent with past studies highlighting the risk for the female gender to develop a somatic disease

The Role of Metacognitions in Predicting Anxiety and Depression Levels in Cancer Patients Ongoing Chemotherapy

Abstract Cancer patients often have to deal with numerous side effects and psychological distress during chemotherapy. Research has shown that dysfunctional metacognitive beliefs are the basis for the development and maintenance of emotional disorders. The present research is a first attempt to explore how metacognitions influence anxiety and depression in cancer patients undergoing chemotherapy. A sample of 175 cancer patients undergoing chemotherapy completed a demographic questionnaire, the Metacognitions Questionnaire-30 (MCQ-30)and the Hospital Anxiety and Depression Scale (HADS). Medical information about the stage of disease and the history of treatment was obtained. Linguistic analysis (Stansfield et al., 1992) was employed to ensure that the form had been correctly translated because the Italian form of the MCQ-30 was utilized (Quattropani, et.al, 2014) Negative beliefs, the need to control thoughts, and positive beliefs explained up to 89% of variance of anxiety in cancer patients during chemotherapy. The negative beliefs about worry and the gender explained up to 81% of variance of depression in cancer patients during chemotherapy. In fact, female gender was positively correlated with depression level of patients. The negative beliefs about worry and the need to control thoughts explained the 81% variance for the overall distress of patients during chemotherapy. In conclusion, some metacognitive factors have a crucial role both for anxiety and depression in cancer patients ongoing chemotherapy. It is suggested that the psychological intervention for cancer patients should assess such factors and try to address them in clinical practice. Statistical analysis was conducted by Massimo Mucciardi. Mary Ellen Toffle wrote the abstract, re-werote entire article, assisted in translation and wrote section 3.3.

The burnout syndrome in palliative home care workers: the role of coping strategies and metacognitive beliefs

Healthcare professionals are daily confronted with events involving the suffering of others, which are likely to generate highly negative and stressful emotions. In palliative care the emotional commitment is exacerbated by the constant confrontation with the theme of suffering and death. The failure to successfully down-regulate negative emotions is a key risk factor for a severe form of discomfort, known as burnout syndrome. Burnout is a psychological state of exhaustion, related to stress at work. Maslach (1996) describes it as a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Recent studies have shown that healthcare worker coping strategies may function either as a risk or aprotective factor for the development of distress and emotional problems. Furthermore, other studies highlighted the role of the dimensions of metacognition as vulnerability factors in predicting the development of psychological symptoms. The aim of this study is to examine and assess the relationships between burnout, coping strategies and metacognitive beliefs in workers involved in home palliative care. The hypothesis of the present work is that the appropriate use of positive and flexible coping strategies and functional metacognitive beliefs may relate to the management of distress and emotional problems. A group of operators working in a team of Integrated Home Palliative Care participated in the research.The study was based on a protocol including the Italian version of MCQ-30, used to assess a range of metacognitive beliefs and processes relevant to vulnerability and maintenance of emotional disorders; the Brief Cope (BC) to survey coping strategies; Maslach Burnout Inventory (MBI) to measure burnout. The questionnaire includes a socio-demographical section. The results show the presence of a statistically significant correlation between the variables investigated

Metacognition and negative emotions in clinical practice. A preliminary study with patients with bowel disorder

In the past few years psychological characteristics in patients with organic bowel disorder have been poorly considered. However recent studies underline that psychological features increase gastrointestinal symptoms. The aim of this study is to investigate metacognition and emotions in patients with organic bowel disorder and functional bowel disorder. 33 outpatients with organic diagnosis and 28 outpatients with functional diagnosis were assessed with MCQ-30, ANPS and Brief-Cope; moreover stress was evaluated in all outpatients.   Results revealed that two groups show the same psychological disturbances and there are no differences between organic patients and functional patients. Statistical analysis indicated significant relations between dysfunctional metacognitive beliefs and negative emotions. Specifically, Beliefs of Uncontrollability and Danger (UD) are significantly related to Fear, Anger and Sadness. Moreover Fear and Anger are significantly related to stress; dysfunctional metacognitive beliefs are related to coping strategies. Beliefs of UD are related to Using Emotional Support; Positive Beliefs (PB) are related to Planning, while Cognitive Confidence (CC) is related to Self-Blame. Unexpectedly results are higher in patients with organic diagnosis. Our results suggest to reconsider psychological influences in patients with organic diagnosis of gastrointestinal disease.  Keywords: Metacognition; Inflammatory bowel diseases; Functional gastrointestinal disorders; Emotions; Coping;

The death of a loved one. A proposal to prevent complicated grief in palliative home care when assistance ends

Background: past studies have investigated the relationship between mourning and the quality of life in caregivers who care for terminally ill patients. Recently, complicated pain has been recognized as a risk factor for mental and physical health and severe suffering can interfere with individual functioning and social relationships. Every day, home-based palliative care workers confront health professionals who may develop complicated pain after the patient's death. Methods: the aim is to identify family members who take care of a high risk of complicated pain and to do this the SISIFO Consortium has developed a psychological intervention program to prevent complicated pain in family caregivers of terminally ill patients. Results: the common features of the psychological intervention and the future directions of the research were discussed. Conclusions: the purpose of this document is to illustrate the detailed procedure of the palliative home care service. Furthermore, the results of the psychological intervention program adopted by the service were briefly summarized

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients' ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety

Pathogenic contribution of the Macrophage migration inhibitory factor family to major depressive disorder and emerging tailored therapeutic approaches.

Abstract Background Immunoinflammatory disorders are often accompanied by depression. Here, we review the available preclinical and clinical studies suggesting a role for the pro-inflammatory cytokine Macrophage migration inhibitory factor (MIF) and the second member of the MIF family, D-dopachrome tautomerase (D-DT; DDT), in the pathogenesis of Major Depressive Disorders (MDD). Methods We prepared a narrative review from a search on PubMed of studies pertaining to MDD and MIF, as for October 2019. Both humans and animal studies haves been considered. Results Preclinical data show conflicting results on the role of endogenous MIF and DDT in depression. In contrast, several human studies show that circulating MIF levels tend to increase during the course of MDD. Higher levels of inflammatory biomarkers have also been associated with poorer responses to antidepressants and the levels of MIF significantly decrease after treatment, despite this may not be necessarily associated to an improvement in psychiatric symptoms. Limitations This is a narrative and not a systematic review of the literature on the involvement of MIF in MDD. We have highlighted studies performed in humans and in animal models, irrespective of population size and methodological approach. Conclusions This review highlights a role of MIF, and possibly DDT, in the pathogenesis of MDD. Whilst studies in animal models are discordant, the studies in patients with MDD convergently suggest that MIF plays a role in induction and maintenance of the disease. Additional studies are also needed on DDT that often displays synergistic function with MIF and their receptors

Clinical Efficacy and Therapeutic Alliance in a Time-Limited Group Therapy for Young Adults

This study evaluated the clinical efficacy of a time limited psychodynamic therapy for a group of young adult patients in terms of outcome and process. The results register a favourable outcome concerning not only the gravity of patients' initial symp-toms but also the structural personality changes and attachment style. In an exploratory perspective this study investigated the connection between the outcome of the tre-atment and therapeutic alliance measured by CALPAS-G in three different time intervals of therapy. A correlational analysis highlighted a strong connection between the Patient Commitment scale assessed at the beginning and the final outcome of the therapy. Work-ing Strategy Consensus and Group Understanding and Involvement assessed in the middle of the therapy course, show significant correlations with the final outcome of therapy

Reflective functioning and dissociative experiences: A comparison study between adolescents at “high-risk” of psychosis and healthy controls

# Background Despite the established contribution to psychological well-being in young subjects, the investigation of reflective functioning and dissociative experiences in help-seekers adolescents still appears an unmet need. # Objective The study aimed to assess reflective functioning and dissociative symptoms in help-seekers adolescents, and compare them to gender-matched healthy controls. # Methods The Reflecting Functioning Questionnaire (RFQ) was used to investigate mentalizing; the Adolescent Dissociative Experience Scale (A-DES) was used to explore dissociative symptoms. # Results The study involved 102 adolescents (mean age 18.06 ± 1.78 years), split into "help-seekers" (N= 51; mean age 19 ± 1.98 years) and healthy controls (N= 51; mean age 17.12 ± 0.84). "Help-seekers" adolescents showed lower RFQ-certainty scores (mean 3.39 ± 2.47), compared to healthy controls (mean 6.73 ± 5.01). Furthermore, "help-seekers" adolescents reported higher scores on RFQ-uncertainty (mean 7.73 ± 4.38), compared to healthy controls (mean 5.14 ± 4.17), which indicates a greater lack of knowledge about mental states (hypomentalizing). Eventually, "help-seekers" adolescents showed significantly worse dissociative symptoms (A-DES total mean score 3.49 ± 2.04), compared to healthy controls (A-DES total mean score 2.06 ± 1.43). # Conclusion The importance of an assessment in early adolescence denotes a topic of increasing concern, in order to identify failures in reflective functioning and the onset of dissociative experiences among help-seekers adolescents, toward the implementation of tailored psychological interventions

Pandemic nightmares: effects on dream activity of the COVID-19 lockdown in Italy

COVID-19 has critically impacted the world. Recent works have found substantial changes in sleep and mental health during the COVID-19 pandemic. Dreams could give us crucial information about people's well-being, so here we have directly investigated the consequences of lockdown on the oneiric activity in a large Italian sample: 5,988 adults completed a web-survey during lockdown. We investigated sociodemographic and COVID-19-related information, sleep quality (by the Medical Outcomes Study-Sleep Scale), mental health (by the Depression, Anxiety, and Stress Scales), dream and nightmare frequency, and related emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our sample and a population-based sample revealed that Italians are having more frequent nightmares and dreams during the pandemic. A multiple logistic regression model showed the predictors of high dream recall (young age, female gender, not having children, sleep duration) and high nightmare frequency (young age, female gender, modification of napping, sleep duration, intrasleep wakefulness, sleep problem index, anxiety, depression). Moreover, we found higher emotional features of dream activity in workers who have stopped working, in people who have relatives/friends infected by or who have died from COVID-19 and in subjects who have changed their sleep habits. Our findings point to the fact that the predictors of high dream recall and nightmares are consistent with the continuity between sleep mentation and daily experiences. According to the arousal-retrieval model, we found that poor sleep predicts a high nightmare frequency. We suggest monitoring dream changes during the epidemic, and also considering the implications for clinical treatment and prevention of mental and sleep disorders