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ObjectiveEvidence suggests that many adults with type 1 diabetes (T1D) experience clinically relevant levels of diabetes distress, indicating coping difficulties. Studies have primarily focused on emotion regulation as a possible construct to be addressed in psychological interventions to alleviate diabetes distress. This study extends the literature by investigating the cross-sectional association between emotion regulation, diabetes distress and the construct of emotional self-awareness as an additional variable to be considered in potentially reducing diabetes distress.MethodsVia an online survey, data was collected on emotional self-awareness dimensions (attention to feelings, clarity of feelings), emotion regulation strategies (cognitive reappraisal, expressive suppression, mood repair) and diabetes distress, along with self-reported clinical and sociodemographic information. Multiple linear regression with stepwise backward method was used to examine associations, controlling for country.ResultsN = 262 Italian and Dutch adults with T1D (80.5% women, M = 38.12 years, SD = 12.14) participated. Clarity of feelings was significantly negatively associated with diabetes distress, resulting in a medium effect size (β = −0.22, p

IntroductionHypophosphatasia (HPP) is a rare genetic disease caused by inactivating variants of the ALPL gene. Few data are available on the clinical presentation in Italy and/or on Italian HPP surveys.MethodsThere were 30 suspected HPP patients recruited from different Italian tertiary cares. Biological samples and related clinical, biochemical, and anamnestic data were collected and the ALPL gene sequenced. Search for large genomic deletions at the ALPL locus (1p36) was done. Phylogenetic conservation and modeling were applied to infer the effect of the variants on the protein structure.ResultsThere were 21 ALPL variants and one large genomic deletion found in 20 out of 30 patients. Unexpectedly, NGS-driven differential diagnosis allowed uncovering three hidden additional HPP cases, for a total of 33 HPP subjects. Eight out of 24 coding variants were novel and classified as “pathogenic”, “likely pathogenic”, and “variants of uncertain significance”. Bioinformatic analysis confirmed that all the variants strongly destabilize the homodimer structure. There were 10 cases with low ALP and high VitB6 that resulted negative to genetic testing, whereas two positive cases have an unexpected normal ALP value. No association was evident with other biochemical/clinical parameters.DiscussionWe present the survey of HPP Italian patients with the highest ALPL mutation rate so far reported and confirm the complexity of a prompt recognition of the syndrome, mostly for HPP in adults. Low ALP and high VitB6 values are mandatory for the genetic screening, this latter remaining the gold standard not only to confirm the clinical diagnosis but also to make differential diagnosis, to identify carriers, to avoid likely dangerous therapy in unrecognized cases.

AimsThe current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff’s attitudes to the use of coercion in treatment.MethodsThe original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria).ResultsResults confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 “Coercion as offending” (items: 3, 13, 14, and 15), Factor 2 “Coercion as care and security” (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 “Coercion as treatment” (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach’s α and yielded acceptable indexes, ranging from 0.64 to 0.77.ConclusionThe present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals’ attitudes toward coercion.

The Covid-19 pandemic and its related restriction measures might negatively impact diabetes management and well-being of adolescents with Type 1 Diabetes Mellitus (T1DM) and their caregivers. Accordingly, the present scoping review is aimed at mapping the literature in line with the question “How has the Covid-19 influenced diabetes management and well-being of adolescents with T1DM and their caregivers?”. A systematic search has been conducted through three academic databases. Studies carried out during the Covid-19 pandemic focused on adolescents aged between 10 and 19 years with T1DM and/or their caregivers were included. A total of 9 studies, performed between 2020 and 2021, have been identified. In particular, N = 305 adolescents with T1DM and N = 574 caregivers were considered. Overall, studies were not specific in reporting adolescents’ age, and only 2 studies were primarily focused on the adolescent population with T1DM. In addition, studies were mainly focused on evaluating adolescents’ glycemic control, which remained stable or has improved throughout the pandemic. Contrarily, psychosocial variables have been marginally considered. Indeed, only one study investigated adolescents’ diabetes distress, which remained stable from pre-to during post-lockdown, albeit improving among girls, specifically. As regards caregivers of adolescents with T1DM, studies showed mixed results concerning their psychological state during the Covid-19 pandemic. Prevention measures, which are aimed at supporting adolescents with T1DM during the lockdown, were considered by one study only, showing the favorable role of telemedicine during lockdown for adolescents’ glycemic control. Altogether, the current scoping review has identified many shortcomings of the available literature, which are given by the limited specificity of the age group considered and by the limited consideration of psychosocial variables, particularly their interplay with the medical ones.

Aims: The COVID-19 pandemic and consequent extreme restrictions imposed by governments across the world forced psychotherapists to abruptly change their working modality. The first aim of the current study was to assess psychotherapists’ self-perceptions (i.e., affective and cognitive perceptions about their self and their self in relation to clients) when providing telepsychotherapy during the first peak of the COVID-19 pandemic in Italy. The second aim was to explore the associations between psychotherapists’ self-perceptions, characteristics, and clinical practices.Method: An online survey was administered to 281 Italian licensed psychotherapists (Mage=45.15; SD=10.2; 83.6% female) between April 5 and May 10, 2020. The survey comprised ad-hoc questions that were designed to collect sociodemographic details and information related to working practices. Moreover, a semantic differential (SD) scale was developed to assess psychotherapists’ self-perceptions, and a factor analysis was performed from the SD items.Results: The SD scale showed an overall trend of positive psychotherapist self-perception during telepsychotherapy, despite reports of greater fatigue and directive and talkative behavior during sessions. Four SD factors accounted for 45% of the variance: “Affective Availability,” “Attitude Predisposition,” “Well-being,” and “Interventionism.” Scores on the first three factors were indicative of psychotherapists’ Positive vs. Negative self-perception. A comparison of the Positive and Negative attitudinal profiles using the chi-squared test with Yates’s correction and a Monte Carlo simulation found that psychotherapists with a Positive profile reported greater satisfaction with the telematic modality and were more likely to perceive that their clients were able to maintain privacy during sessions.Conclusion: The results suggest that Italian psychotherapists have been able to promptly adapt to the imposed telematic modality during the COVID-19 pandemic. However, they may have attempted to compensate for their physical distance from clients by intervening more during sessions. These findings may support psychotherapists who are currently practicing and inform future practitioners who are considering the use of telematic treatment as a routine component of psychotherapeutic care.

Aims: Recent meta-analytic data show that approximately 40% of individuals at clinical high risk for psychosis (CHR) receive at least one personality disorder (PD) diagnosis. Personality pathology could significantly influence CHR patients' prognosis and response to treatment. We aimed at exploring the PD traits of CHR adolescents, in order to outline a prototypic description of their most frequently observed personality characteristics.Methods: One hundred and twenty-three psychiatrists and psychologists used a Q-sort procedure [i.e., the Shedler–Westen Assessment Procedure-200 for Adolescents (SWAP-200-A)] to assess personality traits and disorders in 58 (30 male; mean age = 16 years, range = 13–19 years) CHR adolescents and two gender- and age-matched samples, respectively, with (n = 60) and without PDs (n = 59).Results: Differences between the CHR, PD, and clinical groups showed that CHR adolescents had pervasive and more clinically relevant schizoid, schizotypal, borderline, and avoidant traits, as well as poorer adaptive functioning. Moreover, by collecting the highest mean SWAP-200-A items, we empirically outlined a prototypic description of CHR youths, comprised of avoidance of social relationships; suspiciousness; obsessional thoughts; lack of psychological insight; dysphoric and overwhelming feelings of anxiety and depression; odd and anomalous reasoning processes or perceptual experiences; symptoms of depersonalization and derealization; and negative symptoms of avolition, abulia, blunted affects, and impaired role functioning.Conclusions: The results suggest that avoidant interpersonal strategies, impaired mentalization, and difficulties in emotional regulation could become important targets for psychosocial interventions with CHR adolescent populations.

Aims: Italy was one of the first countries to be significantly affected by the coronavirus disease 2019 (COVID-19) pandemic, determining a unique scenario for Italian psychotherapists to consider changing the modality in which they deliver treatment. The present study aimed at studying which factors related to psychotherapists and their clinical practice had a major role in predicting two main outcomes: (1) the rate of interrupted treatments during lockdown and (2) psychotherapists’ satisfaction with the telepsychotherapy modality.Methods: An online survey was administered to licensed psychotherapists (n = 306), who worked mainly as private practitioners, between April 5 and May 10, 2020 (i.e., the peak of the pandemic in Italy).Results: Psychotherapists reported that 42.1% (SD = 28.9) of their treatments had been interrupted, suggesting that Italy faced an important undersupply of psychotherapy during the lockdown. Using the Akaike information criterion (AIC) model selection, we identified three predictors of the rate of interrupted treatments: (1) psychotherapists’ lack of experience with telepsychotherapy prior to the lockdown, (2) their theoretical orientation (with cognitive behavioral psychotherapists reporting a higher rate of interrupted treatments), and (3) patients’ lack of privacy at home, as reported to the psychotherapists. Furthermore, we found four predictors of psychotherapists’ satisfaction with the telepsychotherapy modality: (1) the rate of interrupted treatments, (2) psychotherapists’ previous experience with telepsychotherapy, (3) their beliefs about the compatibility of telepsychotherapy with their theoretical orientation, and (4) their use of a video-conferencing modality, rather than telephone.Conclusion: The following recommendations can help policy makers, professional associations, and practitioners in promoting the continuity of psychotherapy treatments during the COVID-19 outbreak and in future emergencies: (i) disseminating training programs for practitioners on telepsychotherapy, (ii) supporting patients to pragmatically access a private space at home, (iii) encouraging practitioners to use video-conferencing (instead of telephone) to deliver remote therapy, and (iv) increasing the acceptance of telepsychotherapy among both clinicians and the general public.

In psychodynamic psychotherapy, verbal (structures and intents) and non-verbal (voice and interruptions) dimensions of communication intertwine conveying information and determining the mutual regulation between therapist and patient through conversational sequences. The communication components interplay is the foundation for building the therapeutic alliance, a relational dimension that predicts a psychotherapy outcome and change, influenced by patient-therapist exchanges from the initial stages of their encounter. Depressed patients present specific verbal and non-verbal communication and show difficulties in developing and maintaining the therapeutic alliance. Based on the reviewed literature, the main aim of this study was to analyze how the action of specific communicative modes, implemented by the therapist and depressed patients, affect the reciprocal construction of the early therapeutic alliance by each participant during the mutual regulation processes. We employed a mixed methods approach based on a systematic observation of communication and alliance ruptures and repairs within the audio recordings and verbatim transcripts of 20 psychotherapy sessions (6,232 speaking turns) with seven depressed patients. The observational design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified because we developed a comprehensive procedure that integrates an ad hoc indirect observation system (the Communicative Modes Analysis System in Psychotherapy), analyzing verbal and non-verbal communication, and an observational tool with deductive categories (the Collaborative Interactions Scale-Revised), assessing the therapeutic alliance construction. Once we confirmed the intra-and inter-observer reliability for the ad hoc system and the inter-rater reliability for the tool with deductive (or theoretical) categories, we performed descriptive statistics (to describe quantitatively communicative modes and alliance ruptures and repairs), lag sequential analysis (to detect stable patterns in communication-alliance interactions), and polar coordinate analysis (to identify significant relationships between communicative modes and alliance ruptures and repairs). Results confirm that the therapist's verbal (asking and exploring) and non-verbal (elaborating and cooperatively interrupting) modes and the depressed patients' verbal (asserting and exploring) and non-verbal (expressing emotions and cooperatively interrupting) modes determine stable patterns and significant associations with collaborative behaviors connected to the reciprocal construction of alliance by each participant. All this may provide professionals with useful information to increase the psychotherapy effectiveness with depressed patients.

The aim of this paper was to assess strengths and fragilities in children aged 6 to 10 who suffered one or more hospitalizations. State and trait anxiety, coping abilities, and cognitive and affective functioning through play were assessed using a triangulation approach. Fifty hospitalized children aged 6–10 were compared to 50 non-hospitalized children, and children at first admission were compared with children with more than one hospitalization experience. The State-Trait Anxiety Scales Inventory for Children was administered for assessing trait and state anxiety, and the Children's Coping Strategies Checklist (Revision 1) was administered to assess coping dimensions. The Affect in Play Scale - Preschool - Brief (Extended version) was used to assess cognitive and affective dimensions of play. No significant differences were found for trait anxiety between hospitalized vs. non-hospitalized children. Instead, as expected, state anxiety was significantly higher in hospitalized childen than in the non-hospitalized children. Hospitalized children reported higher scores than non-hospitalized children in support-seeking strategies. As for pretend play, hospitalized children showed significantly higher cognitive scores than non-hospitalized children. However, hospitalized children appeared significantly more restricted in their affect expressions. No significant differences were found for play and anxiety scores between children admitted for the first time in the hospital ward and children with more than one admission. However, children at first admission scored higher in coping and positive cognitive restructuring and in avoidance-coping strategies than children with more than one admission. The initial assessment of the interplay of key variables such as anxiety, coping and play can inform healthcare professionals by serving as a guide in order to determine a child's risk for negative psychological outcomes due to hospitalization, to plan appropriate interventions and to provide substantial assistance to hospitalized children in the future.

Communication represents the core of psychotherapy. The dynamic interaction between verbal and non-verbal components during patient-therapist exchanges, indeed, promotes the co-construction of meanings bringing about change within a process of reciprocal influence of participants. Our paper aims to illustrate the building of a new observational instrument of the therapeutic discourse, the Communicative Modes Analysis System in Psychotherapy (CMASP), and its reliability study from Mixed Methods framework. The CMASP is a single classification system analyzing the communication features within therapeutic exchanges. Born to overcome the limits of traditional psychotherapy research which considers verbal and non-verbal dimensions of communication as in polar opposition, the CMASP building was based on the performative function derived from the Speech Act Theory. We used this function as a comprehensive theorization to interpret the communication components in psychotherapy as an integrated and interacting system. In fact, the instrument detects and classifies, at the overall and dimension level, the verbal and extra-linguistic components of psychotherapeutic communication implemented by the therapist and patients in the form of communicative modes. From the observational methodology framework, it was built an instrument able to record and analyze verbal, vocal and interruption behaviors by combining elements of qualitative and quantitative research approaches. The sample consisted of 30 psychotherapy audio recordings and verbatim transcripts of psychotherapy sessions (for a total of 8327 speaking turns). Four main dimensions were elaborated (Verbal Mode-Structural Form, Verbal Mode-Communicative Intent, Vocal Mode, and Interruption Mode) according to the agency role of communication components. The instrument is a field format combined with category systems. For each dimension, we built a category system that is exhaustive and mutually exclusive. From all dimensions, we have a total of 33 categories. Intra-and inter-judge reliability among four independent judges was computed on a total of 503 speaking turns coded through Cohen’s κ and Krippendorff’s canonical agreement coefficients (Cc), respectively. The CMASP showed high intra-and inter-judge agreement at the global, dimensional, and categorical level providing researchers and professionals with a single and flexible classification system, able to give multiple and concurrent information about the psychotherapy process.

A sample of undergraduate Psychology students (n = 1005), prevalently females (82.4%), mean age 20.5 (sd 2.5), was examined regarding their attitudes toward people suffering from mental illness. The survey instrument included a brief form for demographic variables, the Attribution Questionnaire-9 (AQ-9), the Ten Items Personality Inventory (TIPI), and two questions exploring attitudes toward open-door and restraint-free policies in Psychiatry. Higher levels of stigmatizing attitudes were found in males (Pity, Blame, Help, and Avoidance) and in those (76.5%) who had never had any experience with psychiatric patients (Danger, Fear, Blame, Segregation, Help, Avoidance and Coercion). A similar trend was also found in those who don't share the policy of no seclusion/restraint, while subjects who are favorable to open-door policies reported higher Coercion scores. No correlations were found between dimensions of stigma and personality traits. A machine learning approach was then used to explore the role of demographic, academic and personality variables as predictors of stigmatizing attitudes. Agreeableness and Extraversion emerged as the most relevant predictors for blaming attitudes, while Emotional Stability and Openness appeared to be the most effective contributors to Anger. Our results confirmed that a training experience in Psychiatry might successfully reduce stigma in Psychology students. Further research, with increased generalizability of samples and more reliable instruments, should address the role of personality traits and gender on attitudes toward people suffering from mental illness.

Affect in Play Scale-Preschool (APS-P) is one of the few standardized tools to measure pretend play. APS-P is an effective measure of symbolic play, able to detect both cognitive and affective dimensions which classically designated play in children, but often are evaluated separately and are scarcely integrated. The scale uses 5 min standardized play task with a set of toys. Recently the scale was extended from 6 to 10 years old and validated in Italy preschool and school-aged children. Some of the main limitations of this measure are that it requires videotaping, verbatim transcripts, and an extensive scoring training, which could compromise its clinical utility. For these reasons, a Brief version of the measure was developed by the original authors. This paper will focus on an APS-P Brief Version and its Extended Version through ages (6–10 years), which consists “in vivo” coding. This study aimed to evaluate construct and external validity of this APS-P Brief Version and its Extended Version in a sample of 538 Italian children aged 4-to-10 years. Confirmatory factor analysis yielded a two correlated factor structure including an affective and a cognitive factor. APS-P-BR and its Extended Version factor scores strongly related to APS-P Extended Version factor scores. Significant relationships were found with a divergent thinking task. Results suggest that the APS-P-BR and its Extended Version is an encouraging brief measure assessing pretend play using toys. It would easily substitute the APS-P and its Extended Version in clinical and research settings, reducing time and difficulties in scoring procedures and maintaining the same strengths.