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The Flexible Regulation of Emotional Expression (FREE) Scale assesses the ability to enhance and suppress displayed emotions among a range of hypothetical contexts. The Context Sensitivity Index (CSI) measures the ability to perceive cues to contextual demands across different situations. This study aimed to present the first step of the adaptation and validation to the Italian context of the FREE and the CSI scales.A sample of 120 Italian students took part in this first step. Six focus groups were conducted to explore the Context sensitivity, Emotional Flexibility, and Flexible Regulation of Emotional Expression constructs in the Italian context. Verbatim transcripts were analyzed with T-LAB software and two kinds of analyses were performed.Results of the Thematic Analysis of Elementary Contexts showed four clusters: "emotional flexibility", "emotion management", "emotion regulation", and "context sensitivity". Results of Factorial Analysis of Correspondences indicated three factors with the first two factors explaining about 80% of the variance. Factor 1, which opposed "emotional flexibility" and "context sensitivity" at its negative pole; "emotion management" and "emotion regulation" at its positive pole, was named "Cognitive and emotive functions of mind". Factor 2, which opposed "context sensitivity" and "emotion regulation" on the positive pole, "emotional flexibility" and "emotion management" on the negative pole, was named "Elaboration-adaptation as aim of the subject".Preliminary results obtained through a qualitative approach supported the validity of the flexible regulation of emotional expression and the context sensitivity constructs in the Italian context. These results will be tested with a quantitative approach in the next steps of this research.

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., Mediterranean Journal of Clinical Psychology, Vol 4, No 1 (2016)

Background: Despite the role of metacognition in psychopathology, no studies have explored this construct in the area of gastrointestinal disorders. Moreover, for many times there was a categorization between organic and functional gastrointestinal disorders. The aim of this study was to compare dysfunctional metacognitive beliefs between patients with functional bowel disorders and patients with organic bowel disorders. The purpose of this work was also to examine the relations between metacognitions, alexithymia and symptoms of the patients on the basis of diagnosis. Methods: A between-subject non parametric and correlational design was employed. We formed three clinical groups from a population of patients with gastrointestinal disorders and on the basis of the ‘organic’ and ‘functional’ diagnosis. All the participants underwent the Metacognitions Questionnaire 30, the Toronto Alexithymia Scale-20 and the Gastrointestinal Symptom Rating Scale. Results: There were no significant differences between the three clinical groups on MCQ-30 and TAS-20 scores. However, there were significant correlations based on diagnosis of the gastrointestinal disorder between alexithymic features and metacognitive dysfunctional beliefs. Conclusions: Our results underline the role of metacognitions for both patients with organic and functional gastrointestinal disorders. Moreover, the results highlight the importance to consider these aspects in patients with organic gastrointestinal disorder. Keywords: alexithymia; Crohn’s disease; IBS; metacognition; ulcerative colitis., Mediterranean Journal of Clinical Psychology, Vol 2, No 1 (2014)

The study aims at investigating the operators' impressions about the needs of patients and their families, their idea of palliative care, their moods and what they consider important in everyday clinical activity. Specifically, the study involved a group of 20 operators in a home palliative care service. Data were obtained through a self-report questionnaire. The results find the operators' strong need to share their work experience. Moreover the whole team is reputed to be important. This work is considered to be a source of human and professional gratification rather than economic. Finally, according to operators home palliative care involve a strong interplay between the operators' technical skills and their human resources., Mediterranean Journal of Clinical Psychology, Vol 1, No 3 (2013)

Vittorio Lenzo,1 Alberto Sardella,2 Alessandro Musetti,3 Maria Francesca Freda,4 Daniela Lemmo,4 Elena Vegni,5 Lidia Borghi,5 Giuseppe Plazzi,6,7 Laura Palagini,8,9 Gianluca Castelnuovo,10,11 Roberto Cattivelli,12 Rachele Mariani,13 Giovanni Michelini,14 Tommaso Manari,3 Emanuela Saita,10 Maria C Quattropani,15 Christian Franceschini16 1Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio, Calabria, Italy; 2Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; 3Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy; 4Department of Humanistic Studies, University of Naples Federico II, Naples, Italy; 5Department of Health Sciences, University of Milan, Milan, Italy; 6Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 7IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; 8Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy; 9Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; 10Department of Psychology, Catholic University of Milan, Milan, Italy; 11Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy; 12Department of Psychology, University of Bologna, Bologna, Italy; 13Department of Dynamic and Clinical Psychology, University of Rome “La Sapienza”, Roma, Italy; 14Sigmund Freud University, Milano, Italy; 15Department of Educational Sciences, University of Catania, Catania, Italy; 16Department of Medicine and Surgery, University of Parma, Parma, ItalyCorrespondence: Vittorio LenzoDepartment of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Via del Torrione 95, Reggio Calabria, 89125, ItalyEmail v.lenzo@unidarc.itPurpose: Previous studies showed poor sleep quality during the first Italian lockdown consequent to the quick spread of the virus. Poor sleep quality remained stable during the so-called “second wave”, which started in Autumn 2020. This study aimed to compare sleep quality between the two waves of contagions and to examine the effect of resilience, together with sociodemographic and COVID-related variables, on sleep quality during the second wave.Patients and Methods: A total of 648 participated in this longitudinal study through an online survey during the first lockdown consequent to the COVID-19 and during the second wave. The Medical Outcomes Study—Sleep Scale (MOS-SS) and the Resilience Scale (RS) were administered. Sociodemographic and COVID-related information were also collected.Results: The results showed sleep quality slightly increased in the second wave, even though with a small effect size. Correlational analysis showed that resilience is inversely correlated with sleep quality measured in the two waves. Sleep quality during the second wave was positively correlated with sleep quality in the first lockdown. Likewise, the results of multiple regression revealed that the sleep quality in the first lockdown and resilience were significant predictors of sleep quality during the second wave.Conclusion: These findings highlighted that the prevalence of poor sleepers remained high during the second wave. Together with the sleep quality in the first lockdown, resilience represents an important factor related to sleep quality during the second wave. Interventions to improve sleep quality among the general population should take into account these findings.Keywords: clinical psychology, health, sleep quality, resilience, longitudinal

Starting from the idea that dreaming could be considered an index of the psychological health of individuals regarding the COVID-19 outbreak, a major risk of psychological maladjustment has been registered for maladaptive daydreamers (MDers; i.e., people with a compulsive fantasy activity associated with distress and psychological impairment). Nevertheless, there is a gap in literature about dreaming in MDers in general and particularly during the COVID-19 pandemic. The aim of this study was to investigate differences in dreaming and dream content between probable MDers and non-MDers during the COVID19 lockdown in Italy. A total of 3,857 Italian adults (664 probable MDers), completed the Maladaptive Daydreaming Scale (MDS-16) and the Mannheim Dream Questionnaire (MADRE). Among them, 1,095 participants (222 probable MDers) decided to recount their dreams, subsequently analysed through a cluster analysis performed by T-LAB software. Significantly higher levels of dream recall, emotional intensity of dreams, nightmare frequency, nightmare distress, recurring nightmares about daytime, lucid dreams, interest toward dreams, problem solving and creative dreams, and dreams affecting daytime mood emerged in probable MDers compared to non-MDers. No differences were observed in the emotional tone of dreams. From the quali–quantitative analysis of dream narratives, similar themes emerged in probable MDers and non-MDers, except for a cluster named Dreaming the loss of others, where the non-MDers variable is highly represented. Our results highlight some significant differences between probable MDers and non-MDers with respect to dreaming activity. The massive use of dream activity as an affective regulator emerges for both probable MDers and non-MDers during lockdown.

The psychological consequences of COVID-19 pandemic may include the activation of stress systems, that involve the hypothalamic-pituitary-adrenal axis which influences many physiological functions, including sleep. Despite epidemiological studies evidenced greater prevalence of stress symptoms and sleep disturbances during COVID-19, longitudinal evidence investigating the effects of stress on sleep disturbances during the pandemic is lacking. We collected measures of perceived stress and sleep disturbances during the first wave of COVID-19 (March 2020) and at 8–10 months follow up in a sample of 648 adults (M = 33.52, SD = 12.98 years). Results showed that 39.4% of participants reported moderate to extremely severe stress in March 2020. Prevalence of sleep disturbances was 54.8% in March 2020 and 57.4% at follow-up. Structural equation modelling highlighted that perceived stress in March 2020 significantly predicted sleep disturbances at follow up (β = 0.203; p

Summary 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.

The COVID-19 pandemic and the restrictive measures taken against the spread of the contagion can be considered as traumatic events having a major impact on mental health. Dreams after undergoing traumatic experiences could “replay” traumatic scenes or have a para-therapeutic role that facilitates connections between a traumatic event and associated emotions. However, the studies carried out thus far in the field of sleep and dreams during the COVID-19 pandemic have mostly focused on sleep disorders, emotional tones, and contents of dreams. The aim of the present study was to explore, from a qualitative–quantitative perspective, the contents of dreams and the functions of dreaming during the COVID-19 pandemic. A sample of 1,095 subjects who decide to recount their dreams, during the early phase of the COVID-19 outbreak, was involved. A part of the Mannheim Dream questionnaire was also examined, considering both dream recall and the attitudes toward the dreams—both meaningful and transformative—as indicators of the dreaming process. A cluster analysis was performed on dream narratives through the T-Lab software. In all, 4 thematic clusters emerged: Escape From the Threat; The Work of Mourning, Unrecalled Dreams; COVID-19: As Manifest Content. The factorial mapping organized 3 vectors of meaning, representative of the function of dreaming: Remembering, Repeating, and Working Through; From Traumatic Content to Problem-Solving Strategy; From the Safe-Guardian of Sleep to the Safe-Guardian of Dream Waking continuity. The dreaming process shows functions of integration and processing of memories but also that a decrease in dream recall can act as a defense and have a crucial role in mental life. Clinical implications are discussed.

Objective/BackgroundPoor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach.Patients/MethodsParticipants (n=6276; M=33.62, SD=13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables.Results and ConclusionsCFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω=0.752). Test-retest reliability at 8-10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice.

Background The COVID-19 outbreak is severely affecting the overall mental health with unknown psychological consequences. Although a strong psychological impact is possible, scant evidence is available to date. Past studies have shown that resilience decreases the negative effects of stress. This study aimed to examine depression, anxiety, and stress among the Italian general population during the phase characterized by lockdown, and to investigate the role of resilience as a potential predictor. Methods A total sample of 6,314 Italian people participated in this study. Participants were recruited between March 29 and May 04 2020 through an online survey. The Depression Anxiety Stress Scales-21 (DASS-21) and the Resilience Scale (RS) were administered. Demographic data and lockdown related information were also collected. A correlational analysis was carried out to examine relationships between psychopathological domains and resilience. Three hierarchical regression analyses were conducted using the depression, anxiety, and stress as dependent variables and the resilience as independent variable controlling for age, gender, and education. COVID-19 specific variables were also included in the three regression analyses. A further exploratory analysis was carried out to examine which aspects of resilience predict depression, anxiety, and stress. Results The prevalence of moderate to extremely severe symptoms among participants was 32% for depression, 24.4% for anxiety, and 31.7% for stress. The sample mean scores on depression, anxiety, and stress were higher than the normal scores reported in the literature. Results of correlational analysis showed that resilience factors, such as meaningfulness, self-reliance, existential aloneness, and equanimity, are inversely associated with depression, anxiety, and stress. Results of regression analyses indicated that resilience was statically significant in predicting depression, anxiety, and stress. Geographic area of residence and infected acquaintances were also significant predictors. Regarding the resilience factors, results revealed that meaningfulness, perseverance, and equanimity were statistically significant in predicting all the DASS-21 scales. Conclusion About a third of respondents reported moderate to extremely severe depression, anxiety, and stress. The present study suggests that psychological resilience may independently contribute to low emotional distress and psychological ill-being. These findings can help explain the variability of individual responses during the COVID-19 outbreak.

This article aims at summing up the reflections of a small group of psychologists who work in the domain of palliative treatment. The theory and methodology supporting it are borrowed by a group analysis approach; the group's purpose is a research based on the workers' experience elaboration, which aims at finding out both the specificities of the work apparatus with the people accompanied to the conclusion of their lives, and the main thematic areas of the relationship between healthcare team, patients, and families. The work we present aims at introducing the most meaningful themes that emerged during group meetings: first of all, some service criticalities examined in the area of terminal healthcare and the workers' possible saturation and psycho-social discomfort quotas, generating in some cases a common sense of professional precariousness.

Il Disturbo da Attacchi di Panico (DAP) è, sul piano clinico, una sindrome acuta e cronica, ad alta incidenza epidemiologica, che costituisce oggi, insieme alla fobia sociale e alla depressione, una delle tre maggiori cause d’invalidità della popolazione e, conseguentemente, una delle maggiori fonti di costi sociali, medici e psichiatrici (DSM-IV-TR, 2000). In questo articolo, assumendo il concetto di relazione come elemento caratterizzante il trattamento terapeutico, si cerca di connettere la manifestazione fenomenologica del panico alle modalità relazionali del soggetto e al loro significato. Si cerca di adottare questo “sguardo” anche in una prospettiva di ricerca, attraverso la “lente” dell’alleanza terapeutica. Si prova, sulla base dei risultati di ricerca ottenuti, a formulare alcune ipotesi sulle modalità attraverso cui la sintomatologia panica può influenzare la costruzione e lo sviluppo dell’alleanza terapeutica con il paziente, nel corso del trattamento. La ricerca ha preso in considerazione due pazienti affetti da Disturbo da Attacchi di Panico (DSM-IV, APA, 1994), trattati con una psicoterapia gruppo analiticamente orientata e a lungo termine. Lo studio adotta un disegno naturalistico di tipo osservazionale-descrittivo, del tipo single-case, centrato sull’osservazione longitudinale dei due trattamenti.