Fabio Veglia

Dissociative symptomatology in cancer patients

Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p < 0.001; HADS-Depression: r = 0.364, p < 0.001) and with IES-R scores (IES-R-Intrusion: r = 0.698, p < 0.001; IES-R-Avoidance: r = 0.619, p < 0.001; IES-R- Hypervigilance: r = 0.681, p < 0.001). A stepwise regression analysis was performed in order to find the predictors of cancer-related traumatic dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic spectrum within the context of cancer, emphasizing the close relationship between the origin of dissociative constituents which, according to the scientific literature, compose the traumatic experience. Our results have implications for understanding dissociative symptomatology in a cancer population and can help develop clinical programs of prevention and support for patients.

Attachment Representations in Adults with Congenital Blindness: Association with Maternal Interactive Behaviors during Childhood

This study explores how maternal interactive behaviors experienced during the childhood of adults with congenital blindness are associated with their subsequent development and personality. Many researchers have found a high frequency of maternal directiveness and overprotection in sighted mother-congenitally blind child relationships. One open question is whether these behaviors may have negative effects on congenitally blind childrens subsequent development, or whether they may have a functionally adaptive-strategic role. The purpose of this study was to discriminate between the two hypotheses. This objective was pursued by adopting the theory of attachment and administering the Adult Attachment Interview to 15 participants with congenital blindness. Results suggested that directive and overprotective maternal behaviors are experienced by the persons with congenital blindness as encouraging and functional as long as they are accompanied by an affective, loving, and supportive attitude. Results did not support the hypothesis that directive and overprotective maternal interactive behaviors have a necessarily negative effect on the development of persons with congenital blindness.

Alternative Caregiving Figures and their Role on Adult Attachment Representations

BACKGROUND The present work represents the first Italian study investigating whether and how mothers who describe unloving experiences with both parents during childhood could become more secure as adults (termed earned-secures). METHOD The sample consisted of 94 women from northern Italy. All the subjects were administered the Adult Attachment Interview (AAI) and fill in a screening test evaluating depressive symptoms. RESULTS No significative differences were found regarding depressive symptomatology across the different attachment classifications. The majority of the samples (84%) remember an important alternative support figure during childhood (before 12 years old). Earned-secures significantly differ from continuous-secure and insecure groups (F = 27.202; p ≤ 0.01) on the amount of the emotional support from the main alternative support figure and on the average amount of emotional support across alternative support figures (F = 10.44; p ≤ 0.01). The majority of alternative support figures (80%) were grandparents. CONCLUSIONS A corrective emotional experience allows the subject to work through his negative childhood experiences and acquire modalities of interaction that enable him/her to function more effectively in the world. The clinical implications of this study will be discussed. KEY PRACTITIONER MESSAGE Attachment theory. Clinical implications of attachment experiences. Corrective emotional experience.

Attachment Representation in Institutionalized Children: A Preliminary Study Using the Child Attachment Interview

UNLABELLED The experience of being removed from ones home and the transition to a residential care system pose enormous challenges for a child. Substantial evidence has been found regarding severe developmental effects due to early exposition to extreme psychosocial and affective deprivation. The research on Bowlbys theoretical proposals has highlighted the link between insecure, disorganized and atypical attachment patterns and children both living in foster care facilities and adopted out of those institutions. The goal of this pilot study is to investigate the attachment representation in an Italian sample of children in middle childhood (9-13 years old) who have been removed from their homes. METHOD Two compared groups of children participated in this study. The first group was composed of 24 Italian children who had been removed from their homes. The second group, considered as the control group, was composed of 35 Italian children who had never been in foster care placement. The quality of childrens attachment to their primary caregivers was assessed by the Child Attachment Interview, an innovative semi-structured interview that seeks to bridge the measurement gap identified in middle childhood RESULTS The children in foster care placement show a higher percentage of insecure and disorganized attachment representations and lower scores on the Child Reflective Functioning Scale. CONCLUSIONS The clinical implications and enhancements to effective intervention for foster childrens caretaking are discussed.

Healthcare professionals’ experiences of perinatal loss: A systematic review:

Healthcare professionals’ psychological involvement in perinatal loss is a largely overlooked subject by healthcare systems, scientific research and prevention policies. A systematic scientific review has been carried out about emotional experiences, attributed meanings and needs conveyed by healthcare professionals in relation to perinatal loss. We identified 213 studies between 1985 and 2015, 20 of which were included in the present study for qualitative analysis. Our results point out the need for a targeted vocational training in perinatal loss, enabling healthcare professionals to achieve a proper management of their own internal states.

Sociodemographic characteristics and traumatic experiences in an Italian transgender sample

ABSTRACT The aim of the present study is to define the sociodemographic and clinical characteristics of applicants for gender-affirming surgery at a single Italian institute, officially accredited as the referral unit for gender dysphoria in the Piedmont region. The study population comprised 196 transgender patients (136 trans females and 60 trans males) who met the criteria for gender dysphoria (GD; DSM-5 American Psychiatric Association, 2013). The subjects were asked to supply detailed information about general demographic characteristics, personal relationships, and traumatic events. Our data showed that participants who had experienced traumatic events sought assistance at an older age, had a lower level of education and a higher rate of unemployment, and had taken cross-sex hormonal therapy without a doctors prescription at a higher frequency than those without experience of traumatic events. In order to better understand the role of trauma in the lives of transgender people, further research is needed in order to expand on our findings and make the proper adjustments to psychological treatment to improve patients’ well-being.

Attaccamento Adulto e Temi di Vita: una ricerca qualitativa attraverso l’analisi testuale delle Adult Attachment Interview

L’approccio narrativo in psicologia include il modello teorico della costruzione autobiografica di Temi di Vita. La prospettiva di Veglia (1999, 2006) propone l’esistenza di sei Temi di Vita (Amore, Valore, Potere, Liberta, Verita e Morte) che si sviluppano all’interno delle relazioni interpersonali e tendenzialmente sono costanti attraverso le culture. Questi costituiscono organizzatori di significato attorno ai quali gli individui costruiscono e narrano le proprie esperienze. La precoce relazione di attaccamento crea le condizioni che permettono lo sviluppo di tutte le altre relazioni nel corso della vita. Le strutture cognitive ed emotive, infatti, si evolvono in rappresentazioni e ricordi autobiografici mediati dal sistema di attaccamento (Bowlby, 1969/1982). L’obiettivo di questo studio pilota e stato investigare la presenza dei sei Temi di Vita e delle loro caratteristiche all’interno dei trascritti di Adult Attachment Interview (AAI). Le scelte linguistiche e le sfumature semantiche di ciascun tema sono state analizzate a due livelli: (a) livello tematico per rintracciare i sottotemi emergenti attraverso la codifica di unita di testo; (b) livello semantico per specificare la natura delle relazioni intercorrenti tra temi e sottotemi, esemplificandole in network concettuali. La codifica e l’analisi testuale e stata condotta tramite il software ATLAS.ti. Le associazioni tra Temi di Vita e categorie dell’AAI sono state esaminate da un punto di vista esplorativo. I risultati hanno corroborato l’esistenza dei Temi legati alle diverse storie di attaccamento. Sono emersi 20 sottotemi ognuno dei quali caratterizzato da reciproci collegamenti. Limiti e direzioni future dello studio verranno discussi.

The impact of perinatal loss in maternity units: A psycholinguistic analysis of health professionals’ reactions:

Perinatal loss has a strong emotional impact on health professionals working in maternity units. We aimed to study the impact of this experience on health professionals’ language. We analyzed the answers of 162 health professionals (physicians and non-medical staff) who described their reactions to perinatal loss. A linguistic analysis was performed using the Linguistic Inquiry and Word Count software. Associations between language and burnout were studied. Words typical of a psychological shock reaction were used more by non-medical staff than by physicians. Participants who used pronouns, optimistic words, future tense verbs, and cognitive words registered lower levels of burnout. Clinical implications of the results are discussed.

Life Themes and Interpersonal Motivational Systems in the Narrative Self-construction

What makes unique and unrepeatable individuals is their ability to write their own story attributing meaning, sharing it through narration, giving coherence to the information related to the interpersonal motivational systems, and creating alternative hierarchies to those biologically provided by the genetic code. Through clinical narratives and narrative literature, we can observe the recurrence of specific topics, across time and different cultures. Hence, we wondered whether there are some evolutionary suggestions that guide us in the construction of the narrative-autobiographical contents. In this article we proposed a theoretical-clinical hypothesis about the existence of a biological disposition to identify as fundamental six Life Themes (LTs) that contribute to defining the image of the self and the world: Love, Personal Value, Power, Justice, Truth, and Freedom. Besides the innumerable narratives dependent upon context, there may be many ways of telling stories that, instead, would be reported to these few essential themes. A narrative review of the literature about these concepts follows the systematic explanation of the perspective about the LTs as attractors of meaning. The manuscript considers also the process of co-construction of meanings within the interpersonal relationships and the influences of these on the narratives. In particular, we focused on the importance of episodic and autobiographical memory related to the attachment and significant figures, in the construction of the personal story and the LTs. We also explained the possible clinical implications of the theoretical hypothesis of LTs. Within clinical conversations, the LTs could be expressed rigidly or, otherwise, in a confused way. The lack of narrative integration may lead to the dominance of chaos or rigidity that generates suffering. A better comprehension of the LTs in patients’ narrations could be useful to identify a narrative profile about the areas of greatest suffering related to the idea of self and the world, as well as to construct an adequate care plan.

Sessualità, qualità della relazione di coppia e qualità della vita. Una ricerca promossa dalla Federazione Italiana di Sessuologia Scientificasu campione non clinico

La ricerca si propone di delineare, su un campione non clinico distribuito sul territorio italiano, le relazioni tra aspetti legati alla soddisfazione di coppia, alla soddisfazione sessuale e alla qualita della vita nell’ambito della coppia, analizzando eventuali differenze di matrice socio-demografica, quali eta, genere e scolarizzazione. E stato somministrato un questionario self-report, composto da piu strumenti: questionario sulle attivita sessuali, DAS, PGWBI. Il reclutamento dei partecipanti e avvenuto su base volontaria tramite le sedi FISS di tutta Italia. Il numero finale di questionari analizzati e di 963 (58,7% donne e 41,3% uomini). La maggioranza del campione ha ottenuto un punteggio relativo alla qualita della relazione di coppia (punteggio DAS) al di sopra del cutoff. E stata rilevata una correlazione positiva tra questa variabile e i punteggi alla scala della complicita-soddisfazione sessuale. La percezione della qualita della vita individuale e risultata positivamente correlata alla qualita della relazione di coppia. Rispetto alla dimensione della complicita-soddisfazione sessuale e emerso come uomini e donne si distribuiscano sul continuum soddisfazione-insoddisfazione in modo simile. Sono risultate meno soddisfatte le ultime due fasce d’eta considerate (dai 41 ai 50 anni e dai 51 ai 60 anni). Per quanto riguarda la variabile delle pratiche non-pene-vagina (rapporti orali, rapporti anali, uso di materiale erotico), gli uomini fanno registrare una frequenza maggiormente elevata rispetto alle donne. La scala relativa a tali pratiche e risultata positivamente correlata alla scala della complicita-soddisfazio¬ne sessuale. Da questa analisi e emersa una panoramica della sessualita in Italia che mostra come i soggetti siano in generale soddisfatti della propria vita sessuale e di coppia e come i due tipi di soddisfazione siano tra loro correlati. Un quadro aggiornato su queste tematiche puo essere utile al fine di mobilitare le figure professionali competenti ad attuare piani di informazione ed educazione sessuale in favore della popolazione.