Luigi Solano

Psychosocial factors and clinical evolution in HIV-1 infection : a longitudinal study

The aim of the study was to assess the relationship between the initial psychosocial situation and the probability of later symptom development in HIV-1 infection. One hundred HIV-1 seropositive subjects, 79 in Stage III (LAS) and 21 in Stage II (asymptomatic), were examined both immunologically (CD4+, Skin Test) and psychologically (test battery). Follow-up at 6 and 12 months involved clinical and immunological reassessment of subjects, who were then classified as fully symptomatic (S, Stage IV) or unchanged (U). The two groups were compared through ANOVA on initial psychosocial measures, while stepwise logistic multiple regression was employed to assess the predictive value of psychosocial measures on clinical and immunological evolution. Psychosocial measures most clearly showing an association with clinical evolution were Denial/Repression attitudes (negatively) and Fighting Spirit (positively), whereas aspects of Hardiness and Social Support showed an effect in interaction with initial CD4+ levels. No stable results were obtained on immunologic evolution. The two groups (U and S) did not show significant differences on other independent variables, with the exception of age.

Postoperative Course After Papilloma Resection: Effects of Written Disclosure of the Experience in Subjects With Different Alexithymia Levels

Objective The aim of the investigation was to assess the effects on postoperative course after bladder papilloma resection of a technique for the written disclosure of traumatic events in interaction with individual differences in alexithymia. Methods Forty subjects were administered a general questionnaire and the Toronto Alexithymia Scale (TAS-20) the second day after admittance. Twenty subjects were asked to write for 3 days, 20 minutes a day, about their experience of being in the hospital, following instructions developed by J. W. Pennebaker and coworkers. The postoperative course was assessed objectively by the duration of stay in hospital and subjectively by subjects completing the Symptom Check List 90 (SCL-90) the day before leaving the hospital. Results Subjects who wrote stayed fewer days in hospital and had lower SCL-90 scores. The same effect was shown by low alexithymia levels. Study of interactions showed that the effect of writing was apparent only in subjects high in alexithymia, whereas subjects low in alexithymia showed a favorable course independent of writing. Conclusions Writing about one’s thoughts and feelings about being in hospital for a surgical operation has beneficial effects on postoperative course. This holds particularly true for high alexithymic subjects, who obtain through writing the same outcome as low alexithymic subjects.

Reliability and validity of the Toronto Structured Interview for Alexithymia in a mixed clinical and nonclinical sample from Italy

The reliability and validity of the Toronto Structured Interview for Alexithymia (TSIA) have been demonstrated in previous studies with English-speaking community and psychiatric samples and a German-speaking psychiatric sample. The aim of this study was to evaluate the psychometric properties of the TSIA in a mixed clinical and nonclinical sample from Italy. The original English version of the TSIA was translated into Italian and administered, along with the 20-item Toronto Alexithymia Scale (TAS-20), to 80 healthy subjects, 69 medical outpatients, and 62 psychiatric outpatients. Eighty-one videotaped interviews were used for assessing the interrater reliability. Confirmatory factor analysis supported the hierarchical, four-factor structure of the TSIA obtained in previous studies, with four lower-order factors nested within two higher-order latent factors. The TSIA also demonstrated internal and interrater reliability, and concurrent validity with the TAS-20. The results support the use of the TSIA to assess alexithymia especially when a multimethod approach to measurement is possible.

Hemispheric Differentiation and Dream Recall: Subjective Estimates of Sleep and Dreams in Different Handedness Groups

Previous investigations pointed to a relationship between hemispheric asymmetry and dream recall. Since handedness may reflect the extent to which cerebral organization is lateralized, it was hypothesized that differences in dream recall might exist between different handedness groups. A selected sample of 78 college students (38 right-handers, 25 left-handers, 15 mixed-handers) completed a seven-day sleep and dream diary upon final awakening, at home. Results showed that significantly more dreams are recalled by females compared to males and by right-handers compared to mixed-handers and left-handers. The latter finding is tentatively interpreted as due to a more direct access to aspects of oneiric material structured in the left hemisphere by right-handers, whose language centers are located in the same hemisphere. Unexplained findings of the only other investigation concerning handedness and sleep variables (Hicks, Pellegrini & Hawkins, 1979), which showed greater variability of sleep duration in mixed-handers, were not confirmed by the present study.

Expression and processing of emotions: Relationships with cd4+ levels in 42 hiv-positive asymptomatic individuals

Abstract Background: The study investigated the relationship between CD4+ levels and two emotion-related measures, one of expressed emotion (Hostility directed Inwards, Hdl) and one of capacity for emotional processing (Referential Activity, RA). Method42 HIV-1 positive asymptomatic subjects, under AZT treatment, underwent CD4+ assessment immediately after a brief interview. Interviews were recorded, transcribed and analyzed using the Gottschalk-Gleser and Referential Activity scales. Of the Gottschalk-Gleser scales, only Hdl was considered. ResultsAs hypothesized, the regression of emotion-related scores on CD4 + levels showed a curvilinearrelationship with Hdl scores, and a linearrelationship with RA scores. Subjects with the best immune status therefore showed intermediate levels of expressed emotion and a high capacity for emotional processing. ConclusionThe findings support the usefulness of working through, rather than releasing emotion. Previous negative findings in the field might be explained by the unjustified assumption of linear relationships between expressed emotion and health.

A more global approach to musculoskeletal pain: Expressive writing as an effective adjunct to physiotherapy

The aim of this study was to investigate the effects of written emotional disclosure as an adjunct to physiotherapy. Forty outpatients with musculoskeletal pain were treated with Mézières physiotherapy for 10 sessions. Half of the subjects also wrote about difficult life experiences immediately after four of these sessions. Data analysis showed that although both the writing and non-writing groups displayed lower pain scores after physiotherapy, the difference was stronger in the writing group. Pain scores continued to decrease six months after physiotherapy in the writing group alone. The postural evaluation revealed a greater improvement in the writing group than in the non-writing group, while the TAS-20 and SCL-90 scores decreased in the writing group alone. These results indicate that written emotional disclosure is an effective adjunct to physiotherapy insofar as it promotes further health improvements at both the physical and psychological levels.

Alexithymia according to Bucci's multiple code theory: A preliminary investigation with healthy and hypertensive individuals

OBJECTIVE To evaluate the relation between alexithymia and Referential Activity (RA), a linguistic measure of the process by which non-verbal emotional experience is connected to language. METHODS The 20-Item Toronto Alexithymia Scale (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) were administered to 20 postgraduate students and 15 outpatients with hypertension. The Weighted Referential Activity Dictionary (WRAD) and other linguistic measures (Reflection, Disfluency, and Somatic Sense) were applied to texts derived from the TSIA using the Discourse Attributes Analysis Program (DAAP). RESULTS Multiple linear regressions performed in the whole sample showed a relation between TSIA scores and Somatic Sense. Comparing the two groups, hypertensive subjects yielded higher scores on the TSIA than the young adult sample; no differences in DAAP measures emerged. A significant negative correlation was found between the TAS-20 Difficulty Describing Feelings score and the DAAP measure of references to body activations (Somatic Sense) both in the young adult sample and in hypertensives. In the young adult sample, negative relations emerged between different TSIA factors, WRAD score, and Somatic Sense; a positive relation with fragmented speech (Disfluency) and use of rationalization (Reflection) was also found. In hypertensive subjects, using the TSIA, a negative correlation between alexithymia and Somatic Sense and a positive correlation between alexithymia and the Mean High WRAD (a measure of intensity of engagement during the speech) were found. CONCLUSION The TSIA seems to be a more adequate instrument than the TAS-20 to explore relations between alexithymia and RA. Results appear to suggest a complex, nonlinear relation between alexithymia and RA, presumably influenced by subject-specific characteristics. PRACTITIONER POINTS A relation between alexithymia and RA has been proposed on theoretical grounds, but there has been minimal empirical investigation. This was the first study to employ both a self-report measure and a structured interview for measuring alexithymia in relation to RA. The results of this study suggest a complex, nonlinear relation between alexithymia and RA; this finding is essentially obtained with the structured interview measure of alexithymia. This relation is presumably influenced by subject-specific characteristics.

Writing for All, for Some, or for No One? Some Thoughts on the Applications and Evaluations of the Writing Technique

In the past decades, writing about traumatic events or situations has progressively obtained high status as a fast, efficient, and low-cost method of promoting health. It is increasingly being employed in new populations, notably clinical ones. However, recently a review and meta-analysis including 61 studies on different situations (Meads, 2003) challenged the view that this intervention has overall beneficial health effects. This study received some methodological criticism. However, more recent, often considered as more methodologically sound, meta-analyses by Frisina, Borod, and Lepore, (2004) and Frisina, Lepore, and Borod (2005), which focused on nine studies performed on samples with physical or psychiatric disorders, yielded results that also were not very impressive: although the technique was significantly effective, the effect size obtained was only d = .19. This is a small effect size and low compared to the d = .47 found in a meta-analysis on studies performed in the general population (Smyth, 1998). Comparing results obtained in somatic patients with findings from patients with psychiatric problems yielded a d = .21 for physical disorders and d = .07 (nonsignificant) for psychiatric distress. Concerning the latter finding, it is not surprising that improvement of mental disorders through psychological interventions needs much more effort and a good relationship with the patient. But also the effect on physical symptoms appeared much less impressive when compared to the results obtained in the general population. In our view, this may be due to the same factors as those responsible for the null findings in the Meads (2003) meta-analysis. In both cases, very heterogeneous samples such as terminal renal cancer, prostate cancer, asthma, and rheumatoid arthritis patients were combined. Before proposing an attempt for a classification of patients into those “for whom it does work” (Norman, Lumley, Dooley, & Diamond, 2004) and those “for whom it does not,” it is important to understand the origin of the homogenizing approach, such as used in a meta-analysis, because it refers to a scientific-ideological attitude with a rather long history.

Alessitimia e attacchi di panico: studio longitudinale in soggetti partecipanti a gruppi di aiuto-aiuto

Scopo: con questa ricerca si e voluto monitorare l’andamento dell’alessitimia e del Disturbo da Attacchi di Panico (DAP) durante la partecipazione a dei gruppi di auto-aiuto, ipotizzando che il DAP sia una disturbo della regolazione affettiva: la partecipazione al gruppo dovrebbe avere un effetto su entrambe le variabili. Metodo: Il campione e costituito da 21 soggetti di entrambi i sessi con eta media di 39 anni, membri dei gruppi di auto-aiuto della Lega Italiana contro i Disturbi d’ansia, d’Agorafobia e da attacchi di Panico (LIDAP). A tutti i soggetti sono stati somministrati una scheda socio-demografica e, ad intervalli di due mesi, la 20-item Alexithymia Scale (TAS-20) e la Panic Disorder Severity Scale Self Report (PDSS-SR), per un totale di 5 somministrazioni. Risultati: l’alessitimia e il panico sono significativamente correlati a partire dalla seconda misurazione (p

Effects of an expressive writing intervention on a group of public employees subjected to work relocation

BACKGROUND Pennebakers writing technique has yielded good results on health, psychological and performance dimensions. In spite of the positive outcomes, the technique has rarely been applied directly within the workplace and its effects on burnout have never been tested. METHOD 18 public employees subjected to work relocation were asked to write about their present work situation or another difficult event of their life (Writing Group), while another 17 were not assigned any writing task (Control Group). OBJECTIVE To assess whether there was an improvement in burnout, alexithymia and psychological well-being in the Writing Group compared with the baseline measurement and the Control Group. RESULTS While the baseline levels in the Writing and Control Groups in the 3 dimensions considered were similar, scores in the Writing Group at both a second (1 month after the end of the procedure) and third measurement (7 months after the end) improved when compared with the baseline, whereas those in the Control Group worsened. CONCLUSIONS Pennebakers writing technique appears to promote adaptive coping strategies in stressful situations, and to increase occupational and psychological well-being as well as the ability to process emotions. It also appears to buffer the negative effects of work-related stress.