Martina Cussino

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.

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.

Anorexia Nervosa and EMDR: A Clinical Case

Numerous studies have identified links between psychopathology and a history of traumatic life events and dysfunctional attachment relationships. Hence, given the possible traumatic origins of this pathology, it may be useful to provide a trauma-focused intervention such as the eye movement desensitization and reprocessing (EMDR) therapy. This article illustrates a clinical case by describing the positive results of the EMDR therapy in the recovery of unremitting anorexia nervosa in a 17-year-old inpatient. She had previously been hospitalized on 4 occasions in the previous 4 years and received both psychodynamic and cognitive-behavioral therapy. At pretreatment, the client weighed (28 kg, 62 lb) and had a body mass index of 14. She was designated with a dismissing attachment style on the Adult Attachment Interview. EMDR therapy was provided for 6 months in hospital, in twice weekly 50-minute sessions and consisted of standard procedures primarily focusing on her relational traumas, interspersed with psychoeducational talk therapy sessions, and integrated with ego state therapy. At the end of treatment, the client weighed (55 kg, 121 lb) and had a body mass index of 21.5. She no longer met diagnostic criteria for anorexia nervosa, and her attachment style had changed to an earned free-autonomous state of mind. She reported an increase in self-confidence and in her ability to manage various social challenges. Results were maintained at 12 and 24 months follow-up. The treatment implications of this case study are discussed.

EMDR and Parenting: A Clinical Case

The theory of attachment underlines how traumatic experiences from the parent’s past—when stored in a dysfunctional way—can be reactivated in the parent caregiving system, emerging from an internal working model (IWM) of attachment that holds the memory traces of such traumatic events. This article presents a clinical case report of a mother who was referred to treatment because she presented strong depressive symptoms. Forty sessions were provided, consisting of eye movement desensitization and reprocessing (EMDR) to address maternal trauma issues and cognitive behavioral therapy (CBT) for parenting skill development, debriefing, cognitive restructuring, and psychoeducation. The positive treatment results included distinct evidence of changes in the mother’s relationship with her child, and her mental representation of her caregiving system as measured with the Parent Development Interview (Slade et al., 1993).

EMDR in Anorexia Nervosa: From a Theoretical Framework to the Treatment Guidelines

Studies on the risks and on the positive factors implied in the onset of anorexia nervosa (AN) have reported the role of an insecure or disorganized state of mind (SoM) with respect to attachment. We compare the effects of eyes movement desensitization and reprocessing (EMDR) approach with cognitive behavioral therapy (CBT) in the treatment of AN in terms of SoMs, reflective function (RF), and narrative coherence (Coh). Our results are part of a broader observational clinical comparative study of the two approaches, and it is based on the Adult Attachment Interview (AAI) outcomes. Differences in terms of belongingness to a secure group and an unsecure group before and after the treatments in EMDR and CBT group have been reported through McNemars test. The generalized linear model (GLM) repeated‐measures multivariate ANOVA (RM‐MANOVA) has been selected. Our results suggest that EMDR allows an active reprocessing of traumatic memories related to family dynamics and to eating behaviors, which could enable a positive resolution of eating disorder (ED) symptoms. The emotional reprocessing of unresolved attachment issues can allow a better modulation of the control‐related rigidity that is a commonality between AN patients.