Rita B. Ardito

Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research.

This paper proposes a historical excursus of studies that have investigated the therapeutic alliance and the relationship between this dimension and outcome in psychotherapy. A summary of how the concept of alliance has evolved over time and the more popular alliance measures used in literature to assess the level of alliance are presented. The proposal of a therapeutic alliance characterized by a variable pattern over the course of treatment is also examined. The emerging picture suggests that the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. In our opinion, with regard to the relationship between the therapeutic alliance and outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance. This topic, along with a detailed examination of the relationship between the psychological disorder being treated and the therapeutic alliance, will be the subject of future research projects.

Social Cognition in Anorexia Nervosa: Evidence of Preserved Theory of Mind and Impaired Emotional Functioning

Background The findings of the few studies that have to date investigated the way in which individuals with Anorexia Nervosa (AN) navigate their social environment are somewhat contradictory. We undertook this study to shed new light on the social-cognitive profile of patients with AN, analysing Theory of Mind and emotional functioning. Starting from previous evidence on the role of the amygdala in the neurobiology of AN and in the social cognition, we hypothesise preserved Theory of Mind and impaired emotional functioning in patients with AN. Methodology Thirty women diagnosed with AN and thirty-two women matched for education and age were involved in the study. Theory of Mind and emotional functioning were assessed with a set of validated experimental tasks. A measure of perceived social support was also used to test the correlations between this dimension and the social-cognitive profile of AN patients. Principal Findings The performance of patients with AN is significantly worse than that of healthy controls on tasks assessing emotional functioning, whereas patients’ performance is comparable to that of healthy controls on the Theory of Mind task. Correlation analyses showed no relationship between scores on any of the social-cognition tasks and either age of onset or duration of illness. A correlation between social support and emotional functioning was found. This latter result seems to suggest a potential role of social support in the treatment and recovery of AN. Conclusions The pattern of results followed the experimental hypothesis. They may be useful to help us better understand the social-cognitive profile of patients with AN and to contribute to the development of effective interventions based on the ways in which patients with AN actually perceive their social environment.

Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function

Background Fibromyalgia (FM) is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. In the aetiology of this syndrome a crucial role is played by complex interactions among biological, genetic, psychological, and socio-cultural factors. Recently, researchers have started to explore emotional functioning in FM, with their attention focused on alexithymia, a personality construct that affects the regulation of a person’s own emotions. On the other hand, the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people’s mental states (i.e. Theory of Mind, ToM) in these patients. Here we present the first study investigating a large set of social-cognitive abilities, and the possible relationships between these abilities and the performance on executive-function tasks, in a homogenous sample of patients with FM. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study. Social cognition was assessed with a set of validated experimental tasks. Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM. Relationships between social-cognitive abilities and demographic, clinical and psychological variables were also investigated. Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other’s emotions, as well as in representing other people’s mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed. Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice.

Emotion processing in Parkinson's disease: a three-level study on recognition, representation, and regulation.

Background Parkinson’s disease (PD) is characterised by well-known motor symptoms, whereas the presence of cognitive non-motor symptoms, such as emotional disturbances, is still underestimated. One of the major problems in studying emotion deficits in PD is an atomising approach that does not take into account different levels of emotion elaboration. Our study addressed the question of whether people with PD exhibit difficulties in one or more specific dimensions of emotion processing, investigating three different levels of analyses, that is, recognition, representation, and regulation. Methodology Thirty-two consecutive medicated patients with PD and 25 healthy controls were enrolled in the study. Participants performed a three-level analysis assessment of emotional processing using quantitative standardised emotional tasks: the Ekman 60-Faces for emotion recognition, the full 36-item version of the Reading the Mind in the Eyes (RME) for emotion representation, and the 20-item Toronto Alexithymia Scale (TAS-20) for emotion regulation. Principal Findings Regarding emotion recognition, patients obtained significantly worse scores than controls in the total score of Ekman 60-Faces but not in any other basic emotions. For emotion representation, patients obtained significantly worse scores than controls in the RME experimental score but no in the RME gender control task. Finally, on emotion regulation, PD and controls did not perform differently at TAS-20 and no specific differences were found on TAS-20 subscales. The PD impairments on emotion recognition and representation do not correlate with dopamine therapy, disease severity, or with the duration of illness. These results are independent from other cognitive processes, such as global cognitive status and executive function, or from psychiatric status, such as depression, anxiety or apathy. Conclusions These results may contribute to better understanding of the emotional problems that are often seen in patients with PD and the measures used to test these problems, in particular on the use of different versions of the RME task.

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.

Dreaming as an active construction of meaning

Although the work of Revonsuo is commendable for its attempt to use an evolutionary approach to formulate a hypothesis about the adaptive function of dreaming, the conclusions arrived at by this author cannot be fully shared. Particularly questionable is the idea that the specific function of dreaming is to simulate threatening events. I propose here a hypothesis in which the dream can have a different function. [Revonsuo]

On the Relationship between Theory of Mind and Syntax in Clinical and Non-Clinical Populations: State of the Art and Implications for Research

REVIEW ARTICLE On the Relationship between Theory of Mind and Syntax in Clinical and Non-Clinical Populations: State of the Art and Implications for Research Elena Fontana, Mauro Adenzato, Jacopo S. Penso, Ivan Enrici and Rita B. Ardito Department of Psychology, University of Turin, Turin, Italy Neuroscience Institute of Turin, Turin, Italy Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy Department of Neuroscience, University of Turin, Turin, Italy

Cognitive-constructivist Approach in Medical Settings: The Use of Personal Meaning Questionnaire for Neurological Patients’ Personality Investigation

Objective: The cognitive-constructivist psychotherapy approach considers the self as a continuous regulation process between present and past experience, in which attributions of meaning is characterized by the use of internal rules. In this conception, everyone would be driven by a specific inner coherence called Personal Meaning Organization (PMO). Such approach has never been applied to neurological patients by means of ad hoc developed tools. We performed an explorative study aimed to characterize personality styles in different neurological conditions within the theoretical framework of cognitive-constructivist model. Materials and Methods: Three groups of neurological patients (Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Primary Headache) and a sample of healthy participants, each composed by 15 participants, for a total of 60 participants, were recruited. The Personal Meaning Questionnaire (PMQ), an Italian questionnaire assessing PMOs construct, and other clinical tools for psychological and quality of life assessment were administered to all subjects. Results: The main finding concerned the detection, across all clinical conditions, of a higher prevalence of phobic personality style, with Amyotrophic Lateral Sclerosis showing a relevant prevalence of such PMO with respect to all other neurological conditions and controls. However, with respect to controls, in all clinical conditions, PMQ highlighted a tendency, even if not statistically significant, to codify experience by means of specific cognitive and emotional patterns. Conclusion: Our findings represent the first contribution towards understanding the personality profiles of patients affected by neurological conditions according to cognitive-constructivist theory.

La terapia cognitiva in psicosomatica: una proposta di intervento per la sindrome fibromialgica

La fibromialgia e una sindrome somatica funzionale caratterizzata da dolore muscoloscheletrico diffuso, rigidita muscolare, disturbi del sonno, affaticabilita; non e rara la comorbilita con disturbi d’ansia e dell’umore; il suo decorso tende a essere cronico. Benche l’eziologia sia ancora poco chiara, si ipotizza che possano essere implicati diversi fattori di origine biologica, psicologica e ambientale. Un intervento psicoterapeutico breve puo permettere di individuare e intervenire su alcuni dei fattori psicologici che risultano essere rilevanti per lo specifico paziente, con l’obiettivo di migliorare il funzionamento globale e la qualita della vita della persona. L’obiettivo del nostro lavoro e presentare alcune indicazioni operative che possono essere usate dal terapeuta cognitivo per orientarsi rispetto alla presa in carico di questi pazienti. L’intervento psicoterapeutico che verra descritto si snoda in tre fasi: la prima e dedicata alla costruzione dell’alleanza terapeutica, la seconda all’avvicinamento al mondo emotivo (autosservazione e regolazione emotiva), la terza permette di favorire l’assunzione di un ruolo attivo che sia orientato alla mobilitazione delle proprie risorse da parte del paziente. Infine verra presentato il caso di Anna, una paziente di 70 anni che soffre di fibromialgia da quando aveva 13 anni.

Programmi di prevenzione e trattamento per madri di bambini nati pretermine: stato dell’arte e prospettive alla luce della teoria dell’attaccamento

La nascita pretermine e la seconda causa di morte sotto i cinque anni di eta e rappresenta un fattore di rischio per lo sviluppo del bambino e un evento di natura potenzialmente traumatica per i genitori. L’obiettivo del presente lavoro e presentare alcuni programmi di prevenzione e trattamento che si rivolgono in modo privilegiato alle madri di bambini nati pretermine, la cui efficacia e stata dimostrata e che siano stati sviluppati all’interno della cornice teorica dell’attaccamento. Nel complesso, i programmi presi in considerazione mostrano una certa efficacia nel migliorare la qualita della relazione madre-bambino, favorire lo sviluppo del bambino e migliorare il distress psicologico dei genitori. Tuttavia la comprensione dei meccanismi di funzionamento sottostanti, il ruolo da attribuire ai diversi fattori protettivi e di rischio e il modo in cui integrare tutto cio in un programma di prevenzione e trattamento efficace rimangono questioni aperte. Proponiamo che un contributo in tal senso deriverebbe da una maggiore considerazione dello stato della mente materno rispetto all’attaccamento nella progettazione e nella realizzazione di questi programmi: declinare l’intervento in base alle specifiche caratteristiche materne favorirebbe il raggiungimento di esiti positivi per la madre, per il bambino nato pretermine e per la loro relazione.