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Kick L, Schleicher D, Ecker A, Kandsperger S, Brunner R, Jarvers I. Alexithymia as a mediator between adverse childhood events and the development of psychopathology: a meta-analysis. Front Psychiatry 2024; 15:1412229. [PMID: 39011338 PMCID: PMC11246998 DOI: 10.3389/fpsyt.2024.1412229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Victims of child abuse have an elevated risk of developing mental health issues later in life. Several variables have been suggested as mediators of this correlation, but little is known about the possible influence of alexithymia. Alexithymia is a sub-clinical personality trait that manifests as difficulties recognizing and verbalizing emotions. Methods In this study, two separate meta-analyses were conducted using questionnaire data, and Pearson correlations for overall effects were estimated. Results The correlation between child abuse and alexithymia showed to be significant (r = .26), as did the correlation between alexithymia and general psychopathology (r = .44). Further analyses revealed no indication for possible publication bias. When investigating differences between various subtypes of child maltreatment, each subtype significantly correlated with alexithymia. Emotional abuse, emotional neglect, and physical neglect had stronger correlations than physical and sexual abuse. Discussion These results suggest that alexithymia plays a mediating role, at least in part, in the relationship between experiences of child abuse and general psychopathology in adulthood. Therefore, alexithymia may be relevant to further research and deserves attention in the prevention of and therapy for mental health issues in victims of child abuse.
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Affiliation(s)
- Lorenz Kick
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Daniel Schleicher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Angelika Ecker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stephanie Kandsperger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Irina Jarvers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Shafierizi S, Basirat Z, Nasiri-Amiri F, Kheirkhah F, Geraili Z, Pasha H, Faramarzi M. Predictors of nonresponse to treatment and low adherence to internet-based cognitive behavioral therapy in depressed/anxious women facing the couple's fertility problems: a secondary analysis of a randomized control trial. BMC Psychiatry 2024; 24:39. [PMID: 38200435 PMCID: PMC10782627 DOI: 10.1186/s12888-023-05484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The study aimed to examine the predictors of treatment nonresponse and low adherence to Internet-based cognitive behavioral therapy and face-to-face therapy for treating depression and anxiety in women facing the couple's fertility problems. METHODS This is a secondary analysis based on a previous randomized controlled trial including 152 depressed/anxious women facing the couple's fertility problems. The study defines low adherence as receiving less than 4 sessions (out of 8 sessions). Nonresponse to treatment refers to a < 50% reduction in the anxiety and depression total scores. RESULTS A high level of anxiety/depression score before psychotherapy increases the risk of nonresponse to both Internet-based and face-to-face psychotherapies by 1.4 to 2 times in women facing the couple's fertility problems after the treatment and in the 6-month follow-up. However, 4 factors, including diagnosis of mixed anxiety and depression, low education level, long marriage duration, and infertility caused by mixed female/male factors, reduced the risk of nonresponse to psychotherapies. CONCLUSION Women facing the couple's fertility problems with high depression and anxiety scores are at risk of poor prognosis in response to psychotherapy. Psychologists and healthcare providers of infertility centers should pay more attention to the timely identification and referral of depressed/anxious patients to psychologists.
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Affiliation(s)
- Shiva Shafierizi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Basirat
- Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Nasiri-Amiri
- Department of Midwifery, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farzan Kheirkhah
- Department of Psychiatry, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Geraili
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hajar Pasha
- Department of Midwifery, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Department of General Courses, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Renzi A, Mariani R, Fedele F, Maniaci VG, Petrovska E, D’Amelio R, Mazzoni G, Di Trani M. Women's Narratives on Infertility as a Traumatic Event: An Exploration of Emotional Processing through the Referential Activity Linguistic Program. Healthcare (Basel) 2023; 11:2919. [PMID: 37998411 PMCID: PMC10671616 DOI: 10.3390/healthcare11222919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND the diagnosis of infertility and its related treatment can be traumatic, leading to profound psychological distress and a variety of psychopathological symptoms. The primary objective of this study is to contrast the linguistic features of narratives from women undergoing Assisted Reproductive Treatment with those of women not undergoing any fertility treatment. This study examines the speech of both groups of individuals as an indicator of their capacity to cope with current and past distressing experiences. METHOD 44 women (mean age 36.05; SD = 4.66) enrolled in a fertility medical center in Rome, and 43 control women (mean age 36.07; SD = 3.47) completed a socio-demographic questionnaire and a semi-structured interview designed to collect their memories of a neutral, a positive, and a negative event. This interview also aimed to investigate: (a) (for women with fertility difficulties) how they realized they and their partner had fertility problems and a description of an event when they talked about these difficulties with their partner; and (b) (for control group participants) the most difficult moment of their pregnancy and an event when they talked about it with their partner. The interviews were audio recorded and transcribed, and the text was analyzed using the referential process (RP) linguistic measures software. RESULTS Mann-Whitney non-parametric U tests for the independent samples showed several significant differences regarding the linguistic measures applied to the narratives of neutral, positive, negative, and difficult experiences in the form of a linguistic style, with more intellectualization and defenses in all the narratives associated with the women with fertility problems compared to the women in the control group. CONCLUSIONS the traumatic and painful experience of infertility and ART seems to characterize the whole mode of narrating life experiences. Present findings sustain the importance of helping women to elaborate on their experience and to understand and recognize the difficult feelings that are activated in relation to the difficulties of having a child.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (R.M.); (V.G.M.); (G.M.); (M.D.T.)
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (R.M.); (V.G.M.); (G.M.); (M.D.T.)
| | - Fabiola Fedele
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Vito Giuseppe Maniaci
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (R.M.); (V.G.M.); (G.M.); (M.D.T.)
| | - Elena Petrovska
- Derner School of Psychology, Adelphi University, Garden City, NY 11530-0701, USA;
| | - Renzo D’Amelio
- Department of Gynecologic-Obstetrical and Urologic Sciences, Umberto I Hospital, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuliana Mazzoni
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (R.M.); (V.G.M.); (G.M.); (M.D.T.)
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (R.M.); (V.G.M.); (G.M.); (M.D.T.)
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Camerota F, Mariani R, Cordiano G, Di Trani M, Lodato V, Ferraris A, Pasquini M, Celletti C. The Language of Pain in the Hypermobile Ehlers-Danlos Syndrome: Metaphors as a Key to Understanding the Experience of Pain and as a Rehabilitation Tool. Brain Sci 2023; 13:1042. [PMID: 37508973 PMCID: PMC10377642 DOI: 10.3390/brainsci13071042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Ehlers-Danlos syndromes are a heterogeneous group of Heritable Connective Tissue Disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Among the different types, the hypermobile Ehlers-Danlos syndrome is the most frequent and includes generalized joint hypermobility as the major diagnostic criterion. Joint hypermobility in hypermobile Ehlers-Danlos syndrome is often associated with pain that does not always allow the use of effective pain-reducing treatments. Patients with hEDS constantly describe their pain in detail. Eighty-nine patients with hEDS diagnoses were recruited and evaluated. They were asked to describe their pain in writing. The texts were examined through Linguistic Inquiry and Word Count. Correlational analyses were conducted between pain perception and language. A comparison of high/low pain perception and the quality of metaphors was carried out. The results showed that language quality varies depending on how much pain is perceived. The greater the pain is perceived, the lesser the positive effects and the greater the negative effects and dehumanizing metaphors are being used. Moreover, a greater pain seems to be related to a verbal experience of greater isolation and less self-care. In conclusion, the use of metaphors is a useful tool for examining illness experience and may help clinicians in the rehabilitation program.
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Affiliation(s)
- Filippo Camerota
- Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy
| | | | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy
| | - Valentina Lodato
- Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Ferraris
- Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy
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Renzi A, Fedele F, Di Trani M. Assisted Reproductive Treatments, Quality of Life, and Alexithymia in Couples. Healthcare (Basel) 2023; 11:healthcare11071026. [PMID: 37046953 PMCID: PMC10093954 DOI: 10.3390/healthcare11071026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Infertility and related treatments can negatively affect a couple's wellbeing. The aim of this study was to evaluate couples starting assisted reproductive treatment, differences in alexithymia and quality of life levels between partners, and the association of these psychological dimensions within the couple's members. Data was collected in two fertility centres in Rome; 47 couples completed the Fertility Quality of Life (FertiQoL), the 20-item Toronto Alexithymia Scale (TAS-20), and a socio-demographic questionnaire. Data analysis showed a worsened quality of life in women compared with their partners, as well as higher externally oriented thinking in men compared with their spouses. Associations between alexithymia and quality of life levels between women and men emerged. According to the regression analysis, a better quality of life in women was predicted by a greater partner's capabilities in identifying and describing emotion as well as by a better partner's quality of life, whereas for men, a better quality of life was predicted by their spouse's higher levels of quality of life. This study highlights the protective role that couples can play in the perception of the negative impact that infertility can have on their partner's quality of life. Further investigations are needed for the development of specific therapeutic interventions for the promotion of the couples' wellbeing.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy
| | - Fabiola Fedele
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy
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Castiglioni M, Caldiroli CL, Negri A, Manzoni GM, Procaccia R. Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4482. [PMID: 36901490 PMCID: PMC10002307 DOI: 10.3390/ijerph20054482] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.
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Affiliation(s)
- Marco Castiglioni
- Department of Human Sciences “R. Massa”, University of Milano-Bicocca, 20126 Milan, Italy
| | | | - Attà Negri
- Department of Human and Social Sciences, University of Bergamo, 24129 Bergamo, Italy
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Dube L, Bright K, Hayden KA, Gordon JL. Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis. Hum Reprod Update 2023; 29:71-94. [PMID: 36191078 DOI: 10.1093/humupd/dmac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach. SEARCH METHODS An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence. OUTCOMES There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge's g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate. WIDER IMPLICATIONS This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.
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Affiliation(s)
- Loveness Dube
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Katherine Bright
- Department of Outpatient Psychiatry, Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Department of Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Scaravelli G, Fedele F, Spoletini R, Monaco S, Renzi A, Di Trani M. Toward a Personalized Psychological Counseling Service in Assisted Reproductive Technology Centers: A Qualitative Analysis of Couples' Needs. J Pers Med 2022; 13:jpm13010073. [PMID: 36675734 PMCID: PMC9867277 DOI: 10.3390/jpm13010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Infertility may have a very strong emotional impact on individuals, requiring adequate support, but few studies on patients' demands toward psychological support have been conducted. This study aims to explore the emotions related to the infertility and to the Assisted Reproductive Technology (ART) procedure for which patients consider useful a psychological support. A total of 324 women completed a sociodemographic and clinical questionnaire and an open-ended questionnaire on emotional needs for psychological support. The written texts were explored by the Linguistic Inquiry and Word Count (LIWC) programme and linguistic characteristics were related to sociodemographic and anamnestic variables. Specific linguistic features were connected to several individual characteristics. More specifically, differences in linguistic processes emerged comparing women with an age over or under 40 years, women undergoing their first attempts versus more attempts, women undergoing ART with or without gamete donation, and women undergoing ART for male or unknown causes, as well as those undergoing ART for female or both partners' problems. These differences seem to confirm that older age, more attempts, gamete donation, and ART for unknown or male causes are risk factors that may worsen women's psychological well-being. This study contributes to increase the knowledge about the emotional needs of patients undergoing an ART procedure to develop specific psychological intervention programs.
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Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fabiola Fedele
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Roberta Spoletini
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, Italian National Health Institute, Viale Regina Elena 299, 00161 Rome, Italy
| | - Silvia Monaco
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
- Correspondence:
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Via degli Apuli 1, 00185 Rome, Italy
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Procaccia R, Castiglioni M. The mediating effect of cognitive and emotional processing on PTSD and depression symptoms reduction in women victims of IPV. Front Psychol 2022; 13:1071477. [PMID: 36619070 PMCID: PMC9822704 DOI: 10.3389/fpsyg.2022.1071477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/22/2022] [Indexed: 12/25/2022] Open
Abstract
Intimate partner violence (IPV) is a serious social, physical and mental health issue. Women victims of IPV can develop short- and long-term consequences such as depression and post-traumatic stress disorder (PTSD). Where trauma has been incurred, standard psychotherapies may usefully be complemented by interventions based on expressive writing (EW). Numerous studies have explored the mechanisms underpinning improvement after writing, focusing on the cognitive and emotional processing of traumatic experiences. The aims of this study were to evaluate changes in PTSD and depression symptoms following EW and to examine the mediating effect of emotional and cognitive processing on symptom reduction in subjects who engaged in EW. Seventy-seven abused women (mean age = 41.43, SD = 10.75) were randomly assigned to a three-session expressive writing condition (n = 43) or a neutral writing condition (n = 34). Psychological distress (PTSD and depression) was assessed both before and after the writing sessions. Linguistic inquiry word count software was used to analyze the women's narratives in relation to emotional processing (positive and negative emotions) and cognitive processing (insight and causal attributions). The mediation model indicated that the reduction in depression was fully mediated by negative emotion processing and partially mediated by cognitive processing, while the reduction in PTSD was partially mediated by negative emotion processing and fully mediated by cognitive processing. No effect of positive emotion processing was found. The clinical implications are discussed.
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Affiliation(s)
- Rossella Procaccia
- Faculty of Psychology, eCampus University, Novedrate, Italy,*Correspondence: Rossella Procaccia,
| | - Marco Castiglioni
- Department of Human Sciences “R. Massa,” University of Milano-Bicocca, Milan, Italy
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Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study. Healthcare (Basel) 2022; 10:healthcare10081559. [PMID: 36011216 PMCID: PMC9408275 DOI: 10.3390/healthcare10081559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/16/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to assess the effectiveness of an expressive writing (EW) intervention on psychological and physiological variables after kidney transplant. The final sample of 26 were randomly assigned to an expressive writing group (EWG) and control group (CG). Outcomes were focused on depression, anxiety, alexithymia, empathy, resilience, locus of control, creatinine, CDK-EPI, and azotemia. Depressive symptoms and alexithymia levels decreased in the EWG, with better adherence. Resilience declined over time in both groups. The EWG showed a significantly higher CDK-EPI, indicating better renal functioning. EW seems an effective intervention to improve the psychological health of transplanted patients, with a possible effect on renal functioning. These findings open the possibility of planning brief psychological interventions aimed at processing emotional involvement, in order to increase adherence, the acceptance of the organ, and savings in healthcare costs.
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Wells BE, Samrock S, Pawson M, Starks TJ. Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men. AIDS Behav 2022; 26:584-595. [PMID: 34357477 PMCID: PMC8816814 DOI: 10.1007/s10461-021-03413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.
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Affiliation(s)
- Brooke E. Wells
- Center for Human Sexuality Studies, Widener University, Chester, PA. USA,Interdisciplinary Sexuality Research Collaborative, Widener University, Chester, PA. USA
| | - Steven Samrock
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY. USA
| | - Mark Pawson
- Department of Sociology, Purdue University, West Lafayette, IN. USA
| | - Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY. USA,Health Psychology and Clinical Science Doctoral Program, Graduate Center of CUNY, New York, NY. USA
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Hinkle M, Dodd J. A Systematic Review of Interventions Targeting Infertility-Related Distress: A Search for Active Ingredients. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:167-193. [PMID: 34493164 DOI: 10.1080/0092623x.2021.1974623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Various psychological interventions have been developed to combat negative mental and physical health effects of infertility. However, it is unknown if there are common elements, or "active ingredients," between interventions. This review examined which active ingredients were present among psychological interventions targeting the impacts of infertility. Using a predetermined search strategy, 72 articles and 22 active ingredients were identified. Relaxation/stress management was found to be the most common treatment element. Future research should investigate which active ingredients are most effective for reducing infertility-related stressors so clinicians and researchers can create and implement treatments that contain essential and effective components.
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Affiliation(s)
- Madison Hinkle
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Julia Dodd
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
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Qian J, Sun S, Zhou X, Wu M, Yu X. Effects of an expressive writing intervention in Chinese women undergoing pregnancy termination for fetal abnormality: A randomized controlled trial. Midwifery 2021; 103:103104. [PMID: 34348194 DOI: 10.1016/j.midw.2021.103104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the efficacy of an expressive writing intervention on promoting psychological well-being of women who have had a diagnosis of fetal abnormality. DESIGN AND SETTING An open, randomized controlled trial with parallel group design was conducted at a tertiary hospital in China. 100 women were randomly assigned into either the expressive writing (EW) intervention group or the control group, and 80 women eventually took part in all the phases of the study. Psychological variables including post-traumatic growth (PTG), post-traumatic stress disorder (PTSD) and resilience were assessed at baseline, immediately after the intervention and 1-month follow-up. PARTICIPANTS Women who have had a diagnosis of fetal abnormalities and decided to terminate pregnancies. INTERVENTION Women in the intervention group were asked to write three 15 min essays in regard to their experiences with the fetal abnormalities. FINDINGS The intervention group had significantly higher level of PTG (p = 0.003) and lower level of PTSD symptoms (p = 0.023) immediately after the intervention, as compared with the control group. In 1-month follow-up, intervention participants demonstrated significant improvement in PTG (p = 0.014) but insignificant reduction for PTSD symptoms. No significant effects were observed in both groups in terms of changes over time in resilience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE EW is efficacious for improving women's PTG and easing their symptoms of PTSD to some extent. Medical staff should pay more attention to this population's psychological status. In the future, EW interventions need to be conducted in larger samples with more severe symptoms of PTSD to validate its effectiveness. The efficacy of longer and more frequent writing interventions should also be investigated.
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Affiliation(s)
- Jialu Qian
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shiwen Sun
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Zhou
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengwei Wu
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Yu
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Renzi A, Mariani R, Di Trani M, Tambelli R. Giving words to emotions: the use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:452. [PMID: 33024722 PMCID: PMC7513612 DOI: 10.4081/ripppo.2020.452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/21/2020] [Indexed: 12/02/2022]
Abstract
Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.
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Affiliation(s)
- Alesia Renzi
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
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Renzi A, Di Trani M, Solano L, Minutolo E, Tambelli R. Success of assisted reproductive technology treatment and couple relationship: A pilot study on the role of romantic attachment. Health Psychol Open 2020; 7:2055102920933073. [PMID: 32637146 PMCID: PMC7323283 DOI: 10.1177/2055102920933073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infertility is a deeply distressing experience, which can threaten important personal and martial goals, frequently affecting the psychophysical health. A supportive relationship and a secure romantic attachment appear to reduce infertility stress, as well as play a relevant role in the success of assisted reproductive technology treatments. The principal aim of the study is to investigate the predictive effect of romantic attachment, couple characteristics, quality of life and age on assisted reproductive technology outcome. A total of 88 infertile women, enrolled in an assisted reproductive technology Centre of Rome, completed the Experience in Close Relationship-Revised, the Couple Relationship Inventory, the Fertility Quality of Life and a socio-demographic questionnaire. The participants completed the questionnaires at the beginning of the medical treatment. Data analyses showed significant associations among Experience in Close Relationship-Revised dimensions, Couple Relationship Inventory and Fertility Quality of Life Scales. Assisted reproductive technology outcome was negatively correlated to Experience in Close Relationship-Revised Avoidance and positively related to Couple Relationship Inventory Dependence. A multi-variable logistic regression revealed that Experience in Close Relationship-Revised Avoidance decreased the probability of pregnancy. The present findings partially confirmed the study hypotheses since several associations among couple characteristics, attachment anxiety and avoidance dimensions, infertility-related quality of life in infertile women were found. Furthermore, according to a definition of Avoidance, assisted reproductive technology positive outcome appears to be associated to lower levels of fear of dependence and interpersonal intimacy, and to a low need both for self-reliance and for reluctance to self-disclose within the romantic relationship. Further investigations are needed both to confirm this preliminary finding and for promoting focused therapeutic interventions for couples facing assisted reproductive technology.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi Solano
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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