Let's Start With the End: Bibliodrama in an Italian Death Education Course on Managing Fear of Death, Fantasy-Proneness, and Alexithymia With a Mixed-Method Analysis

Italian adolescents' perception of tele-psychodrama treatment during the COVID-19 Pandemic

BACKGROUND

Psychodrama is an experiential group psychotherapy that is used to enhance adolescents' wellbeing. The COVID-19 pandemic forced the adaptation of this method to an online setting.

OBJECTIVE

This qualitative study investigated whether and how tele-psychodrama provides psychological support to adolescents, in order to better understand its strengths and weaknesses.

PARTICIPANTS

14 adolescents from Northern and Central Italy.

METHOD

14 interviews were conducted at the end of group tele-psychodrama treatment and were analysed with qualitative thematic analysis.

RESULTS

Three themes were identified: (1) contribution of tele-psychodrama to adolescents' well-being; (2) implementation of psychodrama to the online setting; and (3) (the) shortcomings of tele-psychodrama.

CONCLUSIONS

Despite the differences between online and in-person psychodrama, all the participants expressed their appreciation of group tele-psychodrama, which contributed to their overall psychological wellbeing and helped them process difficulties that emerged during the lockdowns.

Exploring Emotions Related to the COVID-19 Pandemic through Death Education: A Qualitative Study at Italian Primary Schools

BACKGROUND

The COVID-19 pandemic has impacted the lives of individuals, families, and children worldwide. In Italy, the implementation of measures such as lockdowns and distance learning in schools affected the mental health of children and families.

METHODS

This article employs a qualitative method to explore the efficacy of a death education project that aimed to help primary school children process the emotions and losses that they experienced during the COVID-19 pandemic. The study encompassed both the children who took part in the death education project and their teachers and parents to investigate their perspectives on the emotions of the minors and the effectiveness of the project.

RESULTS

Distance learning posed challenges for the learning process and exacerbated social inequalities. The children suffered from limited social contact with their friends and experienced negative emotions, including anger, fear, and concern for the health of their loved ones. The death education project provided a safe space for children's emotional expression and facilitated their acquisition of coping strategies. Open communication between adults and children about illness and death proved effective in mitigating the psychological impacts of loss and preventing traumatic bereavement.

CONCLUSION

The findings highlight the utility of death education in enhancing children's ability to express their emotions and approach the topic of death more frankly.

The Influence of Cultural Snapshots on Pre-service Teachers' Attitudes Towards Death Education

Cultural snapshots may be a didactic resource that promotes the understanding of death and provides teachers with tools that can be used to work with students. This study aims to analyse pre-service teachers' attitudes towards death education. A quantitative longitudinal panel design with pre-test and post-test measures was applied, with descriptive, inferential, and predictive approaches. The sample consisted of 161 pre-service primary teachers from a Spanish university who responded to the validated questionnaire "Death Education Attitudes Scale-Teachers" (DEAS-T). The results reveal an improvement in their attitudes towards death education after implementing cultural snapshots in class, producing significant differences between the pre-test and post-test according to gender, in favour of the male participants. The variables of death anxiety and adequate training are relevant for predicting the attitudes of both genders, in addition to the motivation variable in male participants and the variable of interest towards the topic in female participants.

Interest and Confidence in Death Education and Palliative Psychology in Italian and Indian University Students of Psychology: Similarities and Differences

Teaching death education and palliative psychology in universities has proven to be of great importance, especially in the health professions. The present study aims to evaluate the similarities and differences in interest and confidence in death education and palliative psychology between university psychology students from two culturally different countries: Italy and India. For this study, 63 Italian and 35 Indian psychology students were recruited to take part in a course on death education and palliative psychology. The results showed the positive impact of a death education and palliative psychology course on the training of professionals. In particular, this course was useful in helping students become familiar with and learn how to manage future professional situations related to death and dying. Specific differences between the two countries also emerged, particularly with regard to their approach to the end-of-life field, due to different cultural contexts. There is still much to be done by institutions to improve the dissemination and academic teaching of this area, which in turn can promote job opportunities for young people and encourage them to work in this field.

Death Education for Palliative Psychology: The Impact of a Death Education Course for Italian University Students

The present study investigated the effects of a hybrid online course on a group of Italian Master's degree students involved in a European Erasmus+ project. The course was composed of nine modules about death education, palliative psychology and the use of creative arts therapies-such as psychodrama, intermodal psychodrama and photovoice-in the end-of-life-field. The project involved 64 students in the experimental group (who attended the course) and 56 students as the control group. Both groups completed an online questionnaire before and after the delivery of the course and 10 students from the experimental group participated in a focus group at the end of the course. The quantitative analysis revealed that the experimental group students showed lesser levels of perception of death as annihilation, fear of the death and death avoidance, while they increased their levels of death acceptance, creative self-efficacy and attitude toward the care of the dying. Qualitative analysis identified three main themes: the positive impact of the course on death education and end-of-life care; the role of art therapies on death and end-of-life care; and the unhelpful facets of the course. Overall, this intervention changed the perception and the feelings of the students regarding the themes of death and palliative psychology and increased their creative self-efficacy and their interest in working in an end-of-life field.

Application of Dance Movement Therapy to Life-Death Education of College Students Under Educational Psychology

The present work aims to efficiently carry out life-death education (LDE) for college students, improve their psychological problems, and reduce suicide accidents by combining LDE with Dance Movement Therapy (DMT). DMT is a psychosomatic cross therapy that treats mental or physical diseases through dance or improvisation. Firstly, this paper introduces LDE and DMT and designs the activities of DMT intervention. Secondly, the relationship between DMT and LDE is analyzed. Finally, a questionnaire survey is conducted on the research objects. The research objects are divided into the experimental group receiving DMT intervention, the control group participating in sports dance courses, and the benchmark group. The research data show no significant difference in interpersonal skills and emotional psychology among the three groups. The DMT intervention group has substantial changes in other factors except for the conflict control ability before and after the intervention. In addition, the questionnaire survey results after the intervention demonstrate that the DMT intervention group gets a significantly higher score in the interpersonal relationship, interpersonal relationship building ability, moderate rejection ability, self-disclosure ability, and emotional support ability. Therefore, DMT intervention positively impacts college students' interpersonal relationships. After the sports dance course, there are differences in the total score of interpersonal ties and scores of interpersonal relationships building ability, self-disclosure ability, and emotional support ability in the control group, but with no significant difference in moderate rejection ability and conflict control ability. Therefore, compared with traditional psychotherapy methods, the DMT method reported here is conducive to releasing pressure and alleviating physical and mental anxiety. The research content provides new ideas for psychological education in colleges and universities and contributes to improving college students' suicidal tendencies and helping college students grow up healthily.

Death education and photovoice at school: A workshop with Italian high school students

The study shows the effects of a death education workshop with Italian high school students. Students (N = 416) from 10 high schools throughout Italy participated: 212 in the experimental group and 204 in the control group. Four weekly, two-hour workshops about the themes of death, with theoretical lessons and an experiential artistic activity of photovoice. Results show that the students in the experimental group showed significantly increased self-efficacy levels and existential anxiety levels did not increase after death education intervention. Educating youth about death could give them the skills to improve the management of death-related events and cope with negative emotions.

Comparison of Death Anxiety, Death Obsession, and Humor in Nurses and Medical Emergency Personnel in COVID-19 Pandemic

Introduction

COVID-19 has created numerous challenges for the health system. Nurses and medical emergency personnel are at the forefront of fighting COVID-19 and exposed to psychological disorders such as death anxiety and death obsession. Humor is a defense and coping mechanism against the anxiety and obsession associated with death. This study aimed to compare death anxiety, death obsession, and humor among nurses and medical emergency personnel during the COVID-19 pandemic.

Methods

This descriptive cross-sectional study was conducted with 230 nurses and medical emergency personnel. To collect data, the Templer death anxiety scale, death obsession scale, and humor styles questionnaire were used. SPSS 19 was used for data analysis. The significance level was considered at P < .05.

Results

Mean and standard deviation of death anxiety in the nurses and medical emergency personnel were 6.86 (4.04) and 5.68 (3.57), respectively; these values for death obsession were 29.82 (12.30) and 25.30 (12.66) and for humor 116.75 (30.87) and 118.48 (24.66), respectively. The nurses had significantly higher death anxiety (t = 2.33, P = .02) and death obsession (t = −2.68, P = .008) than the medical emergency personnel; moreover, there was no significant relationship among humor, death anxiety (r = .11, P = .10), and death obsession (r = .07, P = .31) in nurses and emergency personnel.

Discussion

The results of this study showed that the levels of death anxiety and death obsession were higher in the nurses than the medical emergency personnel. There was no significant difference between the hospital nurses and medical emergency personnel in terms of humor.

Tele-psychodrama therapy during the COVID-19 pandemic: Participants' experiences

Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis.

The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.

The presence of death in Spanish education law (1812-2006)

The objective of this study is to determine whether death has been present, and if so in what way, in Spanish education law from 1812 to 2006. The presence of 25 terms semantically related to death was analyzed in laws and regulations on school curricula. Death is generally absent as a directly approachable phenomenon within the given period, except in scattered regulations which, as a rule, link death in education to religion. From the beginnings of the democratic period in Spain (1975), socially relevant subjects with indirect but significant relationships with death, such as biodiversity and the Holocaust, appear.

Health Education as a Means of Addressing Death in the Elderly

Education for death is an emerging field of study in which health education research and proposals are increasingly being made with the aim of acquiring knowledge and skills to promote positive attitudes towards health and preparation for the end of life. The aim of this study is to find out what experience older people have had with death education and the importance they give to health education. A qualitative methodological design was selected using a semi-structured interview. The survey consisted of interviews with 28 participants from the city of Granada (Spain) aged 61 to 78. This qualitative-descriptive study is based on an analysis of older people's experience of education and preparation for death throughout their lives. The results show that, in most cases, the only information received was in childhood and always from a religious perspective. Death and health are closely related, so working on death education helps to improve the quality of life of elderly people. Health education offers ways of coping with the end of life through the transmission of values and practices that make it possible to anticipate and resolve situations of instability or anxiety. Facing death naturally and as just another part of life will help to make healthy ageing possible, through educational proposals related to the integral health of elderly people.

The hospice as a learning space: a death education intervention with a group of adolescents

Background

The denial of death in Western society deprives young people of the tools to derive meaning from experiences of death and dying. Literature shows that death education may allow them to become familiar with this topic without causing negative effects. This article describes the effects of a death education course with adolescents, wherein participants were given the opportunity to meet palliative doctors and palliative psychologists at school and in a hospice, where they were able to converse with the families of the dying.

Methods

This study used mixed methods and included an evaluation of a death education intervention with longitudinal follow-up of outcomes. The course involved 87 secondary school students (experimental group) aged between 16 and 20 years. We also recruited a control group of 76 similarly-aged students to observe differences. The variables we examined were: alexithymia, representation of death, value attributed to life and spirituality. These were measured with the following instruments: the Toronto Alexithymia Scale-20, the Testoni Death Representation Scale, the Personal Meaning Profile and the Spiritual Orientation Inventory, respectively. To better understand how the students perceived the experience, we asked the experimental group to answer some open-ended questions. Their answers were analysed through thematic analysis.

Results

The study showed that death education and the hospice experience did not produce negative effects, but rather allowed students to decrease alexithymia, improving their ability to recognise and express emotions. Thematic analysis revealed that all participants perceived the experience as very positive.

Conclusions

Our findings affirm that death education programs can be successfully implemented in high schools, and that they can usefully involve local hospices and palliative care professionals, especially physicians and psychologists.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00747-w.

Students' Confidence and Interest in Palliative and Bereavement Care: A European Study

As part of a European Erasmus Plus project entitled Death Education for Palliative Psychology, this study assessed the ways in which Master's Degree students in psychology and the creative arts therapies self-rated their confidence and interest in death education and palliative and bereavement care. In five countries (Austria, Israel, Italy, Poland, Romania), 344 students completed an online questionnaire, and 37 students were interviewed to better understand their views, interest, and confidence. The results revealed some significant differences between countries, and showed that older respondents with previous experience as formal caregivers for end-of-life clients showed greater interest in obtaining practical clinical competence in these fields. A mediation analysis indicated that students' previous care experiences and past loss experiences were related to students' current interest in death education and palliative and bereavement care through the mediation of their sense of confidence in this field. The qualitative findings identified five shared themes: life and death, learning about death, the psychological burden, personal experience and robust training, and four key training needs. Overall, students' interest in studying and working with terminal illness and death are rooted in internal resources, a preliminary sense of confidence, but also external requirements.

My Future: Psychodrama and Meditation to Improve Well-Being Through the Elaboration of Traumatic Loss Among Italian High School Students

This study was designed as an action research aimed to help students to elaborate their feelings of traumatic grief, due to a car accident and a suicide of two of their classmates, in an Italian high school. A death education project was realized in order to prevent the Werther effect. The intervention was based on psychodramatic techniques and meditation with Tibetan bells to encourage reflection on the suffering of traumatic loss, the sense of life, and their future. A total of 89 students from four classes (46 in the experimental group: two classes, 43 in the control groups: two classes) participated in the study, among which 82 (45 in the experimental group, 37 in the control group) completed the pre- and post-test survey. The intervention consisted of eight 2-h meetings, during which the themes of death and loss were dealt with through theoretical discussions, dramatization, and meditation. Two other classes which participated in the assessment as a control group did not attend the activities. The following instruments were used: Death Attitude Profile-Revised, which measures individual attitudes toward death; Psychological Well-being Scale, which measures a person’s psychological well-being; Resilience Scale for Adolescents, which measures the construct of resilience in adolescents; Self-Transcendence Scale, which measures self-transcendence; and Testoni Death Representation Scale, which measures the ontological representations of death. The results demonstrated that in the experimental group, there was a reduction in the fear of death and its avoidance, and that the students normalized the representation of death as something natural, thus improving their well-being. It is consequently possible to say that well-being is not simply the absence of suffering and worries, but rather, is rooted in the possibility of thinking of creative solutions to the trauma.

"Imagine You Have ALS": Death Education to Prepare for Advance Treatment Directives

The study presents the results of qualitative research carried out within a death education project dedicated to advance treatment directives (ATDs) in which it was proposed to participants to empathize with people who had received a diagnosis of Amyotrophic Lateral Sclerosis (ALS). The study involved 104 people who discussed and reflected on issues related to the knowledge of having to die, palliative care and ATDs, investigating what choices they would have made if they had received such a diagnosis. Finally, they were asked to write a paper describing their impressions and hypothetical choices. Qualitative analysis has elucidated among fundamental themes. Four thematic areas emerged from the data analysis: (1) ATDs and the family; (2) the importance of reducing pain and suffering; (3) emotions and considerations regarding death, illness and spirituality; and (4) opinions on the DeEd course. It has emerged that some people are unfamiliar with palliative care or the right to self-determination and that addressing these issues helps manage the thought of the future with less terror. The experience of death education has therefore proven to be very positive in dealing with complex and often censored issues, allowing thinking about death in a less distressing way.

A Challenge for Palliative Psychology: Freedom of Choice at the End of Life among the Attitudes of Physicians and Nurses

This article considers a particular aspect of palliative psychology that is inherent to the needs in the area of attitudes concerning Advance Healthcare Directives (AHDs) among Italian physicians and nurses after the promulgation of Law No. 219/2017 on AHDs and informed consent in 2018. The study utilized a mixed-method approach. The group of participants was composed of 102 healthcare professionals (63 females and 39 males). The quantitative part utilized the following scales: Attitudes toward Euthanasia, the Religious Orientation Scale, the Balanced Inventory of Desirable Responding, and the Testoni Death Representation Scale. The results were mostly in line with the current literature, especially concerning a positive correlation between religiosity and the participants’ rejection of the idea of euthanasia. However, the qualitative results showed both positive and negative attitudes towards AHDs, with four main thematic areas: “Positive aspects of the new law and of AHDs”, “Negative aspects of the new law and of AHDs”, “Changes that occurred in the professional context and critical incidents”, and “Attitudes towards euthanasia requests.” It emerged that there is not any polarization between Catholics or religious people and secularists: Their positions are substantially similar with respect to all aspects, including with regard to euthanasia. The general result is that the law is not sufficiently understood, and so a quarter of the participants associate AHDs with euthanasia. Discussions on the opportunity for palliative psychologists to help health professionals to better manage these issues through death education courses are presented.

The Hospice as a Learning Environment: A Follow-Up Study with a Palliative Care Team

In Western society, the topic of death has been removed from everyday life and replaced with medical language. Such censorship does not reduce individuals’ fear of death, but rather limits their ability to elaborate their experiences of death, thus generating negative effects. The objective of this follow-up qualitative study was to detect how and if death education can help to improve individuals’ relationship with death and enhance care environments like hospices. Semi-structured interviews were conducted with palliative care professionals and teachers who had taken part in a death education initiative three years earlier. The results confirmed the initiative’s positive effect on both palliative care professionals and teachers. The participants reported that the education initiative helped them to positively modify their perspective on death, end-of-life care, and their own relationship to life, as well as their perception of community attitudes towards the hospice, which seemed to become less discriminatory. This study confirmed that school education initiatives can usefully create continuity between hospices and local communities. This project provided an educational space wherein it was possible for participants to elaborate their experiences in relation to death and to re-evaluate and appreciate hospices.

Can Desire and Wellbeing Be Promoted in Adolescents and Young Adults Affected by Cancer? PhotoTherapy as a Mirror That Increases Resilience

PhotoTherapy represents a recent psychotherapeutic intervention which, through the medium of photography, has the objective of helping a patient reach a higher self-knowledge and explore thoughts, desires, and intimate perceptions that would otherwise remain hidden. Because of this, it may help people overcome their cognitive and emotional boundaries and bring out their interiority, even when exploring some of the most distressing themes. The objective of the present research was to demonstrate that the elaboration and expression of inner desires, fears and needs of wellbeing among adolescents and young adults, who were either sick or had been cured of cancer, could be facilitated through the use of PhotoTherapy. Their responses were also compared with those of healthy young adults, in order to be able to explore the kind of impact such a pathology can have on those who are affected by it and highlight eventual differences in the kind of desires and needs expressed instead by those who never had a diagnosis of cancer. A qualitative research design was adopted. 45 people took part in the study, aged between 12 and 25 (mean age 19). The participants were divided into three groups: those currently being treated for cancer, those with a history of cancer and those who had no experience of cancer (third group). From the data analysis, different preferences and attitudes toward the presented pictures and themes emerged among the participants, depending on the specific group they belonged to. The article discusses these preferences and considers how PhotoTherapy can help treat psychological distress caused by cancer.

Beyond the Wall: Death Education at Middle School as Suicide Prevention

This study investigates the psychological effects of participation in Death Education (DeEd) by middle school children in two towns in northeast Italy in which suicides occur to a greater extent than in the rest of the region. The aims of the project "Beyond the Wall" were inherent to the prevention of suicide, address existential issues and enhance the meaning of life through positive intentions for the future and reflection on mortality. It involved eight classes (150 students in four classes in the experimental group; 81 in four classes in the control group) engaging with films, workgroup activities, photovoice and psychodrama. The constructs of resilience, emotional competency and psychological well-being were monitored with the Resilience Scale for Adolescents, the Hopelessness Scale for Children, the Alexithymia Questionnaire for Children and the Stirling Children's Well-being Scale. The DeEd intervention was found to be significantly related to some of the variables investigated, improving the students' ability to recognise emotions and communicate them verbally while maintaining stable initial characteristics, such as psychological well-being and positive expectations for the future.