Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak

The Up-Side of the COVID-19 Pandemic: Are Core Belief Violation and Meaning Making Associated with Post-Traumatic Growth?

The negative impact of the COVID-19 pandemic on mental health has been extensively documented, while its possible positive impact on the individual, defined as Post-Traumatic Growth (PTG), has been much less investigated. The present study examines the association between PTG and socio-demographic aspects, pre-pandemic psychological adjustment, stressors directly linked to COVID-19 and four psychological factors theoretically implicated in the change processes (core belief violation, meaning-making, vulnerability and mortality perception). During the second wave of the pandemic 680 medical patients completed an online survey on direct and indirect COVID-19 stressors, health and demographic information, post-traumatic growth, core belief violation, meaning-making capacity, feelings of vulnerability and perceptions of personal mortality. Violation of core beliefs, feelings of vulnerability and mortality, and pre-pandemic mental illness positively correlated with post-traumatic growth. Moreover, the diagnosis of COVID-19, stronger violation of core beliefs, greater meaning-making ability, and lower pre-existing mental illness predicted greater PTG. Finally, a moderating effect of meaning-making ability was found. The clinical implications were discussed.

Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic

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.

Psychological Factors Explaining the COVID-19 Pandemic Impact on Mental Health: The Role of Meaning, Beliefs, and Perceptions of Vulnerability and Mortality

This study tested an expanded version of the explanatory model of the negative impact of the COVID-19 pandemic on mental health proposed by Milman and colleagues. Participants (N = 680) completed an online survey on demographic variables associated with poor pandemic mental health, COVID-19 stressors, mental health symptoms, and pandemic-related psychological processes we hypothesized as mediating mechanisms explaining the negative mental health effects of the COVID-19 stressors. Results indicated that these psychological processes (core belief violation, meaning made of the pandemic, vulnerability, and mortality perception) explained the severity of mental health symptoms to a far greater extent than COVID-19 stressors and demographics combined. In addition, these psychological processes mediated the impact of COVID-19 stressors on all mental health outcomes. Specifically, COVID-19 stressors were associated with increased core belief violation, decreased meaning making, and more intense perceived vulnerability and mortality. In turn, those whose core beliefs were more violated by the pandemic, who made less meaning of the pandemic, and who perceived a more pronounced vulnerability and mortality experienced a worse mental health condition. This study's results suggest some possible ways of intervention in pandemic-like events useful for limiting such impact at the individual, group, social and political levels.

Axiology of Covid-19 as a linguistic phenomenon

This work’s aim was to investigate what verbal means are used by English-speaking Twitter accounts to describe the pandemic while focusing on extralinguistic factors that are the primary catalysts for linguistic transformations in society. A critical discourse analysis of the lexeme ‘Covid-19’ and words accompanying it was applied. A total of 1736 English-language tweets (6844 lexical units) posted during March to April 2020 were selected for the analysis. Functional discourse analysis allowed systematising and commenting on sampling results as well as provided the opportunity to make the following conclusions. In tweets, the lexeme ‘Covid-19’ is combined not only with the actual name of the virus. This lexeme became a productive ground for derivation into various linguistic structures: substantive word combinations, abbreviations, neologisms and anthropomorphic metaphors. The research results application in international practice will allow linguists to interpret neologisms that emerged as a result of the pandemic and foster the understanding of axiological indicators of native speakers.

A "Viral Epistolary" and Psychosocial Spirituality: Restoring Transcendental Meaning During COVID-19 Through a Digital Community Letter-Writing Project

This article outlines the results of a three-month-long community letter-writing and letter-sharing project called "Viral Epistolary" (VE), which we completed online in Italy during the first wave of COVID-19 lockdowns. In it, we collected 340 digital letters from all over the country and connected thousands of people through epistolary exchanges. We used the genre of letters as a mediating, meaning-making, and (auto)biographical tool whereby people could share their experiences of domestic isolation and physical distancing, thus creating a community of support. Based on a well-documented understanding of meaning-making as a core human endeavor, especially in times of social disruption and personal crisis, this article frames sense-making as a transcendental and even spiritual process that yields broad principles for organizing life. Thus, the research adopts a psychosocial perspective on spirituality and applies thematic analysis to qualitatively analyze written narratives. The results reveal that many respondents underwent a three-part, not-necessarily-sequential process of collapsing, self-distancing, and transcending during lockdown, which allowed them to rearrange themselves according to the new total social fact of the pandemic. Through this process, respondents negotiated themes of semiotic crisis, striving for meaning, and beyond meaning (the essential). Finally, the article discusses the role of meaning as a transcendental component of psychosocial meaning-making coping processes and tries to highlight how shared writing experiences can stimulate personal and communal healing processes in the wake of social crises.

Narratives of Dreams and Waking Thoughts: Emotional Processing in Relation to the COVID-19 Pandemic

The Coronavirus-19 (COVID-19) pandemic posed a significant challenge to the physical, mental, and emotional well-being of each individual. It also brought the importance of daily emotional management for survival to the forefront of every human being. Our study aims to explore whether emotional processes perform different functions during waking thoughts and night dreams during the first lockdown in Italy. Utilizing Multiple Code Theory (MCT), our goal is to verify whether waking thoughts facilitate a functional disconnection in order to manage the trauma caused by COVID-19. Two online forms were distributed to random participants in the general population, presenting a total of 49 reports of night dreams (23 males; mean age 33.45 ds. 10.12; word mean 238.54 ds. 146.8) and 48 reports of waking thoughts (25 males; mean age 34.54 ds. 12.8; word mean M. 91 words ds. 23). The Referential Process linguistic measures and Affect Salience Index were utilized. It was found that Affect Salience is present in both dreams and in waking thoughts; however, Referential Activity was higher in dreams and Reflection and Affect words were higher in waking thoughts. Two different processes of emotional elaboration emerged. The results highlight the use of greater symbolization processes during dreams and a higher emotional distance in waking thoughts. These results confirm that during the nocturnal processes, there is greater contact with the processing of trauma, while during the diurnal processes, defensive strategies were activated to cope with and manage life via a moment of the defensive disruption of daily activities.

Posttraumatic Stress Disorder and Adjustment Disorder in Lithuanian Healthcare in 2018-2020: A Nation-Wide Cohort Study of the Effects of COVID-19 Pandemic

Multiple empirical studies have revealed significant pandemic effects of COVID-19 on mental health in various populations. This study aimed to analyze the incidences of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) in national healthcare in 2018-2020 in one of the European countries-Lithuania-and estimate the effect of the COVID-19 pandemic on PTSD and AjD incidences in 2020. The national healthcare registry was used for estimations of diagnosis of PTSD, AjD, and major depressive disorder (MD). The study revealed that stress-related disorders PTSD and AjD are diagnosed rarely, resulting in a considerable gap between the expected prevalence and incidences of these diagnoses in healthcare in Lithuania. Moreover, a significant decline in mental disorders incidence in healthcare in 2020, in comparison to 2018 and 2019, was found, revealing that the COVID-19 pandemic had a negative impact on access to healthcare services and increased barriers for mental disorders treatment. The study indicates that major developments in building up knowledge about the effects of trauma and life stressors on mental health are needed in Lithuania and other countries to increase awareness about stress-related disorders and improve care for trauma survivors, in particular in the context of the pandemics or other large-scale disasters.

Putting into Words the COVID-19 Lockdown Experience: Psychological Symptoms and the Referential Process

The coronavirus pandemic is a unique collective event which has affected the physical and psychological health of all individuals. Restrictions imposed by governments to counteract this situation have represented risk factors for developing psychopathological symptoms. This study aims to explore the relationship between psychological symptoms and the referential process (RP). Forty-eight healthy participants (25 males, mean age = 39.3; SD = 16.6) completed a demographic questionnaire and the Symptom Checklist-90-Revised (SCL-90-R) through an online platform and wrote about their experience 3 weeks after the imposition of the lockdown. Different linguistic measures of the RP were applied to the narratives. The logical functions expressed through written narratives (The Italian Reflection Dictionary score, IREF) showed significant positive correlations with the SCL-90-R General Score Index (GSI) and different SCL-90-R subscales (depression, anxiety, obsessive-compulsiveness, interpersonal sensitivity, hostility, and paranoid ideation). On the contrary, the reorganization and reflection function related to emotional events (The Italian Weighted Reflection and Reorganization List score, IWRRL) showed significant negative correlations with the SCL-90-R’s GSI and different subscales (obsessive-compulsiveness, depression, anxiety). The results highlight the relationship between psychological symptoms and complex defense mechanisms based on the intellectualization of negative emotions and a positive strategy of reorganization based on emotional elaboration. These results suggest the importance of supporting collective elaborations of citizens in the context of the pandemic.

Analysis of General Practitioners' Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist's profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.

Effects of an Existential Nursing Intervention for College Students in the COVID-19 Pandemic Situation

This study designed an intervention based on logo-autobiography to reduce Korean college students' stress and depression and help them find meaning in their lives amidst the COVID-19 pandemic. A quasi-experimental design was used to conduct group interventions among college students. A total of 22 and 26 participants were included in the experimental and control groups, respectively. The experimental group received six sessions of a logo-autobiography for college students (LAC). The effects of the LAC interventions were assessed at baseline, post-intervention, and four weeks after the program's end to determine their retention rate. The effects of group, time, and the group-by-time interaction were verified using generalized estimating equations with an autoregressive correlation structure. The experimental group exhibited significantly lower levels of stress and depression and higher levels concerning the meaning of life than the control group. However, only the effects on stress and the meaning of life continued four weeks after the intervention's end. Based on this study's results, LAC can be considered a useful method for reducing stress and depression in college students who have just started their adult life, as well as for aiding them in their pursuit for the meaning of life.

Individual and community psychological experiences of the COVID-19 pandemic: The state of emergency in Portugal

Individuals have different ways of coping with crisis. Individual factors, family and contextual features, and community support may influence how individuals feel, think and act during a crisis. COVID-19 was an unexpected pandemic that forced many European countries to take confinement measures and restrict social face to face interactions. This study is an effort to understand how Portuguese residents dealt with the pandemic during the first confinement period, considering different sociodemographic characteristics and trauma exposure perceptions. Five hundred and five adults, between 18 and 79 years old participated in this study via an online self-report assessment protocol. Sociodemographic characteristics such as gender, age, marital status, employment status, and caring responsibilities had an impact on individuals' perceptions regarding their exposure to the pandemic and their quality of life. Perceived exposure to the pandemic was found to predict quality of life in the physical, psychological, and environmental domains. Results have practical implications for European and local policy-making, as well as for targeting psychological interventions for those whose mental health has been negatively affected by the pandemic and for those who may become more affected if confinement measures are implemented again.

COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in Portugal

The COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs' levels of distress should be identified and reduced, so their work is not impaired.

First Validation of the Referential Process Post-Session Scale - Therapist Version (RPPS-T)

OBJECTIVE

Bucci's multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases.

METHOD

We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale - Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts.

RESULTS

In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the four-factor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts.

CONCLUSIONS

The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision.