Uncertainty, alexithymia, suppression and vulnerability during the COVID-19 pandemic in Italy

Testing behaviour change with an artificial intelligence chatbot in a randomized controlled study

Chatbots can effect large-scale behaviour change because they are accessible through social media, flexible, scalable, and gather data automatically. Yet research on the feasibility and effectiveness of chatbot-administered behaviour change interventions is sparse. The effectiveness of established behaviour change interventions when implemented in chatbots is not guaranteed, given the unique human-machine interaction dynamics. We pilot-tested chatbot-based behaviour change through information provision and embedded animations. We evaluated whether the chatbot could increase understanding and intentions to adopt protective behaviours during the pandemic. Fifty-nine culturally and linguistically diverse participants received a compassion intervention, an exponential growth intervention, or no intervention. We measured participants' COVID-19 testing intentions and measured their staying-home attitudes before and after their chatbot interaction. We found reduced uncertainty about protective behaviours. The exponential growth intervention increased participants' testing intentions. This study provides preliminary evidence that chatbots can spark behaviour change, with applications in diverse and underrepresented groups.

Euthymia, Psychological Well-Being, and Professional Quality of Life in Health Care Workers

Objective

Euthymia is a transdiagnostic construct characterized by the presence of positive mood states, psychological flexibility and resilience. These components contribute to psychological wellbeing and support mental functioning. Exposure to suffering and high levels of stress can lead to the onset of burnout and secondary traumatic stress, but also lack of compassion satisfaction. The study aimed to test the existing relationships between euthymia, psychological well-being, and factors associated with quality of life of healthy participants involved in medical settings.

Method

The sample was composed of 177 healthy participants involved in medical settings, 118 women (66.7%) and 59 men (33.3%) aged between 19 and 69 years old (mean = 27.16; SD = 8.47). Standardized psychodiagnostics instruments were used to assess euthymia (Euthymia Scale-ES), psychological well-being (The Well-Being Index scale-WHO-5) and the quality of life of the involved participants (Professional Quality of Life Measure-ProQOL-5).

Results

The results showed that gender, well-being and psychological well-being were predictors of compassion satisfaction and secondary traumatic stress. Specifically, female gender predicted higher levels of compassion satisfaction. Well-being and psychological flexibility predicted higher levels of compassion satisfaction and lower secondary traumatic stress. Psychological well-being predicted higher levels of compassion satisfaction.

Conclusions

Promoting euthymia and well-being helps individuals to preserve psychological well-being and increase tolerance to stressful life situations. Results highlighted the need for promoting health care professionals' euthymia and well-being. In line with evidence, encouraging interventions based on evidence appears relevant.

Emotion Regulation in Families: Exploring the Link between Parent-Child Alexithymia and Child Post-Traumatic Stress Symptoms Amidst the COVID-19 Pandemic

The COVID-19 pandemic comprises a mass trauma for children and families, and children may face particular vulnerability to post-traumatic stress symptoms (PTSS) through processes of parent and child emotional dysregulation, such as alexithymia. With 88 U.S. children (Mage = 9.94 years; 54.5% female; 59.1% White) and their parents/caregivers (68.2% female; 59.1% White), a path model was tested in which child alexithymia symptoms partially mediated the association between parent alexithymia symptoms and child COVID-19-related posttraumatic stress symptoms (PTSS). We also tested an alternative model in which child alexithymia symptoms moderated the association between parent alexithymia symptoms and child PTSS. The hypothesized mediation model was supported (β = 0.15, SE = 0.05, 95% CI: [0.07, 0.25], p < 0.001), whereas the hypothesized moderator model was not (β = 0.06, p = 0.44). Findings highlight the importance of parents' emotional understanding and regulation for child mental health during mass traumas such as pandemics.

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19

The global COVID-19 pandemic has created significant financial and operational challenges for some businesses. As a result, temporary welfare benefit reduction may be a tough but future-oriented choice for both employers and employees. The present study examined whether default nudges can be used to promote employees' approval of welfare-cutting policy while avoiding negative attitudes. Two online surveys were conducted during the first pandemic wave in China (February 2020). In the first study (N = 310), the participants were presented with a hypothetical welfare-cutting policy that used either an opt-in approach or an opt-out approach. We aimed to investigate how their approval and attitudes were different between two conditions. The results showed that the employees in the opt-out condition were more likely to accept the welfare-cutting policy than those in the opt-in condition, while participants' attitudes toward the policy employing opt-out approach were as negative as that employing opt-in approach. Study 2 (N = 1,519) involved a replication of Study 1 with two additional improved opt-out approaches (opt-out education and opt-out transparency). Compared with the opt-in approach and standard opt-out approach, the opt-out education approach both increased policy support and improved attitudes toward the welfare-cutting policy. The theoretical and practical implications of these findings are discussed.

The psychometric properties and gender invariance of the Italian version of the Perceived Vulnerability to Disease Questionnaire (I-PVDQ) during the COVID-19 pandemic

BACKGROUND

The Perceived Vulnerability to Disease Questionnaire (PVDQ) measures beliefs associated with personal susceptibility to infectious diseases and behaviors or perceptions in the presence of potential risk of pathogen transmission. Given the onset of the Severe Acute Respiratory Syndrome Coronavirus 2 global pandemic, otherwise known as the COVID-19 pandemic, the construct being measured may function differently based on affective, behavioral, and cognitive changes along with the need to change norms and lifestyles in a global context. The present study aims to test the psychometric properties and the gender invariance of the Italian adaptation of the PVDQ to confirm that the scale can be used with Italian-speaking people, and that it functions effectively during a pandemic.

METHODS

A total of 509 participants filled out an online questionnaire including the Italian version of the I-PVDQ (I-PVDQ) and several measures of psychological constructs. Reliability and factor analyses (single and multigroup) were conducted. Bayesian correlation tests and Bayesian independent sample t-tests were used to assess the validity of I-PVDQ.

RESULTS

Exploratory factor analysis supported the two-factor structure of the I-PVDQ, and factor loadings loaded appropriately onto perceived infectability (PI) and germ aversion (GA). In terms of invariance, the scale showed configural, metric, scalar, and strict invariance across genders. Decisive evidence in favor of correlation with the measure of COVID-19 related fears for both PI and GA was found. There was strong evidence for observed correlations with COVID-19 related constructs such as intolerance to uncertainty, psychological inflexibility, resilience, stress, and anxiety. Women showed higher GA than men, while there were no gender differences in PI.

CONCLUSIONS

Taken together, these results suggest that the I-PVDQ confirms the psychometric properties of the original version and that can be used to detect PVD when it is affected by environmental circumstances since its functioning is preserved during a pandemic.

Religion and the Mediating Role of Alexithymia in the Mental Distress of Healthcare Workers During the Coronavirus Disease 2019 Pandemic in a Psychiatric Hospital in China

The outbreak of the coronavirus disease 2019 (COVID-19) has created unprecedented challenges to the healthcare system, religion, and alexithymic trait that impacts the psychological resilience of healthcare workers during the COVID-19 pandemic. This study aimed to investigate the role religion and alexithymia play in mental distress and the level of happiness of psychiatric hospital healthcare workers in China amidst the COVID-19 pandemic. Furthermore, whether symptom dimensions (anxiety, depression, hostility, inferiority, and insomnia) are associated with the level of happiness, and a 6-month follow-up was also investigated. A total of one-hundred and ninety healthcare workers were recruited from a psychiatric hospital in Jilin, China, and 122 were followed up after 6 months. All participants filled out the 20-item Toronto Alexithymia Scale, five-item Brief-Symptom Rating Scale, and the Chinese Oxford Happiness Questionnaire. The mental distress of healthcare workers decreased from 2.6 to 1.5% in 6-months. Religious belief was not associated with the mental distress or happiness of healthcare workers. Instead, for those whose anxiety decreased over 6 months, their social adaptation status increased. For those whose inferiority level decreased over time, their perceived level of psychological well-being and overall happiness increased. In over half a century of living in different societies, religion stabilizes the mental health of those in Taiwan amidst the stress of the COVID-19 pandemic, but not in China. However, both regions found healthcare workers with alexithymic traits experienced a higher level of mental distress, implying that the collectivist culture of Confucian philosophy continues to influence the emotional expression and alexithymic traits of healthcare workers in China and Taiwan. To ensure a healthy and robust clinical workforce in the treatment and control of the pandemic, the cultural impact on the psychological resilience of medical workers needs to be addressed.

Associations between COVID-19 risk perceptions, behavior intentions and worry

BACKGROUND

Risk perceptions are central to health behavior, but some types of risk perceptions may be more strongly connected to behavior than others. This research examined different risk perceptions of COVID-19 and their respective associations with behavior intentions and worry.

PARTICIPANTS AND PROCEDURE

U.S. college students (N = 248) and general adults (N = 300) reported their risk perceptions of COVID-19 - including absolute numerical, verbal, comparative, and feelings of risk - as well as their worry and intentions to do things such as get vaccinated.

RESULTS

Although most risk perceptions related to intentions and worry, feelings of risk were the most strongly and consistently related. The associations showed that the higher people's feelings of risk were, the greater were their intentions and worry.

CONCLUSIONS

Assessing feelings of risk of COVID-19 may provide the best insight into people's perceived threat of this virus.

Influence of Resilience on Burnout Syndrome of Faculty Professors

This research aims to describe the relationship between resilience and burnout facing COVID-19 pandemics. The sample was n = 831 lecturers and professors of a Mexican public university. This study is a quantitative, non-experimental, cross-sectional, explanatory, and ex post facto research using Structural Equations Modeling with latent variables under the partial least square's method technique. We used the CD-RISC-25 and SBI questionnaires to measure resilience and burnout, respectively. Structural Equations Modeling (SEM-PLS) allowed the visualization of the exogenous variable (resilience) in endogenous variables (dimensions of SBI burnout: E9 guilt, E7 emotional exhaustion, E8 indolence, and E6 work illusion). To this day, there are very few previous studies that jointly analyze in Mexico the characteristics of resilience and burnout in the face of the COVID-19 pandemic. Findings show that resources availability has the strongest correlation with accomplishment in teaching, followed by cynicism and emotional exhaustion. These results have important professional implications.

COVID-19 emergency: the influence of implicit attitudes, information sources, and individual characteristics on psychological distress, intentions to get vaccinated, and compliance with restrictive rules

BACKGROUND

To limit the spread of the COVID-19 emergency, a massive vaccination program was implemented and restrictive measures were imposed on the population. However, the propensity to adhere to the vaccination program has struggled to take off. Moreover, complying with the restrictive rules and maintaining social distancing have been highly distressing for many individuals.

PARTICIPANTS AND PROCEDURE

Italian participants (N = 140, females = 65%, mean age = 29.50, SD = 10.80) were presented with an online survey consisting of multiple-choice questions and two single-category implicit association tests (SC-IATs). One SC-IAT evaluated the tendency of participants to automatically associate personal protective equipment (PPE) and vaccines with safety or danger; the other evaluated their tendency to automatically associate social situations with good or bad. Multiple-choice questions explored individual, social, and environmental factors that were expected to contribute to vaccine propensity, compliance with restrictive rules, and feelings of distress.

RESULTS

Using scientific information sources was related to implicitly associating PPE and vaccines with safety, which in turn was associated with the propensity to get the vaccine. Moreover, being female, young, unsatisfied with social relationships, having suffered health and economic consequences due to the pandemic, and having negative implicit attitudes toward social situations contributed to increasing feelings of distress.

CONCLUSIONS

Communication may contribute to individuals' behavior and preferences and it can also be associated with implicit attitudes, becoming consequently one of the main leverages to reduce vaccine hesitancy. Recovery programs should prioritize the development of interventions aimed at fostering psychological well-being through the enhancement of social contacts.

How Does Psychological Distress Due to the COVID-19 Pandemic Impact on Internet Addiction and Instagram Addiction in Emerging Adults?

International research has underlined a worrying increase in Internet and Instagram addiction among emerging adults during the COVID-19 pandemic. Although the role played by alexithymia and psychological distress due to COVID-19 has been evidenced, no study has explored their complex relationship in predicting emerging adults' Internet and Instagram addiction. The present study aimed to verify whether peritraumatic distress due to the COVID-19 pandemic mediated the relationship between emerging adults' alexithymia and their Internet/Instagram addiction, in a sample composed of n = 400 Italian emerging adults. Results showed that females had higher peritraumatic distress due to COVID-19 than males, whereas males had higher externally oriented thinking and higher levels of Internet addiction than females. Emerging adults' psychological distress due to COVID-19 significantly mediated the effect of alexithymia on Internet and Instagram addiction. Our findings supported the presence of a dynamic relationship between individual vulnerabilities and the co-occurrence of other psychological difficulties in predicting emerging adults' Internet and Instagram addiction during the pandemic, with important clinical implications.

Late Adolescents' Attachment to Parents and Peers and Psychological Distress Resulting from COVID-19. A Study on the Mediation Role of Alexithymia

The scientific literature has shown the key role played by attachment to parents and peers and difficulties in recognizing, processing, and regulating emotions (i.e., alexithymia) in the (mal-)adaptive psychological response to the COVID-19 pandemic during late adolescence. No study has yet explored the complex interplay between these variables. We recruited a sample of 454 late adolescents (Mage = 22.79, SD = 2.27) and assessed attachment to parents and peers, alexithymia, and peritraumatic distress due to COVID-19 through self-report instruments. Attachment to fathers and peers, but not to mothers, and alexithymia significantly predicted levels of peritraumatic distress. Alexithymia fully and partially mediated the effect of, respectively, attachment to mothers and attachment to peers on peritraumatic distress due to COVID-19. These findings suggested that intervention programs focused on the promotion of peer social relationships, supportive parent-adolescent relationships, and the ability to recognize and discriminate one's own and others' emotions are needed in helping late adolescents to face the current health emergency and preventing short- and long-term psychopathological consequences related to the COVID-19 pandemic.

Mediator Effect of Affinity for E-Learning on Mental Health: Buffering Strategy for the Resilience of University Students

The pandemic affected the quality of life and wellness of the population, changing living habits through restriction measures. This study aimed to analyze the psychological impact of the fear of the COVID-19 pandemic and the adoption of e-learning for university students. The study was articulated in two research applications: the first application was a rapid review on the psychological effects of the pandemic on the emotional dimension of undergraduate students; the second application was an observational study on the effect of e-learning adoption in the pandemic emergency. In the first step, we performed a systematic search of MEDLINE through PubMed and the Web of Science [Science Citation Index Expanded (SCI-EXPANDED); Social Sciences Citation Index (SSCI); Emerging Sources Citation Index (ESCI)] of all scientific literature published from May 2020 to February 2021. The reviewed articles suggest the impact of the pandemic and lockdown measures on university students due to several mental symptoms, including anxiety, stress, depression, event-specific distress, and a decrease in psychological well-being. Psychological symptoms were related to the experience of several stressors, such as the risk for a reduction of academic perspectives, massive e-learning adoption, economic issues, social restrictions, and implications for daily life related to the COVID-19 outbreak. The second scientific application was conducted to evaluate the affinity for e-learning on a sample composed of Italian undergraduates exposed to massive e-learning adoption. The results evidence the positive influence of e-learning in academic programs for the wellbeing of undergraduates. The mediator effect of the affinity of youth for e-learning can be considered to have had a buffering effect for professional advancement and for the mental health of university students in a public health emergency.

Psychological Impact of the COVID-19 Outbreak on Mental Health Outcomes among Youth: A Rapid Narrative Review

The coronavirus disease (COVID-19) outbreak has affected not only physical health but also mental health and psychological wellbeing. This narrative review aimed to map the literature on the psychological impact on the young generation of the COVID-19 pandemic, social restrictions, and extraordinary measures to curb the spread of coronavirus. We performed a systematic search of MEDLINE through PubMed and Web of Science [Science Citation Index Expanded, SCI-EXPANDED), Social Sciences Citation Index (SSCI), and Emerging Sources Citation Index (ESCI)] of all scientific literature published from May 2020 until 15 March 2021. Based on inclusion and exclusion criteria, a total of 15 articles were included. We conducted a narrative review. The reviewed articles suggested the impact of the pandemic and lockdown measures on young persons for several mental symptoms as well as anxiety, stress, depression, event-specific distress, decrease in psychological wellbeing, and changes in sleep habits. Psychological symptoms were related to the experience of several stressors, such as risk for reduction of academic perspectives, massive e-learning adoption, economic issues, social restrictions, and implications for daily life related to the COVID-19 outbreak. This narrative review points out the negative psychological impact of the pandemic outbreak and the high vulnerability of the young in the development of psychological distress, highlighting the relevant focus on the mental health of young people during the pandemic and the need for structured and tailored psychological support and interventions focused to the improvement of Quality of Life of university students after the pandemic experience.

The Role of Suppression and the Maintenance of Euthymia in Clinical Settings

Background: Defense mechanisms serve as mediators referred to the subjects' attempt to manage stressors capable of threatening their integrity. Mature defense mechanisms represent the high adaptive group, including suppression, which allows the subject to distance disturbing contents from consciousness. In line with general defensive intents, suppression would preserve stable mood states, as in the case of euthymia. Clinical issues usually disturb homeorhesis, so that the study of subjects' suppressive tendencies would suggest possible existing relations among defense mechanisms, mood states, and clinical issues. The study highlighted the significant existing relations among factors such as suppression, euthymia, mood states, and clinical psychological phenomena. Methods: The observation group was composed of 150 participants, 51 males (34%) and 99 females (66%), aged from 25 to 30 years old, with a mean age of 26.63 years old (SD = 1.51). The study was conducted through the use of measures related to subjects' characteristics, euthymia, psychological flexibility and psychological well-being (Euthymia Scale), suppression (Suppression Mental Questionnaire), well-being (Who-5), and compassion (ProQol-5). Results: The performed analyses consisted of descriptive statistics, correlations, differences, and regressions among the considered variables. Starting from the first hypothesis, SMQ factors appeared to be significantly and positively correlated with Euthymia factors, rather than Regression in the Ego service (-). In line with the previous result, significant and positive correlations emerged among SMQ and Well-being (WHO-5) variables, maintaining an inverse relation with Regression in the Ego service. Significant differences emerged between male and female groups concerning SMQ total score and rationalization, with higher male group scores. Finally, significant dependencies emerged among the selected predictors (SMQ variables) and Compassion satisfaction. Conclusion: The emerged results highlighted significant relations among the considered variables so that it was possible to highlight the common directions assumed by suppression variables, well-being, and euthymia. Moreover, suppression appeared as a significant predictor with a causal role in clinical satisfaction. The results that have emerged allow us to consider defenses through an empirical perspective, useful to suggest an extension to other groups, phenomena, and conditions.