Burnout in Italian hospital physicians during the COVID-19 pandemic: a pilot study on the roles of alexithymia and defense mechanisms

Background: COVID-19 pandemic placed unusual additional burden upon international healthcare systems. This study aims to explore the associations between burnout, alexithymia and defense mechanisms in a group of Italian hospital physicians during the COVID-19 pandemic. Methods: 96 hospital physicians completed self-reported questionnaires through Google Forms platform, including Maslach Burnout Inventory (MBI), Defense Style Questionnaire-40 (DSQ-40), and 20- item Toronto Alexithymia Scale (TAS-20). Results: Emotional Exhaustion (EE) and Depersonalization (DP) burnout dimensions were positively correlated with alexithymia and with immature and neurotic defenses, while negative associations were correlated with a mature defensive style. MBI Personal Accomplishment (PA) was negatively correlated with alexithymia levels but positively correlated with mature defenses. According to regression models, EE levels were predicted by female gender (beta = -0.20;p <.04) and DSQ mature defenses (beta= -.24;p<.02);DP levels were predicted by alexithymia total score (beta= 0.26;p <.04) and DSQ mature defenses (beta= -.20;p<.05);and PA levels were predicted by alexithymia total score (beta = -0.29;p <.02) and DSQ mature defense (beta=.45;p<.001). Conclusions: Consistent with the broader literature, an association between burnout and both alexithymia and defense mechanisms emerged. These findings highlight the importance of reducing occupational-related burden on healthcare workers and of promoting protecting strategies to deal with emergency situations.

"Dreams Drawer": Analysis of Dreams During Lockdown in the Italian Population

The COVID-19 pandemic has indiscriminately involved the whole world, producing a collective trauma that may have activated socially shared mental processes. It was hypothesized that the content of dreams could reflect a change in the way people are conceptualizing relationships, their environment, and the world in general after the emergency and the lockdown. We used data from "Dream Drawer," a free online forum where people could read about others' dreams or write about their own. Our sample consisted of 68 participants and 90 dreams. Most of them were students, and 85% of the participants were facing lockdown at home with families. To identify how dream content could reflect the impact of lockdowns, dreams were analyzed with the emotional text mining methodology. The analysis created a factorial space of 2 factors: "Relationship With the Outside" (between the containing and the losing) and "Relationship With the Inside" (between the processing and losing yourself). Each factor presents a symbolic and reflective dimension. In this space, there are 3 clusters ("holding," "refind the other," and "anguish defense"). The findings demonstrate that home isolation, which is portrayed in dreams as an extraordinary and novel event, appears to be the aspect of the pandemic that the unconscious has most exploited, detecting the activation of collective mental processes in dreams. Dreamwork could be the first step in beginning to process this collective catastrophic experience. The results of this research may be useful in determining collective changes in anxiety and distress.