Cognitive and Relational Processes Associated to Mental Health in Italian High School Students during COVID-19 and Russian-Ukrainian War Outbreaks.

The negative impact of the COVID-19 pandemic on mental health has been widely demonstrated; however, few studies have investigated the psychological processes involved in this impact, including core beliefs violation, meaning-making disruption, interpersonal support, or one's relational functioning. This study explored the mental health of 215 Italian adolescents during the COVID-19 pandemic and the subsequent outbreak of the Russian-Ukrainian war. By administering a set of questionnaires, several cognitive and emotional variables were investigated, including core belief violation, meaning attribution to the pandemic and war, attachment, and emotion regulation, social media addiction, and relationships with significant others and teachers. We conducted some descriptive, mean difference, correlational, and predictive analyses that revealed a significant association between core belief violation caused by war and pandemic, ability to integrate war and pandemic within personal meaning universe, the relational support received, and mental health. The relationship with teachers during these challenging periods improved significantly according to the respondents' opinion, becoming both more authoritative and empathic. This study offers insights into what cognitive and relational processes are useful to intervene on to reduce the distress of adolescents who are facing significant moments of crisis due to events that challenge their cognitive and emotional balance.

A Single Case Multimethod Assessment to Detect Significant Changes in the Psychoanalytic Treatment of Psychosomatic Disorders.

Mental disorders with body-centered symptoms, such as somatic, eating, and body dysmorphic disorders, present difficulties in psychotherapy because psychological suffering is manifested in the body rather than expressed verbally. The present study illustrates a single case multi-method investigation sensitive to detecting characteristic change manifestations in the treatment of these disorders. We investigated a treatment of a patient with body dysmorphic disorder. Computerized linguistic measures were applied to 86 sessions to assess changes in symbolic processing; out of the 86 sessions, 40 were analyzed to calculate the proportion of speech focused on bodily symptoms versus on relationships. Changes in personality were assessed using the SWAP-200 on nine sessions from different treatment stages. Measures of linguistic style, speech content, and personality showed marked changes over the treatment. The patient manifested schizoid and schizotypal personality traits that decreased over time, along with an increase in personality high-functioning dimension. The patient's ability to translate his emotional experience into words steadily increased, switching the primary focus of narratives from bodily symptoms to relationships. A multimethod assessment of the treatment of body dysmorphic disorder shows that improvement in personality functioning is accompanied by a shift from a focus on bodily experiences to a focus on relationships.

Women's Narratives on Infertility as a Traumatic Event: An Exploration of Emotional Processing through the Referential Activity Linguistic Program.

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.

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.

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.

Childhood traumatic events, alexithymia and perceived stress in patients with rheumatoid arthritis during the COVID-19 pandemic.

Rheumatoid arthritis (RA) is a chronic inflammatory disease, causing joint-swelling and pain. International literature highlights that patients with RA are more likely to report high levels of alexithymia, adverse childhood events (ACEs) and stress, but studies investigating the association between these dimensions are lacking. The general aim of the present study is to investigate the association between alexithymia, ACEs, and stress in RA patients and to highlight possible predictors of greater perceived stress. One hundred and thirty-seven female patients with RA (mean age = 50.74; SD = 10.01) participated in an online survey between April and May 2021. Participants completed a questionnaire for the collection of sociodemographic and clinical information, the 20-item Toronto Alexithymia Scale, the Adverse Childhood Events questionnaire and the 10-item Perceived Stress Scale. The correlational analysis highlighted several significant associations between the dimensions evaluated. Regression analyses showed that alexithymia, ACEs and the perceived health status have a predictive effect on the perceived stress of RA patients. More specifically, the role of difficulty in identifying feelings, and the physical and emotional neglect, has been highlighted. ACEs and high levels of alexithymia are common in RA clinical populations and seem to affect the wellbeing of these patients. The use of a biopsychosocial approach to RA treatment appears essential in achieving a better quality of life and illness control in this specific clinical population.

Free-Association Session Scale: factor structure and preliminary validity test.

One of the main concepts of the psychoanalytic method postulated by Freud in 1912 is the fundamental rule, which involves asking the patient to say whatever comes to mind as the analyst follows the patient's speech with fluctuating attention. Despite different theoretical models, this concept has remained an invariant element that characterizes the psychoanalytic method. For this reason, the purpose of the current study is to present a new instrument that measures this process based on the clinician's assessment. The Free-Association Session Scale (FASS) has been designed according to the psychoanalytic framework. Study 1 presented the preliminary validation of the FASS factor structure. Experienced Italian psychoanalysts (N = 281; 196 women) completed the FASS and sociodemographic questionnaire. The following two factors were identified using exploratory factor analysis: (1) Perturbing, and (2) Associativity. Study 2 cross-validated the two factors using an independent sample (N = 259; 187 women) of experienced psychoanalysts and confirmatory factor analysis (CFA). The FASS has been tested for concurrent validity using the Session Evaluation Questionnaire (SEQ) and Linguistic measures of the Referential process. The two-factor model achieved a close-fit test, and the FASS items were found to measure the corresponding factors with good reliability. The Perturbing factor is negatively associated with three SEQ factors (Depth, Smoothness, and Positivity) and negatively correlated with symbolization (IWRAD and IWRAD_IWRRL), confirming a more complex and unexpected session. The Associativity factor is positively associated with all four SEQ factors (Depth, Smoothness, Positivity, and Arousal). In conclusion, the FASS is a promising new questionnaire for assessing psychoanalytic session quality processes with satisfactory validity and reliability.

Burnout in Italian anesthesiologists and intensivists during the COVID-19 pandemic: a national survey.

BACKGROUND: COVID-19 pandemic added additional burden upon healthcare systems and anesthesiology and intensive care physicians (AI) who possessed crucial expertise for dealing with the pandemic. Aim of the study was to uncover specific burnout patterns among Italian AI, exploring the hypothesis that burnout has a multicluster structure. Differences in social and professional characteristics between burnout patterns were explored. METHODS: One thousand and nine AI (658 women) members of the Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) working during COVID-19 pandemic participated. Sociodemographic, working information and burnout levels evaluated through Maslach Burnout Inventory (MBI) were collected. RESULTS: According to the MBI cutoff, 39.7% and 25.8% of participants scored high in emotional exhaustion and depersonalization respectively, and 44.2% scored low in personal accomplishment. Cluster analysis highlighted four burnout profiles: resilience, detachment, burnout, and emotional reserve. The results showed that AI in the Resilience and Emotional Reserve groups were significantly older and more experienced than those in the Detachment and Burnout groups. Additionally, more of the individuals in the Resilience group were working in intensive care units and departments dedicated to COVID-19 patients. The Detachment group was comprised of more AI working in operating units, while the Burnout group contained a higher number of AI working in COVID-19 departments. CONCLUSIONS: These findings highlight different burnout patterns in Italian AI: older age, more professional experience, and work in intensive care units and departments dedicated to COVID-19 seemed to be protective factors during the pandemic. This appears a first step to promote focused interventions.

The Relationship between Physiotherapist and Patient: A Qualitative Study on Physiotherapists' Representations on This Theme.

The physiotherapist represents a resource for the psychophysical well-being of an individual. Specific characteristics of the physiotherapist-patient relationship can influence the outcome of rehabilitation. This study aimed to explore physiotherapists' representations on how they perceive their relationship with their patients, in order to highlight helpful elements in promoting the outcome of the intervention. In this study, 50 physiotherapists (27 females and 23 males; mean age = 42 years; sd = 12.2) participated in an individual interview, conducted remotely via videocall. Socio-demographic and occupational data were collected. The interviews were recorded and transcribed. Texts were analyzed using emotional text mining (ETM). Participants organized their work by means of three categories: (1) work with the patient, in which the physiotherapists described two complementary elements of the therapy, which are the observable-technical aspects of their work and the internal predispositions; (2) the healing process, highlighting the aims of their intervention, including the physical pathology and the relationship with the patients; (3) physiotherapist as a psychologist, describing the attempt to understand patients' emotional experience to gradually transition to the practical intervention. Understanding the emotional and relational processes that form the basis of physiotherapist practice can contribute to the development of interventions in which the body and the mind can be integrated, resulting in a real person-centered point of view.

Emotional dysregulation and linguistic patterns as a defining feature of patients in the acute phase of anorexia nervosa.

PURPOSE: This research aims to analyze the relationship between emotional regulation and the symbolic process in autobiographical narratives of a group of individuals diagnosed with restrictive anorexia nervosa (AN), compared to a non-clinical group. The study is framed within multiple code theory (MCT) (Bucci, 1997; 2021), which considers mind-body integration. The purposes of this study are to investigate whether participants of the AN group will show greater alexithymia and emotional dysregulation than the non-clinical group; and whether the specific linguistic and symbolic features, such as somato-sensory words, affect words, and difficulty in the symbolizing process will predict the AN group. METHODS: Twenty-nine female participants hospitalized with AN during an acute phase (mean age 19.8 ± 4.1) and 36 non-clinical female participants (mean age 21 ± 2.4) were selected through snow-ball sampling. The participants completed the Toronto Alexithymia Scale (TAS-20), the Profile of Mood of State (POMS), the Emotion Regulation Questionnaire (ERQ), and the Relationship Anecdotes Paradigm Interview (RAP). The RAP interview was audio-recorded and transcribed to apply the Referential Process (RP) Linguistic Measures. A T test for paired samples and a logistic binary regression was performed. RESULTS: AN presented a significantly higher emotional dysregulation through the ERQ, TAS20 and POMS measures. Specifically, AN showed higher ER expression/suppression strategies, fewer functional cognitive strategies, higher alexithymia, and higher mood dysregulation. Specific linguistic features such as sensory-somatic, word affect, and difficulty in RP symbolizing predict the AN group (R2 = 0.349; χ2 = 27,929; df = 3; p = .001). CONCLUSIONS: Emotional dysregulation is connected to AN symptoms and autobiographical narratives. The results can help a clinical assessment phase showing specific linguistic features in AN patients. LEVEL OF EVIDENCE: Level II, controlled trial without randomization.

The Relationship Between Resilience and Sleep Quality During the Second Wave of the COVID-19 Pandemic: A Longitudinal Study.

PURPOSE: Previous studies showed poor sleep quality during the first Italian lockdown consequent to the quick spread of the virus. Poor sleep quality remained stable during the so-called "second wave", which started in Autumn 2020. This study aimed to compare sleep quality between the two waves of contagions and to examine the effect of resilience, together with sociodemographic and COVID-related variables, on sleep quality during the second wave. PATIENTS AND METHODS: A total of 648 participated in this longitudinal study through an online survey during the first lockdown consequent to the COVID-19 and during the second wave. The Medical Outcomes Study-Sleep Scale (MOS-SS) and the Resilience Scale (RS) were administered. Sociodemographic and COVID-related information were also collected. RESULTS: The results showed sleep quality slightly increased in the second wave, even though with a small effect size. Correlational analysis showed that resilience is inversely correlated with sleep quality measured in the two waves. Sleep quality during the second wave was positively correlated with sleep quality in the first lockdown. Likewise, the results of multiple regression revealed that the sleep quality in the first lockdown and resilience were significant predictors of sleep quality during the second wave. CONCLUSION: These findings highlighted that the prevalence of poor sleepers remained high during the second wave. Together with the sleep quality in the first lockdown, resilience represents an important factor related to sleep quality during the second wave. Interventions to improve sleep quality among the general population should take into account these findings.

To Work or Not to Work, That Is the Question: The Psychological Impact of the First COVID-19 Lockdown on the Elderly, Healthcare Workers, and Virtual Workers.

The spread of COVID-19 created a state of emergency all over the world and played a big role in the decline of the mental health of citizens. The context of the workplace became an important variable in the impact of the lockdown on individuals. In this study, we deepened the categories of healthcare workers (HWs), virtual workers (VWs), and the elderly, along with their emotional approach to this emergency. A sample of 257 participants (ElderlyN = 62; HWsN = 104; VWsN = 91) completed: a semi-structured interview on their experience during lockdown via telephone; an online survey with a sociodemographic questionnaire; the Difficulties in Emotional Regulation Scale (DERS); and the Post-Traumatic Growth Inventory (PTGI). Linguistic measures of the Referential Process were utilized to code the interviews. An independent ANOVA explored the variability among groups. The results show more affective language in the Elderly (M = 0.0310, SD = 0.0070) and a growth in spirituality (M = 4.16, SD = 3.17). HWs displayed a higher PTGI (M = 56.84, SD = 20.29), while VWs displayed a lower PTGI (M = 50.02, SD = 21.05). Moreover, VWs presented higher scores in Impulse on the DERS (M = 11.67, SD = 5.05) and a more cognitive/abstract narration (Reflection IREF M = 0.0260, SD = 0.0071; Reorganization IWRRL M = 0.5419, SD = 0.0032; Referential Activity IWRAD M = 0.4978, SD = 0.0029). This study aims to take the work context into consideration to create focused interventions.

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.

Dreaming in quarantine: linguistic analysis of referential process of dreams during COVID-19 pandemic lockdown.

The spread of coronavirus disease 2019 (COVID-19) became a collective trauma adversely affecting physical and psychological health. The impact of this trauma made itself manifest in a myriad of ways, including through dreams. This study aimed to explore the Referential Process (RP, Bucci, 2021) of dreams reported during quarantine. Dream samples were collected through a social blog. Linguistic analysis and clinical evaluation were conducted to explore the group's collective elaboration of a shared traumatic experience. Sixty-eight people (22 males; mean age 26.16 ds. 7.68) contributed to a social-blog, writing their dreams. 91 dreams were collected and transcribed using transcription rules for the Discourse Attributes Analysis Program (DAAP). Linguistic measures of RP were applied and a statistical cluster analysis was performed. In addition, each dream was evaluated by trained judges on three specific qualities of the RP (Arousal, Symbolizing, and Reflection/Reorganizing). Clinical judges in a double-blinded method reached reliable scoring (Arousal α.874 ICC 0.701; Symbolizing α.783 ICC 0.671; Reflection/reorganization α.884 ICC 0.758). Cluster Analysis yielded three dream clusters. 26 dreams fell under a cluster defined as a symbolizing process (Cluster A); 16 into a cluster defined as arousal of emotional activation (Cluster B); and 49 dreams fell into a cluster defined as Reflection/Reorganizing elaboration (Cluster C). Each cluster showed specific linguistic features. The dreams collected through a blog showed a Referential Process that is similar to that found in psychotherapy process. Results suggests that writing dreams can play different functions in processing and integrating social traumatic experience.

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.

Parental Quality of Life and Involvement in Intervention for Children or Adolescents with Autism Spectrum Disorders: A Systematic Review.

Previous research has examined several parental, child-related, and contextual factors associated with parental quality of life (QoL) among parents with a child or an adolescent with autism spectrum disorders (ASD); however, no systematic review has examined the relationship between parental QoL and parental involvement in intervention. To fill this gap, a systematic review was conducted using four electronic databases and checked reference lists of retrieved studies. Records were included in the systematic review if they presented original data, assessed parental QoL, and involvement in intervention for children or adolescents with ASD, were published in peer-reviewed journals between 2000 and 2020, and were written in English. Among the 96 screened full-texts, 17 articles met the eligibility criteria. The selected studies included over 2000 parents of children or adolescents with ASD. Three categories of parental involvement (i.e., none, indirect, direct) were identified, which varied across studies, although most had direct parental involvement. The results from this review show that increased parental involvement in the intervention for children or adolescents with ASD may be one way to promote their QoL. However, further research specifically focused on parental involvement during the intervention for children and adolescents with ASD is warranted.

The Impact of the COVID-19 Pandemic on Primary Emotional Systems and Emotional Regulation.

(1) Background: The COronaVIrus Disease 2019 (COVID-19) pandemic poses a unique challenge as a severe global crisis affecting physical and psychological health. The main purpose of this work is to study the impact of a traumatic event while also observing the human ability to adapt. One of the first theories to study the adaptive importance of the evolutionary lineage of the affective systems is referred to as BrainMind (Panksepp, 2010). This study aims to explore whether primary emotional systems (PES) and emotion regulation (ER) strategies show differences between the pre- and post- lockdown period; and if positive systems and specific emotion regulation pre-pandemic act as a protective or risk factor for mental and physical wellbeing. (2) Methods: 98 participants who had participated in a previous study before the pandemic were re-contacted to refill the Affective Neuroscience Personality Scale (ANPS) and the Emotion Regulation Questionnaire (ERQ) after the outbreak of the pandemic with the addition of the Symptom Checklist-90-Revised (SCL-90R). (3) Results: The results showed that the COVID-19 lockdown rules had an impact on Emotional Regulation and on a re-balancing of PES. Moreover, pre-pandemic expressive-suppressive ERQ strategies and ANPS SADNESS scores appeared as relevant risk factors, which predicted higher Global Severity Index (GSI) scores during lockdown. (4) Conclusions: The lockdown appears to have activated PLAY and CARE as protective systems, but has detuned the ability to positively reinterpret the situation.

From Resilience to Burnout in Healthcare Workers During the COVID-19 Emergency: The Role of the Ability to Tolerate Uncertainty.

The COVID-19 outbreak has placed extraordinary demands upon healthcare systems worldwide. Italy's hospitals have been among the most severely overwhelmed, and as a result, Italian healthcare workers' (HCWs) well-being has been at risk. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian healthcare workers (HCWs) during the COVID-19 emergency. A group of 267 HCWs from a hospital in the Lazio Region completed self-administered questionnaires online through Google Forms, including the Maslach Burnout Inventory (MBI), Resilience Scale, and Intolerance of Uncertainty Scale Short Form (IU). Cluster analysis highlighted two opposite burnout risk profiles: low burnout and high-risk burnout. The high-risk group had lower resilience and greater difficulties in tolerating the uncertainty than the low-burnout group. A set of general linear models confirmed that both IU subscales, prospective and inhibition, moderated the relationship between resilience and burnout (specifically in the depersonalization dimension). In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty have been significant factors in determining the impact of the COVID-19 emergency on HCWs. The use of emotional strategies that allow individuals to stay in a critical situation without the need to control it appears to protect against burnout in these circumstances.

Analytic Process and Linguistic Style: Exploring Analysts' Treatment Notes in the Light of Linguistic Measures of the Referential Process.

This paper presents a comparison between a clinical evaluation and a computerized linguistic analysis of the treatment notes of the first two years of an analysis conducted four sessions a week with the patient lying on a couch. Clinical notes had been written as part of the analyst's standard practice after every session, some years prior to the planning of this study. The notes describe the analytic interchange and the analyst's internal thoughts. The linguistic analysis focuses on two analytically relevant linguistic variables: Referential Activity (RA), a measure of the degree of connection between emotional processing and language, and Reflection, the use of words referring to thoughts. The examination of the linguistic measures point to overlooked parts of sessions which may be clinically significant. In particular, the examination of the clinical material during the nodal points of the first summer break, where significant changes in the linguistic measures were seen, provided clinical understanding of the analytic work that was not explicitly noted at the time of treatment. This method has the potential to be utilized in ongoing treatments and to improve the supervisory process.

Maladaptive Daydreaming in Relation to Linguistic Features and Attachment Style.

(1) Background: Maladaptive daydreaming (MD) is a concept that describes a significant imaginary activity that replaces human engagement and/or interferes with academic, interpersonal, or vocational functioning. We explored the interaction between attachment style, reflective functioning (RF), and the narrative dimension of MD. (2) Methods: 414 adults completed an online survey, including socio-demographic variables, the 16-item Maladaptive Daydreaming Scale, the Symptom Checklist-90-Revised, Relationship Questionnaire, and Reflective Functioning Questionnaire. Participants were asked to write a short description of the most representative episodes of their daydreams. Eighty-four participants were identified as maladaptive daydreamers (MDers). (3) Results: A set of t-tests between MDers and non-MDers group showed differences in attachment dimensions, RF, and linguistic measures. A linear regression model with Global Severity Index (GSI) of the revised Symptom Checklist-90 as the dependent variable, and psychological scales as independent variables showed that the MD score was the strongest predictor of GSI. Regarding differences between the two groups in linguistic measures, the MDers showed more use of reflection and sensory-somatic words, and a smaller number of affective words. (4) Conclusions: These results support the idea that the MD is a process connected to psychopathological mechanisms, probably to a sub-symbolic activation, and to dysfunctional self-other relational patterns that are difficult to integrate.

The Impact of Coping Strategies and Perceived Family Support on Depressive and Anxious Symptomatology During the Coronavirus Pandemic (COVID-19) Lockdown.

The coronavirus pandemic represents a severe global crisis, affecting physical, and psychological health. Lockdown rules imposed to counteract the rapid growth of COVID-19, mainly social restrictions, have represented a risk factor for developing depressive and anxious symptoms. The research aims are to explore the effect of coping strategies and perceived social support on depressive and anxious symptomatology during the COVID-19 pandemic. Ninety-six healthy people (46 males, mean age = 39.3; SD = 16.6) completed through on-line platform: Socio-demographic questionnaire, Coping Inventory for Stressful Situations (CISS), Multidimensional Scale of Perceived Social Support (MSPSS) and Symptom Checklist-90-Revised (SCL-90-R), 3 weeks after the imposition of lockdown restrictions. SCL-90-R Depression scores showed significant positive correlation with CISS Emotion (r = 0.85; p = 0.001) and Avoidant (r = 0.34; p = 0.018), a significant negative correlation with MSPSS Family support (r = -0.43; p = 0.003). SCL-90-R Anxiety scores showed a significant positive correlation with CISS Emotion (r = 0.72; p = 0.001) and Avoidant (r = 0.35; p = 0.016). No significant correlations between both CISS Emotion and Avoidant scales with social support emerged. Two Multiple Linear Regression analysis were performed using, respectively, SCL-90-R Depression and Anxiety scores as dependent variables, and the CISS and MSPSS scales, age, and gender as predictors. The first regression model (R 2 = 0.78; adjusted R 2 = 0.75) revealed CISS Emotion (ß = 0.83; p = 0.001) and MSPSS Family support (ß = -0.24; p = 0.004) had a predictive effect on SCL-90-R Depression scores. The second regression model (R 2 = 0.52; adjusted R 2 = 0.472) revealed that only CISS Emotion (ß = 0.71; p = 0.001) predicted the SCL-90-R Anxiety scores. In conclusion, during the COVID-19 pandemic lockdowns, coping focus on emotions seemed to increase anxious and depressive symptoms, probably due to the uncontrollable nature of the stressful event and the high emotional response. Family support which reduces the sense of loneliness had an exclusive role in mitigating depressive symptoms. These results highlight the importance of promoting psychological strategies to improve emotional regulation skills, reducing isolation from family, to prevent mood symptomatology in healthy citizens during large-scale health crises.