The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective Across Therapeutic Schools.

Objective: There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the diferent functions of safety in psychotherapy on a theoretical basis. Method: We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations. Results: Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases. Conclusions: Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy.

Social Odour Perception and Stress Responses in Women's Quality of Partner Relationship and Attachment Style.

The perception of body and social odours (SOP) is crucial for interpersonal chemosensory signalling and mate choice, yet little is known about the role of the SOP on the quality of partnerships and the attachment style. The aim of this study was to investigate the role of the SOP in women's stress responses by considering the role of biopsychosocial variables in the quality of interpersonal relationships (also considering intimate partner violence). In total, 253 women filled out an online survey that included a series of questionnaires to investigate self-perceived stress (PSS), emotional regulation (ERQ), olfactory social assessment (SOS), quality of partnership (RRQ), attachment style (RQ), and the Conflict Tactile Scale 2 (CTS-2). The main results highlight that a high awareness of social odours correlates with a good quality of relationship and with an emotional regulation capacity; the PSS correlates negatively with the ERQ (i.e., as the PSS increases, the ERQ decreases). The level of IPV predicts an interpersonal style characterized by a low desire to develop meaningful relationships but with a tendency to depend on and trust another. The idea of being hurt by the other is not central in women who experience this type of relationship. The study's main conclusion is that social odour perception is important for emotional regulation and in partner relationships.

A three-wave panel study on longitudinal relations between problematic social media use and psychological distress during the COVID-19 pandemic.

BACKGROUND: It still remains unclear whether problematic social media use (PSMU) is a cause or a consequence of psychological distress. The present study aimed to investigate the temporal relationships between PSMU and psychological distress through a three-wave panel study (between April and July 2020, with an interval of 1 month between each period of time). METHODS: 3,912 adult Italian participants were surveyed during the COVID-19 pandemic for psychological distress (Depression, Anxiety and Stress Scale) and PSMU (Bergen Social Media Addiction Scale). Random-Intercept Cross-Lagged Panel Models were applied to disaggregate between-person from within-person associations as regards PSMU and an individual's distress. RESULTS: On a between-person level we found that adults with higher PSMU also reported heightened levels of psychological distress across the three waves. However, on a within-person level, no cross-lagged associations were found between changes in distress and subsequent changes in PSMU and vice versa. The results were largely unchanged with the inclusion of participants' gender and age or COVID-19-related fears as covariates, and when the three subscales of depression, anxiety and stress were examined in separate models. CONCLUSIONS: The current study suggests that the link between PSMU and psychological distress is mainly driven by trait-like differences and not by state-like individual changes over time.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

Factors Related to Women's Psychological Distress during the COVID-19 Pandemic: Evidence from a Two-Wave Longitudinal Study.

BACKGROUND: A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women's mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women's psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women's psychological distress. METHODS: This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. RESULTS: No significant changes were found in women's psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. CONCLUSIONS: Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis.

BACKGROUND: Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown). METHODS: 1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures. RESULTS: Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes. LIMITATIONS: Only 32.7% of participants provided complete responses for both waves. CONCLUSION: The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients.

The present study focused on demographic and personality differences in the use of 30 defense mechanisms in adolescents with personality psychopathology and explored the hierarchical organization of personality traits based on the adaptiveness of defensive functioning. A total of 102 self-referred adolescent outpatients were interviewed and assessed on defense mechanisms and personality traits using the Defense Mechanisms Rating Scales and the Shedler-Westen Assessment Procedure 200 for Adolescents, respectively. Age and gender differences were found throughout the hierarchy. Pearson's correlations revealed a hierarchical organization of emerging personality disorders (PDs) in adolescence. More adaptive defenses were clearly associated with healthier personality style, whereas more pathological personality styles such as those with borderline traits were characterized by more rigid and maladaptive defenses. Dissociation was also associated with maladaptive personality types. Identifying the defenses associated with emerging personality disorders may inform the unconscious function of defense mechanisms in specific PDs. The systematic assessment of defense mechanisms might also help therapists to monitor changes during treatment.

What Differentiates Poor- and Good-Outcome Psychotherapy? A Statistical-Mechanics-Inspired Approach to Psychotherapy Research, Part Two: Network Analyses.

Statistical mechanics is the field of physics focusing on the prediction of the behavior of a given system by means of statistical properties of ensembles of its microscopic elements. The authors examined the possibility of applying such an approach to psychotherapy research with the aim of investigating (a) the possibility of predicting good and poor outcomes of psychotherapy on the sole basis of the correlation pattern among their descriptors and (b) the analogies and differences between the processes of good- and poor-outcome cases. This work extends the results reported in a previous paper and is based on higher-order statistics stemming from a complex network approach. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and transcripts of the sessions were coded according to Mergenthaler's Therapeutic Cycle Model (TCM), i.e., in terms of abstract language, positive emotional language, and negative emotional language. The relative frequencies of the three vocabularies in each word-block of 150 words were investigated and compared in order to understand similarities and peculiarities between poor-outcome and good-outcome cases. Network analyses were performed by means of a cluster analysis over the sequence of TCM categories. The network analyses revealed that the linguistic patterns of the four good-outcome and four poor-outcome cases were grounded on a very similar dynamic process substantially dependent on the relative frequency of the states in which the transition started and ended ("random-walk-like behavior", adjusted R 2 = 0.729, p < 0.001). Furthermore, the psychotherapy processes revealed statistically significant changes in the relative occurrence of visited states between the beginning and the end of therapy, thus pointing to the non-stationarity of the analyzed processes. The present study showed not only how to quantitatively describe psychotherapy as a network, but also found out the main principles on which its evolution is based. The mind, from a linguistic perspective, seems to work-through psychotherapy sessions by passing from the most adjacent states and the most occurring ones. This finding can represent a fertile ground to rethink pivotal clinical concepts such as the timing of an interpretation or a comment, the clinical issue to address within a given session, and the general task of a psychotherapist: from someone who delivers a given technique toward a consultant promoting the flexibility of the clinical field and, thus, of the patient's mind.

Fear, Affective Semiosis, and Management of the Pandemic Crisis: Covid-19 as Semiotic Vaccine?

The COVID-19 pandemic represents an extraordinary challenge to clinicians, health care institutions and policymakers. The paper outlines a psychoanalytically grounded semiotic-cultural psychological interpretation of such a scenario. First, we underline how the actual emotional reaction (mainly of fear) of our society is a marker of how the mind functions in conditions of affective activation related to heightened uncertainty: it produces global, homogenizing and generalizing embodied interpretations of reality, at the cost of more fine-grained and differentiated analytical thought. Such a process, called affective semiosis, represents an adaptive response to the emergency in the short-term. Second, we argue that this adaptive value provided by affective semiosis will be reduced when we have to deal with the process of managing the transition to the post-crisis and the governance of the medium and longterm impact of the crisis. Third, we suggest that, in order to manage the pandemic crisis on a longer temporal frame, affective semiosis has to be integrated with less generalized and more domain-specific ways of interpreting reality. To this end, semiotic capital (i.e., culturally-mediated symbolic resources) should be promoted in order to enable people to interiorize the supra-individual and collective dimension of life. Accordingly, COVID-19 is proposed as a semiotic vaccine, a disruption in our everyday life routines which has the potential of opening the way to a semiotic reappropriation of the collective dimensions of our experience.

Which Methodological Practice(s) for Psychotherapy Science? A Systematic Review and a Proposal.

Three main methodological practices have been employed in psychotherapy science: the empirical-quantitative, empirical-qualitative, and theoretical one. Some scholars have argued for a monopoly of the empirical-quantitative methodological practice, sustained by scientific monism. This systematic review aims at exploring the contribution of each methodological practice to the field. Fifteen journals were searched from 2003 to 2013. A total of 9796 publications and 9915 studies met inclusion criteria and were coded for the methodological practice employed. Empirical-quantitative studies were the most published overall, over time, and in most of the journals considered. This overwhelming prevalence increased when considering the citation rates of the publications. We argue that these results are indicative of a quantitative monopoly, which in turn is due to a lack of critical thinking sustaining scientific monism. We call for disciplinary critical thinking and the consequent scientific pluralism valuing the plurality, diversity, and multiplicity of all the existing methodological practices.

Correction to: Which Methodological Practice(s) for Psychotherapy Science? A Systematic Review and a Proposal.

We would like to note the following corrections to the original version of Zhang, Sun, Lin and Ren.

[Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD (Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]. / Psychotherapie-Berufsausbildung in Österreich: Basis- und soziodemographische Hintergrunddaten aus einer SPRISTAD-Pilotstudie (Society of Psychotherapy Research Interest Section on Therapist Training and Development).

Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.

An overview of the Italian contribution to the international multisite SPRISTAD study on psychotherapy training.

The Interest Section on Therapist Training and Development of the Society for Psychotherapy Research (SPRISTAD) has launched a multisite collaborative longitudinal study of psychotherapy trainees' development, a large-scale study involving a number of countries all over the world. In the present article, we present an overview of the early Italian contribution to the SPRISTAD study, based on preliminary paper-and-pencil data collection. Our preliminary findings showed cross-sectional differences at different years of training and two-years longitudinal changes in trainees' perceived development. Moreover, trainees' characteristics such as their motivation, relational manner, current life, and personal background have shown to deserve attention in research on trainees' development. These findings encourage the continuation of the SPRISTAD online data collection.

A systematic review of psychotherapy research topics (2000-2016): a computer-assisted approach.

The present work aims to empirically map what has been investigated and which issues (i.e. topics) characterize the debates of psychotherapy research, using a computer-assisted, bottom-up method of content analysis. The abstract of papers (N=13,499), published between 2000-2016 and retrieved from a sample of 10 journals selected as representing the field of psychotherapy research, were subjected to a method of automated content analysis. Five different research topics were identified (clinical relationship, clinical efficacy, clinical practice and research, psychopathology, and neuroscientific approaches to mental disorders) and each abstract was labeled according to the retrieved research topic. Two different Chi-square analyses investigated the distributions of research topics over time and among the selected journals. Results concerning the distribution over time highlighted an increase in the clinical relationship and clinical efficacy topics and a decrease in the others. An examination of the distribution among journals showed that psychopathology and neuroscientific approaches to mental disorders were associated with psychiatric journals, while the others were associated with non-psychiatric journals. The findings are discussed in light of the theoretical, methodological, and practical implications offering pointers for a critical understanding of the current psychotherapy research domain.

Trainees' self-evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training.

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., ). Although the main project is longitudinal in design, this preliminary study investigated cross-sectional differences between trainees in different years of training and explored the influence of core training experiences-including supervision and personal therapy-on their perceived development as therapists. Using the trainee current-progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4-year training programs in Italy provided self-evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training.

An automated method of content analysis for psychotherapy research: A further validation.

OBJECTIVE: The aim of the study is to validate the ability of ACASM (Automated Co-occurrence Analysis for Semantic Mapping) to provide a representation of the content of the therapeutic exchange that is useful for clinical analysis. METHOD: We compared the clinical case analyses of a good outcome psychodynamic therapy performed by a group of clinicians (n = 5) based on the verbatim transcripts (transcript-based analysis) with the clinical case analyses performed by another group of clinicians (n = 5) based on the ACASM representation of the same sessions (ACASM-based analysis). Comparison concerned two levels: the descriptive level and the interpretative level of the clinical case analysis. RESULTS: Findings showed that, inconsistently with our hypothesis, ACASM-based descriptions of the case obtained worse evaluations than transcript-based descriptions of the case (on all 3 criteria adopted). On the contrary, consistently with our hypothesis, ACASM is undistinguishable from the verbatim transcripts as regards the case interpretation (on 2 out of 3 criteria adopted). CONCLUSIONS: ACASM provides a description of the case that, though different from the one provided by the transcripts, enables clinicians to elaborate clinical interpretations of the case which approximate those produced by clinicians working directly on verbatim transcripts.

A dynamic systems approach to psychotherapy: A meta-theoretical framework for explaining psychotherapy change processes.

Notwithstanding the many methodological advances made in the field of psychotherapy research, at present a metatheoretical, school-independent framework to explain psychotherapy change processes taking into account their dynamic and complex nature is still lacking. Over the last years, several authors have suggested that a dynamic systems (DS) approach might provide such a framework. In the present paper, we review the main characteristics of a DS approach to psychotherapy. After an overview of the general principles of the DS approach, we describe the extent to which psychotherapy can be considered as a self-organizing open complex system, whose developmental change processes are described in terms of a dialectic dynamics between stability and change over time. Empirical evidence in support of this conceptualization is provided and discussed. Finally, we propose a research design strategy for the empirical investigation of psychotherapy from a DS approach, together with a research case example. We conclude that a DS approach may provide a metatheoretical, school-independent framework allowing us to constructively rethink and enhance the way we conceptualize and empirically investigate psychotherapy. (PsycINFO Database Record

Social representation of therapeutic relationship among cognitive-behavioral psychotherapists.

The present study investigates the content and structure of the social representation (SR) that cognitive-behavioral (CBT) psychotherapists have of the therapeutic relationship (TR), through a discovery-oriented, mixed-methods approach. For this purpose, our reference point was social representation theory, in particular, the theory of the central nucleus (Abric, 2003; Moscovici, 1961). Data came from a sample of 63 CBT therapists. The results enabled us to identify a series of contents marking CBTs SR of the TR that overlap with the current pan-theoretical conceptualization of this construct. The results also allowed us to identify the complex, clear, and stratified organization of these contents, which are characteristics of a majority and of a minority of the sample studied. These results are discussed with regard of their theoretical, methodological, and practical implications. (PsycINFO Database Record

Hypnobehavioral and hypnoenergetic therapy in the treatment of obese women: a pragmatic randomized clinical trial.

This study compared the effectiveness of hypnobehavioral therapy (HypBe) and HypBe enhanced by elements of energetic psychotherapy (hypnoenergetic therapy, HypEn) for obese women. Sixty clients were randomized to either HypBe or HypEn. Body weight, BMI, eating behavior, and body concept were assessed at baseline, posttreatment, and at a follow-up. Mixed ANOVA models and effect sizes were used for statistics. Both treatments improved weight, BMI, eating behavior, and some aspects of body concept. Improvements in eating behavior and body concept were higher for those who also lost weight (responders). Weight and BMI reductions were not significantly different for the HypEn versus HypBe groups at follow-up.