The aim of the dissertation was to test the feasibility of a new psychotherapeutic protocol for treating children and adolescents with mood and anxiety disorders: Child-Well-Being Therapy (CWBT). It originates from adult Well-Being Therapy protocol (WBT) and represents a conceptual innovation for treating affective disorders. WBT is based on the multidimensional model of well-being postulated by Ryff (eudaimonic perspective), in sequential combination with cognitive-behavioral therapy (CBT). Results showed that eudaimonic well-being was impaired in children with affective disorders in comparison with matched healthy students. A first open investigation aimed at exploring the feasibility of a 8-session CWBT protocol in a group of children with emotional and behavioural disorders has been implemented. Data showed how CWBT resulted associated to symptoms reduction, together with the decrease of externalizing problems, maintained at 1-year follow-up. CWBT triggered also an improvement in psychological well-being as well as an increasing flourishing trajectory over time. Subsequently, a modified and extended version of CWBT (12-sessions) has been developed and then tested in a controlled study with 34 patients (8 to 16 years) affected by mood and anxiety disorders. They were consecutively randomized into 3 different groups: CWBT, CBT, 6-month waiting list (WL). Both treatments resulted effective in decreasing distress and in improving well-being. Moreover, CWBT was associated with higher improvement in anxiety and showed a greater recovery rate (83%) than CBT (54%). Both groups maintained beneficial effects and CWBT group displayed a lower level of distress as well as a higher positive trend in well-being scores over time. Findings need to be interpret with caution, because of study limitations, however important clinical implications emerged. Further investigations should determine whether the sequential integration of well-being and symptom-oriented strategies could play an important role in children and adolescents’ psychotherapeutic options, fostering a successful adaptation to adversities during the growth process.

In recent decades fascinating studies in developmental psychology, especially in infant research (for review see Lavelli, 2007) and recent discoveries in neuroscience (Welsh, et al, 2007; Siegel, 2001; Pally, 2007) have brought great interest to study the mode of sharing subjective experiences (affective states, intentions and attentional focus) in children and adults.It therefore appears today in the clinic is a growing consensus about the fact that the psychological disorder can be read as a deficit in intersubjective processes of affect regulation (see Benecke C. et al 2005; psychodynamic Diagnostic Manual-PDM, 2006) leading many authors to assume the centrality of affect regulation in the construction of the psychotherapeutic process of change (just to name a few Tronick, Greenberg, Stern, Sander, Fonagy, Beebe, Philippot, Rimé etc..). As previously stated, this study has led us to hypothesize that the long process of therapy is to assist with the sessions continue, a growing "emotional attunement" between the communication styles of both patient and therapist. And also to speculate that this synchronization can represent the existence of a significant positive correlation between the increased level of "emotional synchronization" and increased capacity for regulation of emotions by the patient.The research results despite the limitations of small sample showed encouraging results about the verification of the existence of an increasing degree of attunement between therapist and patient long psychotherapy sessions and also showed a good degree of positive correlation between the increase the latter construct and emotional regulation through the implicit mode of expression and nonverbal communication.

Social visual orienting in typical and atypical development.

L'Infant research ha ampiamente dimostrato l’importanza e gli effetti che le interazioni precoci hanno sullo sviluppo mentale del bambino (Stern, 1985; Tronick Tronick, 1989; Emde, 1985; Greenspan, 1997). Nell’ambito dello sviluppo atipico (SA) diversi studi mettono in luce la presenza di alterazioni precoci della sfera interattiva genitore bambino che hanno una ricaduta negativa sullo sviluppo mentale del bambino, già in parte compromesso dai deficit neurobiologici (Dawson, Hill, Spencer, Galpert, & Waston, 1990; Doussard-Rossevelt, Bazhenova, & Porges, 2003; Hodapp, 2002; Kasari, Sigman, Mundy & Yirimiya, 1988; Venuti, Esposito, 2008; Venuti, de Falco, Esposito, Bentenuto, Villotti & Bornstein, 2008; de Falco, Cimmino, La Femina & Venuti, 2008). Scopo generale dello studio è la verifica degli effetti di un intervento genitore bambino con SA il cui obiettivo è la promozione di una modalità interattiva maggiormente sincronica e responsiva. In particolare si intende indagare gli effetti del trattamento su tre aree specifiche: l’interazione genitore bambino, le rappresentazioni del genitore e lo sviluppo del bambino. Lo studio è stato condotto su quattro diadi genitore bambino con SA, con età compresa tra i 30 e i 54 mesi. Due bambini hanno una diagnosi di Disturbo Pervasivo dello Sviluppo (PDD) e uno di Ritardo Mentale (RM). La ricerca è stata effettuata mediante il disegno sperimentale su singolo soggetto senza gruppo di controllo. Per valutare degli effetti del cambiamento nelle tre aree indagate sono state applicate diverse misure pre e post trattamento e misure osservative ripetute nel tempo. Per tutte le misure ripetute sono state calcolati i livelli di attendibilità sul 33% delle osservazioni attraverso il test k di Cohen. L’analisi degli andamenti delle sedute mettono in evidenza la presenza di incrementi percentuali significativi in diverse aree indagate. In particolare, si è rilevato l’aumento del livello di disponibilità emotiva e di sincronia della diade; un aumento delle attribuzioni positive rispetto al proprio figlio e alle capacità genitoriali; infine, rispetto allo sviluppo del bambino si è registrato un aumento del livello di autoregolazione e di intenzionalità sebbene in misura diversa nei tre soggetti.

This thesis is composed of two individual but interconnected studies. The first study investigated the gestural ability of aphasic patients in comparison with healthy speakers, by analysing both qualitatively and quantitatively co-speech gestures during a story-retelling task. The objective was to understand the relation between language and gesture ability in the aphasic patient: whether impairments in language production influence gesture production, as suggested by the long existing notion “asymbolia†. If this is not the case, gesture then may play a very potential role in aphasic daily communication and rehabilitation, as suggested by researchers and clinicians (e.g., Marshall, 2006; Rodriguez et al., 2006) who proposed the use of gesture as a compensatory and facilitative means to assist aphasic individuals to communicate. In our first study, four aphasic patients and four age-matched healthy speakers were recruited. They were requested to retell stories after watching eight short films from the cartoon “Tweety and Silvester†. Both verbal and non-verbal production from the participant were video-taped for analyses. Group and individual analyses were performed to examine representational and non-representational gestures in per-100-word and per-minute measures. We found that in aphasic subjects, as a group, gestures were quantitatively indistinguishable from those produced by normal controls. Also, qualitative analyses demonstrated that the aphasic subjects tended to use representational gestures to cue or substitute for difficult-to-name words. This supports the notion that gesture may cue naming and may be a potential treatment approach in aphasia rehabilitation. The second study explored treatment efficacy of three approaches in aphasia rehabilitation – the Gesture-based, the Language-based, and the Combined approach, aiming to understand the effects elicited by these techniques in improving single word naming ability in aphasic patients. Previous research suggested that gesture training can facilitate word naming (see Rose, 2006 for review). Language-based treatment aiming to reconstruct concepts and restore phonological information on difficult-to-name words has been widely studied, but the therapeutic role played by gesture in language recovery has been rarely considered. Our second study recruited four chronic aphasic patients with word-finding difficulty to explore the effects of three types of treatment – Gesture-based, Language-based, and Combined, on the retrieval of nouns and verbs. It was hypothesized that gesture and language-based treatments alone would yield positive effects and that combined treatment would result in the largest improvement of single-word naming. In gesture-based treatment, patients were trained to produce a gesture that can be mapped onto a corresponding word. In language-based treatment, Semantic Feature Analysis and Phonological Component Analysis were used. The combined treatment includes the same materials used in the gesture-based and language-based treatments, but materials were alternated across sessions. Training materials included verbs of hand-related actions and nouns of manipulable objects. We found that all types of treatment, as hypothesized, led to significant item-specific improvement in both verb and noun naming. Three of four subjects showed the largest recovery following combined treatment, especially on verbs. This suggests that gesture, when combined with logopedic treatment, can boost naming skills.

Numerosi studi considerano il sottotrattamento del dolore pediatrico uno dei problemi più critici associati alla cura e degenza ospedaliera (Schechter et al., 2002). La soluzione risiede in una valutazione accurata e sistematica dello stato di algesia del paziente (Reaney, 2007); tuttavia, vi è una notevole reticenza all’impiego costante e regolare di scale di valutazione del dolore nei reparti pediatrici (Zernikow et al., 2005). Questa tesi si propone due obiettivi: innanzitutto, osservare l’atteggiamento degli operatori sanitari circa l’impiego di scale di valutazione del dolore nelle Unità Operative pediatriche di due Ospedali del Trentino. In particolare, si vuole stabilire se a livello locale sussistono le medesime condizioni evidenziate dalla letteratura internazionale sull’argomento; quindi, indagare le cause del problema, e verificare l’effetto che una semplice restituzione con feedback costruttivo ha sulle modalità di valutazione del dolore pediatrico nelle U.U.O.O. così trattate.

In the last decade, neurobiological studies have focused efforts on investigating the biological substrates (i.e., cerebral structures, neurotransmitters, and hormones) underlying parental attuned behavior to salient infant stimuli (i.e., infant cries), that plays an important role in child affective, social, and cognitive development (Venuti, 2007; Bornstein, 2002). Both human and animal studies have primarily focused on the neurobiology of mothers and have shown that subcortical and cortical cerebral structures such as the prefrontal cortex, thalamocingulate network, hypothalamus, amygdala, and substantia nigra are important in maternal motivation and attuned behaviors (Barrett & Fleming, 2010; Swain, Lorberbaum, Kose, & Strathearn,2007). However, there is a lack of literature concerning gender differences and only a few studies have investigated the sensitivity of response to infant stimuli in non-parent adults (Caria, de Falco, Venuti, Lee, Esposito, Rigo, Birbaumer & Bornstein, 2012; Glocker, Langleben, Ruparel, Loughead, Gur & Sachser, 2009; Parsons, Young, Kumari, Stein & Kringelbach, 2011; Montoya, Landi, Kober, Worhunsky, Rutherford, Mencl, Mayes & Potenza, 2012). In this research project we focused our investigations on mechanisms in human adults (parents and non-parents) involved in parental care, and in specific: (a) on neural mechanisms underlie BOLD response to infant vocalizations, crying in particular; (b) on brain changes (grey matter volume) occurring during the early postpartum period in new fathers. Using functional magnetic resonance imaging (fMRI), in the first study (second chapter) we looked at gender differences in resting-state brain activation associated with the cry condition at the default mode network (DMN) level in a sample of healthy adults (parents and nonparents). The design was balanced by parental status and gender. The DMN is preferentially activated when individuals are not involved in externally oriented tasks, namely during the mind wandering and it is deactivated during external goal-oriented activities. In the second longitudinal study (third chapter) we investigated in new fathers the GM volumes change amongst 2-4 weeks and 3-4 months postpartum in brain areas responsible for parental behaviors over time during the early postpartum period. Anatomical changes and their relationships with parenting behaviors have never been examined in human fathers despite the importance of paternal care for child development. In the third study (fourth chapter) we investigated, using fMRI and behavioral (Response Time RT) techniques, how the pattern of cerebral activation when listening to infant cry modulates concomitant behavioral tasks, which could require or not require the attention toward the cry stimuli, and thus affecting parental responsiveness.

La tesi fornisce un inquadramento teorico e metodologico sull'uso del test di Rorschach di coppia, passando in seguito ad esaminare l'affidabilità della siglatura nei protocolli individuali e congiunti, la loro validità discriminante e accuratezza per concludersi con un esame più approfondito del significato relazionale di alcune specifiche combinazioni di indicatori. / This dissertation covers theoretical and methodological issues in couple Rorschach assessment, the scoring reliability and validity of individual and conjoint records. Finally, the diagnostic accuracy and the clinical meaning of composite Rorschach indicator are considered.

Background and aim Ulcerative Colitis (UC) and Crohn’s Disease (CD), collectively labelled as inflammatory bowel disease (IBD), are idiopathic, chronic inflammatory disorder of the bowel with a remitting and relapsing course. IBD are associated to poor emotional functioning and psychological distress. We have investigated the brain involvement in patients with IBD using functional magnetic resonance imaging (fMRI). Materials and methods We developed an emotional visual task to investigate the emotional functioning in 10 UC patients and 10 healthy controls (HC). Furthermore, we have compared the brain stress response between a group of 20 CD patients and a group of 18 HC. Finally, we evaluated potential morphological differences between 18 CD patients and 18 HC in a voxel based morphometry (VBM) study. Results We found brain functional changes in UC patients characterized by decreased activity in the amygdala in response to positive emotional stimuli. Moreover, in CD patients, the brain stress response and habituation to stressful stimuli were significantly different in the medial temporal lobe (including the amygdala and hippocampus), the insula and cerebellum. Finally, in CD patients there were morphological abnormalities in the anterior mid cingulated cortex (aMCC). Conclusion IBD are associated to functional and morphological brain abnormalities. The previous intestinal inflammatory activity in IBD patients might have contributed to determine the functional and morphological changes we found. On the other hand, the dysfunctions of the brain structures we found may influence the course of the disease. Our findings might have clinical implications. The differences in the emotional processing may play a role in the development of psychological disorders in UC patients. Furthermore, in CD patients, the different habituation to stress might contribute to stress related inflammatory exacerbations. Finally, the structural changes in the aMCC might be involved in the pain symptoms associated to the bowel disorder.

It is believed that the way of being and the communicative-relational skills of every individual have multifactorial origins, including the quality of primary relationships with caregivers. For some time, the need for health care professionals to possess specific communicative and interpersonal skills has been highlighted. To the degree course in Nursing, like to all other degree programs related to health, access is granted to students who have large individual differences, both in terms of personality, and in terms of relational skills. Each academic year, therefore, the people responsible for the didactic organization of every course, are faced with having to prepare a training plan capable of addressing communicative-relational aspects and, at the same time, of being adequate to the real attitudes of incoming students. Thus, the need for appropriate tools for measuring the personological and vocational traits considered specific to health professions was born. This study has a twofold objective. On one hand, it aims at selecting a battery of psychological tests to detect psychological and attitudinal patterns, to facilitate the coordinators of graduate courses in their didactic organization and planning of educational training; on the other hand, it seeks to assess the correlations between communicative-relational skills (Relational-Communicative style, according to the model of patient-centered medicine-TRS) (Mucchielli’s Test of Spontaneous Attitudes – usual kind of attitude in dual relationships), personality traits (Alexithymia), styles of attachment to parental figures (PBI), and the capability of recognizing facial emotions, in a sample of students enrolled in the first year of a degree in Nursing.