La Fondazione ANT rappresenta una delle più ampie esperienze al mondo di assistenza socio-sanitaria gratuita a domicilio ai malati di tumore, tramite équipe di specialisti costituite da medici, psicologi e infermieri. La patologia oncologica ha un enorme impatto sul benessere dei pazienti. Un modo per raggruppare i diversi sintomi di disagio psicologico è utilizzare il concetto di distress, che sarebbe importante monitorare in modo semplice e veloce. Primo studio: 66 pazienti oncologici (40% uomini; età media 54 anni) in cure palliative domiciliari. Il 79% dei pazienti ha mostrato livelli clinicamente significativi di distress. Il 55% dei partecipanti allo studio ha riportato alti livelli di ansia, e l'81% dei pazienti ha riportato alti livelli di depressione. Dall'analisi delle curve ROC il singolo item del Distress Thermometer, con un cut-off maggiore o uguale a 4, è stato in grado di rilevare il 97% dei soggetti con punteggi clinici di ansia e depressione, quindi può essere utilizzato anche come uno strumento di screening precoce rapido ed affidabile per i disturbi dell'umore. I familiari sono la prima risorsa dei malati di tumore, e l'identificazione dei loro bisogni è utile per individuare chi ha maggiore necessità di aiuto ed in quali aree. Secondo studio: 115 caregiver di pazienti oncologici (37% uomini; età media 52 anni). Di seguito i bisogni più frequenti. Salute psicofisica: “preoccupazioni circa il/la paziente” (72%), ansia (53%) e rabbia (52%). Informazioni: “come prendersi cura del paziente” (64%), “terapie alternative e/o complementari” (64%) e “come gestire lo stress” (57%). Servizi e strutture sanitarie: “un operatore di riferimento”, (65%), “cure infermieristiche a domicilio” (62%), “indicazioni su servizi ospedalieri” (57%), ed “assistenza per caregiver, ad esempio consulenza psicologica” (55%). Il monitoraggio dei bisogni consentirebbe un'ottimizzazione dell'assistenza, prevenendo situazioni che potrebbero compromettere il benessere della famiglia e la qualità dell'assistenza fornita al paziente. / ANT Foundation provides free medical and psychological home care for cancer patients, with team of phisicians, psychologists and nurses. Cancer has a huge impact on patients' wellbeing. Emotional distress is a concept used to group and describe different symptoms of psychological disorders, but it is important to assess it in a quick and simple way. First study: 66 cancer patients (40% men; mean age 54 years) in palliative home care. 79% of patients showed high levels of distress. 55% reported high anxiety scores, and 81% showed high levels of depression. ROC curves analysis showed that the Distress Thermometer single item, with a cut-off of 4, was capable of detecting 97% of subjects with clinical levels of anxiety and depression, and therefore it can be used as a early screening instrument, both quick and reliable, for mood disorders. Caregivers are the first resource of cancer patients, and it is important to detect and assess their needs in order to know who needs more help and in which specific areas. Second study: 115 caregiver of cancer patients (37% men; mean age 52 years). Most frequent needs are presented as following. Psychological and physical health: “worries about patient” (72%), anxiety (53%) and anger (52%). Informations: “how to take care of the patient” (64%), “alternative or complementary therapies” (64%) and “how to manage stress” (57%). Services and hospital facilities: “a designated staff member”, (65%), “nurse service at home” (62%), “indications on hospital services” (57%), and “specific help for caregivers, i.e. psychological counselling” (55%). The monitoring of needs could optimize home care, avoiding the risk of psychological, practical and physical problems and helping supporting patients' and families' wellbeing and quality of life.

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.

La Terapia Cognitivo Comportamental (TCC) es la terapia de elección para los TCA. Sin embarbo no todos los pacientes responden de manera optima, algunas pacientes no eliminan los atracones y los vómitos y muestran una mejoría parcial y limitada.Las alteraciones de la Imagen Corporal (IC) es un aspecto central en los TCA y son un predictor principal de las recaídas. Por todo ello pensamos que la IC debería ser un objetivo central de la terapia y del tratamiento de los TCA. Por otra parte la Realidad Virtual se ha mostrado eficaz en el tratamiento de los TCA y otros trastornos mentales (claustrofobia, fobia a volar, Trastornos de la IC, etc.). En un estudio previo comprobamos que el tratamiento de la IC es más eficaz cuando se aplica con Realidad Virtual.El objetivo de la tesis es realizar un estudio controlado para comparar la TCC para los TCA, con la TCC para los TCA incluyendo un componente específico de IC a través de técnicas de Realidad Virtual.La muestra era 34 pacientes (17 Bulimia Nerviosa, 5 Anorexia Nerviosa, 12 Trastorno Alimentario No Especificado). Todas las pacientes presentaban grave psicopatología secundaria. Se realizó una evaluación en tres momentos diferentes, pretratamiento, posttratamento y al año de seguimiento. Se utilizaron medidas de evaluación de psicopatología del TCA, de las alteraciones de la IC y de la psicopatología secundaria.Realizamos un Análisis Multivariado de los datos para comprobar la Eficacia Estadísticamente Significativa y posteriormente se realizó un análisis del Cambio Clínicamente Significativo.Los resultados indican que al comparar las dos condiciones experimentales vemos que la condición donde se trataba la IC con tecnicas de Realidad Vitual alcanza una mejoría mayor (estadísticamente significativa) que la condición donde no se trataba la IC en las diferentes variables evaluadas al finalizar el tratamiento y que esta mejoría se mantiene al año de seguimiento. también se produjo una mejoría clínicamente significativa.Conclusión: es necesario incluir un componente de tratamiento que aborde las alteraciones de la IC en el tratamiento de los TCA

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas. Programa de Pós-Graduação em Psicologia. / Made available in DSpace on 2012-10-20T06:38:15Z (GMT). No. of bitstreams: 0 / Este estudo trata da caracterização da população e dos atendimentos realizados no serviço de atendimento infantil da clínica-escola de Psicologia de uma Universidade pública da cidade de Florianópolis. O percurso metodológico exploratório-descrivo ocorreu através de pesquisa documental da população infantil (de 2 a 12 anos) que buscou atendimento no período de 1997 a 2000. As variáveis examinadas foram: idade, sexo, escolaridade, queixas, origem do encaminhamento, renda familiar, idade e tipo de profissionalização dos pais, tempo de espera; tempo, quantidade e modalidades de atendimento; tipos de encerramento e motivos das desistências. Os resultados, analisados através de tratamento estatístico, constataram: a faixa etária de maior concentração de 7 a 10 anos, predominantemente de meninos e a escolaridade com maior ocorrência é a de 1ª a 4ª série do Ensino Fundamental. As queixas principais mais freqüentes são de mau desempenho escolar e de comportamento agressivo e/ou agitado; a origem do encaminhamento com maior freqüência é da escola ou de profissionais da saúde. O intervalo de tempo de espera para atendimento é longo e a evasão é alta, pois 45% desistem antes de iniciar o atendimento, e, dos que iniciam, 40,7% interrompem o processo. A média do tempo de atendimento é de 5,6 meses nas modalidades de psicodiagnóstico, psicoterapia breve e terapia familiar. Na análise dos resultados compara-se os resultados de pesquisas nacionais similares. As clínicas-escola estão mais a serviço do estágio do que das demandas da clientela, é necessário a implantação de estratégias de avaliação dos processos terapêuticos.

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.