Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Psicologia, Florianópolis, 2009. / Made available in DSpace on 2012-10-24T08:18:43Z (GMT). No. of bitstreams: 1 266544.pdf: 349579 bytes, checksum: 46e31ebaf644adb3952710d2fcbc3603 (MD5) / A pesquisa teve como objetivo caracterizar a influência da religiosidade dos clientes no trabalho clínico, na perspectiva dos Psicólogos. O estudo de natureza exploratório-descritivo se desenvolveu sob a perspectiva da metodologia qualitativa e realizou-se com 13 psicólogos clínicos, sendo a coleta de dados efetuada através de entrevista semi-estruturada em seus ambientes de trabalho. Utilizou-se o modelo de análise categorial temática de conteúdo, proposta por Bardin (1977), e os critérios de homogeneidade, recorrência e exaustividade. Os resultados da análise foram sistematizados em 04 categorias, as quais representam as regularidades e aspectos diferenciais presentes nos dados, e que tentaram abarcar a dinâmica e complexidade da prática profissional dos participantes, no que diz respeito à influência da religiosidade de seus clientes nos processos de psicoterapia e análise. Constatou-se que embora com informações escassas ou imprecisas obtidas em suas formações acadêmicas, esses profissionais apresentam-se atualmente com concepções formadas sobre o tema, ancoradas em suas práticas clínicas e amparadas por preceitos éticos. Observou-se que os psicólogos em questão consideram a religiosidade/espiritualidade como um aspecto próprio de cada indivíduo, que reflete suas crenças e valores, direcionando a maneira de pensar e de se comportar, devendo por isso ser investigada dentro de um trabalho clínico. Foi possível verificar que a forma como a religiosidade/espiritualidade é vivenciada depende do desenvolvimento psicológico do cliente/paciente, o que possibilita que o tema esteja ligado tanto a aspectos facilitadores do processo terapêutico/analítico, quanto a aspectos que o dificultam. Percebeu-se ainda, que existem não apenas estratégias terapêuticas para lidar com a temática em questão, mas também a possibilidade de utilizar a própria religiosidade/espiritualidade dos clientes/pacientes como recursos que visam atingir objetivos terapêuticos ligados a promoção de saúde. / Se trata de un estudio de abordaje cualitativo en la modalidad de etnoenfermería que tuvo por objetivo general identificar el itinerario terapéutico seguido por las familias con niños menores de cinco años con diarrea. El referencial teórico adoptado fue el modelo de Arthur Kleinman y conceptos de la teoría de Madeleine Leininger. Los participantes del estudio fueron ocho familias con niños menores de cinco años que buscaron la emergencia de un hospital de pediatría del municipio de Florianópolis cuando sus niños presentaron diarrea. La colecta de los datos se dio, inicialmente, con la observación participante para elegir los participantes, en la emergencia y en el domicilio fueron realizadas entrevistas con las madres, abuelos y padres siguiendo un guia escrito. Mediante permiso, todas las entrevistas fueron grabadas y transcritas, un diario de campo auxilió a complementar los registros. El análisis ocurrió concomitante a la colecta de los datos buscándose los dominios culturales. La discusión de los datos ocurrió a la luz del referencial teórico y la aproximación con otros estudios. La discusión de los datos se produjo en la luz del marco teórico y el enfoque a otros estúdios, como resultados surgieron los dominios. Los informantes percibieron el problema, caracterizándolo, desarrollaron una acción y luego evaluaron sus resultados. Cuestiones de orden económico y factores socioculturales estuvieron presentes en todos los momentos en conjunto con las redes de apoyo social. Las razones para la elección de la emergencia se justificaron por distintos motivos, sea por el marketing del hospital, falta de profesionales en las Unidades Locales de Salud, capacidad de los hospitales en realizar exámenes o la propia cualidad de la atención ofrecida por los profesionales del Sector Profesional. Estas razones apuntan para la diferencia de modelos explicativos sobre la gravedad del cuadro de diarrea entre los sectores familiar y profesional de cuidado, haciéndose necesarios más estudios.

Phenomenology is a critical component of autobiographical memory retrieval. Some memories are vivid and rich in sensory details whereas others are faded; some memories are experienced as emotionally intense whereas others are not. Sutin and Robins (2007) identified 10 dimensions in which a memory may vary—i.e., Vividness, Coherence, Accessibility, Sensory Details, Emotional Intensity, Visual Perspective, Time Perspective, Sharing, Distancing, and Valence—and developed a comprehensive psychometrically sound measure of memory phenomenology, the Memory Experiences Questionnaire (MEQ). Phenomenology has been linked to underlining stable dispositions—i.e. personality, as well as to a variety of positive/negative psychological outcomes—well-being and life satisfaction, depression and anxiety, among others. Using the MEQ, a cross-sectional and a longitudinal study were conducted on a large sample of American and Italian adults. In both studies, participants retrieved two ‘key’ personal memories, a Turning Point and a Childhood Memory, and rated the affect and phenomenology of each memory. Participants also completed self-reported measures of personality (i.e. Neuroticism and Conscientiousness), and measures of depression, well-being and life satisfaction. The present research showed that phenomenological ratings tend (a) to cross-sectionally increase across adulthood (Study 1), and (b) to be moderately stable over time, regardless the contents of the memories (Study 2). Interrelations among memory phenomenology, personality and psychological outcome variables were also examined (Study 1 and Study 2). In particular, autobiographical memory phenomenology was proposed as a dynamic expression of personality functioning that partially explains adaptive/maladaptive psychological outcomes. In fact, the findings partially supported the hypothesized mediating effect of phenomenology on the personality association with psychological outcomes. Implications of the findings are discussed proposing future lines of research. In particular, the need for more longitudinal studies is highlighted, along with the combined application of both self-report questionnaires and narrative measures.

The general aim of this dissertation was to uncover the association between psychosocial factors and rehabilitation outcome after stroke. METHOD. A sample of patients with stroke (n=40) and their caregivers (n=36) were assessed at admission to and six months after discharge from rehabilitation hospital, using the following instruments: Structured Clinical Interview for DSM-IV, structured interview based on Diagnostic Criteria for Psychosomatic Research, Symptom Questionnaire, Psychosocial Index, Psychological Well-Being Scales, and Family Assessment Device. 40 subjects from the general population underwent the same psychological assessment. In addition, patients' functional status was measured using the Functional Independence Measure. RESULTS. Stroke survivors reported lower education and higher alcohol consumption than controls. No significant differences emerged between the two groups in the prevalence of psychiatric diagnoses or psychosomatic syndromes, however patients reported significantly higher levels of anxiety, depression, somatic symptoms, and lower autonomy than controls. Caregivers reported significantly higher scores in anxiety, depression, and somatic symptoms compared to normative data, while no impairments emerged in psychological well-being and family functioning. At six-month follow-up, in patients a significant decrease in smoking habit and an increase in DSM diagnoses were reported. Both stroke survivors and caregivers showed significant reductions in anxiety, with patients displaying also a decrease in somatic symptoms, an increase in stress and a deterioration in quality of life. Significant deteriorations in several aspects of family functioning was perceived only by patients. An association between patients' functional recovery in the cognitive domain and family behavior control emerged. For caregivers, family functioning significantly predicted hostility and somatic symptoms were associated with family affective involvement. CONCLUSIONS. These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation, in order to development interventions properly targeted to the characteristics of patients and their family members.

Emotional intelligence (EI) represents an attribute of contemporary attractiveness for the scientific psychology community. Of particular interest for the present thesis are the conundrum related to the representation of this construct conceptualized as a trait (i.e., trait EI), which are in turn reflected in the current lack of agreement upon its constituent elements, posing significant challenges to research and clinical progress. Trait EI is defined as an umbrella personality-alike construct reflecting emotion-related dispositions and self-perceptions. The Trait Emotional Intelligence Questionnaire (TEIQue) was chosen as main measure, given its strong theoretical and psychometrical basis, including superior predictive validity when compared to other trait EI measures. Studies 1 and 2 aimed at validating the Italian 153-items forms of the TEIQue devoted to adolescents and adults. Analyses were done to investigate the structure of the questionnaire, its internal consistencies and gender differences at the facets, factor, and global level of both versions. Despite some low reliabilities, results from Studies 1 and 2 confirm the four-factor structure of the TEIQue. Study 3 investigated the utility of trait EI in a sample of adolescents over internalizing conditions (i.e., symptoms of anxiety and depression) and academic performance (grades at math and Italian language/literacy). Beyond trait EI, concurrent effects of demographic variables, higher order personality dimensions and non-verbal cognitive ability were controlled for. Study 4a and Study 4b addressed analogue research questions, through a meta-analysis and new data in on adults. In the latter case, effects of demographics, emotion regulation strategies, and the Big Five were controlled. Overall, these studies showed the incremental utility of the TEIQue in different domains beyond relevant predictors. Analyses performed at the level of the four-TEIQue factors consistently indicated that its predictive effects were mainly due to the factor Well-Being. Findings are discussed with reference to potential implication for theory and practice.

Abstract Background: Turner syndrome (TS) is a chromosomal abnormality (total or partial absence of one of the sexual chromosomes in some or all cells of the body), which affects approximately 1:2000 female. Principal characteristics are short stature and gonadal disgenesis. Clinical management consist of Growth Hormone (GH) treatment and oestrogen replacement therapy (HRT), to induce development of secondary characteristics and to avoid the sequelae of oestrogen deficiency. Aim of the study: To assess clinical management, quality of life (QoL) and general psychosocial adjustment of women with TS. Population: 70 adult Caucasian females with TS (mean age: 27.8, ± 7.6; range 18-48 y.). Setting: Specialist service for Rare Disease care, University Hospital. Methods: Subjects were required to fill in questionnaires collecting ASR, WHOQOL, and 8 open questions. Data were compared with those of the Italian population or to those collected in a comparison group (70 healthy females, mean age: 27.9, ±7.3, range 21-48 y.). Results: Women with TS are educated as well as the Italian Population, but they have a less successful professional life. They show good QoL in general, but they appeared less satisfied in social area. They had statistically higher scores than the comparison group for depression, anxiety and withdrawal. Are less involved in a love relationship. Diagnosis communication was mostly performed by doctors or parents, satisfaction was higher when information was given by parents. Main preoccupation about TS are infertility, feeling of being different and future health problem. Conclusions: Italian people with TS were generally well adapted and have a good QoL, but lived more often with parents and show impaired sentimental and sexual life. They have higher degree of psychological distress compared to a comparison group. Psychological intervention should firstly address parents in order to encourage an open communication on diagnosis issues and on sexual education.

The present research expanded on the literature investigating mother-child feeding and playing interactions during the transition to self-feeding (18-30 months) in the preterm population. Maternal and infant factors were also considered. A total of 69 mother-child dyads (44 preterm and 25 full-term) participated in the research. Assessments took place at 18, 24, and 30 months of the child. At each assessment, mother-child interactions during feeding (Study 1) and during a doll-play (DP) situation representing feeding (Study 2) were video recorded and later coded, respectively through the SVIA (Ammaniti et al., 2006) and the EAS (Biringen, 2008). Moreover, the child’s development was assessed through the Griffiths Scale (Griffiths, 1996, 2006) and mothers filled the BDI-II (Beck & Steer, 1996), the STAI (Spielberg, 1983), and an anamnestic questionnaire built Ad-Hoc. Results of Study 1 showed a greater occurrence of dysfunctional feeding interactions in the preterm compared to the full-term group from 18 to 30 months. Specifically, preterm dyads reported greater maternal negative affective state, greater interactional conflict and lower dyadic reciprocity. Moreover, a significantly lower percentage of children in the preterm group reached eating autonomy compared to the full-term group during the 18-30 months period. Furthermore, adverse past feeding history (difficult breastfeeding and reflux) and lower total scores on the Griffiths were associated to a higher risk of child’s food refusal. Results of Study 2 showed that the preterm group displayed lower emotional availability than the full-term group during mother-child DP interactions from 18 to 30 months, with lower maternal sensitivity, greater maternal intrusiveness, and lower child’s involvement. These findings indicate that special attention should be paid to support mother-child interactions during the transition to self-feeding in the preterm population in order to foster the mother-child relationship and promote the child’s healthy eating behavior and affective development.

Introduzione. Nonostante il dolore sia un’esperienza comune a tutti gli esseri umani, è molto difficile darne una definizione esauriente sia esso fisico che psicologico. A tutt’oggi il dolore mentale è stato poco indagato. L’obiettivo principale del seguente progetto di ricerca è di delineare una più accurata definizione del costrutto di dolore mentale, verificare l’applicabilità dell’Orbach and Mikulincer Mental Pain Scale (OMMP) nella valutazione psicologica e la validazione della versione italiana di tale strumento. Metodologia. Sono stati condotti tre studi: il primo, su un campione di 15 soggetti, per verificare e confermare la validità di facciata dell’OMMP; il secondo, realizzato su un campione di 442 soggetti, oltre ad indagare le caratteristiche sociodemografiche associate con la dimensione del dolore mentale, si concentra sulla valutazione delle proprietà psicometriche dello strumento; il terzo è stato eseguito allo scopo di verificarne la struttura fattoriale ed indagare la relazione che intercorre tra dolore mentale e gli altri costrutti psicologici (n = 728). Risultati. Dai dati ottenuti è possibile delineare il profilo sociodemografico dei soggetti della popolazione generale con un maggior livello di dolore mentale: l’essere giovani, nubili/celibi e avere un livello di istruzione inferiore. L’analisi fattoriale esplorativa, non ha confermato la struttura a otto dimensioni descritta dagli autori, rivelandone una a quattro (19 item), e gli indici dell’analisi fattoriale confermativa lo supportano. Infine, le dimensioni del dolore si mostrano correlate con il distress psicologico. Discussioni e conclusioni. Il presente lavoro ha confermato la multidimensionalità del costrutto di dolore mentale nella popolazione italiana ed ha confermato la validità e l’attendibilità del OMMP_19_ITA. All’interno di diversi quadri psicopatologici è stata rilevata la presenza di un maggior livello di dolore mentale. / Introduction. Despite the pain is a common experience to all human beings, it is still very difficult to give a comprehensive definition both physical and psychological. Up till now, mental pain has been understudied The main objective of the following research project is to outline a more accurate definition of the mental pain construct, to verify the applicability of the Orbach and Mikulincer Mental Pain Scale (OMMP) in the psychological evaluation and validation of the Italian version of such tool. Methodology. Three studies were conducted: the first one, on a sample of 15 subjects, to verify and confirm the validity of the OMMP face; the second, conducted on a sample of 442 subjects, as well as investigate the socio-demographic characteristics associated with the mental pain dimension, focuses on the evaluation of the psychometric properties of the instrument; the third instead, was performed in order to verify the factorial structure and investigate the relation between mental pain and other psychological constructs (n = 728). Results. From the data obtained it is possible to outline the socio-demographic profile of the subjects of the general population with a higher level of mental pain: being young, maiden / celibate and have a lower level of education. The factorial explorative analysis, has not confirmed the eight-dimensional structure described by the authors, revealing a four one (19 item), and indexes of the confirmatory factorial analysis support it. Finally, the dimensions of the pain are shown correlated with the psychological distress. Discussions and conclusions. This work confirmed the multidimensionality of mental pain construct in the Italian population and also confirmed the validity and reliability of the OMMP_19_ITA. Within different psychopathological was detected the presence of a higher level of mental pain.

Il presente lavoro comincia con una descrizione dettagliata del “McMaster Model of Family Functionig” (MMFF), modello che al suo interno integra una teoria multidimensionale sul funzionamento familiare, diversi strumenti di auto ed etero valutazione e chiare indicazioni terapeutiche racchiuse all’interno della “Problem Centered System Therapy of the Family” (PCSTF). Grazie alla sua completezza il Modello fornisce ai clinici metodi coerenti, pratici ed empiricamente validi per valutare e trattare le famiglie, essi inoltre, sono stati formulati in modo da essere adattabili a differenti setting clinici e di ricerca, applicabili ad un’ampia gamma di problematiche e verificabili empiricamente. Obiettivo finale della presente ricerca è stato quello di porre le basi per l’esportazione del MMFF in Italia e poter quindi procedere alla sua applicazione in ambito clinico. La ricerca è cominciata alla Brown University con la traduzione dall’inglese all’italiano del Family Assessment Device (FAD), uno degli strumenti di autovalutazione compresi nel MMFF, ed è in seguito continuata con la validazione del suddetto strumento in un campione di 317 soggetti appartenenti alla popolazione generale italiana. Il FAD si è dimostrato uno strumento valido ed affidabile, in grado quindi di fornire valutazioni stabili e coerenti anche nella sua versione italiana. Il passo successivo è stato caratterizzato dalla somministrazione di FAD, Symptom Questionnaire (SQ) e delle Psychological Well-Being scales (PWB) a 289 soggetti reclutati nella popolazione generale. In accordo con il modello bipsicosociale che vede l’ambiente familiare come il più immediato gruppo di influenza psicosociale dello stato di benessere o malessere dell’individuo, i nostri dati confermano una stretta relazione tra scarso funzionamento familiare, spesso espresso attraverso difficoltà di comunicazione, di problem solving e scarso coinvolgimento affettivo e distress psicologico esperito con sintomi depressivi, ansiogeni ed ostilità. I nostri dati sottoliano inoltre come un funzionamento familiare positivo sia altamente correlato ad elevati livelli di benessere psicologico. Obiettivo della parte finale del lavoro ed anche il più importante, è stato quello di esplorare l’efficacia della Problem Centered Systems Therapy of the Family nella gestione della perdita di efficacia degli antidepressivi nel trattamento della depressione ricorrente. 20 soggetti con diagnosi di depressione maggiore ricorrente secondo il DSM-IV sono stati randomizzati a due diverse condizioni di trattamento: 1) aumento del dosaggio dell’antidepressivo e clinical management, oppure 2) mantenimento dello stesso dosaggio di antidepressivo e PCSTF. I dati di questo studio mettono in evidenza come, nel breve termine, PCSTF e farmacoterapia sono ugualmente efficaci nel ridurre la sintomatologia depressiva. Diversamente, ad un follow-up di 12 mesi, la PCSTF si è dimostrata altamente superiore all’aumento del farmaco ner prevenire le ricadute. Nel gruppo sottoposto all’aumento del farmaco infatti ben 6 soggetti su 7 ricadono entro l’anno. Nel gruppo assegnato a terapia familiare invece solo 1 soggetto su 7 ricade. Questi risultati sono in linea con i dati della letteratura che sottolineano l’elevata probabilità di una seconda ricaduta dopo l’aumento dell’antidepressivo all’interno di una farmacoterapia di mantenimento e suggeriscono l’efficacia dell’utilizzo di strategie psicoterapiche nella prevenzione della ricaduta in pazienti con depressione ricorrente.

Objectives: The aim of this research was to evaluate the impact of Cardiac Rehabilitation (CR) on risky lifestyles, quality of life, psychopathology, psychological distress and well-being, considering the potential moderating role of depression, anxiety and psychosomatic syndromes on lifestyles modification. The influence of CR on cardiac morbidity and mortality was also evaluated. Methods: The experimental group (N=108), undergoing CR, was compared to a control group (N=85) of patients affected by cardiovascular diseases, not undergoing CR, at baseline and at 1-month, 6- and 12-months follow-ups. The assessment included: the Structured Clinical Interview for DSM-IV, the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), GOSPEL questionnaire on lifestyles, Pittsburgh Sleep Quality Index, Morisky Medication Adherence Scale, MOS 36-Item Short Form Health Survey, Symptom Questionnaire, Psychological Well-Being Scale and 14-items Type D Scale. Results: Compared to the control group, CR was associated to: maintenance of the level of physical activity, improvement of correct dietary behaviors and stress management, enhancement of quality of life and sleep; reduction of the most frequently observed psychiatric diagnoses and psychosomatic syndromes at baseline. On the contrary, CR was not found to be associated with: healthy dietary habits, weight loss and improvement on medications adherence. In addition, there were no relevant effects on sub-clinical psychological distress and well-being, except for personal growth and purpose in life (PWB). Also, CR did not seem to play a protective role against cardiac recurrences. The presence of psychosomatic syndromes and depressive disorders was a mediating factor on the modification of specific lifestyles. Conclusions: The findings highlight the need of a psychosomatic assessment and an evaluation of psychological sub-clinical symptomatology in cardiac rehabilitation, in order to identify and address specific factors potentially associated with the clinical course of the heart disease. / Obiettivi: Lo scopo della presente tesi di dottorato è stato valutare l’impatto della Riabilitazione Cardiologica (RC) sulla modificazione di stili di vita, qualità di vita, psicopatologia, distress e benessere psicologico, considerando il possibile effetto moderatore di disturbi depressivi, ansiosi e sindromi psicosomatiche sul cambiamento degli stili di vita. È stata inoltre valutata l’influenza della RC su morbilità e mortalità cardiaca. Metodi: Il gruppo sperimentale (N=108), sottoposto a RC, è stato confrontato con un gruppo di controllo (N=85), composto da pazienti cardiopatici non sottoposti a RC, sia alla baseline che a 1 mese, 6 e 12 mesi. L’assessment ha incluso: la Structured Clinical Interview for DSM-IV, l’intervista strutturata basata sui Diagnostic Criteria for Psychosomatic Research (DCPR), il questionario GOSPEL sugli stili di vita, il Pittsburgh Sleep Quality Index, la Morisky Medication Adherence Scale, il MOS 36-Item Short Form Health Survey, il Symptom Questionnaire, la Psychological Well-Being Scale e la 14-items Type D Scale. Risultati: La RC, rispetto alla condizione di controllo, è risultata associata a: mantenimento dei livelli di attività fisica, aumento dei comportamenti alimentari corretti e della capacità di gestione dello stress, miglioramento della qualità di vita e del sonno; diminuzione delle diagnosi psichiatriche e psicosomatiche più frequentemente riscontrate alla baseline. Al contrario, non è risultata associata a: stile alimentare sano, perdita di peso e miglioramento dell’aderenza farmacologica. Inoltre, non sono stati riscontrati effetti rilevanti riguardo a benessere e distress psicologico sub-clinico, fatta eccezione per la crescita personale e lo scopo nella vita (PWB). La RC non ha inoltre svolto un ruolo protettivo sul decorso clinico. La presenza di sindromi psicosomatiche e disturbi depressivi ha influenzato l’andamento di specifici stili di vita. Conclusioni: I risultati evidenziano l’importanza di una valutazione psicologica integrata in riabilitazione cardiologica, allo scopo di identificare e gestire fattori potenzialmente associati al decorso clinico della patologia cardiaca.

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