Research in Psychotherapy: Psychopathology, Process and Outcome 2020-05-21T16:53:57+00:00 Francesca Savio Open Journal Systems <p><strong>Research in Psychotherapy: Psychopathology, Process and Outcome</strong> (RIPPPO) is an online, open-access, peer reviewed journal published by the <strong>Italian Area Group of the Society for Psychotherapy Research</strong> (<a href="">SPR Italy Area Group</a>). Its aim is to promoting a fruitful communication between the Italian and International communities, enriching clinicians and researchers mutual collaboration. It welcomes high quality articles from any part of the world, concerning a variety of topics (<em>e.g.</em>, psychotherapy process and outcome, diagnosis and assessment, psychopathology <em>etc.</em>), with different formats (<em>e.g.</em>, reviews, empirical studies, methodological works, clinical studies) and from different epistemological, theoretical and methodological perspectives of the contemporary research in psychotherapy.</p> <p>RIPPPO publishes three issues every year and provides immediate open access to its contents, on the basis of the principle that making research results freely available to researchers and practitioners supports a better exchange of knowledge.</p> <p>Since 19th January 2020, this journal applies the article processing charge to Authors, see: <a href=""></a>.</p> Panic disorder: attack of fear or acute attack of solitude? Convergences between affective neuroscience and phenomenological-Gestalt perspective 2020-05-21T16:53:55+00:00 Gianni Francesetti Antonio Alcaro Michele Settanni <p>There is consensus among scientists in considering Panic Attack (PA) as an exaggerated fear response triggered by intense activation of the amygdala and related Fear brain network. Current guidelines for treatment (e.g. National Institute for Clinical Excellence, NICE, 2011), that are based on this view, do not achieve satisfactory results: one-third of all treated patients report persistent PAs and other Panic Disorder (PD) symptoms, and several meta-analyses report the high likelihood of relapse. Here we review findings from Affective Neuroscience and clinical insights from a phenomenological-Gestalt perspective, putting into question the link between PD and activation of the Fear brain network. We propose an alternative hypothesis about PD etiology: PD is mainly connected to the Panic system, that is activated in situations of separation from affective support and overexposure to the environment. In our view, PA can be understood as an acute attack of solitude which is not adequately recognized by the patient due to the intervention of a dissociative component that makes it impossible to integrate all neuro-physiological responses activated by the Panic/Separation brain system within a coherent emotional feeling. This perspective can explain many evidences that otherwise remain isolated elements without a comprehensive frame: i.e., the association with agoraphobia, the onset of PD during adolescence and young adult life, the need to be accompanied, the connection with air hunger and other respiratory anomalies, the efficacy of antidepressants and the lack of activation of the Hypothalamic-Pituitary-Adrenal (HPA) axe. We discuss future steps to test this hypothesis and the consequences for psychotherapeutic treatment.</p> 2020-05-21T14:52:48+00:00 Copyright (c) 2020 The Authors Psychological factors of sibling caregivers of patients with severe mental disorders: an observational study 2020-05-21T16:53:56+00:00 Francesca Pierazzuoli Elisa Gatti Maria Rosa Castelli Giuseppe Primerano Osmano Oasi Giacomo Tognasso Livio Finos Alessandra Santona <p>The goal of the present study is to explore the perception of the relationship with parental figures, traumatic experiences, personality traits and psychosocial characteristics of the participant sibling caregivers. The sample was composed of 30 sibling caregivers recruited at psychiatric facilities in Italy, and of 30 control siblings. The battery of instruments administered included Parental Bonding Instrument (PBI), Minnesota Multiphasic Personality Inventory 2 (MMPI-2), and The Inventory of Traumatic Experiences (TEC). This research found that sibling caregivers of patients with severe psychiatric pathologies are distinctly different from the siblings of the control group with respect to the perception of their relationship with parental figures more frequently regarded as dysfunctional, and were also characterized by a higher presence of traumatic experiences. The problematic relationship with parental figures, some traumatic experiences, and the burden of taking care of a sibling with psychiatric disorders are probably important variables with regards to the individual’s overall psychological condition.</p> 2020-05-21T14:45:17+00:00 Copyright (c) 2020 The Authors A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations 2020-05-21T16:53:56+00:00 Sandra Marie Reyno Maria Simmons Jackie Kinley <p>Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations.&nbsp; Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels.&nbsp; This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning.&nbsp; We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations.&nbsp; Studies using two common measures of these constructs were included (i.e., the Toronto Alexithymia Scale and the Dissociative Experiences Scale).&nbsp; Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation.&nbsp; The strength of the association increased in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> 2020-05-21T09:33:37+00:00 Copyright (c) 2020 The Authors Further data on the reliability of the mentalization imbalances scale and of the modes of mentalization scale 2020-05-21T16:53:56+00:00 Giulia Gagliardini Laura Gatti Antonello Colli <p>The aim of this study was to provide data on the Inter-Rater Reliability (IRR) and the test-retest reliability of the Mentalization Imbalances Scale (MIS) and the Modes of Mentalization Scale (MMS) in two different studies. Three junior raters and two senior raters assessed blindly 15 session transcripts of psychotherapy of five patients, using both the MIS and the MMS. The same 15 sessions were rated after the junior raters completed a training at the use of the scales and after on month from the end of the training to assess testretest reliability. Four therapists used the MIS and the MMS to provide different ratings of 22 patients undergoing a psychotherapy in different settings. Intraclass Correlation Coefficient (ICC) values ranged from sufficient to good and increased after the training. Test re-test reliability was sufficient for both scales (Study 1). ICC values ranged from sufficient to good, and were globally higher than the ones found in the first study sample (Study 2). Our results provide support to the inter-rater reliability of the MIS and the MMS.</p> 2020-05-21T09:18:26+00:00 Copyright (c) 2020 The Authors Episodes of meeting in psychotherapy: An empirical exploration of patients’ experiences of subjective change during their psychotherapy process 2020-05-21T16:53:57+00:00 Javiera Duarte Claudio Martinez Alemka Tomicic <p>This study aims to assess moments of meeting in psychotherapy -understood as moments of intense connectedness and intimacy, shared between patient and therapist during any therapeutic encounter that enable a spin in the therapy process- using a qualitative interview with patients who were undergoing or had finished psychological treatment. Micro-pehenomenological interviews were conducted with nine patients who were undergoing or had finished psychological treatment. Transcriptions of the interviews were subject to micro-phenomenological analysis. A general structure of episodes of meeting showing their temporal evolution was identified and divided into six consecutive phases. These findings suggest that episodes of meeting in psychotherapy are lived and remembered by patients in a significant way; they are emotionally charged and have a meaning for each participant. Also, emotional and nonverbal cues seem to be highly relevant features. Moments of meeting could be understood as implicit mechanisms that allow changes in the implicit relational domain.</p> 2020-05-21T07:49:10+00:00 Copyright (c) 2020 The Authors Values in persons with borderline personality disorder: their relevance for the therapeutic interview 2020-05-21T16:53:57+00:00 Milena Mancini Giovanni Stanghellini <p>This is an explorative study on values of 25 patients affected by borderline personality disorder interviewed in a clinical setting (phenomenological-dynamic psychotherapy) and re-classified following Consensual Qualitative Research. We identified three main categories of values: recognition (the importance for attention, acknowledgment, commendation and acceptance by the other), authenticity (the importance of absolute emotional fusion with the other), and immediacy (the importance of instantaneous, hic et nunc satisfaction of one’s needs/desires). Each of these values expresses a kind of ‘logic’, namely the logic of intimacy (the other’s closeness as indispensable for defining oneself and establish/reinforce one’s selfhood and identity), spontaneity (over-reliance on feelings unrestricted by social norms undermining their intensity), and instantaneity (glorification of ‘now-moments’/execration of procrastination draining the vitality of feelings). The borderline person lives an emotional normativity constituted by the intensity of feelings under the spell of a frustrated normativity since they enter into a collision with the hypocrisy of common-sense ethical norms and social rules and conventions, as well as by potential conflicts with the feelings of the other. Acknowledging the values affirmed by borderline persons may help to better understand their condition - that is, to grasp ‘what it is like’ and make sense of the phenomena that affect them – and particularly to find a logic in their otherwise irrational and incomprehensible self-defeating behavior.</p> 2020-05-21T06:38:07+00:00 Copyright (c) 2020 The Authors Anxiety sensitivity dimensions in young individuals with at-risk-mental states 2020-05-20T19:26:01+00:00 Andrea Pozza Anna Meneghelli Maria Meliante Luisa Amato Davide Dèttore <p>Anxiety Sensitivity (AS) is a transdiagnostic risk factor involved in the development and maintenance of different psychopathological conditions including anxiety disorders and psychosis. It consists of Physical Concerns (e.g., the belief that palpitations lead to a cardiac arrest), Social Concerns (the belief that observable anxiety reactions will elicit social rejection), and Cognitive Concerns (the belief that cognitive difficulties lead to mental incapacitation). No study investigated whether specific AS dimensions are related to At-Risk Mental States (ARMS). This study compared AS dimensions between young individuals with ARMS, patients after a recently occurred First-Episode Psychosis (FEP) and matched community controls. Based on models of ARMS and previous evidence, it was hypothesized that ARMS individuals have higher physical, social and cognitive concerns than FEP patients and controls. Thirty individuals with ARMS and 30 with FEP and 30 controls recruited from the general population completed the Anxiety Sensitivity Index-3 (ASI-3) and Penn State Worry Questionnaire. ARMS and FEP individuals had higher scores than controls on ASI-3 Cognitive Concerns [F(2,87)= 11.48, p&lt;.001]. Individuals with ARMS had higher ASI-3 Physical Concerns scores than FEP patients [F(2,87)= 5.10, p&lt;.01] and at a marginal significance level than controls. No between-group difference was found on Social Concerns. Higher ASI-3 Physical Concerns scores [B = -.324, Wald’s χ2(1) = 8.29, p &lt; .01] and psychiatric comorbidities [B = -2.726, Wald’s χ2(1) = 9.33, p &lt; .01] were significantly related to ARMS than FEP. Higher ASI-3 Social Concerns scores were related to FEP, despite at a marginal significance level [B =.213, Wald’s χ2(1) = 3.79, p = .052]. Interventions for AS Cognitive/Physical Concerns could be incorporated in the treatment of ARMS. A replication of the findings is required. Future longitudinal studies should examine whether Cognitive Concerns predict development of FEP in ARMS to improve early detection and prevention strategies.</p> 2020-05-20T16:21:38+00:00 Copyright (c) 2020 The Authors Using exercise to protect physical and mental health in youth at risk for psychosis 2020-05-20T19:26:29+00:00 Joseph Firth Felipe Schuch Vijay A. Mittal <p>A large body of literature has demonstrated that exercise interventions can improve a broad range of outcomes in people with established schizophrenia, including reducing psychiatric symptoms, increasing cognitive functioning, and improving physical health. Furthermore, these benefits seem just as pronounced in first-episode psychosis. However, there have been few clinical studies to date examining the effects of exercise in those found to be ‘at-risk’ of psychosis, particularly for those meeting the criteria for ‘Clinical High Risk’ (CHR) state (a classification which includes both those meeting the ‘ultra-high risk for psychosis’ criteria and/or those with ‘atrisk mental states’). This is surprising, as a proportion of those in the CHR state go on to develop psychotic disorders, and a growing body of evidence suggests that early interventions in this period have significant potential to improve the course of illness. In this article, we shall review the existing literature for i) exercise as an adjunctive intervention for those treated for psychosis; ii) exercise as a standalone intervention in CHR groups; and iii) the rationale and supportive evidence for widescale use of exercise to preserve physical and mental health in those identified as at risk for psychosis. From this, we will put forth how the CHR phase represents an under-researched but highly-suitable timepoint for administering structured exercise interventions, in order to improve physical, psychological and neurocognitive outcomes; while also potentially reducing the odds of transition to full-threshold psychotic disorders. Following this, directions, recommendations and considerations around both the clinical implementation and future research around exercise in CHR individuals will be discussed.</p> 2020-05-20T15:54:24+00:00 Copyright (c) 2020 The Authors Clinical presentation and need for treatment of a cohort of subjects accessing to a mental illness prevention service 2020-05-20T19:27:24+00:00 Marco Solmi Mara Campeol Federica Gentili Angela Favaro Carla Cremonese <p>Outreaching activities decrease prognostic accuracy of at-risk mental state defining tools, over-attracting subjects who are not at increased risk of mental illness. The setting was a mental illness primary indicated prevention outpatients service embedded within the Psychiatry Unit of Padua University Hospital, Italy. Help-seeking patients accessing the service between January 2018 and December 2018 were evaluated with validated tools assessing functioning, at-risk mental state, schizotypal personality features, depressive and anxious symptoms, together with medical and family history collection. The primary outcome was the prevalence of drop in functioning at presentation according to the Social and Occupational Functioning Assessment Scale (SOFAS). Secondary outcomes were diagnoses according to DSM-5 criteria and meeting criteria for at-risk mental state. Fifty-nine patients accessed the service, mean age was 18.8 (2.12) years old, 54.2% were females. Virtually all subjects (97.7%) had a drop in functioning. Baseline primary diagnoses were depressive episode in 33%, anxiety disorder in 21%, personality disorder in 17%, adjustment disorder 9%, conduct disorder 7%, schizophrenia spectrum disorder 5%, bipolar disorder 5%, eating disorder in 1.7%, dissociative disorder 1.7%. Overall, 59.1% met at-risk mental state criteria. Lower functioning was associated with anxious symptoms (p=0.031), a family history of mental illness (p=0.045) and of suicide (p=0.042), and schizotypal personality traits (p=0.036). Subjects accessing a prevention service embedded within the mental health department already present a trans-diagnostic drop in functioning, mainly due to a non-psychotic mental disorder, with at-risk mental state in one patient out of two, and schizophrenia or bipolar disorder already present in only 10% of subjects. Prevention service within mental health facility setting appears to properly detect subjects in need of treatment with a drop in functioning, at risk of developing severe mental illness, without any outreaching activity in the general population.</p> 2020-05-20T15:38:09+00:00 Copyright (c) 2020 The Authors Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective 2020-05-20T19:27:53+00:00 Maria Pontillo Maria Cristina Tata Roberto Averna Prisca Gargiullo Silvia Guerrera Stefano Vicari <p>Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (<em>i.e.</em>, different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed</p> 2020-05-20T15:20:41+00:00 Copyright (c) 2020 The Authors