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ABSTRACTA wide range of survey studies have explored vaccination hesitancy/resistance during the COVID-19 pandemic and provided evidence that this can be explained by several individual variables from the ideological, clinical, and socio-affective domain. However, evidence about which individual variables predict vaccine hesitancy in the post-pandemic state of COVID-19 is meager. We administered a battery of questionnaires to a group of 120 Italian participants with high and low scores on the adult vaccine hesitancy scale (aVHS) to investigate the predictive role of ideological (i.e. political orientation), clinical (i.e. anxiety, interoceptive accuracy), and socio-affective (i.e. alexithymia, disgust sensitivity/propensity, empathy) variables on vaccine hesitancy/resistance. This study provides evidence that lower interoceptive awareness and cognitive empathy are predictors of a greater hesitancy to get vaccinated in the post-pandemic COVID-19 state.

Introduction: Projective methods are recognized as a core instrument in the description and interpretation of personality. The Zulliger test (Z-test) is based on the Rorschach Inkblot test, but it consists of only three cards. It has been mainly used in the collective administration mode and in the context of human resources assessment in organizations. The aim of the present study is to start a standardization of the Z-test on non-clinical Italian population, in individual administration mode. Method: Sample was composed by 360 healthy subjects (180 male and 180 females, mean age 38.25), divided into age groups (18-30; 31-45; 46-60) and education (high and low). All subjects were administered the Z-test in individual form. Results: Results show popular responses for each card, obtained by 17% of sample, and answers of statistical good formal quality, reported by at least 2% of subjects. Conclusion: Although this study has some limitations, it can be considered a good starting point for introducing the Z-test into clinical practice. In future research the sample may be expanded, also including clinical population and detecting specific psychopathological indicators.

Background: Recurrence in glioblastoma lacks a standardized treatment, prompting an exploration of re-irradiation’s efficacy. Methods: A comprehensive systematic review from January 2005 to May 2023 assessed the role of MRI sequences in recurrent glioblastoma re-irradiation. The search criteria, employing MeSH terms, targeted English-language, peer-reviewed articles. The inclusion criteria comprised both retrospective and prospective studies, excluding certain types and populations for specificity. The PICO methodology guided data extraction, and the statistical analysis employed Chi-squared tests via MedCalc v22.009. Results: Out of the 355 identified studies, 81 met the criteria, involving 3280 patients across 65 retrospective and 16 prospective studies. The key findings indicate diverse treatment modalities, with linac-based photons predominating. The median age at re-irradiation was 54 years, and the median time interval between radiation courses was 15.5 months. Contrast-enhanced T1-weighted sequences were favored for target delineation, with PET-imaging used in fewer studies. Re-irradiation was generally well tolerated (median G3 adverse events: 3.5%). The clinical outcomes varied, with a median 1-year local control rate of 61% and a median overall survival of 11 months. No significant differences were noted in the G3 toxicity and clinical outcomes based on the MRI sequence preference or PET-based delineation. Conclusions: In the setting of recurrent glioblastoma, contrast-enhanced T1-weighted sequences were preferred for target delineation, allowing clinicians to deliver a safe and effective therapeutic option; amino acid PET imaging may represent a useful device to discriminate radionecrosis from recurrent disease. Future investigations, including the ongoing GLIAA, NOA-10, ARO 2013/1 trial, will aim to refine approaches and standardize methodologies for improved outcomes in recurrent glioblastoma re-irradiation.

This study aimed to explore the relationships among the variables involved in a Comprehensive Model of Addiction (CMA), which posits that the presence and severity of addictive behaviors are related to the configuration of seven psychological variables, namely childhood trauma, insecure attachment, affect dysregulation, dissociation, impulsivity, compulsiveness, and obsessiveness. A vulnerability model was proposed, in which it was suggested that affect dysregulation and complex trauma mediated the association between insecure attachment and dissociation. Furthermore, a maintenance model was elaborated, in which it was hypothesized that dissociation influenced affect dysregulation via impulsivity, compulsiveness, and obsessiveness. A clinical sample of 430 individuals with substance use disorder was involved. All participants received a DSM-5 clinical diagnosis of Substance-Related and Addictive Disorders and were recruited from the Italian National Health System. A parallel mediation emerged, confirming the vulnerability model, with complex trauma and affect dysregulation mediating the relationship between insecure attachment and dissociation. Furthermore, a mixed serial–parallel mediation described the maintenance model, where impulsiveness, compulsiveness, and obsessiveness significantly mediated the relationship between dissociation and affect dysregulation. Our findings offer a better understanding of the variables associated with addictive disorders, thus providing important indications for both treatment and preventive interventions.

Abstract Background: Among the various components of subjective well-being, satisfaction with life attracts consider-able interest, and the research about the antecedents of this construct is a thriving field in the scientific literature. Therefore, the present study aimed at investigating the factor that may in-fluence satisfaction with life, by specifically focusing on post-traumatic stress symptoms and mature defence mechanisms, controlling for gender and age as covariates. Method: A sample of 703 Italian individuals (495 Women; 208 Men; Mage = 34.80 years; SD = 11.81) completed an online survey including the Satisfaction with Life Scale, Impact of event scale – revised, and the Forty Item Defense Style Questionnaire. Data were analysed by implementing two moderation models. Results: In the first moderation model, the total score of post-traumatic stress symptoms showed a significant and negative association with satisfaction with life, moderated by mature defences. Such data was further investigated, exploring the role of intrusion, avoidance, and hyperarousal sub-dimensions. Results showed that avoidance was significantly and negatively related to satisfaction with life, with the moderation of mature defences. Finally, age was found to interact with satisfaction with life, so younger subjects had lower levels of life satisfaction. Conclusions: The present study highlighted the negative association between post-traumatic stress symptoms (and specifically, avoidance) and satisfaction with life, highlighting the critical protective role of mature defences in this relationship. Such data may provide useful knowledge to implement tailored interventions.

The Zulliger Test, or more commonly Z-Test, is a projective psychodiagnostic instrument developed by Hans Zulliger in 1942. Like the Rorschach test, it is based on the interpretation of inkblot tables, which in this specific case are three. Born as a test for collective administration, it was then also adapted in the individual mode and applied both in the organizational and clinical evaluation. This work proposes a review of the literature on the main studies conducted on the Z-Test, in order to better frame the current state of the art on the applicability of this interesting but neglected instrument, with particular attention to the clinical evaluation. In this context and in particular in individual administration, the studies available in the literature highlight good reliability and validity, however they are small and this discourage the use of the test, nowadays mainly adopted in the selection evaluation.

Evidence suggests that incidental modulation of affective states affects the ability to keep track of time. Alexithymia represents an ideal condition to further address the emotion-time processing link, as it refers to a trait characterized by a deficit of affective processing. 31 healthy participants completed an online version of the TAS-20 scale, which measures alexithymia, and a time reproduction task of visual stimuli related to positive (i.e., happiness) and negative (i.e., anger) facial expressions. Results documented a positive correlation between TAS-20 score and the variability in reproducing sub-second durations of the anger expression stimuli We also found an overestimation of sub-second durations of non-affective expressions in borderline/alexithymic participants. Finally, in line with the literature, we confirmed the overall tendency to overestimate the duration of anger expression stimuli. These findings, which can be interpreted in terms of abnormal scalar timing property in alexithymia, expand previous investigations linking this personality trait with abnormal processing of negative emotions. The evidence that alexithymia predicts the reproduction variability of sub-second durations of negative affective stimuli corroborates previous neuroimaging studies documenting cerebellar deficits in these individuals.

Background: The present study reports on the outcomes of our mono-institutional experience of Helical Tomotherapy (HT)-based SRT for brain metastases. The use of this linac is less frequently reported for this kind of treatment. Methods: This retrospective study displays a series of patients treated with HT-SRT. The eligibility of using SRT for brain metastases was defined by a Karnofsky performance status of >70, a life expectancy of >6 months, and controlled extra-cranial disease; no SRT was allowed in the case of a number of brain metastases larger than 10. All the cases were discussed by a multidisciplinary board. Toxicity assessments were performed based on CTCAE v5.0. Survival endpoints were assessed using the Kaplan–Meier method, and univariate and multivariate analyses were carried out to identify any potential predictive factor for an improved outcome. Results: Sixty-four lesions in 37 patients were treated using HT-SRT with a median total dose of 30 Gy in five fractions. The median follow-up was 7 months, and the 1- and 2-year LC rates were both 92.5%. The IPFS rates were and 56.75% and 51.35%. The OS rates were 54% and 40%. The UA showed better IPFS rates significantly related to male sex (p = 0.049), a BED12 of ≥42 Gy (p = 0.006), and controlled extracranial disease (p = 0.03); in the MA, a favorable trend towards LC (p = 0.11) and higher BED (p = 0.11) schedules maintained a correlation with improved IPFS rates, although statistical significance was not reached. Conclusions: HT-based SRT for brain metastases showed safety and efficacy in our monoinstiutional experience. Higher RT doses showed statistical significance for improved outcomes of LC and OS.

Background: The COVID-19 pandemic represents a global challenge which may have pervasive effects in several areas of community and individual life. Consequently, the virus could generate fear and anxiety that must be managed in a new and unknown situation, such as that of lockdown, with potential consequences for mental health outcomes. Therefore, with the theoretical guide of the Polyvagal perspective, this research aimed to analyse the mediation of social support, passive aggression, avoidance and dissociation in the relationship between fear and anxiety during the COVID-19 pandemic. Methods: During the national COVID-19 lockdown phase, a sample of 992 Italian participants with a mean age of 35.07 years (SD = 12.11) completed the Ten Penn State Worry Questionnaire, State-Trait Anxiety Inventory – Form X3, Coping Orientation to Problems Experienced and Forty Item Defense Style Questionnaire, after providing written informed consent. Results: Results showed that fear affected anxiety, both directly and indirectly, highlighting a serial multiple mediation model with two parallel chain of mediators. Social support coping strategy negatively influenced fear and passive aggression, which instead were positively associated. Furthermore, in the second chain, avoidance directly induced fear in the presence of anxiety, opposite of dissociation defense mechanism. Conclusions: Such findings highlighted some possible answers that could be implemented as a consequence of the fear perception during the COVID-19 lockdown, according to the framework of the Polyvagal Theory. These data could provide an important contribution in shedding light on mechanisms put in place during the pandemic, promoting valuable information for a more effective clinical practice.

Background: Cancer is a major public health problem worldwide. Being the second leading cause of death in the world, this fearsome disease is a stressful event capable to cause a time of considerable upheaval in people’s lives and their loved ones. The illness condition can influence the patients’ social relationships, even reducing social involvement and fostering isolation. Hence, cancer adjustment-related variables are worth studying. Specifically, the research on coping strategies is crucial since the patients’ response style can act on the quality of the psychosocial outcomes. Objective: The aim of this study was deepening the association between coping styles and perceived social support from family, friends, and significant others among a sample of 121 cancer patients. Method: Participants were 121 cancer patients (70.2% females), aged 26 to 88 (M=61.90, SD=12.16). We assessed the adopted coping strategies by means of the Mini-Mental Adjustment to Cancer Scale (mini-MAC Scale), whereas the perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). Results: We found: (1) a positive association between fighting spirit and the perception of social support from friends; (2) the hopelessness/helplessness strategy seemed negatively related with the perception of social support, regardless of the source; (3) higher levels of fatalism were connected with higher levels of perceived social support from family; (4) both anxious preoccupation and avoidance did not show any association with perceived social support. Conclusions: Working on maladaptive coping responses might be useful for the purpose of improving the receptivity to the support from family, friends and significant others. Further research focusing on patients’ coping styles is needed to promote holistic-oriented psychological treatments.

Background: Eating disorders (ED) can be considered in terms of affective disorders. In this perspective, abnormal eating behaviors would be dysfunctional defensive behaviors related to difficulties to recognize and modulate traumatic emotional experiences. The aim of this study is to explore the associations between alexithymia, boredom, impulsiveness, and desire thinking in subjects with eating disorders. Methods: 45 patients with ED and 45 healthy controls completed the following questionnaires: Toronto Alexithymia Scale, Barratt Impulsiveness Scale, Multidimensional State Boredom Scale, Desire Thinking Questionnaire, Body Uneasiness Test and Somatoform Dissociation Questionnaire. Results: Our results seem to confirm that alexithymia, boredom, impulsivity, and desire thinking are strictly related in ED. In particular, difficulties in identifying feelings contribute to determine boredom experiences which, in turn, contribute significantly to structure body image disorders. Conclusions: This study adds new insights into the associations between alexithymia, boredom, impulsiveness, and desire thinking in subjects with eating disorders. Future areas of investigation could better explore the role of boredom experiences in structuring body image dissatisfaction and its relationship with alexithymia.

Background: Many studies demonstrate that early trauma affects the development of cognitive and affective processing, the integration between thoughts and feelings and the ability to understand and regulate emotional experiences. Some researchers emphasize the role of dissociation. Methods: In our study, we involved 62 participants that have completed the following questionnaires: TAS-20, TEC, DES-II, PBI, and RQ. The aim was to evaluate, through descriptive statistics, univariate variant analysis and hierarchical regression analysis, the correlation between alexithymia, traumatic, dissociative experiences, parenting style, and adult relational style in two groups. Results: The results of our research have partially confirmed the significant differences between clinical group and control group. In the clinical group we observed dysfunctional parenting and relationship style in rapport with an alexithymic condition. In addition, alexithymia would also represent a risk factor for the development of an addictive behavior. Regarding to the relationship between dissociation and trauma, our data confirm a significant relationship between these two variables. Conclusions: Our study underlines the importance to consider the role of emotional experiences linked to early traumatic experiences and dissociative defensive reactions.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

This research consists of two studies which aimed to: (1) evaluate the psychometric properties of a new self-report measure for the assessment of mentalizing, the Multidimensional Mentalizing Questionnaire (MMQ); and (2) investigate the ability of the instrument to discriminate between community and clinical populations. A sample of 349 participants (19% male, 81% female; Mage = 38.6, SD = 15.3) filled in the MMQ and other self-report measures, in order to assess the factor structure, reliability and some aspects of construct validity of the measure. Then, a clinical sample (N = 46; 52% male and 48% female; Mage = 33.33, SD = 12.257) and a community one (N = 50; 42% male and 58% female; Mage = 38.86, SD = 16.008) filled in the MMQ, to assess its clinical sensitivity. The factorial analysis identified six principal dimensions of the measure: reflexivity, ego-strength, relational attunement, relational discomfort, distrust, and emotional dyscontrol. The MMQ showed satisfactory psychometric properties and a theoretically relevant factor structure. Furthermore, significantly greater impairment in mentalizing was found in the clinical sample in respect of the community one. The findings are discussed in terms of clinical implications, emphasizing the usefulness of the MMQ in both research and clinical practice.

Neuroscience research links alexithymia, the difficulty in identifying and describing feelings and emotions, with left hemisphere dominance and/or right hemisphere deficit. To provide behavioral evidence for this neuroscientific hypothesis, we explored the relationship between alexithymia and performance in a line bisection task, a standard method for evaluating visuospatial processing in relation to right hemisphere functioning. We enrolled 222 healthy participants who completed a version of the 20-item Toronto Alexithymia Scale (TAS-20), which measures alexithymia, and were asked to mark (bisect) the center of a 10-cm horizontal segment. The results document a significant rightward shift in the center of the line in participants with borderline and manifest alexithymia compared with non-alexithymic individuals. The higher the TAS-20 score, the greater the rightward shift in the line bisection task. This finding supports the right hemisphere deficit hypothesis in alexithymia and suggests that visuospatial abnormalities may be an important component of this mental condition.

In the framework of Positive Organizational Behavior, the construct of Psychological Capital identifies four psychological capacities that affect motivation and performance in the workplace: self-efficacy, hope, optimism and resilience. Emotional Intelligence, then, addresses self-regulatory processes of emotions and motivation that enable people to make adjustments to achieve individual, group, and organizational goals; Emotional Intelligence is strongly correlated with individual advancement and success in an organizational setting and with individual performance. Moreover, Emotional Intelligence is considered an antecedent to resilience. The present study aims to investigate the role of resilience and emotional intelligence in achievement motivation, verifying if emotional intelligence mediates the relationship among resilience and achievement motivation. Participants are 488 Italian workers, aged between 18 and 55 years. The findings confirm the significant role played by emotional intelligence on resilience and on motivation to achievement.

Literature show that the presence of an insecure attachment is at the root of a difficulty in affect regulation and of the implementation of dysfunctional coping and resilience strategies. Adult attachment perspective posits that individuals with secure attachment are engaged in adaptive coping strategies, because their internal working models support a self-efficacy in achieving goals through their behavior. The aim of the study is to evaluate the relationships between alexithymia, adult attachment styles, coping and resilience strategies, in a group of 488 subjects (M = 248; F = 240) with ages ranging from 18 to 55 years (M = 34.9, SD = 12.52). The following instruments were used: the 20-Item Toronto Alexithymia Scale (TAS-20); the Coping Orientation to Problems Experienced (COPE); the Attachment Style Questionnaire (ASQ); and the Resilience Scale for Adults (RSA). The data show that the secure adult attachment is positively associated with the ability to modulate affects, the correct use of coping strategies is correlated with resilience. The study underlines that the type of attachment styles (secure or insecure) and the ability to modulate feelings are closely associated.

Background: Internet addiction (IAD) is one of the most diffuse mental disorders among adolescents. Aims: The aim of our study was to evaluate the relationships between shame, self-efficacy and Internet addiction. Materials and Methods: We recruited a total of 670 college students (males = 164, 24.5%; females = 506, 75.5%). The subjects were aged between 18 and 36 years (M = 20.93, SD = 2.52; males: M = 21.43, SD = 2.95; females: M = 20.76, SD = 2.35). We administered the following instruments: Experience of Shame Scale; Perceived Social Self-Efficacy Scale - Adult Version; Perceived Self-Efficacy in Handling Negative Emotions Scales; Internet Addiction Test. Statistics Analysis: We applied multivariate analyses of variance (MANOVA), Pearson′s correlation indices and linear regression analysis. Results and Conclusion: We found a significant inter-relation between Internet addiction and shame. Shame could be a good predictor of Internet addiction.

Background: The link between early traumatic experiences of abuse/neglect and criminal behaviour has been widely demonstrated. Less is known, however, about the relationship between these experiences and the development of psychopathic personality. Objective: This study investigated childhood relational trauma in a group of violent offenders from Italy. We hypothesised a higher level of early relational trauma associated with higher scores on psychopathy. Method: Twenty-two offenders convicted for violent crimes aged 22–60 (M=38, SD=11) participated in this study. Participants were selected by the Italian justice system for an experimental research programme aiming at the evaluation of psychopathic personality traits among violent offenders. Within the group, 14 participants (64%) had committed murder, 4 (18%) had committed rape, and 4 (18%) were convicted child sex offenders. The Traumatic Experience Checklist was used to assess childhood relational trauma; the Hare Psychopathy Checklist—Revised (PCL-R) was used to assess psychopathy. Results: There was a high prevalence of childhood experiences of neglect and abuse among the offenders. Higher levels of childhood relational trauma were found among participants who obtained high scores on the PCL-R. There was also a significant negative association between age of first relational trauma and psychopathy scores. Conclusions: Findings of this study suggest that an early exposure to relational trauma in childhood can play a relevant role in the development of more severe psychopathic traits.For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Several investigations document altered emotion processing in opiate addiction. Nevertheless, the origin of this phenomenon remains unclear. Here we examined the role of alexithymia in the ability (i.e., number of errors—accuracy and reaction times—RTs) of thirty-one heroin addicts and thirty-one healthy controls to detect several affective expressions. Results show generally lower accuracy and higher RTs in the recognition of facial expressions of emotions for patients, compared to controls. The hierarchical multivariate regression analysis shows that alexithymia might be responsible of the between groups difference with respect to the RTs in emotion detection. Overall, we provide new insights in the clinical interpretation of affective deficits in heroin addicts suggesting a role of alexithymia in their ability to recognize emotions.

This article evaluates the psychometric properties of a new measure for assessing Substance-Related and Addictive Disorders: the Addictive Behavior Questionnaire (ABQ). The ABQ is a self-report measure composed of two sections: the Severity Index (SI) and the Seven Domains Addiction Scale (7DAS). Materials and methods. A total sample of 698 subjects divided into two groups (515 subjects in the clinical sample and 183 subjects in the control sample), participated in this study. We applied Exploratory Factor Analysis (EFA) to examine features of ABQ construct validity, we used Cronbach’s alpha coefficient to assess its internal reliability, and explored some aspects of its concurrent validity by examining its associations with other measures assessing addictive behaviors and psychopathology. Results and conclusions: results of EFA indicated that all the scales of the ABQ are unidimensional and showed good internal consistency. The correlations between the sections of the ABQ and the other measures used in the current study were significant and in the expected directions. These results suggest that the ABQ has good psychometric properties and allows researchers and clinicians to gather relevant information regarding behaviors, psychopathology and severity of symptoms, for the best clinical reasoning and for planning tailored treatment for each patient.

Partendo dall’analisi teorico-clinica della dissociazione patologica implicata nelle addiction, l’autore propone una rilettura dei sintomi additivi (la compulsione ad assumere un qualsiasi oggetto-droga) alla luce della distinzione fra inconscio rimosso e inconscio non rimosso. L’ipotesi è che, in coloro che soffrono di una qualsiasi addiction (dal sesso, da internet, da sostanze psicotrope, dal cibo ecc.), la natura dissociativa dei loro comportamenti compulsivi sia associata ad un’alterazione dell’inconscio non rimosso a causa di esperienze relazionali traumatiche vissute sin dall’infanzia.