The Effectiveness of Remote Psychological Support During the Italian COVID-19 Lockdown
An Exploratory Investigation
Abstract
Abstract. The aim of the present study was to address the psychopathological impact of the interruption of traditional mental care during the COVID-19 lockdown on a group of public psychology service (PPS) users. For this purpose, a sample of 17 individuals requesting psychotherapeutic treatment within an Italian PPS was selected. Symptoms of psychopathologies were measured before and after the lockdown period. The investigation explored the effects of remote support, and the possible influence of adverse childhood experiences, dissociation, somatoform symptoms, and maladaptive personality traits. The results of this study showed that patients who continued with their psychological treatment by means of remote technological supports, resumed their in-person sessions showing a significant reduction of global psychopathological symptoms, anxiety, and phobic anxiety. The results also suggest that dissociative tendencies and maladaptive personality traits prevented symptomatic improvement. Finally, it was found that symptomatic improvement was favored by an absence of subjective distress during the lockdown. Implications for public services are discussed.
Impact and Implications:
The present research demonstrated the effectiveness of implementing remote psychological support for public psychology service users who transitioned out of traditional face-to-face therapy during the COVID-19 lockdown. As such, the work addressed two objectives from the 2016 to 2030 United Nations Sustainable Development Goals (United Nations, 2015). Goal 3 addresses the promotion of well-being by providing access to quality essential healthcare services for all. Goal 16 includes the promotion of inclusive and effective institutions providing access to all. This article supports these two goals by showing how a PPS can adapt its way of functioning to cope with users’ basic psychological needs in times of communal crisis.
References
(2021, May 19). Coronavirus in Sicilia, come hanno funzionato (e BENE) le misure di contenimento. Sicilia Report. https://www.siciliareport.it/province/palermo/coronavirus-in-sicilia-come-hanno-funzionato-le-misure-di-contenimento/
(2020). Economic impacts of Wuhan 2019-nCoV on China and the world. Journal of Medical Virology, 92(5), 473–475. 10.1002/jmv.25706
(2004). Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatric Services, 55(9), 1055–1057. 10.1176/appi.ps.55.9.1055
(2008). A comprehensive review and a meta-analysis of the effectiveness of internet based psychotherapeutic interventions. Journal of Technology in Human Services, 26(2–4), 109–160. 10.1080/15228830802094429
(2003). Something wicked this way comes: Trauma, dissociation, and conflict: The space where psychoanalysis, cognitive science, and neuroscience overlap. Psychoanalytic Psychology, 20(3), 558–574. 10.1037/0736-9735.20.3.558
(2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395(10227), 912–920. 10.1016/S0140-6736(20)30460-8
(1993). An update on the dissociative experiences scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27.
(2020). Covid-19 concerns among persons with mental illness. Psychiatric Services, 71(11), 1188–1190. 10.1176/appi.ps.202000245
(2021, April 09). Money and mental health at a time of crisis. https://www.moneyandmentalhealth.org/wp-content/uploads/2020/04/Money-and-mental-health-coronavirus-policy-note.pdf
(1990). Relation of clinical variables to dissociative phenomena in eating disorders. American Journal of Psychiatry, 147(9), 1184–1188. 10.1176/ajp.147.9.1184
(1994). Symptom checklist-90-r: Administration, scoring and procedures manual (3rd ed.). National Computer Systems.
(1977). Confirmation of the dimensional structure of the SCL90: A study in construct validation. Journal of Clinical Psychology, 33(4), 981–989. 10.1002/1097-4679(197710)33:4%3C981::AID-JCLP2270330412%3E3.0.CO;2-0
(2017). Analysis of small sample size studies using nonparametric bootstrap test with pooled resampling method. Statistics in Medicine, 36(14), 2187–2205. 10.1002/sim.7263
(1996). Un contributo alla standardizzazione della Dissociative Experiences Scale (DES) di Bernstein e Putnam. Bollettino di Psicologia Applicata, 219, 39–46.
(2011). Somatoform and psychoform dissociation among students. Journal of Clinical Psychology, 67(7), 665–672. 10.1002/jclp.20787
(1998). Adverse childhood experiences (ACE) study. Rivista di Psicoterapia EMDR. EMDR Italia, 27, 56–59.
(1998). Relationship of childhood abuse and household dysfunction to many of the causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. 10.1016/S0749-3797(98)00017-8
(2000). Psychotherapy of personality disorders. The Journal of Psychotherapy Practice and Research, 9(1), 1–6.
(2020). Decree of the President of the Council of Ministers 9 March 2020. https://www.gazzettauciale.it/eli/id/2020/03/09/20A01558/sg
(2023). Guidelines for the processing of personal data in clinical trials of medicinal products – 24 July 2008 [1533155]. https://www.garanteprivacy.it/home/docweb/-/docweb-display/docweb/1533155
(2021, April 04). Survey raises concerns about the provision of mental health services in Wales during the Covid-19 outbreak. https://www.hafal.org/2020/04/survey-raises-concerns-about-the-provision-of-mental-health-services-in-wales-during-the-covid-19-outbreak/
(2020). Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain, Behavior, and Immunity, 87, 100–106. 10.1016/j.bbi.2020.04.069
(2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. 10.1016/S0140-6736(20)30183-5
(2021). Psychological distress in patients with serious mental illness during the COVID-19 outbreak and one-month mass quarantine in Italy. Psychological Medicine, 51(6), 1054–1056. 10.1017/S0033291720001841
(2020, October 23). Prot. N° 13588, 13/3/2020. https://www.insanitas.it/wp-content/uploads/2020/03/circolare.jpg
(2020). Psychological distress related to COVID-19: The contribution of continuous traumatic stress. Journal of Affective Disorders, 277, 129–137. 10.1016/j.jad.2020.07.141
(2012). Depression after exposure to stressful events: Lessons learned from the severe acute respiratory syndrome epidemic. Comprehensive Psychiatry, 53(1), 15–23. 10.1016/j.comppsych.2011.02.003
(2021). The impact of switching from face-to-face to remote psychological therapy during the COVID-19 pandemic. Psychotherapy and Psychosomatics, 90(4), 285–286. 10.1159/000515543
(1997). Millon Clinical Multiaxial Inventory-III (MCMIIII) manual (2nd ed.). National Computer Systems.
(2007). La dissociazione Somatoforme: Elementi Teorico Clinici e Strumenti di Misurazione [
Somatoform dissociation: Phenomena, measurement and theoretical issues ] (A. SchimmentiA. Mulé.). Astrolabio-Ubaldini (Original work published in 2004).(1996). The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184(11), 688–694. 10.1097/00005053-199611000-00006
(1998). Psychometric characteristics of the Somatoform dissociation Questionnaire: A replication study. Psychotherapy and Psychosomatics, 67(1), 17–23. 10.1159/000012254
(2010). The scoring and interpretation of the SDQ-20 and SDQ-5. Activitas Nervosa Superior, 52(1), 24–28. 10.1007/BF03379561
(2020). Telepsychotherapy: A leaflet for psychotherapists in the age of COVID-19. A review of the evidence. Counselling Psychology Quarterly, 34(3–4), 352–367. 10.1080/09515070.2020.1769557
(2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22(2), 203–212. 10.1037/a0018679
(2019). Factor structure models of the SCL-90-R: Replicability across community samples of adolescents. Psychiatry Research, 272, 491–498. 10.1016/j.psychres.2018.12.146
(2013). Comparative psychometric analyses of the SCL-90-R and its short versions in patients with affective disorders. BMC Psychiatry, 13, Article
104 . 10.1186/1471-244X-13-104(2021). Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: Framework synthesis of international experiences and responses. Social Psychiatry and Psychiatric Epidemiology, 56(1), 13–24. 10.1007/s00127-020-01924-7
(2021, April 09). 80% of people living with mental illness say current crisis has made their mental health worse. https://rethink.org
(2011). SCL-90-R symptom checklist 90-R. Adattamento italiano. Giunti OS.
(2020). A review of Coronavirus disease-2019 (CoViD-19). Indian Journal of Pediatrics, 87(4), 281–286. 10.1007/s12098-020-03263-6
(2020). Dysfunctional personality features, non-scientifically supported causal beliefs, and emotional problems during the first month of the COVID-19 pandemic in Italy. Personality and Individual Differences, 165, Article
110139 . 10.1016/j.paid.2020.110139(2013). Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Medicine and Public Health Preparedness, 7(1), 105–110. 10.1017/dmp.2013.22
(2008). Factors influencing psychological distress during a disease epidemic: Data from Australia’s first outbreak of equine influenza. BMC Public Health, 8, Article
347 . 10.1186/1471-2458-8-347(2021, April 09). Survey results: Understanding people’s concerns about the mental health impacts of the COVID-19 pandemic. https://acmedsci.ac.uk/file-download/99436893
(2015). Sustainable Development Goals. https://sdgs.un.org/goals
(1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the dissociative experiences scale (DES). Clinical Psychology Review, 16(5), 365–382. 10.1016/0272-7358(96)00006-2
(1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. 10.1037/1082-989X.1.3.300
(2020). A novel coronavirus outbreak of global health concern. Lancet, 395(10223), 470–473. 10.1016/S0140-6736(20)30185-9
(2021, April 21). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). WHO. https://bit.ly/2zc56Vk
(2009). The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Canadian Journal of Psychiatry, 54(5), 302–311. 10.1177%2F070674370905400504
(2020, November 9). Coronavirus: Impact on young people with mental health needs. https://www.youngminds.org.uk/media/xq2dnc0d/youngminds-coronavirus-report-march2020.pdf
(2008). Adattamento italiano del MCMI-III: Studi di validazione. GiuntiOrganizzazioni Speciali.
