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Abstract

The coronavirus disease 2019 represents an unprecedented threat to human health worldwide. In the absence of a specific available cure for this disease, countries are adopting mitigation strategies that largely depend on physical distancing, with a dramatic restriction of social contacts. Whereas the psychological burden related to the coronavirus disease 2019 pandemic is starting to be well characterized by population-based surveys, we would like to capitalize from infant research evidence about the potentials of psychological reparation for human trauma and disconnection. Reparation can be defined as the human ability to coregulate emotions and to resolve interactive mismatches and separations by reciprocally engaging in attuned interactive exchanges capable of expanding our capacities for resilience. Alongside economical and medical health solutions, investing in psychological, emotional, and affective reparatory acts is warranted to be a key component of the recovery strategies worldwide. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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... Stressors relate to the duration of quarantines, fear of infection, frustration, boredom, shortage of basic supplies, uncertainty about the future, lack of information and separation from loved ones (Brooks et al., 2020). This latter stressor, in addition to the restriction of support systems, has special relevance since they contradict the way humans have historically dealt with crises, disasters and emergencies (Newkirk, 2020) and because of the negative impact isolation has on cognitive and emotional growth, particularly during sensitive developmental periods (Cacioppo & Hawkley, 2009;Provenzi & Tronick, 2020). ...
... Additionally, the current pandemic has increased the risk of mental health issues in parents and children, mainly because of social isolation and disruption as well as changes in face-to-face educational, recreational and productive activities (Brooks et al., 2020;Cluver et al., 2020;Coyne et al., 2021;da Silva et al., 2020;Provenzi & Tronick, 2020;Van Gelder et al., 2020). In particular, pregnant women and young children have been identified as the most vulnerable (Frey et al., 2019;Jiao et al., 2020;Pozniak et al., 2020;Thapa et al., 2020;Wang et al., 2020). ...
... Since the beginning of the coronavirus pandemic, a negative impact on daily functioning, mental health and deterioration of well-being in expectant parents and families of young children has been identified (Cluver et al., 2020;Coyne et al., 2021;da Silva et al., 2020). In line with previous literature, the present study suggests that the Chilean state of emergency, lockdowns and quarantines have increased feelings of vulnerability, uncertainty and stress that are already intense during parenthood (Jiao et al., 2020;Provenzi & Tronick, 2020). As previously shown, participants were mainly mothers of medium and high socioeconomic statuses who lived in Chile's central zone, were expecting a baby and/or had one or more children under 5 years old. ...
Article
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The unprecedented COVID-19 pandemic has impacted families’ mental health around the globe. In June 2020, 1163 parents of high (43%), middle (47%), and low socioeconomic status (SES) (10%) participated in an online survey developed to explore how daily life changes and restrictions that came with COVID-19 affected the experiences of pregnancy and/or parenting children under the age of 5 in Chile. The survey's design had an exploratory and descriptive scope, with a mix of qualitative and quantitative questions. With the aim of exploring differences before and after COVID-19, two time periods were established, and the 47-item questionnaire covered participants’ sociodemographic information, support networks, health concerns, mood changes, self-regulation, adult and children's perceived well-being, parental competencies and parents’ perceptions of the unborn baby and/or their children's needs. The results relative to retrospective reporting of pre-pandemic levels, showed an increase in children's crying and tantrums as well as in parental irritability and sadness. Additionally, decreases in the ability to calm down and sleep quality in both parents and children were identified. Finally, at a qualitative level, COVID-19 stands out both as an opportunity to get to know their children better and as a stressor related to parental burn-out and discomfort.
... Previous literature has extensively demonstrated that individuals exposed to such intense adverse conditions during developmental windows of heightened plasticity (Kim, 2016) may be susceptible to developing maladaptive stress responses and affective symptoms (Davis & Narayan, 2020;Pluess & Belsky, 2011). Consistently, it is of paramount importance to study the impact of pandemic-related stress on the health of individuals who are experiencing sensitive periods and the protective role of preventive and supportive interventions (Horesh & Brown, 2020;Provenzi & Tronick, 2020). ...
... Mirroring the findings that showed how the dyadic interactive aspects of mother-infant relationship were the ones that benefitted more from the intervention, we confirm that the social connections and support are the core of a heightened well-being perception in mothers who were exposed to social separations during pregnancy. Home-visiting may provide a social resource in the face of the isolation and trauma experienced by expecting mothers during the COVID-19 pandemic (Provenzi & Tronick, 2020). ...
Article
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Objectives The COVID-19 pandemic resulted in a particularly adverse and stressful environment for expecting mothers, possibly enhancing feelings of anxiety and parenting stress. The present work assesses mothers' anxiety levels at delivery and parenting stress after 3 months as moderated by home-visiting sessions. Methods Women (n = 177) in their second or third trimester of pregnancy during the COVID-19 lockdown were enrolled in northern Italy and split into those who did and did not receive home visits. After 3 months, the association between anxiety at delivery and parenting stress was assessed with bivariate correlations in the whole sample and comparing the two groups. Results Higher anxiety at birth correlated with greater perceived stress after 3 months. Mothers who received at least one home-visiting session reported lower parenting stress at 3 months than counterparts who did not receive home visits. Conclusions for Practice The perinatal period is a sensitive time window for mother-infant health, especially during a critical time like the COVID-19 pandemic. We suggest that home-visiting programs could be beneficial during global healthcare emergencies to promote maternal well-being after delivery.
... Parents of young children had multiple adjustments to navigate: adjusting to the unexpected lack of structure and out-of-home care for their children, planning indoor daily activities, dealing with the financial burden, threat of job loss and income, and the demand of working remotely without support and help. Moreover, the reduction of social contacts and the closure of the social-based educational, recreational, and productive activities has had a severe impact on the emotional and psychological well-being of humans (Provenzi & Tronick, 2020). ...
... Our hypothesis is that building relationships can be an effective intervention that overcomes the negative effects of social isolation. This assumption was also found to be true in animal and human research on emotional and cognitive well-being (Cacioppo et al., 2015;Cacioppo & Hawkley, 2009;Provenzi and Tronick, 2020). In particular, the reparation of the inevitable mismatches and miscommunications of typical interactions -their messiness -generates a sense of trust and connection to others, increases individuals' coping capacity, and engenders a sense of safety and hope (Tronick, 2006;Tronick & Gold, 2020). ...
... In this setting, the direct and indirect implications for citizens and healthcare specialists have been largely highlighted Tian et al., 2020;Wang et al., 2020). Fragile and at-risk people-such as children with neurodevelopmental disabilities and their parents-are especially exposed to psychological stress related to the Covid-19 contagion and the lockdown (Provenzi and Tronick, 2020;. A major consequence of the lockdown was the suspension of psychological and rehabilitation services for the healthcare and educational needs of children with neurodevelopmental disability (Schiariti, 2020;Thompson and Rasmussen, 2020). ...
... Tele-medicine tools and programs may be useful to promote not only remote rehabilitation programs for children but also parental consultations and psychological support during an unprecedented threat to mental health [23,24]. By promoting family well-being during the present epidemic, the healthcare systems might further increase their ability to provide smarter family-centered care for children with neurodevelopmental disabilities and their caregivers even when the COVID-19 outbreak will be over [25]. ...
Article
Background: The present study investigated the impact of the COVID-19-related rehabilitation services lockdown on the mental health of caregivers of children with neurodevelopmental disabilities. Methods: Between 26 March and 11 May 2020, 84 caregivers filled out ad-hoc and standardized ques- tionnaires through an online survey in order to measure their psychological response to the emergency and lockdown as well as their levels of parenting stress, anxiety and depression. Results: Worries about COVID-19 contagion and concerns for the child left without rehabilitation pro- grams were the greatest sources of mental health burden for caregivers. Nonetheless, only the concerns for the child were significantly associated with caregivers’ reports of stress, depressive and anx- ious symptoms. Discussion: These findings highlight the burden faced by caregivers of children with neurodevelopmental disabilities during the COVID-19 emergency in Italy. These families should be considered as a high-risk population that requires dedicated healthcare attention, such as promoting continuity of care by inves- ting in tele-rehabilitation programs.
... Society is increasingly confirming that the digital is the original so that they are disconnected from their social reality. However, the termination of social relations is needed by society to achieve a new balance and prosperity [2]. People no longer see relationships based on mutual interactions because they do not meet face to face directly. ...
Conference Paper
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The Covid-19 pandemic requires everyone to live in the excitement of the digital world. The critical quality of citizens is shown as the real quality of citizens who are immersed in demagogue-style misleading opinions. The process of digitalization emerges sudden popularity, that the figure of Tirta, who graduated from medical faculty and now run his digital shoe entrepreneurship, has more influential statement than a doctor who is serious about pursuing his job. The effect of Tirta's speech in the digital world is more impactful than the voice of experts. This study aims to 1) describe the presence of a new type of consensus in the digital world that was born during the pandemic, 2) re-analyze the demagogical potential in a democracy consisted in Kompas.com using the democratic perspective by Jacques Rancière. This research used Norman Fairclough's critical discourse analysis method. The data were taken from the online news entitled Cerita Dokter Tirta, Influencer yang Terjun Langsung Lindungi Tenaga Medis dari Covid-19 (The Story of Doctor Tirta, an Influencer Who Directly Involve to Protect Medical Workers from Covid-19). The data were analyzed by applying three-dimensional stages, namely micro, meso, and macro. The results show that Covid-19 has changed social relations only through digital media and produce a demagogic nuance. The society becomes disconnected from their social reality. Critical thinking is lost because of the unsuccessful dissensus. The digital world creates a new consensus that only represents social emotions.
... Infections, deaths, and uncertainty about the future as well as the economic and social consequences of essential public health measures used to contain the spread of the virus (i.e., shelterat-home, quarantine, isolation and lockdown) are playing key roles in the short-and long-term social and psychological impacts of the COVID-19 pandemic (Osofsky et al., 2020;Provenzi and Tronick, 2020). Sheltering in place entails the loss of daily routines and a reduction in social activities and in-person interactions (which, among other things, provide emotional support). ...
Article
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The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.
... psichico del soggetto colpito, ma nel caso della pandemia anche del sistema di relazioni tra individui nella comunità. La connessione, l'incontro reciproco dello sguardo sono indispensabili per la sopravvivenza psichica: lo sguardo empatico della madre responsiva di cui parla Winnicott [10] ne è il paradigma e sta alla base dei meccanismi di regolazione emotiva, come ci ricorda Provenzi richiamando l'esperimento dello still face di Tronik [11]. La barriera relazionale che disconnette le persone annulla le possibilità di empatia e, nell'esercizio delle professioni di cura, la connessione emotiva con quello che si fa con l'altro: senza empatia curare diventa solo un atto tecnico e favorisce il meccanismo di reificazione dell'identità del paziente in una diagnosi e un processo di deumanizzazione (come vedremo oltre). ...
Article
The pandemic represents a stress test for a community and its health services. For NICU for example a there has been a widespread withdrawal towards parental closures, in contrast with the available guidelines and despite the consolidated evidence regarding the health outcomes of their role as caregivers. The different choices of the various working groups can be explained by the different abilities to deal with internal emotional disturbances, to the extent of the solidity of the process of construction and deep interiorization of inclusive care models. The main psychological dynamics revealed and emphasized by the pandemic are analyzed, in particular the defensive detachment from emotionally involving relationships, and how individual emotional responses find resonance in organizational structures, working groups, services and in various institutional levels. Understanding which elements the resilient and non-regressive responses to collective trauma in emergencies rest on, allows us to identify which paths must be activated to re-establish constructive bonds between professionals and with the “caregiver” parents, strengthening group cohesion towards the primary goal of care.
... The Central Bureau of Statistics in Israel (2020) reports that 19 percent of people ages 21 and up reported feeling depressed in November 2020 as opposed to 16 per cent in April 2020. A survey conducted in Israel around the same time as the present study related loneliness and pre-existing chronic illness to high levels of distress (Horesh, Kapel Lev-Ari, & Hasson-Ohayon, 2020) and found that disconnection and isolation significantly contributed to the former (Provenzi & Tronick, 2020). In addition, the pandemic has also led to anger, lack of trust, misunderstanding, stigma, unemployment and poverty. ...
Article
This study looks at 102 images made by women in the month of April 2020 at the time of COVID-19 and during the first lockdown in Israel. Submissions were anonymous and participants were asked to write a few words of description alongside their images. The data collected was analyzed by thematic analysis approach. Four major themes were revealed: Art making for self-regulation, artmaking as embodying and containing mental states and emotional expression, art as enabling creativity, imagination, experimentation and play and art making as related to time. The art making in this study pointed to the mental processes of the contributors as well as to the role that art played.
... As suggested by Provenzi and Tronick (2020), the evidence obtained from the research should be used to generate strategies promoting psychological reparation and reduce the generated damage, mainly social disconnection during the pandemic. The present results, as well as previous studies (e.g., Roos et al., 2021), evidence the need to generate psychosocial intervention strategies to support parents during and after the pandemic. ...
Article
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Since the onset of the COVID-19 pandemic, many parents have felt anxious, overwhelmed, and stressed out due to the changes in education and family and working routines. This work aimed to (a) describe three dimensions of perceived parenting (positive parenting, parenting stress, and parental school support) in the COVID-19 pandemic context, (b) describe possible changes perceived by mothers in their children’s behavior during the social isolation phase, (c) analyze if behavioral changes vary according to the dimension of perceived parenting, and (d) analyze whether the characteristics of perceived parenting dimensions vary with mother’s age, number of children and number of work hours. The purposive sample consisted of 646 mothers of school-aged children in Argentina. Questionnaires on sociodemographic and work-related data, and on children’s behavior were administered, as well as an instrument (Vargas Rubilar et al., 2021) that assessed the three parenting dimensions (positive parenting, parenting stress, and parent-school support). The sociodemographic and work-related variables of the study were described using descriptive statistics: measures of central tendency, frequencies, and percentages. The changes perceived in children’s behavior according to the reports given by the mothers regarding positive parenting, parenting stress, and school support were compared using the Mann Whitney’s U test, respecting the qualitative nature of the evaluated indicators. A factorial MANOVA was conducted to analyze the effect of mother’s age, ä number of children, and the number of work hours on parenting perceived by mothers. Parenting dimensions influenced the perceived children’s behavior. Mothers with higher positive parenting perceived more changes in their children’s behavior. In addition, those mothers who were more stressed out perceived more problems in almost all the measured behaviors than less stressed mothers. The mothers who reported to have provided more school support to their children perceived that they adapted better to online classes. Finally, mothers’ age and the number of children I parenting, particularly on parenting stress and school support, whereas work hours did not. A number of children affected stress and school support, and age only affected parenting stress. The only significant interaction regarding parenting was observed between the number of children and the number of work hours, which specifically affected parenting stress. Although social isolation due to COVID-19 affected children’s behavior, according to mothers, this might be partially linked to the number of children, mothers’ age, and the mothers’ parenting style. These initial findings may allow the identification of some protective factors and some risk factors of parenting in the Argentine context of a pandemic, and the design of preventive psychoeducational interventions to optimize the psychological wellbeing of families.
... Although extensive research provided evidence of the short-term and long-lasting effects of maternal prenatal stress on infants' developmental outcomes, there is a paucity of studies on the effects of pandemic-related prenatal stress on infants' temperament. As the present COVID-19 healthcare emergency should be considered as a global traumatic experience (Masiero, Mazzocco, Harnois, Cropley, & Pravettoni, 2020;Provenzi & Tronick, 2020), efforts should be dedicated to evaluating the potential indirect effects of pandemic-related prenatal stress on infants' development. The present healthcare emergency is a quasi-experimental condition suitable to study prospectively the short-and long-term effects of prenatal maternal stress in a community sample of low-risk women. ...
Article
The COVID-19 pandemic is a global traumatic experience for citizens, especially during sensitive time windows of heightened plasticity such as pregnancy and neonatal life. Pandemic-related stress experienced by mothers during pregnancy may act as an early risk factor for infants' regulatory capacity development by altering maternal psychosocial well-being (e.g., increased anxiety, reduced social support) and caregiving environment (e.g., greater parenting stress, impaired mother-infant bonding). The aim of the present longitudinal study was to assess the consequences of pandemic-related prenatal stress on infants' regulatory capacity. A sample of 163 mother-infant dyads was enrolled at eight maternity units in northern Italy. They provided complete data about prenatal stress, perceived social support, postnatal anxiety symptoms, parenting stress, mother-infant bonding, and infants' regulatory capacity at 3 months of age. Women who experienced emotional stress and received partial social support during pregnancy reported higher anxious symptoms. Moreover, maternal postnatal anxiety was indirectly linked to the infants' regulatory capacity at 3 months, mediated by parenting stress and mother-infant bonding. Dedicated preventive interventions should be delivered to mothers and should be focused on protecting the mother-infant dyad from the detrimental effects of pandemic-related stress during the COVID-19 healthcare emergency.
... I genitori che hanno preso parte al programma di tele-riabilitazione EnFORCE hanno riportato una valutazione positiva dell'intervento erogato da remoto, con benefici sia per i figli che per sé stessi, e limitati aspetti critici. Questi risultati preliminari sono coerenti con le precedenti ricerche che suggerivano che le soluzioni di tele-riabilitazione rivolte a bambini con disabilità possono essere vantaggiose in condizioni di emergenza Provenzi e Tronick, 2020). Nel presente studio non sono stati confrontati i benefici percepiti della tele-riabilitazione e delle tradizionali sedute presso l'ospedale, tuttavia, i benefici del programma di tele-riabilitazione sembrano essere più rilevanti per la continuità delle cure, piuttosto che per l'eventuale maggior efficacia rispetto alle sessioni in presenza. ...
Article
Full-text available
Il presente articolo presenta due studi riguardanti l’esperienza di lockdown durante l’emer- genza Covid-19 in genitori di bambini con disabilità. Il primo studio ha indagato, tramite un que- stionario online, l’impatto dell’emergenza sanitaria e dell’interruzione dei servizi di riabilitazione sul benessere di 84 caregiver. Le preoccupazioni per il bambino in seguito all’interruzione dei servizi ambulatoriali sono emerse come una delle maggiori problematiche affrontate dai caregiver ed erano significativamente associate ai loro livelli di stress genitoriale, ansia e depressione. Il secondo studio ha raccolto la valutazione di 36 genitori sull’esperienza del programma di tele- riabilitazione EnFORCE. I genitori hanno riportato benefici sia per i propri figli che per sé e limitate criticità tecniche nell’uso della tele-riabilitazione. Queste famiglie dovrebbero essere considerate come una popolazione ad alto rischio e l’investimento su programmi di tele-riabilitazione può ga- rantire loro continuità di cura e assistenza.
... After all, it is in the reciprocal and mutual exchange of affective states that happen within the parent-child relationship, that children can develop appropriate and successful emotional regulation strategies and resilience to stress (28). Parents who are able to be in deep touch with their affective inner world, validating not only their positive emotional states but even depressive and anxious ones, can provide regulatory support and help their children deal with similar feelings, co-constructing with them instruments capable of adaptive emotional regulation (5). In other words, parents who let themselves express their real emotions will also grant the same permission to their young children. ...
Chapter
Autism is many things to many people. To a psychologist offering an evaluation, it could be a mere “diagnosis” or client referral. To a parent “autism” could be a story of tremendous loss, and grief, or joy; love, and lifetime happiness—or sorrow. To the general public, it could a mystery, and to the untrained eye a threat. Autistic people are only full of love and maybe missing social or communicational skills. Hence, communicating may bring stress to them, to their families, friends, colleagues, teachers, and doctors among others. Parental stress is a condition all too familiar and depending on the severity of the autistic characteristics it can accumulate through time. Parents in various countries experience stress in similar ways. Research and best practices so as to improve the quality of life are discussed.
Article
Zombie films and shows have accelerated in popularity through the decades, and the genre is produced the world over. The Walking Dead, one such show, has been rated among the most popular cable network television programs since its inception. When watching a herd of zombie walkers, the viewer faces some important questions. In some ways, many can identify with the experience of the zombie, as it reflects the psychological state of inner deadness. The psychodynamic literature has a rich history describing this experience. A review of these ideas and the metaphor of the zombie help guide us in the treatment of our patients who do not experience themselves as truly living. The Walking Dead also provides a glimpse into the response of detachment to a viral pandemic, and how we might discover our best self during such times while helping our patients to do the same.
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The COVID-19 pandemic is a collective trauma that is threatening citizens’ mental health resulting in increased emotional stress, reduced social support, and heightened risk for affective symptoms. The present study aimed to investigate the effects of antenatal pandemic-related emotional stress and perceived social support on the symptoms of depression and anxiety of mothers who were pregnant during the initial COVID-19 outbreak in northern Italy. A sample of 281 mothers was enrolled at eight maternity units in the first hotspot region of the COVID-19 outbreak in northern Italy. Participants filled out online questionnaires assessing the direct or indirect exposure to the SARS-CoV-2 virus, pandemic-related stress, perceived social support, as well as symptoms of depression and anxiety. Depressive and anxious symptomatology was above clinical concern, respectively, in 26 and 32% of the respondents. Mothers who reported no exposure to SARS-CoV-2 during pregnancy and those who reported at least one direct or indirect exposure did not differ in terms of affective symptoms. Continuous scores and risk for severe depression and anxiety were positively associated with prenatal pandemic- related emotional stress and negatively linked with perceived social support during pregnancy. Women who become mothers during the COVID-19 emergency may be at high risk for affective problems. Dedicated preventive programs are needed to provide adequate preventive support and care for maternal mental health during and after the COVID-19 pandemic.
Article
Numerose ricerche sugli effetti della pandemia da COVID-19 su famiglie e bambini si sono focalizzate sul periodo del lockdown, evidenziando importanti conseguenze disadattive, mentre minori sono i dati sulle fasi successive, analizzate invece nel nostro studio attraverso un questionario online compilato da 945 genitori di bambini in età prescolare. L'analisi dei dati evidenzia un aumento delle problematiche emotive e comportamentali dei bambini durante il lockdown, e un decremento nei mesi successivi, ma con consistenti strascichi dei sintomi, che permangono più alti rispetto alla fase non emergenziale, con differenze associate a genere ed età dei bambini, clima familiare e vissuti emotivi genitoriali. È, dunque, fondamentale intervenire per ridurre i fattori di rischio attraverso la presa in carico delle vulnerabilità del sistema familiare e promuovere strategie di resilienza.
Article
Background: The spread of SARS-CoV-2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use and treatment adherence among people living with HIV (PLWH) in Argentina. Setting: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. Methods: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. Results: 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321)=8.86, p=.003 and loneliness ΔF(1,1326)=5.77, p=.016 was buffered by resilience. A three-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325)=4.76, p=.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. Discussion: The impact of COVID-stress and lockdown on emotional distress appeared mitigated by resilience coping strategies and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.
Article
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Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter of a century. Although the focus of research has been on objective social roles and health behavior, the brain is the key organ for forming, monitoring, maintaining, repairing, and replacing salutary connections with others. Accordingly, population-based longitudinal research indicates that perceived social isolation (loneliness) is a risk factor for morbidity and mortality independent of objective social isolation and health behavior. Human and animal investigations of neuroendocrine stress mechanisms that may be involved suggest that (a) chronic social isolation increases the activation of the hypothalamic pituitary adrenocortical axis, and (b) these effects are more dependent on the disruption of a social bond between a significant pair than objective isolation per se. The relational factors and neuroendocrine, neurobiological, and genetic mechanisms that may contribute to the association between perceived isolation and mortality are reviewed. Expected final online publication date for the Annual Review of Psychology Volume 66 is November 30, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Article
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A microanalysis of 4-month mother-infant face-to-face communication revealed a fine-grained specification of communication processes that predicted 12-month insecure attachment outcomes, particularly resistant and disorganized classifications. An urban community sample of 84 dyads were videotaped at 4 months during a face-to-face interaction, and at 12 months during the Ainsworth Strange Situation. Four-month mother and infant communication modalities of attention, affect, touch, and spatial orientation were coded from split-screen videotape on a 1 s time base; mother and infant facial-visual "engagement" variables were constructed. We used contingency measures (multi-level time-series modeling) to examine the dyadic temporal process over time, and specific rates of qualitative features of behavior to examine the content of behavior. Self-contingency (auto-correlation) measured the degree of stability/lability within an individual's own rhythms of behavior; interactive contingency (lagged cross-correlation) measured adjustments of the individual's behavior that were correlated with the partner's previous behavior. We documented that both self- and interactive contingency, as well as specific qualitative features, of mother and infant behavior were mechanisms of attachment formation by 4 months, distinguishing 12-month insecure, resistant, and disorganized attachment classifications from secure; avoidant were too few to test. All communication modalities made unique contributions. The separate analysis of different communication modalities identified intermodal discrepancies or conflict, both intrapersonal and interpersonal, that characterized insecure dyads. Contrary to dominant theories in the literature on face-to-face interaction, measures of maternal contingent coordination with infant yielded the fewest associations with 12-month attachment, whereas mother and infant self-contingency, and infant contingent coordination with mother, yielded comparable numbers of findings. Rather than the more usual hypothesis that more contingency is "better," we partially supported our hypothesis that 12-month insecurity is associated with both higher and lower 4-month self- and interactive contingency values than secure, as a function of mother vs. infant and communication modality. Thus, in the origins of attachment security, more contingency is not necessarily better. A remarkable degree of differentiation was identified in the 4-month patterns of "future" C and D infants, classified as resistant and disorganized, respectively, at 12 months. The central feature of future C dyads was dysregulated tactile and spatial exchanges, generating approach-withdrawal patterns. The intact maternal contingent coordination overall safeguards the future C infant's interactive agency. However, future C infants likely come to expect maternal spatial/tactile impingement, and to expect to "dodge" as mothers "chase." They managed maternal touch by tuning it out, sacrificing their ability to communicate about maternal touch. They "approached" by vigilantly coordinating their facial-visual engagement with maternal facial-visual engagement, but they "withdrew" by inhibiting their facial-visual engagement coordination with maternal touch. We proposed that future C infants will have difficulty feeling sensed and known during maternal spatial/tactile impingements. The central feature of future D dyads is intrapersonal and interpersonal discordance or conflict in the context of intensely distressed infants. Lowered maternal contingent coordination, and failures of maternal affective correspondence, constituted maternal emotional withdrawal from distressed infants, compromising infant interactive agency and emotional coherence. The level of dysregulation in future D dyads was thus of an entirely different order than that of future C dyads. We proposed that the future D infant represents not being sensed and known by the mother, particularly in states of distress. We proposed that the emerging internal working model of future D infants includes confusion about their own basic emotional organization, about their mothers' emotional organization, and about their mothers' response to their distress, setting a trajectory in development which may disturb the fundamental integration of the person. The findings have rich implications for clinical intervention, with remarkable specificity for different kinds of mother and infant distress. Heightened and lowered self- and interactive contingency, in different modalities, as well as the specific behavioral qualities identified, provide a more differentiated set of concepts to guide clinical intervention.
Article
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We describe an evidence-based approach to enhancing the resilience of healthcare workers in preparation for an influenza pandemic, based on evidence about the stress associated with working in healthcare during the SARS outbreak. SARS was associated with significant long-term stress in healthcare workers, but not with increased mental illness. Reducing pandemic-related stress may best be accomplished through interventions designed to enhance resilience in psychologically healthy people. Applicable models to improve adaptation in individuals include Folkman and Greer's framework for stress appraisal and coping along with psychological first aid. Resilience is supported at an organizational level by effective training and support, development of material and relational reserves, effective leadership, the effects of the characteristics of "magnet hospitals," and a culture of organizational justice. Evidence supports the goal of developing and maintaining an organizational culture of resilience in order to reduce the expected stress of an influenza pandemic on healthcare workers. This recommendation goes well beyond the provision of adequate training and counseling. Although the severity of a pandemic is unpredictable, this effort is not likely to be wasted because it will also support the health of both patients and staff in normal times.
Article
Background: During the last decades, the research on mother-infant dyad has produced a great amount of data, methods and theories, which largely contributed to set a revolution in the way we look at developmental changes during infancy and childhood. Very different constructs depict the different aspects of the “dyadic dance” occurring between a mother and her infant; nonetheless, a comprehensive and consistent systematization of these concepts in a coherent theoretical landscape is still lacking. Aim: In the present work, we aim at disentangling the different theoretical and methodological definitions of 9 dyadic constructs and we highlight their effects on infants' and children developmental outcomes. Methods: A literature search has been conducted on three databases—PubMed, Scopus, Web of Science. Three different reviews are reported here: (1) a review on the theoretical definitions of dyadic constructs; (2) a review of operational definitions, settings and methods of dyadic processes; (3) a systematic review of dyadic processes' outcomes for infants' and children developmental trajectories. Results: Two constructs emerged as wide meta-theoretical concepts (reciprocity and mutuality) and seven described specific processes (attunement, contingency, coordination, matching, mirroring, reparation, synchrony). A global model resuming the relationships among different processes is reported, which highlights the emergence of two specific cycles of dyadic functioning (i.e., matching-mismatching-reparation-synchrony; contingency, coordination, attunement, mirroring). A comprehensive review of the adopted measures is also provided. Finally, all the processes provided significant contributions to infants' behavioral, cognitive, and socio-emotional development during the first 3 years of age, but limited research has been conducted on specific processes (e.g. reparation and mirroring). Conclusion: The present study provides an original research-grounded framework to consider the different nature of mother-infant dyadic processes within a unified dyadic eco-system. Different levels of evidence emerged for the role of diverse mother-infant dyadic processes on infants' and children development. Open questions and future research directions are highlighted.
Article
Infants must be seen as a component of a dyadic – a two-part – communicative system in which the infant and adult mutually regulate and scaffold their engagements with each other and with the world of things. In interactions they communicate their individual needs, intentions, and meaning about themselves in the world and in relation to the other; they respond to each other's meanings. In this view, generally referred to as the Mutual Regulation Model (MRM), infants have the capacity to express their sense of themselves in the world and the capacity to respond to the expressed needs and intentions of the other person. The MRM operates in a messy reparatory manner with both positive and negative effects related to its successful function. A critical addition to the MRM, the buffer-transducer model (BTM) of the dyad, is presented. The BTM attempts to understand the effects of events, including micro and macro events as well as trauma, that either enhance or deplete and divert the needed resources of the infant for growth and development.
Article
The Face-to-Face Still-Face (FFSF) paradigm is a widely adopted experimental procedure to assess infants' response to socio-emotional stress during the first months of life. Previous reviews demonstrated that this procedure elicits specific behavioral responses, including an increase in negative emotionality and gaze aversion as well as a decrease in positive emotionality and social engagement. Infants also give evidence of hypothalamic-pituitary-adrenal (HPA) axis reactivity to the FFSF. Unfortunately, previous studies reported inconsistencies in the association between the exposure to the FFSF paradigm and HPA activation during the first months of life. In this paper, the HPA axis correlates of FFSF stress regulation were examined through a narrative review and a meta-analysis. A literature search was conducted on three databases (i.e., Scopus, Web of Science, PubMed) and led to 17 studies included in the review and 10 included in the meta-analysis. The findings suggested that infants tend to show a clearly observable activation of the HPA axis in response to the socio-emotional stress elicited by the FFSF paradigm, although considerable variation in methodology and sample characteristics was documented. A five-episode repeated-exposure version of the FFSF procedure emerged as a more suitable procedure to elicit a significant neuroendocrine response. In summary, the FFSF appears to elicit HPA axis activation in response to socio-emotional stress, but only in specific contextual conditions. As such, open questions remain and require continuity in FFSF research efforts.
Article
The study of infants' interactive style and social stress response to repeated stress exposures is of great interest for developmental and clinical psychologists. Stable maternal and dyadic behavior is critical to sustain infants' development of an adaptive social stress response, but the association between infants' interactive style and social stress response has received scant attention in previous literature. In the present article, overtime stability of infant, maternal, and dyadic behaviors was measured across 2 social stress (i.e., Face-to-Face Still-Face, FFSF) exposures, separated by 15 days. Moreover, infant, maternal, and dyadic behaviors were simultaneously assessed as predictors of infants' social stress to both FFSF exposures. Eighty-one mother-infant dyads underwent the FFSF twice, at 6 months (Exposure 1: the first social stress) and at 6 months and 15 days (Exposure 2: repeated social stress). Infant and mother behavior and dyadic synchrony were microanalytically coded. Overall, individual behavioral stability emerged between FFSF exposures. Infants' response to the first stress was predicted by infant behavior during Exposure 1 Play. Infants' response to the repeated social stress was predicted by infants' response to the first exposure to the Still-Face and by infants' behavior and dyadic synchrony during Exposure 2 Play. Findings reveal stability for individual, but not for dyadic, behavior between 2 social stress exposures at 6 months. Infants' response to repeated social stress was predicted by infants' earlier stress response, infants' own behavior in play, and dyadic synchrony. No predictive effects of maternal behavior were found. Insights for research and clinical work are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
Article
Background: The latency to reparation of interactive mismatches (interactive repair) is argued to regulate infant distress on a psychobiological level, and maternal anxiety disorders might impair infant regulation. Sampling and methods: A total of 46 dyads (19 mothers with an anxiety disorder, 27 controls) were analyzed for associations between interactive repair and infant cortisol reactivity during the Face-to-Face-Still-Face paradigm 3-4 months postpartum. Missing cortisol values (n = 16) were imputed. Analyses were conducted on both the original and the pooled imputed data. Results: Interactive repair during the reunion episode was associated with infant cortisol reactivity (original data: p < 0.01; pooled data: p < 0.01) but not maternal anxiety disorder (p > 0.23). Additional stepwise regression analyses found that latency to repair during play (p < 0.01), an interaction between distress during the first trimester of pregnancy and latency to repair during reunion (p < 0.01) and infant self-comforting behaviors during the reunion episode (p = 0.04) made independent contributions to cortisol reactivity in the final regression model. Conclusions: This is the first study demonstrating that interactive repair is related to infant psychobiological stress reactivity. The lack of a relation to maternal anxiety disorder may be due to the small sample size. However, this result emphasizes that infants respond to what they experience and not to the maternal diagnostic category.
Article
Resilience is often associated with extreme trauma or overcoming extraordinary odds. This way of thinking about resilience leaves most of the ontogenetic picture a mystery. In the following review we put forth the Everyday Stress Resilience Hypothesis, in which resilience is analysed from a systems perspective and seen as a process of regulating everyday life stressors. Successful regulation accumulates into regulatory resilience, which emerges during early development from successful coping with the inherent stress in typical interactions. These quotidian stressful events lead to activation of behavioural and physiological systems. Stress that is effectively resolved in the short run and with reiteration over the long term increases children’s, as well as adults’, capacity to cope with more intense stressors. Infants, however, lack the regulatory capacities to take on this task by themselves. Therefore, through communicative and regulatory processes during infant–adult interactions, we demonstrate that the roots of regulatory resilience originate in infants’ relationships with their care givers and that maternal sensitivity can help or hinder the growth of resilience.
Article
When faced by a suddenly unresponsive social partner, young infants typically react by sobering and gazing away. This still-face reaction has intrigued researchers for several decades. In this article, we present a history of the still-face paradigm in which we locate early observations of the still-face effect, describe the formalization of a procedure that reliably produces it, and discuss how this procedure has been used to investigate a broad range of questions about early social and emotional development. In addition, we reflect on the heuristic value of shared experimental paradigms.
Article
The Still-Face Paradigm (SFP) designed by Tronick, Als, Adamson, Wise, and Brazelton (Tronick, E., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). Infants response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child and Adolescent Psychiatry, 17, 1–13) has been used for many different purposes in over 80 empirical studies. In the current paper, the nature and correlates of infant behavior in the SFP were examined in a systematic narrative review and a series of meta-analyses. The results of the meta-analyses confirmed the classic still-face effect of reduced positive affect and gaze, and increased negative affect, as well as a partial carry-over effect into the reunion episode consisting of lower positive and higher negative affect compared to baseline. The still-face effect is very robust as it was found regardless of most sample variations such as infant gender and risk status, and regardless of most procedural variations, such as the length of the SFP episodes and the use of intervals between episodes. The few moderator effects that were found in the meta-analyses tended to put findings from the narrative review in a new perspective. Additional meta-analyses confirmed the narrative review in finding that higher maternal sensitivity predicted more infant positive affect during the still-face. Infants’ higher positive affect and lower negative affect during the still-face were predictive of secure attachment at age 1 year. The meta-analytic results for maternal depression were equivocal. Implications for future research include a need for studies testing the role of the adults’ identity (parent versus stranger, mother versus father) to elucidate the relationship-specificity of the still-face effect. Also, the role of maternal sensitivity and temperament as potential moderators of the still-face effect need to be examined further. On a procedural level, the effects of the timing of the still-face and of the duration of the reunion on infant responses deserve future research attention.
Article
Social species, from Drosophila melanogaster to Homo sapiens, fare poorly when isolated. Homo sapiens, an irrepressibly meaning-making species, are, in normal circumstances, dramatically affected by perceived social isolation. Research indicates that perceived social isolation (i.e. loneliness) is a risk factor for, and may contribute to, poorer overall cognitive performance, faster cognitive decline, poorer executive functioning, increased negativity and depressive cognition, heightened sensitivity to social threats, a confirmatory bias in social cognition that is self-protective and paradoxically self-defeating, heightened anthropomorphism and contagion that threatens social cohesion. These differences in attention and cognition impact on emotions, decisions, behaviors and interpersonal interactions that can contribute to the association between loneliness and cognitive decline and between loneliness and morbidity more generally.
Article
The hypothesis is advanced that behavioral and physiologic resilience develops in part from infants' and young children's experience coping with the inherent normal stress of daily life and social interaction. Data on the stress of normal social interactions and perturbated interactions from the Face-to-Face Still-Face Paradigm (FFSF) are presented for young infants. These findings, including behavioral, heart rate and vagal tone, and electrodermal reactivity demonstrate the stress inherent in normal interaction and how coping with normal stress develops infants' coping with more intense environmental and social stressors.
How will country-based mitigation measures influence the course of the COVID-19 epidemic?
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