Dottorato in PSICOLOGIA DINAMICA E CLINICA

Titolo della tesi: EFFICACIA E CORRELATI EPIGENETICI DEGLI INTERVENTI PSICOLOGICI IN DIVERSI CONTESTI: TRE METANALISI CON REVISIONI SISTEMATICHE

Objective: The purpose of the work is to define and identify, through meta-analysis and systematic reviews, the most effective psychological intervention on traumatic events in the context of migration, in the context of organ transplantation and in the context of epigenetic mechanisms on the lines of bringing a more "contextual" mentality in the implementation of interventions for health and psychological well-being within the contexts of higher density of individuals. Method: All meta-analyses and systematic reviews submitted in this work adhere to the PRISMA guidelines, to Cochrane and New Castle Ottawa bias scales and GRADE assessment guidelines, and their protocols are systematized in PROSPERO. Both randomized and observational research designs are taken into consideration and are subjected to meta-analysis and systematic review according to a perspective of statistical analysis of both quantitative and qualitative type. The papers included collect from a minimum of 14 studies to a maximum of 52 studies. Results: Regarding Migrants, all treatments reported significant effects on depression, anxiety, and somatization, and the cognitive-behavioral treatment appeared to be the most effective intervention. Refugee status versus asylum seeker status appears to have a large effect on treatment effectiveness. Regarding the organ transplant setting, the main findings showed that psychosocial interventions were effective on depression and anxiety in kidney recipients and anxiety in heart recipients, mainly when administered after surgery and that dynamic therapies were the most effective in the observational studies. In addition, the results showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning. With respect to the contest of epigenetic changes, the results showed that, subjects who responded to therapy were associated with specific hypo- or hypermethylation, and that in subjects who did not respond to therapy it was associated in an opposite way. Meta-analysis showed significant hypermethylation of the MAOA gene after cognitive-behavioral symptom-focusing therapy only in participants with anxiety. Discussion and Conclusions: An analytical synthesis of the various results shows that the most investigated outcomes, in all works, were depression and anxiety and that the cognitive behavioral treatment seemed to be the intervention of choice applied and studied in most settings. This work could be a precious contribution in practice especially because it raises questions to be explored in future research. Future perspectives could focus on deepening the application of psychotherapies in asylum seekers, with regard to the migratory context; on deepening the adherence to treatment and the functionality of transplanted solid organs, for surgery contexts. It would be interesting, moreover, to examine the epigenetic effects after the application of other psychotherapies in addition to cognitive-behavioral treatments, and finally, to increase the use and application of dynamic psychotherapies in more contexts in order to verify their actual effectiveness.