Problems of Psychology in The 21st Century, Vol. 16, No. 1, 2022

Problems of Psychology in the 21st Century, Vol. 16, No.
1, 2022
ISSN 2029-8587 (Print) ISSN 2538-7197 (Online)
PROBLEMS OF
PSYCHOLOGY
IN THE 21ST
CENTURY
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Scientia Socialis Ltd. in cooperation with Scientific Methodical Center „Scientia Educologica“,
Lithuania, the Associated Member of Lithuanian Scientific Society, the Association of Lithuanian
Serials, European Society for the History of Science (ESHS) and International Council of Associations
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Editor-in-Chief
Dr., prof. Vincentas Lamanauskas, Vilnius University & SMC „Scientia Educologica“, Republic
of Lithuania
Deputy Editor-in-Chief
Dr., prof. Sergii Boltivets, Grigory Kostyuk Psychological Institute of the Ukrainian National Academy
of Pedagogical Sciences, Ukraine
Editors
Dr., prof. Ferda Aysan, Dokuz Eylul University, Turkey
Dr., assoc. prof. Maria Annarumma, University of Salerno, Italy
Dr. Sefa Bulut, Abant Izzet Baysal University, Turkey
Dr. Vaitsa Giannouli, Aristotle University of Thessaloniki, Greece
Dr., prof. Irakli Imedadze, Dimitri Uznadze Georgian Psychological National Society, Georgia
Dr. Julia Lakhvich, Belarusian State University, Republic of Belarus
Dr., prof. Vladimir S. Karapetyan, Armenian State Pedagogical University named after Kh. Abovyan,
Armenia
Dr. Charles Kimamo, University of Nairobi, Kenya
Dr., assoc. prof. Vadim N. Kolesnikov, Petrozavodsk State University, Republic of Karelia, Russia
Dr., prof. Mary Anne Lauri, University of Malta, Malta
Dr., prof. Maria Ledzińska, University of Warsaw, Poland
Dr., prof. Aleksandr Lobanov, Belarusian State Pedagogical University, Republic of Belarus
Dr., assoc. prof. Tetiana M. Shyriaieva, National University of Ostroh Academy, Ukraine
Dr., assoc. prof. Stanislava Yordanova Stoyanova, South-West University “Neofit Rilski”, Bulgaria
Dr., prof. Guna Svence, University of Latvia, Latvia
MSc. Dennis Relojo, Psychreg, United Kingdom
Dr., assoc. prof. Yolanda Zografova, Institute for Population and Human Studies, Bulgarian Academy
of Sciences, Bulgaria
Copyright of this issue is the property of Scientia Socialis Ltd., Lithuania. By virtue of their appearance
in this open access journal, articles are free to use, with proper attribution, in educational and other
non-commercial settings.
Index Copernicus (IC™ Value): 100.00 (2020).

ICDS (Secondary Composite Index Broadcasting): 3.8
CGIJ OAJI: 0.201
Problems of Psychology in the 21st Century is an international, periodical, peer reviewed scientific
journal, issued by the Scientia Socialis Ltd. in cooperation with SMC „Scientia Educologica“.
PPC is an open access journal. DOI prefix: 10.33225/ppc
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ISSN 2029-8587 (Print)
ISSN 2538-7197 (Online)
PROBLEMS
OF PSYCHOLOGY
IN THE 21st CENTURY
Vol. 16, No. 1, 2022
Contents
Editorial
HOW TO BE A DIGITALLY SAVVY RESEARCHER . . . . . . . . . . . . . . . . . . . . 4

Dennis Relojo-Howell
Articles
CLINICAL DIFFERENCES IN MANIFESTATIONS OF SELF-DESTRUCTIVE BEHAVIOR IN

PATIENTS WITH SCHIZOPHRENIA SPECTRUM PSYCHOTIC DISORDERS . . . . . . . . 11
Oleksandr Bashynskyi
TO BE YOUNG, ALIENATED AND UNEMPLOYED: SOCIAL IDENTITY, ATTITUDES AND

WELL-BEING OF GEORGIA’S NEET YOUTH . . . . . . . . . . . . . . . . . . . . . . 20
Anastasia Kitiashvili, Tamar Abashidze, Irine Zhvania
MISOPHONIA: SYMPTOMS, COMORBIDITIES AND PERSPECTIVES OF

INTERVENTION. FROM THEORY APPROACH TO INTEGRATED CLINICAL
PRACTICE RESEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Zachary M. Rosenthal, Maria Annarumma, Francesco Sessa, Iris Consalvo, Valerio De Masi, Luana Pagano
Information
INSTRUCTIONS FOR AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
JOURNAL OF BALTIC SCIENCE EDUCATION . . . . . . . . . . . . . . . . . . . . . . 51

PROBLEMS https://doi.org/10.33225/ppc/22.16.04
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Vol. 16, No. 1, 2022
This is an open access article under the
4 Creative Commons Attribution 4.0
International License
HOW TO BE A DIGITALLY SAVVY

RESEARCHER
Dennis Relojo-Howell
Psychreg, United Kingdom
E-mail: dennis@psychreg.org
It is easier than ever for researchers to disseminate and report their findings once the job of
collecting data and formulating a conclusion is complete. The process of research, scholarship,
and publication is central to higher education (Mason et al., 2021). However, the existing model of
research dissemination is far from adequate, as it does not meet the demands of the more competi-
tive side of academia; journal publications and conference participation are no longer sufficient to
build and establish professional reputations (Relojo-Howell, 2021a). Both your academic colleagues
and the broader lay audience of those seeking to learn more about your specific area of study now
have significantly more tools at their disposal to find the information they are looking for. As a
result, researchers need to work harder at establishing themselves as respected professionals in their
respective fields through a broader range of networking activities, including creating an online
presence where their work can be found quickly and efficiently.
Getting Started
Often, those that have dedicated their lives to scholarly endeavours spend years laser-focused
on furthering their education and conducting arduous research projects to establish themselves
as an expert in their field (Relojo & Pilao, 2018). This often comes at the expense of learning other
essential skills and processes that are necessary to further one’s career. Once all of the work of ob-
taining an advanced degree is complete, it may be time to learn other necessary tools of the trade
that will ensure that your work and level of expertise are as visible as possible to others. The social
media platforms that have emerged over the past decade have changed how we all communicate
and have also expanded how students, staff and faculty learn, interact, teach, and conduct research.
Undoubtedly, the trend towards a largely digital life has also affected our professional lives, par-
ticularly for those working in higher education (Kuha et al., 2018). In essence, the way you portray
yourself digitally is likely how you will be viewed professionally within the academic community
(Jensen Schau & Gilly, 2003).
Expand Your Online Presence
Making an effort to expand your academic online presence means taking the time and effort
to learn how to connect and engage professionally with the online community of students and
Dennis RELOJO-HOWELL. How to be a digitally savvy researcher ISSN 2538-7197 (Online)
https://doi.org/10.33225/ppc/22.16.04 PROBLEMS
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academics in an ever-expanding digital space (Bautista et al., 2018). Let us make sure that you
5
know how to navigate these waters and review the necessary steps to take in digitally establishing
yourself as a savvy scholar.
Create an online home for your professional endeavours with a dedicated website. Establishing
a dedicated academic website of your own is an important and frequently overlooked first step
in starting your path towards a professional online presence (Relojo & Pilao, 2016). Your website
serves as your online home and the central nexus through which all of your other online efforts
should flow. Having a website entirely under your creative control means acquiring a custom URL
address that will serve as a consistent location to which you can refer colleagues and students to
find your work, even if you change institutions. Additionally, your website affords the opportu-
nity to consistently create content in the form of blogposts, which will help harness the power of
search engines so that interested parties can find you and your work more efficiently. An academic
website provides a way for you to thoroughly display your educational background, experience,
and credentials in an organised manner. It also functions as a hub to link to all of the other online
areas where you and your work can be found, including your social media accounts. Developing a
personal academic website is a significant undertaking, but the potential benefits are substantial.
Moreover, it is, perhaps, the best way to manage your online presence on a macro, long-term basis.
Any visitor to your site will have instant access to a plethora of information on your academic career
and accomplishments – all in one central location.
The benefits of a personal academic website include easily displaying the following informa-
tion: (a) educational opportunities for students; (b) links and information on where to find your
research; (c) your publication history, with links to relevant journals; (d) announcements of up-
coming speaking engagements; (e) an updated overview of your professional accomplishments; (f)
contact information; (g) information for current and potential research funders; (h) representative
work for potential publishers; and (i) links to your public social media accounts. Creating a personal
academic website produces a better public understanding of the impact of your work. However, it
will require ongoing effort to maintain the accuracy of the site and consistently update it over the
long-term.
Keep your academic profile on your departmental website up-to-date. The second area of im-
portance is your departmental academic profile. If you are affiliated with an institution of higher
education, you will want to keep all of your credentials and contact information as up-to-date as
possible. You want to link your academic profile to your institutional web presence so your associa-
tion and position at the university are clear, increasing your academic credibility.
Incorporate professional photos. The importance of a professional photo cannot be stressed
enough. This may seem like a minor part of your academic online presence, but remember that
your image is likely to be the first impression anyone will have of you in your digital professional
life. If your profile photo is a low-resolution image and/or is out of focus, it immediately reflects
poorly on you. On the other hand, a high-quality photo in which you are dressed professionally,
demonstrating your academic background, can go a long way in instilling confidence in anyone
that comes across your university, website, or social media profiles.
Taking the time, effort, and money to have professional photos taken is well worth it. If pos-
sible, try to incorporate the same professional photo of yourself across all platforms. This allows
your network to quickly recognise you, regardless of what site they may find you on.
Determine your motivations and find your audience. Determining your goals for your personal
website is a vital step before furthering your efforts to establish your digital presence and expand
your network.
Are you focused on bringing more awareness to your publications? Or, is your purpose for
expanding your digital presence and network to communicate more effectively with students and
other professionals in your field? In particular, your goals will determine where and how you be-
come involved in social media. First, decide what goals you want to achieve and how you want to
portray yourself digitally. Then, most importantly, try to remain consistent with how you represent
yourself across all platforms you decide to be active in.
ISSN 2538-7197 (Online) Dennis RELOJO-HOWELL. How to be a digitally savvy researcher
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Focus on Networking
6
Once you are armed with the tools to build the foundation of an online academic presence,
turn your attention to taking things a step further to expand the visibility of your scholarly back-
ground through networking.
Networking through academic and traditional social media platforms is now an essential
task for academics. It is a vital component in ensuring that your work is out there and available to
anyone looking for it. Networking has always played an important role in business – and academia
is no different. Researchers need to make strong connections to facilitate knowledge exchange.
There will come a time when you need a trusted confidant to review your research findings or
compare your results to theirs. This sharing of ideas and review of results is essential to the scien-
tific, academic process.
Years ago, a simple business card and a contact list would suffice to meet these needs. However,
today, it is rare for our network of contacts to develop solely as a result of in-person meetings at
conferences or presentations. Learning the skills to curate a network of other academics online is
essential to your success in any field of research.
Expand Your Network
Networking breaks down to growing your list of contacts and those you interact with regularly
within a community of like-minded individuals. People you include in your network can be other
professionals you respect, colleagues you work alongside in your research, or those looking to grow
in your field under your mentorship. In each case, you can develop a dedicated following for your
work on any number of networking platforms, both casual and professional.
Additionally, as a researcher, you have a responsibility to disseminate and share your findings.
If your research is interesting, people are going to want to know about it. If you do not take the
time to develop an extensive network, it is unlikely that your research will have the same impact as
it would if you made an effort to ensure that your work reaches as many people as possible. Show-
ing the ability to mobilise a network of contacts willing to collaborate with you in your research
projects can also be a powerful asset for furthering your scholarly career. However, before jumping
directly into academic and social media networking platforms, several other opportunities are
worth consideration.
Consider the following networking methods: (i) join an association or society in your area
of research; (ii) participate in academic conferences; (iii) contribute as a presenter at workshops
or masterclass events; (iv) register for an Open Researcher and Contributor ID. ORCID is an
alphanumeric code uniquely identifying scientific and other academic authors and contributors.
Social Media
Social media has evolved from a way to communicate with friends and family into a power-
ful tool to connect with others in higher education and research. Through networking and social
media, researchers can spread the word about their work to an exponentially more expansive audi-
ence. Each social networking platform operates differently from the rest, and more recently, several
networking ecosystems specifically tailored towards more professional and academic endeavours
have gained traction (Pinto-Coelho & Relojo, 2017). Through these academic social networking
sites, you are more likely to find an audience of individuals that are directly interested in connect-
ing with others within the communities of academic research (Cain, 2008).
Academic Social Networking Sites
•• ResearchGate. ResearchGate was founded in 2008 in Berlin, Germany. ResearchGate

is a commercial social networking site for scientists and researchers to share papers,
ask and answer questions, and find research collaborators. ResearchGate is one of the
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best places to connect and communicate directly with highly educated and respected
7
researchers.
•• Academia.edu. Academia currently has over 1.5 million users and is a free, easy way
to share research papers worldwide (Chavez Valdez et al., 2019; Matthews, 2016).
Studies have shown that papers uploaded to Academia receive a 69% boost in citations
over a five-year period. Suppose you are a researcher with a back catalogue of research
papers. In that case, Academia would be an excellent opportunity to get more eyes on
your work and to find other publications in your area of study.
•• Google Scholar. Google Scholar was launched in 2004 and is a freely-accessible search
engine that indexes the full text and metadata of scholarly literature across multiple
publishing platforms and disciplines.
•• LinkedIn. LinkedIn is perhaps the most well-known professional networking site on
this list. The site went online in 2003 and has become the most popular and most
used site for professional networking and career development (Relojo et al., 2016).
LinkedIn includes features allowing users to submit resumes and list and apply for
job openings. Over the years, the site has expanded to include a community of users
who post primarily on topics related to their profession and connect and collaborate
with others in the field.
These networking sites present an excellent way for academics to connect with a finely-tuned
audience of individuals who are already looking for educational and research-based content. It is
well worth the time and effort to become active in these communities and regularly contribute to
them, as they are held in higher regard in academia. The perception is that users on these sites are
intentionally seeking to connect with people on a professional, rather than a casual, level, resulting
in a more targeted potential audience (Armstrong & McAdams, 2009).
Of course, these facts are not intended to dismiss the merits and usefulness of the more casual
social sites. Despite having a user base with a broader scope of interests, sites like Facebook, Twitter,
and Instagram can be just as effective in expanding your network and disseminating your work
to more and more people. Using strategies like hashtags, groups, and pages, these less-specialised
social media sites can still offer a powerful way to improve your visibility as a scholar.
‘Mass Market’ Social Media Platforms
These social media platforms were initially intended to provide users with an easy way to con-
nect and communicate with friends and family. While this remains a core service of these platforms,
each has also evolved into a viable tool for academics to develop a following on their chosen topic.
Facebook. With over 2.89 billion users, this has emerged as the premier social media platform
and is continuously adding new features to meet the demands of users looking to grow their network
for a variety of reasons (We Are Social, 2021). When considering academic endeavours, Facebook
groups and Facebook pages have become a fantastic way to connect with and provide value to your
audience. A Facebook group is a highly niche, targeted audience based around any topic the group’s
administrator selects. Starting a Facebook group focused on your research is a viable way to grow
your contacts list. Additionally, sharing valuable content to group members through posts or links
to your research, with a call to action to encourage engagement, is a great strategy to get people
talking and interacting with you about your work. Starting a Facebook page centred around your
research is another viable way to engage followers. Additionally, both of these tools are excellent
methods to ensure that people can find you. Facebook and Google are likely two of the first places
people will search for you and your content, and these tools will ensure that your content shows
up in Facebook search results.
Instagram. This site began primarily as an image-sharing social networking site. However,
similar to Facebook, the platform has added several valuable features that are beneficial to net-
working professionals. Instagram has added hashtag functionality to allow users to more easily find
content on common and popular topics and has also put an increased emphasis on video content
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(Na & Kim, 2019). These factors make the site a practical option for sharing your research-based
8
information targeted towards hashtags where you might find your ideal audience.
Twitter. In many ways, Twitter has replaced the morning news in terms of how people consume
information. Twitter may not elicit the same amount of engagement as Facebook or Instagram, but
users are constantly scrolling their Twitter feeds, searching for the latest breaking news on topics
that interest them. News reporters, politicians, and prominent business figures all use Twitter to
quickly and succinctly share information on a plethora of different topics with their followers. With
Twitter, much like Instagram, the key is in the use of hashtags (Bossetta, 2018). So, take some time
to find the hashtags pertinent to your research and academic background and share exciting or
engaging snippets of the latest happenings in your field.
YouTube There is no question that video is an effective means of presenting educational infor-
mation. Although many viewers use YouTube primarily for entertainment purposes, more and more
learners are turning to YouTube for education (Relojo-Howell, 2021b). YouTube is now considered
one of the most used search engines on the internet, coming in second only to Google. Starting a
YouTube channel and publishing content regularly can reach far more people than traditional in-
person, academic presentations (Amarasekara & Grant, 2019). The power of your viewers being
able to hear and see what you have to say cannot be underestimated. The simple fact that you can
amass a large number of subscribers to your channel can lead to millions of views and grow your
academic network at a rapid rate. A YouTube channel is an excellent option for establishing yourself
as a scholarly research expert and a fantastic way to spread your wealth of knowledge much faster
than traditional methods.
Comprehensive Networking Strategy
Considering that your research and academic responsibilities take up a large portion of your
effort and energy, maintaining an online presence and networking can seem like a lot of work.
Of course, it is not necessary to utilise all of these strategies, and you are not required to be on
each of the social media platforms discussed here. A viable strategy may be to start with the basics,
establishing your academic website and ensuring that your institutional, professional profile is up
to date. Then, choose one or two of the social media platforms you enjoy and are most comfortable
with to expand your network and share your work. Each week, set aside time to create content cen-
tred around your research work, and share that content simultaneously across multiple platforms.
Professional Online Behaviour
One area that is not discussed nearly enough is the subject of your online behaviour. We
have spent a lot of time talking about developing your network and creating an online persona
while sharing your work with as many people as possible. These are all positive aspects of social
networking for savvy scholars.
However, we all know that there are times that online interactions can take a negative turn. Of
course, sharing your research and expertise is meant to spark interest and conversation. Nonethe-
less, these conversations can turn into a heated debate with a colleague who may disagree with you.
Alternatively, you may get people you have never met making negative comments on your content.
In these instances, it is sometimes easy to forget that you are still in a professional environment.
The anonymity of the internet leaves the door open for some unprofessional, off-putting behaviour,
and interactions can happen instantly (Regner & Reiner, 2017).
After putting in all of the effort to develop your online persona, it is important to remember
to conduct yourself as professionally as you would at any brick-and-mortar institution. As we have
established, you are now on a larger stage with many more eyes on your work and behaviour, and
it is imperative as an academic that you take care to keep your reputation as a professional intact
at all times.
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Summing-up
9
As we move forward with a generation of new learners whose lives are increasingly spent
online, if you are to be a successful, savvy scholar, you will need to choose at least a few of these
methods to ensure that you remain relevant. There is no question that the future is digital, and to
ignore the curation of an online persona for your academic career could potentially be an error
that negatively impacts your career. Maintain an online presence that accurately reflects your skills
and expertise, leverage digital communities to expand the reach and impact of your work, and
remember to carry yourself as professionally in your digital life as you would in person, and you
will find a wider audience for your work than ever before.
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Received: April 25, 2022 Revised: May 22, 2022 Accepted: June 14, 2022
Cite as: Relojo-Howell, D. (2022). How to be a digitally savvy researcher. Problems of Psychology in
the 21st Century, 16(1), 4-10. https://doi.org/10.33225/ppc/22.16.04
Dennis Relojo-Howell MSc Research Methods in Psychology, Founder & Managing Director,
Psychreg, United Kingdom.
E-mail: dennis@psychreg.org
ORCID: https://orcid.org/0000-0001-8898-2077
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Creative Commons Attribution 4.0
11
CLINICAL DIFFERENCES IN
MANIFESTATIONS OF SELF-
DESTRUCTIVE BEHAVIOR IN PATIENTS
WITH SCHIZOPHRENIA SPECTRUM
PSYCHOTIC DISORDERS
Oleksandr Bashynskyi
Shupyk National University of Healthcare of Ukraine, Ukraine
E-mail: bashynskyioleksandr@gmail.com
Abstract
Manifestations of self-destructive behavior (SDB) differ in patients with schizophrenia spectrum psychotic
disorders and our study aims to identify these differences through the demonstration of clinical cases.
The purpose of the study is to explore clinical differences in manifestations of self-destructive behavior
in patients with schizophrenia spectrum psychotic disorders. The study involved 95 patients diagnosed
with schizophrenia spectrum disorders. The patients were divided into two groups. The first group (Gr1
PermSDB) included 40 patients (42% of the total number of subjects) with psychiatric disorders, who
expressed a constant presence of manifestations of self-destructive behavior throughout the whole dis-
ease period or during more than half of this period (both according to the patients and to the medical
records). The second group (Gr2 ImpSDB) included 55 patients (58% of the total number of subjects),
where the manifestations of self-destructive behavior appeared only at the height of exacerbation of psy-
chopathological symptoms, and this caused the acts of impulsive self-harm. Looking at the examples, we
see a difference in motivational statements in different groups of patients: in Gr2, the main factor that
motivated patients to harm themselves was the exacerbation of psychotic symptoms. At the same time, the
main factors influencing the self-harm in Gr1 were personal experiences related to psychological problems
Keywords: self-destructive behavior, schizophrenia, schizophrenia spectrum psychotic disorders, clini-
cal cases
Introduction
Suicide is a significant health issue. According to the World Health Organization (WHO)
about one million people die each year from suicide worldwide. It means that every 40 seconds a
person dies from suicide somewhere on the globe, and many other people make non-lethal suicide
attempts. According to some estimates, the number of people who make non-lethal suicide attempts
is about 10-15 times higher than of those who die from suicide (World Health Organization Pre-
venting Suicide. A Global Imperative. WHO, 2014).
As early as 1911, E. Bleuler described “suicidal tendencies” as “the most serious of all symp-
toms of schizophrenia”(Bleuler, 1911). In 1919, Kraepelin stated that suicide occurred in both acute
and chronic stages of schizophrenia. In 1939, before modern treatments became available, Rennie
(Rennie, 1939) noted that 11 percent of 500 patients with schizophrenia died of suicide during the
20-year follow-up period.
ISSN 2029-8587 (Print) Oleksandr BASHYNSKYI. Clinical differences in manifestations of self-destructive behavior in patients with schizophrenia spectrum
ISSN 2538-7197 (Online) psychotic disorders
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One of the important predictors of SDB is usually depressive disorders in patients with psy-
12
chotic disorders of the schizophrenic spectrum. Studies have shown that the presence of a history of
depressive disorders and the presence of a depressive episode are associated with the manifestations
of SrPv in patients with schizophrenia who are in both outpatient and inpatient treatment (Balhara,
2012; Large M et al., 2011). More than 50% of patients who have completed suicide attempts have
been diagnosed with depressive disorder (Harris, 2015) and the presence of depressive symptoms
in patients with schizophrenia may be a trigger for the development of SDB (Carlborg et al., 2010).
Most studies highlight one of the most important factors in the development of suicide actions
is the presence of previous suicide attempts (Carlborg et al., 2010). Previous attempts have affected
the overall risk of completed suicide during the first 2 years after the suicide attempt (Tidemalm et
al., 2018). At the same time, patients with schizophrenia are more prone to suicide by more lethal
and fancy methods than in the general population (Hunt et al., 2006).
Significant evidence suggests that schizophrenia reduces life expectancy by approximately
ten years (White et al., 2019). Suicide is the leading factor in reducing life expectancy in patients
with schizophrenia. Some studies show that the manifestations of self-destructive behavior in
patients with psychiatric disorders of the schizophrenic spectrum are quite common (Jokinen et
al., 2018). Thus, almost 50% of patients with schizophrenic spectrum disorders commit self-harm
(White et al., 2019). A study of self-destructive behavior in patients with psychiatric disorders of
the schizophrenic spectrum shows that its manifestations depend on the duration of the disease
(Hedegaard et al., 2017), on the plot behind the psychopathological experiences, on their level of
social and emotional intelligence (Rutz et al., 2007).
Research Aim
To study clinical differences in manifestations of self-destructive behavior in patients with

schizophrenia spectrum psychotic disorders.
Research Methodology
General Description
In recent years, on the clinical bases of the Department of Psychiatry, Psychotherapy and
Medical Psychology, Shupyk National University of Healthcare of Ukraine - Territorial Medical
Association (TMA) “PSYCHIATRY” a clinical examination, diagnosis, and treatment of 95 patients
with paranoid schizophrenia was conducted with informed consent in compliance with the prin-
ciples of bioethics and deontology.
Sample Selection
According to the purpose of the study, all examined patients were divided into two groups.
The first group (Gr1 PostSDB) included 40 patients (42% of the total number of subjects) with psy-
chiatric disorders, who expressed a constant presence of manifestations of self-destructive behavior
throughout the whole disease period or during more than half of this period (both according to the
patients and to the medical records). The self-harm by these patients occurred under the influence
of exacerbation of suicidal ideation or painful experiences with self-destructive content, which
did not fully depend on the severity of psychopathological symptoms. The second group (Gr2
ImpSDB) included 55 patients (58% of the total number of subjects), where the manifestations of
self-destructive behavior appeared only at the height of exacerbation of psychopathological symp-
toms, and this caused the acts of impulsive self-harm. An essential feature of patients in this group
was that after the reduction of acute psychotic symptoms, the manifestations of self-destructive
behavior in patients disappeared.
Instruments and Procedures

Oleksandr BASHYNSKYI. Clinical differences in manifestations of self-destructive behavior in patients with schizophrenia spectrum ISSN 2029-8587 (Print)
psychotic disorders ISSN 2538-7197 (Online)
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The patients were diagnosed with psychiatric disorders of the schizophrenic spectrum accord-
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ing to the criteria of the International Classification of Diseases, revision 10, (ICD-10) (Centers for
Disease Control and Prevention. International Classification of Diseases, Tenth Revision (ICD-10).
http://www.cdc.gov/nchs/icd/icd10.htm (accessed 23 Sep 2011).), all of them had manifestations
of self-destructive behavior during the disorder. Among the examined, 39 (41%) were diagnosed
with schizophrenia (Sch, F20.0), 25 patients (26%) had schizoaffective disorder (SchAD, F25), 20
persons (21%) had an acute polymorphic psychiatric disorder with symptoms of schizophrenia
(APPD, F23.1), in 11 patients (12%) schizotypal disorder (SchTD, F21) was diagnosed.
The patients were diagnosed with psychiatric disorders of the schizophrenic spectrum ac-
cording to the criteria of the International Classification of Diseases, revision 10, (ICD-10), all of
them had manifestations of self-destructive behavior during the disorder. All subjects underwent
a semi-structured clinical-diagnostic interview which was utilized as a clinical-psychopathological
method of study (according to the diagnostic criteria of ICD-10). The interview revealed the lead-
ing syndromic structure of the clinical picture and the nature of signs of self-destructive behavior
at the time of examination and in the anamnesis, and also the specifics of the self-harming actions
for the patient.
Research Results
As a result of the study, as shown in table. 1, among the whole group of examined patients by
nosological affiliation.
Table 1
Distribution of Examined Patients in Groups by Nosological Affiliation
Nosological units Gr1 PermSDB Gr2 ImpSDB Total
Sch (F20.0) 13 26 39
SchAD (F25) 9 16 25
APPD (F23.1) 8 12 20
SchTD (F21) 10 1 11
In total 40 55 95
It was found that in the sample the largest number of patients was diagnosed with schizo-
phrenia, on the 2nd place, the number of patients diagnosed with schizoaffective disorder, on the
third - acute polymorphic psychotic disorder, and 4 - schizotypal disorder.
As already mentioned, all patients underwent a semi - structured clinical diagnostic
interview, during which a study of motivational attitudes in the statements of patients with SDB
about their implementation of the suicidal acts was conducted.
Table 3
Distribution of the Examined Patients by Groups, According to the Motivational Attitudes that Preceded
the Commission of the Suicide Actions
Motivational attitudes of patients Gr1 PermSDB Gr2 ImpSDB
Attempts to reduce the high level of subjective anxiety («… wanted to reduce
21
anxiety… stress ..», «… then it became easier….»)
Efforts and the way to attract attention (… so she didn’t notice me, only then
9
she understood… «,»… when I did so they paid attention to me… «)
Impossibility to accept the presence of a mental illness or psychiatric diagnosis
(«I don’t want to live like that», «Who needs me so much?», «What’s the point 2
of living like that?»)
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14 Motivational attitudes of patients Gr1 PermSDB Gr2 ImpSDB
Attempts to overcome feelings of conflict in the family (… «got conflicts…», «…

3
I can no longer tolerate these quarrels…»)
Influence of imperative pseudo-hallucinations «… I was ordered (told) by
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voices…».
Influence of hallucinatory symptoms and delusions (mostly harassment and
influence) («… I was watched…. I didn’t want to be caught…» and «… I was 8
followed… I got…. I wanted to be stopped. I wanted to stop…»)
Delusional ideas of self-blame («I don’t want to live after what I did» and «I
5 6
have a lot of suicides, it’s my fault»)
This analysis confirmed differences in each of the groups of examined patients and allowed
to distribute patients according to their response (data are given in table 3).
Below are presented several clinical cases from each of these groups and subgroups to show
differences in the manifestations of self-destructive behavior.
Clinical case of a patient from Gr1 PostSDB (Attempts to reduce the high level of subjective
anxiety). Patient V., girl, 18 years old, diagnosis: SchtD; anxiety - depressive syndrome with hal-
lucinatory inclusions.
The heredity is not burdened by psychopathological disorders. The patient was ill for about
three years. The analysis of anamnestic data (clinical interview data and information from medical
records) revealed that the patient in difficult life situations (exams, poor grades, failures in personal
life) constantly inflicted cuts on her forearms and thighs. It all started once when she still studied
in school, she got a bad grade. She was extremely worried and thought it was unfair because she
was prepared and had good grades in this subject, and also she was afraid that at home her folks
would quarrel a lot. When the level of anxiety was very high, she wanted to “cut her veins”, but
when she began to cut her forearms with a stationery knife, she suddenly felt relieved. After that,
very often in stressful situations causing a high level of anxiety, she begins to inflict self-cuts and,
in her own words, «… becomes easier… releases…”. Although the self-cuts brought some relief,
suicidal thoughts stayed.
Parents noticed some weirdness in the behavior of their daughter (talked to herself, began
to communicate less with friends, constantly stayed in her room behind closed doors). Then they
saw the cuts and persuaded her to consult a psychiatrist. During the consultation she confirmed
suicidal thoughts and also told about “voices in my head… but not voices, but my thoughts…”. In
connection with this condition, two times underwent inpatient treatment in a psychiatric hospital.
In the periods between episodes of mental state deterioration (inpatient treatment), acute
psychotic symptoms were absent in the clinical picture. At the same time, the patient throughout
the disease had manifestations of self-destructive behavior in the form of almost constant suicidal
thoughts, which lost their intensity due to improving mental state, but still stayed.
Due to intake of psychopharmacotherapy in inpatient treatment (risperidone 2 - 4 mg, que-
tiapine 100 - 200 mg, duloxetine 60 mg per day), hallucinatory-delusional symptoms were reduced,
depressive symptoms were deactivated. At the re-examination a month later, hallucinatory symptoms
were absent, but suicidal thoughts which lost some of their intensity persisted.
Clinical case of a patient from Gr1 PostSDB (Attempts and means to attract attention). Patient
G., girl, 20 years old, diagnosis: SchAD, mixed type; depressive - paranoid syndrome.
The heredity is not burdened by psychopathological disorders. The patient was ill for four
years; many times underwent inpatient treatment. The analysis of anamnestic data (clinical
interview data and information from medical records) revealed that in the periods between
psychotic episodes (inpatient treatment) delusional symptoms were absent. However, through-
out the disease, the patient showed self-destructive behavior in the form of almost constant
suicidal thoughts and statements, which, amidst improving mental state, lost their intensity
but remained persistent.
The mental condition of the patient deteriorated about two weeks ago when she told her par-
ents that men at work followed and tried to kidnap and rape her, that she had heard them discuss
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it, although each time there were different men. Because of this, she stopped going to work. She
15
stayed at home, did not want to do anything, did not get out of bed for days, citing the fact that
they still would find her someday: “… if they (kidnappers) want her so much, they will find… then
why do something”. She started to show suicidal intentions: “… it’s better to kill oneself than to let
to defile…”. She was hospitalized in a psychiatric hospital.
After the treatment, the delusional symptoms vanished. She explained the reason for the
behavior as follows: “… my parents did not pay attention to me, and then they ran around me all
day long, like I was a little girl…”.
Later, after discharge, the patient, even in the periods of remission (between inpatient treat-
ments), started to talk about suicidal intentions (according to parents) when she needed something.
In the re-examination a month later, residual delusional ideas of persecution remained in the
clinical picture of G., suicidal thoughts and statements lost some of their intensity but still persisted.
Clinical case of a patient from Gr1 PostSDB (Inability to accept mental disease or psychiatric
diagnosis). Patient S., man, 35 years old, diagnosis: schizophrenia, paranoid form, continuous type,
hallucinatory - paranoid syndrome.
Heredity is without psychopathology. Mental disorders first appeared 2 years ago. Mental illness
debuted in the form of acute hallucinatory-delusional symptoms, it was the first time S. was treated
in a psychiatric hospital. According to the anamnesis, he was treated inpatient several times. During
the deterioration of the mental state in the clinical picture of the patient to the fore came hallucina-
tory - delusional symptomatic with delusional ideas of influence and verbal pseudo-hallucinations.
About a year ago, he made a suicide attempt. During the conversation, he explained his action:
“… for what anybody would need such a person… I’m sick …”.
Amidst psychopharmacological treatment, the condition improved. Upon re-examination
months later - hallucinatory - delusional symptoms ceased to be actual. At the same time, the
manifestations of self-destructive behavior in the form of suicidal statements persisted, however
without affective intensity.
Clinical case of a patient from Gr1 PostSDB (Trying to overcome the experiences of family
conflict). Patient S., woman, 35 years old, diagnosis: schizoaffective disorder, mixed type, affective
- paranoid syndrome.
Heredity is without psychopathology. Mental disorders first appeared five years ago. Mental
illness debuted in the form of affective-delusional symptoms, it was when S. was treated in the mental
hospital for the first time. According to the anamnesis, then she was treated inpatient several times.
During the deterioration of the mental state, to the fore in the clinical picture of the patient came
affective - delusional symptomatic with delusional ideas of enrichment and psychomotor arousal.
About a year ago have made a suicide attempt. During conversation, explained her actions: “… I’m
sick and tired of conflicts … “, “… can’t take anymore these quarrels … “.
months later - hallucinatory - delusional symptoms ceased to be actual. At the same time, the
manifestations of self-destructive behavior in the form of suicidal statements persisted, however
without affective intensity.
Clinical case of a patient from Gr2 ImpSDB (Influence of imperative pseudo-hallucinations).
Patient O., woman, 42 years old, diagnosis: schizophrenia, paranoid form, continuous type, hal-
lucinatory - paranoid syndrome.
Heredity is without psychopathology. Mental disorders first appeared six years ago. Mental
illness debuted in the form of acute hallucinatory-delusional symptoms, it was when O. was treated
in the mental hospital for the first time. According to the anamnesis, she underwent inpatient
treatment 8 times. During the deterioration of the mental state, to the fore in the clinical picture
of the patient came hallucinatory delusional symptomatic with verbal pseudo-hallucinations of
imperative nature and delusional ideas of persecution.
During the period of aggravation of her mental condition six months ago, O. executed a self-
harm action by stabbing herself in the heart. The patient explained how it happened: “A voice told
me to do it, and I did”.
In the course of given study (with the mental state improved amidst onset of the treatment –
deactivation of the acute psychotic state), the patient clearly described the hallucinatory-delusional
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symptoms in her condition, but categorically denied the presence of suicidal thoughts or any other
16
manifestations of self-destructive behavior at the time of re-examination.
Clinical case of a patient from Gr2 ImpSDB (Influence of hallucinatory symptoms and de-
lusional ideas (mainly of persecution and influence)). Patient K., woman, 32 years old, diagnosis:
schizophrenia, paranoid form, continuous type, hallucinatory - paranoid syndrome.
Hereditary psychopathological problems on the paternal line (mother’s sister had schizo-
phrenia). Mental disorder first appeared three years ago. Mental illness debuted in the form of
acute hallucinatory-delusional symptoms, it was when K. was treated in the mental hospital for
the first time. According to the anamnesis, she underwent inpatient treatment 4 times. During the
deterioration of the mental state, to the fore in the clinical picture of the patient came hallucinatory
delusional symptomatic with verbal pseudo-hallucinations and delusional ideas of persecution.
During the period of aggravation of her mental condition six months ago, O. harmed herself by
jumping out from the second-floor window. The patient explained her actions as follows: “… They
followed me… they wanted to hurt me… it’s better to die than to be in their hands”.
In the course of given study (with the mental state improved amidst onset of the treatment –
deactivation of the acute psychotic state), the patient clearly described the hallucinatory-delusional
symptoms in her condition, but categorically denied the presence of suicidal thoughts or any other
manifestations of self-destructive behavior: “… I’m better now … I understand that nobody looks
for me … I don’t want to do anything bad to myself …”.
Clinical case of a patient from Gr2 ImpSDB (Delusional ideas of self-accusation). Patient K.,
woman, 32 years old, diagnosis: APPD with symptoms of schizophrenia, hallucinatory - paranoid
syndrome.
Heredity is without psychopathology. Ill for six months. An analysis of the anamnestic data
(clinical interview data and information from medical records) revealed that the mental state
changed about a month ago, when the circle of friends narrowed SchAD. Relatives began to notice
that the patient was talking to herself. Later, the mental state deteriorated. On the eve of hospitaliza-
tion, she locked herself in a room and did not want to let anyone in. Relatives knocked out the door
and found that the patient had inflicted self-cuts on both forearms. She was hospitalized first in the
emergency room, then in a mental hospital. Mental state at the time of admission was determined
by the presence of acute psychotic symptoms – she denied hallucinatory symptoms, but judging
by her behavior they cannot be ruled out. When asked why she harmed herself, answered “ … I
am to blame for the war, I don’t shouldn’t live ...”.
months later - hallucinatory - delusional symptoms ceased to be actual. Residual delusional ideas
of self-blame remained. At the same time, she actively denied the desire to harm herself, and re-
gretted what she had done.
Discussion
Based on the literature (Ambrumova et al., 1980; Pylyagina, 2017) we can assume that the
manifestations of SDB differ in patients with psychotic disorders. In addition to the above group,
we can also talk about patients who have manifestations of SDB not only during the exacerbation of
psychopathological symptoms, but also in remission. It is possible to note that SDB differs at patients
of the psychotic register in an acute state and in a state of remission. During the exacerbation of
SDB in these patients is due to the nature of the actual psychotic experiences and is characterized
by a special brutality and sophistication. It is then that the most common self-amputations, self-
castration, enucleation of the eyes are performed. While in periods of remission, CPR reflects
personality changes caused by the disease (Sevryukov et al., 2016).
Analyzing the global data on the manifestation of SDB, we found that suicide mortality ex-
ceeds the annual global mortality rate from killings and military conflicts (Hawton et al., 2009).
The frequency of suicide attempts is even higher, which is 10-20 times higher than the frequency of
completed suicides. In the literature, this phenomenon is called the “iceberg phenomenon”, where
completed suicides are just the tip of the iceberg, and suicide attempts are the underwater part.
However, only one in four cases of suicide attempts leads to contact with the occupational health
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system and can be taken into account in statistics (Diekstra et al., 1993).
17
In turn, researchers identify risk factors for suicide. The most common of these are mental
disorders, aggression, impulsivity, previous suicide attempts, suicidal family history, family problems,
social isolation, problems at work and serious somatic diseases (González-Navarro et al., 2012). Ac-
cording to some other researchers, up to 90% of people who commit suicide have a mental disor-
der (Mehlum, 2010) and the risk of suicide in people with mental illness is 35 times higher than in
the general population (Polozhiy, 2011). It is believed that the presence of mental disorders is one
of the factors that are most often associated with the risk of suicide (Page et al., 2009).
At the same time, according to research, patients who committed suicide in general hospitals
were more likely to have mental disorders associated with stress and personality disorders, while
the vast majority of patients who committed suicide in psychiatric hospitals had disorders spectrum
of schizophrenia and affective disorders (Oiesvold et al., 2012).
Conclusions
Looking at these examples, we see a difference in motivational statements in different groups

of patients: in Gr2, the main factor that motivated patients to harm themselves was the exacer-
bation of psychotic symptoms. After the relief of the acute psychotic state, the manifestations of
self-destructive behavior were either completely removed or significantly reduced in intensity and
did not significantly affect behavior of the patients. At the same time, the main factors influenc-
ing the self-harm in Gr1 were personal experiences related to psychological problems - they, to a
greater extent, caused an exacerbation of psychopathological symptoms and became the basis for
the suicidal decision.
In the course of the study we found some significant differences in the pathogenetic develop-
ment and dynamics of self-destructive behavior in patients with schizophrenia spectrum psychotic
disorders, which significantly affect the nature of their implementation of suicidal acts. Thus, there
are two main groups: those with psychotic disorders who had some manifestations of self-destructive
behavior during the entire period of the disease or more than half of this period and performed the
trial under the influence of exacerbation of suicidal or self-destructive pain often on the background
of personal traumatic factors and to some extent, regardless of the severity of psychopathological
symptoms (Gr1 PermtSDB- in current study); as well as patients with psychotic disorders, in whom
the manifestations of self-destructive behavior were secondary and appeared only at the height of
exacerbation of psychopathological symptoms, which caused the implementation of impulsive
suicidal acts (under the influence of imperative pseudo-hallucinations), while after the reduction
of acute psychotic symptoms (Gr2 ImpSDB).
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Medical Journal, 337, 2205. https://doi.org/10.1136/bmj.a2205
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White, J., Gray, R., & Jones, M. (2009). The development of the serious mental illness physical Health
Improvement Profile. Journal of Psychiatric and Mental Health Nursing, 16(5), 493–498.
19
https://doi.org/10.1111/j.1365-2850.2009.01375.x
World Health Organization Preventing Suicide. A Global Imperative. WHO, 2014. http://www.who.int/
mental_health/suicide-prevention/world_report_2014/en/
Received: January 30, 2022 Revised: May 10, 2022 Accepted: June 15, 2022
Cite as: Bashynskyi, O. (2021). Clinical differences in manifestations of self-destructive behavior in

patients with schizophrenia spectrum psychotic disorders. Problems of Psychology in the 21st Century,
16(1), 11-19. https://doi.org/10.33225/ppc/22.16.11
Oleksandr Bashynskyi PhD Student, Department of Psychiatry, Psychotherapy and Medical

Psychology, Shupyk National University of Healthcare of Ukraine,
Kiev, Ukraine.
E-mail: bashynskyioleksandr@gmail.com
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TO BE YOUNG, ALIENATED AND

UNEMPLOYED: SOCIAL IDENTITY,
ATTITUDES AND WELL-BEING OF
GEORGIA’S NEET YOUTH
Anastasia Kitiashvili, Tamar Abashidze, Irine Zhvania

Ivane Javakhishvili Tbilisi State University, Georgia
E-mail: anastasia.kitiashvili@tsu.ge, tamar.abashidze@tsu.ge, irine.zhvania@tsu.ge
Abstract
Education and employment are essential factors for social inclusion of young people in society, so it is
important to study young people who are neither in education or in employment (called NEETs) to deter-
mine how they deal with their social status and their mechanisms to integrate into society.
This study examines how negatively or positively NEET young people perceive their social status, how
NEET status affects young people’s attitudes, social identity, or well-being, and whether young people
try to escape from the status of NEET. The survey was conducted with 380 young people and in-depth
interviews with 12 people.
Research shows that the social status of NEET is neither desirable nor appreciated. NEETs are associ-
ated with diminished well-being mainly because of their lower life satisfaction. NEET youth scores lower
than the general population in life satisfaction, although they have similar level of self-esteem. Research
has shown that NEET youth use psychological mechanisms, such as identifying with a positively assessed
group, to help young people maintain high self-esteem or use strategies to escape from the NEETs group,
get a job, or continue their education. The following factors positively contribute to the desire to leave the
NEET group: self-esteem is the most important motivator, followed by social identity, attitudes towards
education and employment, and family economic status.
The high NEET rate in Georgia suggests that NEETs youth should be a particular target group for inter-
ventions to enable their ‘activation’ to integrate into society.
Keywords: attitudes towards education, attitudes towards employment, NEET youth, social identity,
well-being
Introduction
Education and employment of young people are essential issues in the modern world. Studies
show that education is closely linked to employment opportunities, social inclusion, and human
capital development in general (Balatti & Falk, 2002). An educated workforce quickly masters
innovative technologies that help them find suitable employment and attain career advancement
(Nelson & Phelps, 1966). Quality education gives a person the opportunity to be employed, earn
Anastasia KITIASHVILI, Tamar ABASHIDZE, Irine ZHVANIA. To be young, alienated and unemployed: Social identity, attitudes and ISSN 2029-8587 (Print)
well-being of Georgia’s neet youth ISSN 2538-7197 (Online)
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an income, and socialize with others (O’Dea et al, 2014). Termination of education at an early age
21
reduces employment opportunities in high-paying fields and diminishes the competitiveness of
young people in the labor market. People with an incomplete education are at greater risk of poverty
than those with a complete secondary education (Bridgeland et al., 2006). The consequences of
early educational termination negatively contribute to the mental health of young people.
Unemployment is a negative experience associated with financial problems and declining
social ties (Bolton & Oatley, 1987). Unemployment may cause a decrease in human contact, since
friendships are harder to maintain when people do not work in any organization. High levels of
youth unemployment negatively affect the personal lives and well-being of the jobless. Unemploy-
ment contributes to social exclusion and isolation in what is called “social disqualification” (Paugam,
1996), especially when long-term (Lorenzini & Giugni, 2012).
As education and employment are essential determinants of social inclusion, young people
who are not employed or educated are considered at risk of social exclusion (Roberts, 2005). Young
people who are neither involved in education nor employed are called NEETs. NEET group is at
the core of the European policy debate and many interventions are envisioned to bring them back
to education and /or the labor market. European member states have experience designing and
implementing various policy measures (Mascherini, 2020) to reintegrate youth within higher edu-
cation or the labor market. For example, the policy of the “Youth Guarantee program” indicates a
situation in which young people are guaranteed to receive a good offer of employment, a grant or
scholarship for continuing their education, an apprenticeship, or a traineeship within four months
of losing employment or leaving formal education” (Council of the European Union, 2013). Such
programs have been successfully implemented in several countries, including Austria, Finland, and
Sweden, since the 1990s (Mascherini, 2020).
There are several reasons for becoming NEET. The results of various research revealed that
parents’ educational level and support may be important as protective factors against young people
becoming NEET. In terms of gender-specific variables, survey results reveal that a lack of autonomy
harmed males, while parental intrusiveness mainly impacted females. These findings are consistent
with the results of other research studies (Bynner & Parsons, 2002), which shows that parents with
lower educational levels have less capability in advising children about future educational choices;
furthermore, as negative role models, uneducated parents may lead offspring to make poor deci-
sions in applying for admission or successfully completing a higher education. In another study,
Bäckman et al (2014) examined the reasons for NEET status in three Swedish-born cohorts. As
the study showed, all groups’ individual-level risk factors were the same for NEET status. Bainer
and Parsons (2002) concluded that achieving low education is essential for NEET status. Factors
also include lack of resources in childhood and adolescence, social problems, and health and
education-related challenges.
In another study, Bäckman et al., (2014) examined the reasons for NEET status in three
Swedish-born cohorts. As the study showed the individual level risk factors of all groups were the
same for NEET status. Bainer and Parsons (2002) concluded that achieving low education is an
important factor for NEET status. Factors also include lack of resources in childhood and adoles-
cence, social problems, health, and education problems.
Social status can affect individuals and shape their identity and well-being. Education is also
essential because it creates a basis for employment and offers the means to elevate oneself from a
lower social status. Social identity (Tajfel & Turner, 1979) and self-categorization theories (Turner,
1987) can be used to analyze how young people within the NEET demographic perceive NEET
status or if they identify themselves with NEET group.
Tajfel (1978, p. 63) defined social identity as “that part of an individual’s self-concept that
derives from (...) his knowledge of (...) membership in a social group (or groups) together with the
value and emotional significance attached to that membership”. Hence, individuals develop their
social identities from affiliation with broader groups (Tajfel, 1978, 1982; Tajfel & Turner, 1979).
It is easy for individuals who belong to groups with a high status to identify with them as this is a
rewarding affiliation, while the opposite is true regarding those with low status (Schmitt & Brans-
combe, 2002). Tajfel and Turner (1979) proposed that the lower and inferior the group’s status is,
the less its contribution to forming a positive social identity. One relevant criterion for comparison
ISSN 2029-8587 (Print) Anastasia KITIASHVILI, Tamar ABASHIDZE, Irine ZHVANIA. To be young, alienated and unemployed: Social identity, attitudes and
ISSN 2538-7197 (Online) well-being of Georgia’s neet youth
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with others is employment. Unemployment status is likely to prevent unemployed individuals

22
from developing a positive sense of self based on group membership. Thus, they may experience
devaluation, which affects their overall self-esteem, leading to lower levels of well-being (Schmitt
et al., 2014). It will contribute to the formulation of a negative social identity.
According to Tajfel and Turner (1979), six main strategies can be identified to manage
disadvantaged group positions; among them are individual and group-based initiatives. These
strategies are: (a) individual mobility (i.e., people aim at leaving the in-group to become a member
of another group); (b) recategorization at a higher level (i.e., people claim as individuals belonging
to a broader and positively evaluated group rather than thinking of themselves belonging to the
lower category group ); (c) social competition (i.e., people attempt to gain a positively evaluated
group status level for their group,); (d) realistic competition (i.e., this group of people aim at receiv-
ing more material resources than the other group); (e) preference for temporal comparison (i.e.,
a comparison of the present situation with the past (before reunification) is perceived as more
relevant than other comparison), and (f) reevaluation of the material dimension (i.e., people de-
value the material dimension as less critical for their positive social identity) (Mummendey et
al., 1999). Individual mobility and categorization at a higher level are individual strategies, while
social competition and real competition are collective behaviors and closely related. Preference
for temporal comparison and reevaluation of the material dimension are examples of creative
strategies.
Research shows that attitudes can be influenced by social identity processes (Hogg &
Smith, 2007). Attitude as an intrapersonal construct determines a person’s favorable or unfavorable
response to specific social objects. Group status affects attitudes towards group members and their
desire to leave or not that group, even with children (Nesdale & Flesser, 2001). A positive attitude
towards education or employment may become a kind of motivation of enlightenment and will be
reflected in a specific behavior in the future.
Well-being is a subjective evaluation of how one feels about and perceives one’s own life. Well-
being is mainly associated with positive beliefs, good feelings and satisfying relationships, along
with a sense of meaning and purpose in life (Friedli, 2009). Social psychology analysis uses the
following indicators of well-being: high self-esteem and life satisfaction (Diener & Diener, 1996).
Membership in a group that shares our goals and interests is expected to increase self-esteem (Tajfel
& Turner, 1986), which will have a positive impact on well-being (Brenden, 1969).
The Context of Georgia
Georgia signed the Association Agreement with the European Union (including the Establish-
ment of a Deep and Comprehensive Free Trade Area, AA/ DCFTA) in 2014, which creates a basis
for cooperation between the EU and Georgia on employment, social policy, and equal opportunities
(Chapter 14, Articles 348–354, Annex XXX) in the fields of education, training, and youth (Chapter
16, Articles 358–361, Annex XXXII).
Georgia has a low share of primary school dropouts (around 7%) and a high share of those
who are educated (25%). However, the share of Georgian youths not involved in employment,
education, and training endeavors (NEET) is also high (28% in 2019). The analysis of the European
Training Foundation (ETF) based on secondary data of youth transition from education to work
(Diakonadze & Bardak, 2018) shows that 60% of NEETs in Georgia are females who are more likely
to be graduates with a medium-level general and Vocational Education and Training (VET) (ETF,
2015b). The primary reason for being NEET is linked to time-consuming responsibilities for fam-
ily care, early marriage (UNFPA, 2014). In Georgia, domestic tasks, including child-rearing and
elder-care are performed largely by women, resulting in their economic inactivity. Among other
reasons for unemployment are discouragement, disability, illness, and other personal factors. Ac-
cording to ETF research, the individual’s education level does not contribute much to being NEET,
although those with secondary VET and upper secondary education have the highest probability
of being NEET in Georgia.
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Research Problem
23
Though there is much research worldwide on how individual, familial, and contextual factors
are associated with the risks of becoming NEET youth, research on psycho-social factors underly-
ing the formation of NEETs is limited, especially in Georgia. As education and employment are
important factors for social inclusion and self-realization of young people in society, it is relevant
to study the youthful social strata that are neither in education nor employment to determine how
they deal with their social status and their mechanisms to integrate into society.
Thus, the current research was focused on studying a range of topics surrounding the NEETs
phenomenon: from self-perception and group affiliation to social integration strategies.
The research aimed to analyze the following issues:
1. How negatively or positively do NEETs youth perceive their own status?
2. Is NEETs status related to corresponding internal factors (such as attitudes towards
education and employment) or other external factors?
3. Which social groups do NEETS youth choose to identify with – those within or outside
of the NEETS demographic?
4. Do NEETS youth share the same perceptions of well-being as society in general, or
do they measure their own happiness by a different scale of values?
5. Do affected youth try to escape from their NEETs status? What mechanisms do they
use, and how do other social factors contribute to this attempt?
This type of research is essential in its applications. These psychological factors, - including
attitudes, social identity, and well-being significantly impact the successful integration of young
people into society or their long-term alienation.

Research Methodology
General Background
Education and employment significantly determine the integration of young people into so-
ciety. Therefore, young people who are neither in education or in employment (so-called NEETs)
have to deal with their social status and use various mechanisms for integration into society.
Only a few research in the Georgian context have been conducted mainly within the mas-
ter’s theses focused on the study of attitudes of young people behind education or employment
towards various social issues. However, there is no research on psycho-social factors underlying
the formation of NEETs in Georgia. The psychological factors, such as attitudes, social identity,
or well-being have significant impact on the successful integration of young people into society.
Due to a lack of empirical research experience in this field, research instruments also need to be
developed and piloted.
Thus, the current research was focused on studying a range of topics surrounding the NEETs
phenomenon: from self-perception and group affiliation to social integration strategies. This research
is important both from a scientific point of view as well as for the development of evidence-based
social policy to bring NEET youth back to education and /or the labor market.
Social identity Theory (Tajfel & Turner, 1979) and self-categorization theories (Turner, 1987)
can be used to analyze how young people within the NEET demographic perceive NEET status or
if they identify themselves with NEET group. Ajzen’s Theory of Planned Behavior can be used to
explain how one of the main factors underlying the desire to leave the NEETs group is a positive
attitude towards vocational education and employment (Ajzen, 1991).
The research was conducted through survey research and qualitative interviews. The online
survey was carried out in May-June 2021 with 380 young people and qualitative interviews with
12 participants during the same period.
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Sample
24
In total, 380 young people (200 females and 180 males) took part in Tbilisi and three other
rural areas covered in the study: Tbilisi – 107; Batumi- 98; Telavi – 60 and Kutaisi- 85. The average
age was 22 years (SD = 3.55; min_17, max_29); the Confidence level was 95, and the confidence
interval was 5.
Study participants were selected based on convenience sampling. The sample did not represent
the whole population as the target group of the research belonged to the vulnerable group of society.
The following criteria determined the selection of the participants: 1) individual of age group
15 -29 years; 2) based on ILO criteria, i.e., “unemployed” was a term we applied to anyone 15 years
or older who did not to work (even for one hour) before the interview for seven days, or was look-
ing for a job for at least four weeks and was ready to work in the next two weeks. To these criteria,
one more was added - not been involved in any educational program during the past 12 months.
The research was conducted in accordance with ethical norms. All respondents made an
“informed” consent to participate in the research. They could stop participating in the study at any
stage of the study. Confidentiality was guaranteed.
Instrument and Procedures
The research tool was a questionnaire that included questions on the following variables:
respondents’ demographic characteristics, marital status, education, unemployment experience,
evaluation of NEET status, attitudes towards education and employment, measures of social identity,
happiness, and well-being (self-esteem and life satisfaction).
Respondents were asked to evaluate the status of a group of young people not involved in
education or employment according to three 7-point Likert-type scales where (-3) - was very nega-
tive and (+3) very positive.
1. Inferior status - superior status

2. Undesirable status - desirable status
3. Not appreciated in the community - appreciated in the community.
Attitudes towards education and employment were measured according to a 7-point scale
where (-3) was very negative and (+3) very positive.
The social identity measure was based on Weimeich’s (1980) social identity instrument. Eleven
relevant descriptive constructs were selected and tested in piloted, semi-structured interviews. Re-
searchers identified eleven items measured according to a 7-point Osgood’s Semantic differential
scale. These scales were
1. Friendly - Unfriendly
2. Happy - Unhappy
3. Pessimistic - Optimistic
4. Popular - Unpopular
5. Passive - Active
6. Able to take initiative - unable to take initiative
7. Wealthy - Unhealthy
8. Talented - Not talented
9. Uneducated - Educated
10. Successful - Unsuccessful
11. Dependent - Independent
(α =.865).
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25
The respondents first evaluated themselves on the scale, then who quieted education and
were unemployed at the same (NEET peers) time and last the peers who continued education
(Non-Neet peers).
A questionnaire for study participants was given a scale of “faces” measuring happiness (An-
drews & Whitye, 1976). Respondents were asked to choose one of the seven positive and negative
emotions that most accurately expressed their current attitude towards their own lives.
Well-being was measured on two scales: self-esteem (Rosenberg, 1965) and life satisfaction
(Diener & Diener, 1996). The questionnaire used the Rosenberg 10-point self-assessment scale
(1965), which was adapted to the Georgian language (Cronbach’s α = .73) (Sumbadze et al., 2012).
A 7-point scale of life satisfaction adapted to the Georgian language was used in tandem.
The research was conducted following ethical norms in a self-administered form. All respond-
ents gave “informed” consent to participate in the research. They were fully informed about the
research’s aim and could stop participating in the study at any stage.
In-depth Interviews
In-depth interviews were conducted with 12 NEET youth, 6 females, and 6 males, aged 18 to
25 years. The number of interviews was due to the fact that research shows data saturation can be
achieved in qualitative interviews usually around 6-12 studies (i.e. Glaser and Straus 1967, Morse
1994, etc.).
The interviews were focused on the perception of NEET status, reasons for dropping out of
school or university, evaluation of the decision made, the importance of education, and the future
plans of the young people. Qualitative interviews were transcribed for content analysis.
Data Analysis
SPSS 26 program was used to perform quantitative data analysis; descriptive statistics were used
as part of the data analysis. Correlational analysis was utilized to assess bivariate associations among
continuous variables, while Chi-squared tests were applied to examine the relationships among
categorical variables. Multiple regression analysis was carried out to identify whether various factors
significantly predicted young people’s desire to escape from the NEETs group. In-depth interview
results were transcribed and analyzed by qualitative content analysis.
Research Results
Reasons for Becoming a NEET Youth
The most significant percentage of the respondents, 89.3%, identifies their family’s low socio-
economic status and the need to start working immediately as a reason for dropping out of school.
An additional 4.7% of the respondents planned to continue their studies in vocational education and
offered this as the reason they stopped academic studies. However, their plans changed. Another 3.2
% of the respondents were not interested in studying, so they terminated their education. Others
named other reasons: marriage, conflict within the family, and conformity with peers (see table 1).
In-depth interview respondents noted:
“We had a hard time in our family, so I decided to drop out of school; I wanted to find a job, but I still could
not get one” (18-year-old male).

As Table 1 shows, the majority of respondents decided to drop out independently (89%),
while the minority of respondents did so based on someone else’s advice (parent, friend, school
psychologist).
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According to the interviews, although many parents opposed their children’s plans to drop
26
out of school, the young people were determined to follow their own course:
“I thought a lot and decided to leave school; My mom did not want me to, but I persuaded her” (19-year-old
female).
As it turns out, students generally started thinking about dropping out much earlier, around
the 8th grade, although the final decision was made in the 9th grade. 9th grade is crucial because
students have to decide if they will continue their studies in the field of vocational education or
secondary education or if they drop out of education to enter the labor market.
According to the respondents, about 28.2% think their peers dropped out of school after the
9th grade, which shows that young people believe it is not common practice among their peers.
About 62.8% came to regret their decision with time.
“I think I acted foolishly, somehow could I score 6-7 grades and finished school; Maybe it would be easier to
get a job, even if I was uneducated” (18-year-old male).
while about 1/3 of respondents suppose that they made the right decision when they termi-
nated their studies.
“For what reason should I go to school? They teach you nothing! I still could not pass the final exams, and I
would not earn my diploma” (20-year-old male).
However, the respondents overall would not suggest that other young people drop out of
school. In their opinion, both high-achieving and unmotivated students should stay in school and
try their best to graduate from high school, because it requires time and experience to appreciate
the long-term significance of education.
“I would not advise others to give up studying; being in class is more rewarding than sitting at home; you lose
friends, classmates, teachers. I would not recommend it” (21-year-old male).
Table 1
Information about Terminating Education
Reason for leaving school %
I needed to start a job because of my family. 45.8

My family could not support my education. 43.5
I was going to continue VET 4.7
I lost interest in school. 2.2
Other factors 3.8
Factors influencing decision making
Parental advice 3.5

Friends’ advice 2.7
Personal decision 89
Advice of school psychologist 2.4
Teachers’ advice 2.4
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Evaluation of the decision 27

It was the correct decision 37.2
It was the wrong decision and I regret it 62.8
Planning to continue my education
Yes, in VET 43.1

Yes, higher education 2.3
No 17.3
Difficult to answer 37.3
Should others terminate their education early?
Yes 11.8
No 88.2
According to the survey results, the study participants are unemployed.
“I think sometimes I still could find a job if I tried. But I cannot! I am always searching for jobs on Jobs.Ge. I
am tired so I can no longer do it! This is horrible” (22-year-old female).
Almost half of the respondents mentioned the lack of available jobs as one of the central fac-
tors hindering their own employment (50%). One-quarter of the respondents, 25.0%, believe that
the leading cause of their own unemployment is their lack of education, while a smaller proportion
name family conditions. A small percentage also believes that their personal problems, laziness,
and health issues have led to their unemployment.
Among those surveyed, 31% have some working experience, the most recent being some 13-
15 months prior to the survey. They earned money on an informal basis, mainly without steady
salaries, often on a per diem basis, in positions such as construction assistant, day laborer on a
farm during harvest season, cleaner, caregiver at home. As they noted, the jobs were mainly short-
term, and they were not asked to work again as there was no need from the employers’ side. Daily
payment ranged from 20-35 GEL (5.60-9.80 Euros by 13.03.2022).
Attitudes towards Education and Employment of NEET Youth
A positive attitude towards education may become a kind of motivation of enlightenment and
will be reflected in a specific behavior in the future. Thus, it was interesting to study young people’s
attitudes towards Vocational and Higher Education.
According to the interviews, respondents generally have a positive attitude towards both types
of education. They think that education is an essential precondition for employment and, thus,
economic well-being. Education also gives a person the opportunity to interact with the public;
it allows others to share their experiences and extend their circle of relationships. However, they
think that Vocational Education and Training (VET) is more relevant to them because of their
socio-economic background than higher education, even though a university degree is considered
more prestigious.
“Learning is good in every way; It keeps your mind in shape. People like you more, and you have something
to do” (23- year-old female).
A large proportion of respondents to the survey have a positive attitude towards vocational
education (64.8%) and 13.8% felt very positive; the rating on a 5-point scale is 4 (SD=.66).
When evaluating the attitude towards higher education, about 43.7% had a positive attitude
towards it and 27.0% were very favorable. The average is 3.90 (SD=.84).
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Overall, more young people have positive attitudes towards VET than higher education (78.5
28
% vs. 70.7%)
Figure 1
Attitudes towards Vocational (VET) and Higher Education
80
64,8
60
43,7
40 27
25,6
19,9
20 13,8
3,7
0
Vocational Education Higher education
Very negative Negative Neutral Positive Very positive
The research identified barriers that prevented young people from continuing their educa-
tion; this is an important issue given that the majority of respondents negatively evaluate their own
decision to drop out of school.
The main barrier identified by 85% of respondents, was the immediate need for paying work,
which is why many young people interrupt their education. In their view, working and studying
simultaneously is impossible for them, and they prefer working because they require some income.
A small proportion of the respondents think it is too late now to continue their studies (6%). Only
9% did not continue their studies due to negative attitudes.
The views expressed in interviews confirm the same:
“I needed a job, I had to help my family due to my family circumstances. My father used to drink all the time,
my mother was a cleaner.” (19-year-old female)
Attitudes towards employment are positive, with a rating of 4 (SD=1.9)
“I am willing to take on any kind of job, but there is nothing” (23-year-old male)
As mentioned, many respondents named their family dire economic situation as the primary
reason for leaving school. Most respondents (71%) assess their family’s economic situation as
problematic or very poor, 20% as average, and others (9%) as good.
Evaluation of the Social Status of NEET Group
Respondents were asked to evaluate the status of the NEET demographic of young people
according to three 7-point scales:
Table 2
Young People’s Evaluation of Themselves, other NEETs Youth, and the Young People who Have Con-
tinued Their Education
Evaluation of Evaluation of
Evaluation of Self
NEET Peers Non-NEET Peers
M SD M SD M SD
1 Friendly 4.21 0.10 4.00 1.07 3.71 0.96

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Evaluation of Evaluation of 29
Evaluation of Self
NEET Peers Non-NEET Peers
M SD M SD M SD
2 Happy 5.15 10.01 3.81 1.05 4.0 0.88

3 Optimistic 3.70 1.01 3.34 1.00 3.79 0.85
4 Popular 3.71 1.01 3.43 1.18 3.78 0.91
5 Active 3.90 0.9 3.81 1.0 3.88 0.9
6 Able to take initiative 3.81 0.02 3.62 1.10 3.72 0.97
7 Wealthy 3.41 0.99 3.51 1.01 3.61 0.92
8 Talented 3.50 1.14 3.51 1.03 3.87 0.81
9 Educated 3.40 .09 3.40 .96 3.85 0.86
10 Successful 3.21 0.96 3.31 .97 3.72 0.95
11 Independent 3.51 1.03 3.72 1.15 3.6 1.16
3.77 1.5 3.59 1.04 3.78 1.14
1. Inferior status - superior status

2. Undesirable status - desirable status
3. Not appreciated in the community - appreciated in the community
The average evaluation was 2.03 (scores by scales, 2; 2 and 2.1), showing a low status for the
young people.
“Do you know how it is? Such people are nowhere! You are nothing! Neither at school, nor with friends, nor
with co-workers. They cannot even meet people! Where should they meet? They are home mostly surfing the
internet or playing video games; they rarely go out in the neighborhood, and that is it.” (21-year-old male.
Social Identity of NEET youth
Participants were asked to rate themselves, their NEET and non-NEET peers alongside peers
who decided to continue their studies at college the level on the same eleven scales, with 7-points
in the study. The results showed that participant Youth consider themselves more friendly, happy,
and able to take initiative than other 2 groups (NEETs group and youth who continued study) and
more optimistic and popular than the NEETS groups, while they think non-NEET groups are more
wealthy, talented, educated, and successful (see Table 2).
The average self-esteem is more favorable than that of NEETs peers, but less positive than that of
peers who continued their academic studies.
Young people’s social identity is closer to the non-NEETs group (0.01) than the NEET peers (0.18).
Happiness and Well-being
Respondents were asked to choose one of the seven positive and negative emotions that most
accurately expressed their current attitude towards their own lives.
The answers were distributed: very happy – 41.3%; happy – 31.3%, neutral – 23.5% l, un-
happy –1.3%, very unhappy – 2.6%.
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Participants have high self-esteem out of a maximum of 40 points (M = 30.92; SD=3.45)

30
“Hopefully, I will get a job one day and will have my own salary; I am not the worst in the world “ (23-year-
old male).
One-fifth (19.5%) of the respondents were satisfied with their own life, while 26.1% were
very dissatisfied, and more than half (54.6%) are neither satisfied nor dissatisfied. In the Georgian
population within this age range, 18-24, previous researchers determined that 25.1% were satis-
fied, while 57.1% are felt neither satisfied nor dissatisfied, and a remaining 17.8% were dissatisfied
(Sumbadze et al., 2012). The average score on life satisfaction scale is 2.4 (SD=1.2), showing low
level of life satisfaction.
A maximum well-being score can be 200 (40 self-esteem X 5 life satisfaction), while the re-
search participant’s score is 120.59 (30.92 self-esteem X 3.9 life satisfaction) is slightly higher than
an average score.
“How can I be satisfied with my life? I am not satisfied with my appearance, employment, finances, economic
condition, education, achievements! I have healthy children, thank God, but what else?” (23-year-old female.)
Only 39 % of all respondents believe that their life outcomes will be in accord with their ambi-
tions and goals, showing a lack of perceived control over their lives.
Table 3
Correlations Matrix among the Main Variables (n=380)
1 2 3 4 5
1. Self-esteem
2. Life satisfaction .624 .
3. Well-being .946** .498**
4. Social identity .244** .247** .008
5. Happiness .242** .223** .183*8 .415**
6. Family economic status .316** .188** .242** .170** .065
** Correlation is significant at the level of .01 (2-tailed)
* Correlation is significant at the level of .05 (2-tailed)
A positive correlation was identified between well-being, self-esteem (r=.946, p <.01); and
life-satisfaction (r=.498, p <.01) that was expected as self-esteem and life satisfaction determine
well-being.
Social identity is also positively correlated with self-esteem (r =.244; p <.05) and life satisfac-
tion (r =. 247 p <.05).
As table 3 shows, with increased happiness people’s self-esteem also rises (r=.242; p <.01);
they are satisfied with their life (r =.223; p <.01), have higher well-being (r =.183; p <.01), social
identity is shared with non-NEET youth (r =.415; p <.01).
Family economic status is positively and significantly correlated with life satisfaction (r = .183;
p <.05), as well as influencing self-esteem (r =.316; p <.05); The same can be said about the correla-
tion of family economic status with well-being (r =.242; p <.05) and social identity (r =.170; p <.05).
Escaping of Youth from the Status of NEET
Most of the respondents regretted dropping out of school and accordingly, about 43.1 % of
the surveyed youth want to continue their education in VET, 6.1% hope to enroll in college or
university, 13.1% think about participating in various training opportunities; 2.7% do not want to
study anymore. Other respondents (42.0%) would not answer or were undecided.
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The young people who want to continue their education are, on average, 22.16 years old
31
(SD = 3.58; 18-29), a slightly older age group than the respondents who do not want an education,
whose average is 21.78 (SD = .09; 18-29). A sector of 15.5% of respondents answered that they have
a very good or quite good economic situation; while 67.7% evaluate their own economic condition
as average; this group of youth has lower self-esteem (29.5 Vs. 32.34; F=9.32; p<.05), but they are
happier (3 vs. 2.2; F=9.32; p<.05 ) and have more positive attitudes than the demographic group
who do not want to continue education (4.44 Vs. 4.20 F=10.500; p<.05). Young people who want
to continue their education evaluate their decision more incorrectly than young people who do
not (65% and 60%; Chi-square = 8.384; p <.05).
There was a link between the desire to pursue vocational education and the perception of
unemployment; 70% of respondents who want to continue their education in VET think that the
main reason for their unemployment is lack of job qualifications (Chi-square = 18.639; p <.05).
Multiple regression analysis was carried out to identify if various factors significantly predicted
young people’s desire to escape from the NEETs group.
A desire to leave the NEETs group was considered as the dependent variable, while among
the dependent variables were age, gender, attitudes towards education, attitudes towards education
and employment, social identity, self-esteem, satisfaction with life, perceived control in life, and
family economic status.
The overall regression was statistically significant (R2=.956; R= .978) F = 583.024; p<.01. Analy-
sis indicated that predictor variables significantly predicted the dependent variable. Self-esteem,
social identity, attitude towards education and employment, and family economic background
showed positive predictive values.
Table 4
Results of Multiple Regression Analysis in Predicting Individual Intention to Escape from NEETs Group
β t p
Self-esteem 24.47 58.280 <.01

Social identity 7.68 5.11 <.01
Attitudes towards education 6.84 2.65 <.01
Attitudes towards employment 6.44 2.45 <.01
Family economic status 5.735 3.85 <.01
Discussion
The majority of young people noted that their family’s dire financial situation was the main
reason for dropping out of school after receiving just a basic level of education. Financial need
causes many young people to leave school prematurely and start a job in order to earn an income,
although they could find a steady job, and their only work opportunities were short-term, low
paying and inconstant.
Most of the students decided to drop out independently without considering parents’ wishes,
teachers’ advice or career guidance specialist suggestions. However, they did not have relevant
labor market information about available employment opportunities and lacked the job skills to
achieve their goals. Thus, young people had to make uninformed decisions. They could not con-
sider significant risks, downsides, or consequences in advance. These findings are relevant to other
research that showed that youth in Georgia terminate their education primarily because of their
family’s pressing economic need, and have to make uninformed decisions (Kitiashvili et al., 2016).
Vocational and career planning courses offered to 9th graders informed students of the risks of
dropping out, although overall, counseling was limited, thus facilitating uninformed decision-making.
The problem of awareness must be solved from the lower levels of the school before the student com-
plete 9th grade. By this point, students should be aware of the benefits of completing general educa-
tion or vocational education as it affects their employment and career advancement opportunities.
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Although they dropped out and lack jobs, most NEETS youth still attach an overall positive
32
value to learning and employment. Their attitudes are especially positive towards vocational educa-
tion as they consider it more relevant to their economic background than higher education. Analy-
sis showed that the following factors contribute to the desire to continue education: self–esteem,
attitudes towards education, attitudes towards employment, social identity, and family economic
status. One of the main factors underlying the decision to continue education is a positive attitude
towards vocational education and employment, which can be easily explained based on the theory
of planned action (Ajzen, 1991). According to the theory, the main factors of intentional behavior
are the attitude towards the behavior and the subjective norm. If a person does not encounter an
obstacle that he cannot overcome, the intention is to trigger the appropriate behavior. In our case,
such obstacles are institutional and situational barriers to education. By overcoming them, this
group of young people is expected to continue their education and eliminate the group of NEETs.
The survey reveals that many respondents who regret their decision to drop out want to continue
their education, and about 1/3 had made no final decisions.
The same can be said about the attitudes towards employment that are also positive. A need to
find employment forced the youth to leave school prematurely, but because of a lack of jobs or low
level of skills and experience, they could not find salaried jobs; moreover, they could not improve
their crucial competencies for employment because of resulting educational deficits. Thus, young
people have found themselves in a vicious circle whose transcendence is possible only through
proper education, like completed secondary, VET or higher education which is necessary for find-
ing employment and professional development, career advancement, and integration into society.
The surveyed youth negatively perceive the status of NEET. According to other research, ap-
proximately 65.5% of the respondents who left education after grade 9 belong to the NEETS (do not
pursue studies nor do they work) group (Kitiashvili et al., 2016). This group of youth is vulnerable,
and their numbers are significant in Georgia. In 2016, among the youth aged between 15 and 29,
a total of 26.6% were NEETs, (Household Survey Data, 2016), while in developed countries this
rate averages at 15.5%.
The results showed that NEETs evaluate themselves as more friendly, happy, and able to take
initiative than the groupings of NEETs and non-NEET peers, and more optimistic and popular
than NEETS groups. Respondents believe that peers who have continued their education are more
wealthy, talented, educated, and successful than they. The results showed that the social identities
of the surveyed youth were closer not to the NEET group, but to their non- NEET peers. When
young people identify with a particular group, they share group-related evaluation criteria.
Research has shown that NEET youth typically use psychological mechanisms, such as
identifying with a positively assessed non-NEET group, to maintain high self-esteem or use indi-
vidual mobility strategies to escape from an underprivileged social group that can be considered
as a novelty of this research. Analysis showed that the following factors contribute to the desire
to continue education: self–esteem, positive attitudes towards education and employment, social
identity, and family economic status.
NEETs are associated with diminished well-being mainly because of their lower life satisfaction.
NEET youth scores lower than the general population in life satisfaction, although they display a
similar level of self-esteem.
The high NEET rate in Georgia suggests that NEETs youth should be a particular target
group for interventions. Escape through upward mobility from the NEETs group is not only a
consequence of individual or family factors but depends upon the influence of higher education
and labor-market systems. Access to training and/or retraining represents the key strategic focus;
in addition, NEET youth face challenges during the school-to-work transition, there is a lack of
available job opportunities on the market, frustrating those who continue to search for steady em-
ployment and even discouraging those who might consider continuing their education and training.
These young people require special attention from policymakers to enable their ‘activation’ in the
labor market and thus empowering more individuals to leave the NEETs group. It is essential to
activate this group of young people, to offer them evening courses, weekends, helpful information,
and career counseling to help them return to education.
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Providing practical career guidance is essential to supporting pupils during transition peri-
33
ods. Career guidance services, that are available in some schools in Georgia, should be available in
every school. Young people need to have tailored, intensive support through easily accessed career
guidance measures. It is important to successfully calibrate the factors identified in the current
research that, as motivations, contribute to individual upward mobility away from NEET groups,
such as increasing one’s self-esteem, social identity, attitudes towards education and employment,
and family economic status.
It is impotent to introduce policies to help young people to continue vocational education in
order to acquire the skills and qualifications for sustainable employment in the future, or to sup-
port study within integrated programs when young people can get vocational education in paral-
lel with general education. By the end of their secondary education, young people will thus have
VET qualifications and enjoy a better opportunity to integrate within the labor market, or they can
continue their study at higher education
It is possible to successfully share the best practices and successful experience of some coun-
tries (e.g., Bulgaria, Cyprus, Greece, Italy, Romania, Slovenia, Spain, and Slovakia) to promote
youth entrepreneurship and self-employment. Entrepreneurship is a priority in Georgia, although
it is still in the early stages of development. Young people who want to start their own business
should be provided with special services to promote alternative pathways in the country’s develop-
ing economy. Another measure is to provide financial support mechanisms for continued school
attendance in the form of subsidies (in Poland), free school meals, allowances, and scholarships
(available in Italy, Poland, Portugal, and Slovakia) (Mascherini, 2020).
Using proactive measures is especially important to protect vulnerable young people from
becoming NEETs. Here, too, Georgians can successfully adopt other member states’ experience of
using various measure, including measures aimed at identifying potential early school dropouts,
policies focusing on specific vulnerable geographical areas, the provision of alternative learning
environments, and increased career guidance or personal assistance, with the aim to create financial
support mechanisms and greater parental engagement (Mascherini, 2020).
Conclusions and Implications
The research shows that one of the main reasons for becoming a NEET youth is terminat-
ing one’s education, and subsequent challenges related to finding steady employment. Research
shows that students started thinking about dropping out of school over the last 1-2 years of general
education and did not instantly decide, though most ultimately made uninformed decisions. Ac-
cordingly, only 1/3 of the respondents think they made the right decision, while the rest regret that
they dropped out of school and think they should not have rushed to make a decision.
Barriers to continuing education were mainly situational, over which the respondents them-
selves had little control. According to their subjective assessment, their individual family’s dire
financial situation was a decisive factor in pushing them to leave school prematurely, and try to
find immediate, paying work. Only a small number of students attributed their early termination
of studies to a lack of interest in learning and/or personal laziness.
Most NEETS youth have positive attitudes towards education and employment. About 1/3 of
the surveyed youth want to continue their education through vocational education.
NEET has an inferior social status that is neither desirable nor appreciated, thus young people
want to escape from this status. One of the novelties of this research is that the social identities
of the surveyed youth were closer not to the NEET group, but to their non-NEET peers. NEETs
are associated with diminished well-being mainly because of their lower life satisfaction. NEET
youth have lower scores than the general population in life satisfaction, although they display a
similar level of self-esteem. The following factors contribute to the desire to continue education:
self–esteem, attitudes towards education, attitudes towards employment, social identity, and family
economic status.
NEETs youth should be a particular target group for interventions in Georgia based on the
best international experience.
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34 Declaration of Interest
The authors declare no competing interest.
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Received: March 28, 2022 Revised: May 09, 2022 Accepted: June 15, 2022
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Anastasia Kitiashvili PhD, Professor, Tbilisi State University, 1 Chavchavadze av., Tbilisi,
(Corresponding author) Georgia.
E-mail: anastasia.kitiashvili@tsu.ge
Tamar Abashidze PhD, Associate Professor, Ivane Javakhishvili Tbilisi State University, 1
Chavchavadze av., Tbilisi, Georgia.
E-mail: tamar.abashidze@tsu.ge
Irine Zhvania PhD, Associate Professor, Ivane Javakhishvili Tbilisi State University, 1
Chavchavadze av., Tbilisi, Georgia.
E-mail: irine.zhvania@tsu.ge
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MISOPHONIA: SYMPTOMS,
COMORBIDITIES AND PERSPECTIVES
OF INTERVENTION. FROM THEORY
APPROACH TO INTEGRATED CLINICAL
PRACTICE RESEARCH
Zachary M. Rosenthal
Duke University Medical Center, U.S.A.
E-mail: mark.rosenthal@duke.edu
Maria Annarumma
University of Salerno, Italy
E-mail: mannarumma@unisa.it
Francesco Sessa, Iris Consalvo, Valerio De Masi, Luana Pagano
International Centre of Psychology and Strategic Psychotherapy of Salerno (CIPPS), Italy
E-mail: f.sessa@cipps.it, i.consalvo@cipps.it, v.demasi@cipps.it, l.pagano@cipps.it
Abstract
Recent scientific studies have noted that misophonia is a complex neurophysiological and behavioural
syndrome characterised by high physiological and emotional reactivity, resulting from an intolerance to
specific auditory stimuli. People with this distress have emotional and behavioural responses, excessive
in relation to the auditory stimulus that provokes them; in fact, these people may have outbursts of anger,
severe anxiety crises, and even panic attacks. One of the questions that the first studies of this syndrome
have asked was what link occurred between misophonia and certain psychological disorders such as
anxiety, depression, and personality disorders. Another important research objective was to examine the
differential diagnosis between misophonia and hearing disorders such as tinnitus. In view of the current
literature on misophonia, it has become important to define the comorbidity and differential diagnosis of
misophonia with other disorders. The next step is, through further research on clinical cases, to define the
most effective psychotherapeutic techniques on misophonic symptoms, and the psychoeducational tools
needed to intervene in family systems with misophonic patients.
Keywords: comorbidity, differential diagnosis, psychological disorders, hearing disorders, misophonia,
behavioural response, emotional response, psychoeducational tools, psychotherapeutic techniques
Introduction
Misophonia is a lesser-known clinical syndrome, with little to no scientific literature not always
methodically reliable. Misophonia was originally described by Jastreboff (Jastreboff & Jastreboff,
2001, 2014); yet although syndromic features are beginning to be described empirically, misophonia
has not been scientifically recognised as a mental illness (Sullivan et al., 2018).
Zachary M. ROSENTHAL, Maria ANNARUMMA, Francesco SESSA, Iris CONSALVO, Valerio DE MASI, Luana PAGANO. Misophonia: ISSN 2029-8587 (Print)
Symptoms, comorbidities and perspectives of intervention. From theory approach to integrated clinical practice research ISSN 2538-7197 (Online)
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The etymology behind the term ‘misophonia’ consists of the Greek words ‘misos’ and ‘pho-
37
nos’, i.e., hate and noise. Consequently, its features are a reluctance towards certain human-made
noises and mechanical noises. Misophonia is a condition recognised by the newsfeed of the New
York Times (Cohen, 2011) and the Today Show (Carroll, 2011) as characterised by mental illness
of irritation, anger or disgust when presented ‘trigger’ sounds, that vary between people and en-
vironmental contexts.
Excessive reactivity to noises is found in many neurological, auditory, medical and psychi-
atric disorders such as tinnitus, hyperacusis (Jastreboff & Jastreboff, 2001), migraine (Sullivan et
al., 2013), autism spectrum disorder (Ben-Sasson et al., 2009a; Danesh & Kaf, 2012; Lane et al.,
2012), post-traumatic stress disorder (Attias et al., 1996; Finsterwald & Alberini, 2014), borderline
personality disorder (Rosenthal et al., 2016), bipolar disorder and schizophrenia (Cabranes et al.,
2013). The extent of the connection between the aforementioned disorder and the misophonic
syndrome is not well defined yet.
CIPPS (Centro Internazionale di Psicologia e Psicoterapia Strategica, Salerno, Italy) with the
scientific collaboration of Duke University (North Carolina, U.S.A.) aims to advance the knowl-
edge of the symptomatology of this syndrome; to identify the therapeutic tools that can be used to
tackle the symptoms; to understand whether misophonia is comorbid with psychological patholo-
gies such as anxiety, depression, personality disorders and, in differential diagnosis, with organic
pathologies, such as tinnitus, phonophobia and other hearing problems; to identify the resources
and strategies that misophonic patients implement; to identify which neuroscientific and strategic
psychotherapy techniques (CIPPS) are effective in treating misophonic symptoms, to compare
them with cognitive-behavioural techniques (Duke University) and to hypothesise an integration
between the two therapeutic orientations.
The joint work between CIPPS and Duke University aims to collect data on the most frequent
symptoms, and whether any new ones emerge from the existing literature; for example, if new noises
are identified that trigger disproportionate reactions; if misophonia comes before a disorder, such
as anxiety, or manifests itself afterwards; which strategies are used by the patients; which psycho-
therapeutic techniques, based on the analysis of the interviews with patients, are more effective on
misophonic symptoms.
After an initial survey of the data, an important result would seem to emerge, one already
presents in the known literature (Tyler et al., 2014): the intensity of the annoyance to a sound seems
to be linked to the degree of the relationship that the misophonic patient has with the persons from
whom the trigger sound comes; it would seem that the person making the annoying sound is usually
a significant individual within the family system. Consequently, a comprehensive intervention could
be aimed at the entire family system with both psychotherapeutic and psychoeducational tools.
In the following, we will present the current state of knowledge on misophonia, the charac-
teristics of a methodology that has just been launched by the International Centre of Psychology
and Strategic Psychotherapy (CIPPS) and the first data that have emerged, on the basis of which we
can hypothesise how to improve the same methodology, hypothesise techniques and intervention
strategies in the psychotherapeutic and psychoeducational spheres.
Misophonia: Trigger Sounds, Emotional and Behavioural Responses
Misophonia is characterised by extreme sensitivity to specific human-generated sounds

(Schroder et al., 2013). In the 1990s, audiologist Johnson spoke of ‘selective sound sensitivity syn-
drome’, then Jastreboff and Jastreboff used the word misophonia. It all started with Pawel Jastre-
boff ’s model of tinnitus (Jastreboff, 1990). Based on this, Pawel and Margaret Jastreboff developed
Tinnitus Retraining Therapy (TRT), which includes recurrent exposure to a low-level broadband
sound in an attempt to facilitate habituation by interfering with the neural regions responsible for
tinnitus generation (Jastreboff et al., 1996). Using TRT during a study with patients suffering from
hyperacusis, Jastreboff coined the term misophonia.
During this study, Jastreboff and Jastreboff noticed that patients with hyperacusis responded
with annoyance to sounds that have fixed patterns, such as the clicking of a pen, chewing or the
dropping of a drop of water, regardless of the decibel level (Jastreboff & Jastreboff, 2001).
ISSN 2029-8587 (Print) Zachary M. ROSENTHAL, Maria ANNARUMMA, Francesco SESSA, Iris CONSALVO, Valerio DE MASI, Luana PAGANO. Misophonia:
ISSN 2538-7197 (Online) Symptoms, comorbidities and perspectives of intervention. From theory approach to integrated clinical practice research
OF PSYCHOLOGY
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Jastreboff and Hazell in 2014 pointed out that the most common reaction to trigger sounds is
38
anger, but can also include anxiety, frustration, disgust, and thoughts of wanting to hurt the person
who produces the annoying sound (Jastreboff & Hazell, 2014).
Subjects suffering from misophonia seem to have difficulty in continuing to manage their
lifestyle, as the symptoms affect the relational environment up to and including the workplaces.
Schwartz noted during his study that misophonic subjects often alienate those close to them, re-
sulting in the loss of relationships, employment, and even social isolation (Schwartz et al., 2011).
In a study of sound evocation, Kumar et al. (2017) highlights the main ‘trigger’ sounds that
trigger patients’ reactions of disgust, anger, anxiety, and helplessness. Specifically: loud chewing,
coughing, sniffing, nibbling, deep breathing, clattering of cutlery, swallowing, loud drinking, tick-
ing, knuckle cracking, clinking, nail biting. In addition to this classification, one can also associate
with ‘trigger’ sounds those noises produced by computer fans, refrigerators, air conditioners, i.e.,
all those noises that present characteristics of continuity and repetitiveness, as is emerging from
the first data CIPPS collected at the listening desk for misophonic patients.
It is suggested (Jastreboff & Jastreboff, 2014; Wu et al., 2014) that misophonic individuals
present annoyance to visual stimuli associated with repetitive movements, such as hair twirling,
and with auditory triggers, i.e., jaw movement related to chewing, or movements that precede an
auditory trigger. Triggers are initially located in a small number of sounds or behaviours produced
by a small number of people in the misophonic subject’s life (Schroder et al., 2013). As a person
with misophonic symptoms increases avoidance from triggers, the number and type of triggers
for the aversive reaction increases, until these triggers and attempts to avoid them become harm-
ful (Edelstein et al., 2013). We might add that the trigger sounds, which generate an annoyance
response in misophonic subjects, are produced by a close person (Jager et al., 2020; Taylor, 2017;
Wu et al., 2014) and this increases anger and anticipatory anxiety in misophonic subjects for not
being able to cope with this difficulty and results in social withdrawal. It should also be kept in mind
that the response to ‘trigger’ sounds may depend on many factors besides the person producing
them, such as: personal experience, social context, or the psychological profile of the individual
(Schewemmie & Arens, 2021).
Aetiological Hypotheses of Misophonia
According to the scientific literature, there is no clear specification behind the causes for the
annoyance related to trigger sounds, but there is one analysis of the brain activations associated
with them. The aetiology and nature of misophonia has been attributed to physiological anomalies
in the brain (Møller, 2011), hyperresponsiveness similar to sensory processing disorder (Schröder
et al., 2013) and classical conditioning (Dozier, 2015b; Jastreboff & Jastreboff, 2014; Schröder et al.,
2013). In fact, Kumar, while investigating the neurobiology in relation to misophonia, described
how in misophonic patients there is an increased activation of the insular cortex in the anterior por-
tion which seems to be related to associative learning processes and memory (Kumar et al., 2017).
And again, Kumar et al., hypothesised the involvement of the mirror neuron system in misophonia
as most activation sounds arise from orofacial movements. Schorder et al. studying misophonic
subjects exposed to trigger sounds, using an audiovisual technique, found functional activation
of the right insula, right anterior cingulate cortex, and temporal cortex (Schorder et al in 2019).
Palumbo et al. suggested that, however, within learning, classical conditioning, non-associative
learning and sensitisation there may be significant helpful indices that can explain the mechanisms
underlying misophonia, linking also to Jastreboff ’s hypothesis in 2001 that misophonic responses
are developed and maintained through associative learning processes in particular contexts, con-
cluding that these responses are based on neural circuits responsible for emotion, memory and
learning (Palumbo et al., 2018, Jastreboff et al., 2001).
Moreover, as Kumar observed in 2017, that in the brains of patients with misophonia there
was hyperactivity of the anterior insular cortex and abnormal functional connectivity with the
medial frontal, medial parietal, and temporal regions (Kumar et al.2017).
Misophonia is not yet described within any of the diagnostic manuals such as the DSM-5
and ICD-11. Although there is a study conducted by the Amsterdam University Medical Centers
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in 2013, which proposed the first diagnostic criteria for misophonia as a clinical disorder, there is
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still no unified view within the scientific groups that can define misophonia as a condition in its
own right (Schorder et al., 2013).
Based on clinical diagnoses we know that excessive reactivity to trigger sounds is a feature
found in several disorders of neurological, auditory, medical and psychiatric disorders such as
tinnitus, hyperacusis (Jastreboff & Jastreboff, 2001), migraine (Sullivan et al., 2013), autism spec-
trum disorder (Ben-Sasson et al., 2009a; Danesh & Kaf, 2012; Lane et al., 2012), post-traumatic
stress disorder (Attias et al., 1996; Finsterwald & Alberini, 2014), borderline personality disorder
(Rosenthal et al., 2016), bipolar disorder and schizophrenia (Cabranes et al., 2013), but despite this,
research has felt the need to investigate comorbidities and differences between misophonia and
the various personality disorders and other clinical conditions classified in diagnostic manuals.
McKay et al. in 2018, in a study of 628 participants who associated misophonia with obsessive-
compulsive symptoms, highlighted that in misophonic subjects there was a higher prevalence of
levels of order and harm avoidance than obsessional traits (McKey et al., 2018). Schorder et al.
through a recruitment of 42 adult subjects, in a mental health centre, who self-reported misophonic
symptoms, assessed that most of these subjects fulfilled the criteria for obsessive-compulsive per-
sonality disorder, while others for ADHD, anxiety disorder and obsessive-compulsive disorder,
concluding that misophonia can also be defined as a sub-disorder of the broader classification of
obsessive-compulsive disorder categorised in DSM-5. Rouw et al. in 2018 found that post-traumatic
stress disorder was prevalent in people with misophonia, where misophonic symptoms presented
in a more severe condition (Rouw et al., 2018). An additional highly correlated disorder, noted
through studies conducted by Erfaniano et al. in 2018, is depression; the greater the severity of
misophonic symptoms, the higher the percentage of major depressive conditions. From what has
been reported, it emerges that despite the multiple studies conducted, the correlation between
misophonia and personality disorders cannot be given as a certainty, as the number of samples
subjected to assessment is not random and free of interference, stemming from evaluations carried
out through self-report interviews (Bellavista et al., 2022); this is why research on the topic is yet
again necessary.
Hearing Disorders, Misophonia and Differential Diagnosis
As we move on to the differential diagnosis, we could deduce that there are conditions that
exclude misophonia from the characteristic symptoms of tinnitus, hyperacusis and synesthesia
(Taylor, 2017; Robinson et al., 2018). Hyperacusis is a medical condition in which the subject has
a strong annoyance at a sound perceived to be very loud. The presence of such a sound induces in
subjects with hyperacusis, pain, fear and annoyance, experiencing them separately or all together.
What differentiates hyperacusis from misophonia is the characteristic of the sound, in that, in miso-
phonia, the reaction to sound is not related to the decibels of the sound itself, whereas in subjects
with hyperacusis, the reaction is linked to volume and frequency. Furthermore, another distinction
is that misophonic triggers are not the same for all people, e.g., not all misophonic individuals are
bothered by the chewing trigger; furthermore, the same trigger can provoke angry reactions or
anxious states at home, but not at work (Robinson et al., 2018; Taylor, 2017).
Tinnitus is a complex neurological condition; sufferers experience ringing in one or both
ears, sometimes even hearing loss occurs. According to Jastreboff, tinnitus arises due to abnormal
neural activity in the auditory pathways, which is perceived by the neocortex as a ringing noise
(Jastreboff & Jastreboff, 2014). Tinnitus refers to the perception of sounds in the absence of external
acoustic stimulation, whereas in misophonia the trigger response is generated by a sound emitted
by a nearby person and/or objects.
Synesthesia is a condition in which one sensory stimulus or sensation evokes another sensation
that is apparently neither related nor associated (Edelstein et al., 2013). What differentiates the two
clinical conditions is that in synaesthesia there is a set of inducer-to-concurrent associations, a fea-
ture not defined in misophonia, as the stimulus from which the trigger originates is not established
and unambiguous but varies from subject to subject; furthermore, synaesthetic responses remain
constant, an undetermined aspect in misophonic patients (Edelstein et al., 2013). The likelihood that
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misophonic responses may change over time is confirmed by a study conducted by Edelstein et al.
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in 2014. That study collected significant data from participants reporting that symptoms worsened
over time (Edelstein et al., 2013; Kluckow et al., 2014; Bernstein et al., 2013), presumably caused by
the negative reinforcement to the trigger responses (Jastreboff & Jastreboff, 2014).
In conclusion, it would seem important to dwell on two aspects: it is unclear, to this day, as we
need to keep moving in the field of research, how much misophonia can be considered as a disorder
in its own right or as a sub-disorder related to other disorders and/or clinical pathologies; and what
the triggers of misophonic symptoms are, their age of onset and the course they take over time.
The Methodology of the International Centre of Psychology and Strategic

Psychotherapy: Listening Desk, Interviews, Checklists
On 27 March 2021, an important collaboration between the CIPPS (International Centre of

Psychology and Strategic Psychotherapy) and the AIMIF (Associazione Italiana Misofonia, or Italian
Misophonia Association) began via a listening desk dedicated to misophonic patients. The service,
which can be accessed from all over Italy, aimed to welcome and support misophonic patients from
a psychological point of view, and to carry out research into this little-known clinical syndrome.
The listening desk can be accessed by those affiliated with the AIMIF; people who become aware
of the listening desk can contact the helpline and are told, if they are not already members of the
Association, how to proceed with affiliation, as affiliates benefit from three free meetings with the
therapist. A therapist contacts the user to acquire an e-mail to which should be sent the consent
for personal data processing, the Duke Misophonia Questionnaire, abbreviated DMQ (Rosenthal
et al., 2021) and the Duke Misophonia Interview checklist, abbreviated DMI. These documents
must be completed and sent to the therapist before the first interview begins.
Said checklist, known as the Duke Misophonia Trigger, an addendum to the Duke Misophonia
Interview (Rosenthal et al., 2021), is used to preliminarily identify misophonic triggers as reported
by interviewees.
This addendum facilitates the administration of the DMI, helping to determine the presence
or absence of triggers and inviting subjects to select the most disturbing noises before starting the
clinical interview.
It is important for the therapist to acquire this information prior to the first interview, in
which an intervention aimed at improving the person’s problem already takes place. The strategic
approach, on which the CIPPS team is based, originates as a brief therapy and within the first
interview an immediate intervention is made on the patient’s symptoms (Nardone & Watzlawick,
2010). At the moment the interviews take place on-line as the CIPPS team operates in Salerno (in
Southern Italy) and the first patients called from regions in Northern Italy.
The First Three Interviews
During the first two interviews, the therapist, in addition to establishing a clinical relationship
with the patients, explaining how the service works and that they could continue, depending on
the discomfort encountered, with a psychological support or psychotherapy treatment, examines
together with the patient the answers given to the questionnaire, integrating them, and exploring
them in depth with the DMI.
During these three interviews, the therapist’s objective is to acknowledge the patient’s request
for help, to have an overview of what the person’s misophonic symptoms are, what personal solu-
tions they have implemented, consequently which ones have worked, and which ones have failed,
and to know to what extent the misophonic symptoms create psychological discomfort and whether
this discomfort influences and/or compromises the person’s social, work, and affective functioning.
The therapist aims to find out whether the misophonic symptoms have created other difficul-
ties on a psychological level, whether they have therefore caused, for example, anxiety, or whether
the person was suffering from an anxious state that has been succeeded by misophonia; whether
or not tinnitus, hearing loss, hyperacusis/hypersensitivity to sounds, selective sound sensitivity
syndrome (Taylor, 2017; Robinson et al., 2018) have been detected.
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At the end of the third interview, the clinician provides the patient with feedback on what
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emerged from the first three interviews and, based on the level of distress detected through the
answers given to the questionnaire, the interview, and the subjective assessment by the therapist,
proposes an extended psychotherapy or psychological support program.
Patients who continue the treatment will retake the Duke Misophonia Questionnaire at the
last meeting, in order to compare the answers given on the first DMQ compiled before the start of
the three interviews with those given at the end of the whole treatment.
After the three interviews, the therapist compiles a checklist that was constructed by the
CIPPS team and presented at the Duke University meetings. The checklist is updated if the patient
continues with psychological support or psychotherapy. The team behind the listening desk consists
of six therapists coordinated by a supervisor. It may be important for the team to make use of other
professional figures such as an audiologist and an ENT specialist, for a diagnostic framework that
also takes into account the more organic aspects related to hearing. If the team deems it necessary,
it can also request a consultation with a psychiatrist from the CIPPS Clinical Centre for patients
at the counter.
DMQ (Duke Misophonia Questionnaire) and DMI (Duke Misophonia

Interview)
The CIPPS team employed the first version of two tools, the Duke Misophonia Questionnaire
(Rosenthal et al., 2021) and the semi-structured interview (Duke Misophonia Interview) abbrevi-
ated respectively DMI and DMQ, to perform an adequate analysis of the misophonic patients’ help
request. These tools facilitated the therapist in structuring the first two interviews.
The psychometrically validated DMQ questionnaire consists of 86 items, divided into the
following subscales: trigger frequency, investigated by 16 items; affective responses to triggers,
investigated in 5 items; physiological responses, 8 items; cognitive responses, 10 items; coping
before (6 items), coping during (10 items) and coping at the end of the trigger event (5 items);
the harm and invalidation caused by the misophonic event (12 items), and beliefs related to the
pathology (14 items). In addition, there are consequential composite scales for overall symptom
severity (assessing affectivity, physiology, and cognition in combination) and for coping strategies.
The choice to use the DMQ proved to be significant as, unlike other similar instruments such as
the Misophonia Questionnaire (Wu et al., 2014), the Amsterdam Misophonia Scale (Naylor et al.,
2021), and the Misophonia Response (Dibb et al. 2021), it does not focus on the symptoms and
disabling facets of the syndrome, but rather on the patients’ processes; as a matter of fact, the Duke
Misophonia Questionnaire originated from the need to have an instrument that would take into
account, in a clinical and research context, and in a comprehensive manner, the affective, cognitive,
behavioural and physiological processes that arise in response to misophonic symptoms (Rosenthal
et al., 2021). Thus, by administering this questionnaire, it is possible to arrive at the development
of targeted interventions that take into account the differences in reactivity and responsiveness
of patients to misophonic triggers. For example, patients who report distressing experiences as a
symptom would benefit from a different therapeutic intervention than those who report primary
problems of hypervigilance, excessive avoidance, or other. In other words, the intervention must
be accordingly tailored to the patient.
The DMQ scales have been psychometrically validated to investigate a wide range of responses
and coping strategies to misophonic stimuli before, during and after exposure to the respective
triggers, as well as affective, physiological, behavioural, and cognitive response scales to these trig-
gers. The frequency over the past month of exposure and type of response to the same stimuli is
also measured (Rosenthal et al., 2021).
The DMI is a semi-structured clinical interview consisting of 25 items and used to assess the
misophonia-related experiences that individual experiences on a daily basis and, more specifically,
that they have experienced in the month prior to administration. The structure of the DMI is based
on other interview instruments used in clinical and research settings, including the Clinician-
Administered PTSD Scale for DSM-5 (CAPS-5) and the Anxiety Disorders Interview Schedule for
DSM-5 (ADIS-5). The importance of this interview stems from the fact that there are currently no
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other psychometrically validated interviews for misophonia capable of gathering information about
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the clinical syndrome, and the results of the DMI provide preliminary support in clinical proce-
dures (Guetta et al., 2022). The semi-structured interview is developed from the above-mentioned
addendum, through which the patients identify their three most annoying sound triggers, which
should be noted prior to the administration of the questionnaire. Subsequently, the patients will
be asked to rate on a scale from 1 (lowest) to 10 (highest) the level of the intensity of distress they
have experienced, in the last month, due to the symptoms. This measure is called the Subjective
Unit of Distress Scale (SUDS) and is necessary because it provides a subjective specificity to the
salience of the events experienced that can be referred to during the later stages of the interview,
so as to improve the reliability and validity of the answers.
Each interview item is then reformulated and addressed to the patients, using their own lan-
guage, in order to reflect their chosen definitions (e.g., if the patients reported the noise of chewing
as the main trigger, the questions would not be asked in terms of “trigger” but rather “the noise of
chewing” would be used). Each item of the interview surveys first of all the presence or absence
of the symptom in question, in terms of frequency and distress; after the subject has answered the
questions that make up an item, the clinician assigns the whole item a score ranging from zero to
four (from absent to very severe).
Frequency is defined as the number of times the symptom occurred during the last month,
a frequency that the patient can express as a percentage of time or by expressing the number of
times the symptom was relevant during a day in terms of waking hours. The detection of distress
is done by means of the SUDS “Subjective Unit of Distress Scale” (structured within the interview)
of the individual and by the description of the intensity of the symptom, on average, during the
last month. Based on the answers on frequency and distress, the clinician designates the severity
score of each item on a Likert scale. The frequency and discomfort scores are not always directly
related to each other: there may be cases in which a symptom presents itself daily, incessantly, at
every hour of the day, but has a very low intensity of distress and is defined as barely relevant by the
patient, just as a single episode over a thirty-days period may have an intensity that causes severe
impairment. In cases of inconsistency, the interview guidelines advise the clinician to cautiously
focus on the low intensity or the lowest frequency.
Several items also include an assessment of overall impairment, also measured by a Likert
scale, in areas related to sensory, behavioural, emotional, interpersonal, and physiological domains,
as well as an overall assessment of symptom severity.
In order to collect and highlight the data functional to achieving some of the set objectives, i.e.,
greater knowledge of misophonic symptomatology, comorbidity with other psychological problems
and with other hearing disorders, useful resources used by the patients, the team at CIPPS con-
structed a checklist for each patient in order to collect the data that emerged during the interviews.
The Checklist: Data Collection, First Interventions and Results
The questions from the Duke Misophonia Questionnaire and the content analysis of the first
patient interviews at the listening desk were used to construct the CIPPS’ checklist. The checklist,
which serves to collect data on the targets set by CIPPS and Duke University, was divided into the
following items:
•• Comorbidity with other psychological disorders, specifically anxiety disorder, mood
disorders, sleep disorders, obsessive-compulsive disorder (OCD), attention deficit
disorder and/or Hyperactivity Disorder (ADHD), cognitive deficits;
•• Reactions associated with listening to trigger sounds such as anger, anticipatory anxi-
ety, isolation, brooding;
•• Trigger sounds: chewing noise, snoring, ticking, nasal noises, breathing, paper noise,
car noise, particular speech sounds.
•• Strategies used by the patient to cope with misophonic symptoms;
•• Significant symptom-related relationships, i.e., relationships within which the patient
is most activated by trigger sounds;
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•• Presence of other hearing disorders: tinnitus, hyperacusis, selective hypersensitivity

and hypersensitivity to sounds.
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Seven patients are currently attending the listening desk. Five of them came through informa-
tion received from the AIMIF, one through research carried out using search engines and the last
through contact information provided by acquaintances.
The checklist was compiled for each patient after the first three interviews provided by the
listening desk, and at the end of the psychological support or psychotherapy treatment, both to
record and observe the frequency with which each item occurs in the cases studied, and to record
any changes between the beginning, the first three interviews, and the end of the treatment course
in the individual subject. The checklist was compiled taking into account the answers given to the
DMQ, the DMI and the therapy itself.
In detail, the following emerges from the first three interviews:
The psychological disorders included in the checklist are those that, from the existing scientific
literature, appear to have a higher comorbidity with misophonia (Robbins et al., 2021; Jager et al.,
2020). Specifically, three out of seven patients report having previously been diagnosed with an
anxiety disorder, two out of seven with a mood disorder, one with traits of obsessive-compulsive
disorder with mild cognitive impairment and one with a diagnosis of dependent personality disorder.
The analysis of the DMQ responses on the reactions associated with listening to trigger sounds
shows that
Two out of seven patients use isolation, i.e., limiting attendance at places and situations where
there is a likelihood of hearing trigger sounds;
•• Two out of seven patients record brooding, i.e., repetitive thinking triggered in an at-
tempt to implement a problem-solving process about a potential danger represented
by the likelihood of the occurrence of the trigger sound;
•• Five out of seven patients state that they feel agitated and emotionally activated by
the possibility of the occurrence of the trigger sound, showing anticipatory anxiety;
•• Five out of seven patients state that they experience high levels of anger as a conse-
quence of hearing the trigger sounds;
•• Four out of seven patients experience a sense of helplessness, i.e., inability to react to
the presence of the trigger sounds.
The data concerning trigger sounds were also extrapolated from the analysis of the Duke
Misophonia Questionnaire, which has an area dedicated to the categorical gathering of information
concerning sounds that the patient perceives as misophonic. Five out of seven patients consider
nasal sounds, breathing and chewing sounds to be triggers; four consider the sound of snoring,
three the sound of ticking and two out of seven patients the sound of hearing the pronunciation of
the letter “s”. In addition, the sound of cars, computer fans, children’s footsteps, footballs, and loud
music were reported by individual patients.
From the analysis of the clinical interviews, all patients report that reactions to trigger sounds
are exclusively correlated and/or intensified when produced by significant others. It would there-
fore seem that the relational dynamics between the misophonic patient and the significant person
of reference have a relevant impact on the activation of misophonic reactions, as also reported by
some studies (Tyler et al., 2014).
In the checklist we find an item indicating the presence or absence of any hearing disorder,
based on what the patients reported, since in the scientific literature several studies (Jastreboff &
Jastreboff, 2001; Jastreboff & Jastreboff, 2014) were based on the hypothesis of finding correlations
and/or making a differential diagnosis between the aforementioned disorders and misophonia. From
our initial data, it would appear that only one in seven patients had, from previous audiometric
investigations, been diagnosed with a hearing disorder, specifically tinnitus.
In the checklist there is also an item in which we report the strategies, described during the
interviews, through which the patients used to cope with trigger sounds, differentiating, for each
patient, those through which they experienced relief in the short term and those from which they
never benefited. The most important ones were: using earplugs, listening to music and changing
rooms. Specifically, the use of earplugs/earphones was tested by five patients, with a positive ef-
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fect in four of them. Listening to music in conjunction with the presence of the trigger sound was
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tried out by six patients, with a positive effect in five of them. Changing rooms was tried out by six
patients, having a positive effect in five of them.
At the end of the three interviews provided by the listening desk, the patient has the option
of starting a psychological support or psychotherapy treatment; four of the patients decided to do
so. Before the last session of the support treatment, the patients recompile the Duke Misophonia
Questionnaire and their answers, together with the contents that emerged during the interviews, are
used to fill in the items on the checklist. In this way, it is possible, within the checklist, to compare
the patient’s condition before the start of support or psychotherapy with the condition at the end of
the treatment. It would appear from this comparison that the significant differences between before
and after are above all inherent in the decrease in the intensity with which trigger-related reactions
appear and in the perceived annoyance of hearing trigger sounds. What appears to be unchanged
are the reactions to the emission of trigger sounds by persons significant to the patient. On the basis
of what has been said, it should be pointed out that the correlation between misophonic reactions
and the sound origin, although it emerges in our data, does not yet have statistical significance and
scientific value and will therefore be the subject of further research by the CIPPS team
Future Perspectives
The main future goal will be to expand and deepen knowledge on misophonia. CIPPS, in
collaboration with the Duke Centre for Misophonia and Emotion Regulation (CMER) and the
University of Salerno, plans to administer the Duke Misophonia Questionnaires to a significant
sample of university students and trainees in TFA course (Teachers’ Training internship Programmes,
postgraduate specialisation to support disability students in schools).
The analysis of the questionnaire scores would first of all make it possible to spread aware-
ness of the existence of misophonia, to identify people who might have misophonic symptoms and
consequently to collect data on misophonic symptoms, frequency, strategies. The administration of
such an instrument would represent an initial investigation from which to design interventions to
raise awareness of a syndrome that is unknown especially by those who suffer from it not knowing
they belong to the category of misophonic subjects.
Patients who come to the listening desk could be administered self-report tools to detect
personality disorders, anxiety disorders, depressive disorders, so as to possibly detect comorbidity
or differential diagnosis with other clinical pathologies, with the aim of deducing whether miso-
phonia can be considered a consequence or a symptom of other diagnoses or a condition in its own
right. Some of these tests to detect these psychological disorders could be the following: SCID-1,
MMPI-2, SCL-90; CORE-OM. Assisted patients will be referred, if they have not already done so,
for audiometric screening to exclude or diagnose other hearing disorders.
The ultimate aim behind the entire project is to find, through constant discussion with the
Duke University team, techniques that will help the patient to manage trigger sounds in everyday
life and thus mitigate the negative reactions associated with them.
Based on a cognitive-behavioural approach, Duke currently refers to two main protocols in
the treatment of misophonia. Their choice of protocols and techniques to be implemented with the
patient is made by taking into account the peculiarities of the patient. This starting point unites
Duke’s approach with the CIPPS’ approach, in which the therapeutic intervention is strategically
constructed on the individual patient, starting from their difficulties, and taking into account their
strengths above all.
The first protocol Duke uses for misophonic patients is Process-based CBT (Hofmann &
Hayes, 2019) which is based on a careful functional analysis where the patient is trained to notice
and record what happens before, during and after hearing the trigger sound.
The analysis is done by investigating attentional, psychological, cognitive, relational, and
behavioural reactions. On the basis of the data recorded by the patient, a decision is made to work
towards the acquisition of cognitive, attentional or bodily techniques aimed at learning and tolerat-
ing the trigger sounds and managing the reactions associated with them.
Among the typical methods of the strategic approach that have features in common with
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Process-based CBT are the logbook technique and the technique of problem deconstruction. In the
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use of the logbook, the therapist asks the patient to write in a notebook, recording the progress and
developments of the problem under investigation, noting physiological, emotional, and behavioural
reactions when they feel discomfort at a certain sound. The requirement to keep a diary can be
extremely useful to the therapist in gathering information about how and how often the symptom
occurs. Moreover, when the patient is asked “to meticulously note down situations, times, people
present, places and other details related to the problem at the very moment it manifests itself, a shift
of attention from the symptomatology to the task is achieved and this frequently results in greater
awareness and, more importantly, a reduction in the intensity of the symptoms” (Secci, 2012, p. 69).
The deconstruction technique “aims to identify the cognitive, emotional and behavioural structures
through which the problem manifests itself and lasts. In order to deconstruct the problem, the
therapist invites the patients to recount specific situations experienced with particular discomfort
and helps them to break them down into chronologically ordered and interconnected units, so that
they collectively represent a description of the sequence of events that generates and maintains the
disorder. [...] Deconstruction leads to the discovery of recursive elements that precede, accompany,
and follow the manifestation of the symptomatology. The patient’s emotions, thoughts and behav-
iour are inserted into the sequence of the problem by establishing a vicious circle, an endless game
that would be invisible without the breakdown and punctuation of events that is achieved through
this technique” (Secci, 2021, p. 68)
The CIPPS approach will also investigate the attempted solutions, i.e., the strategies that the
subject is accustomed to employ in order to deal with the perceived sound as frustrating, unpleas-
ant, negative. As emerges from the scientific literature (Schewemmie & Arens, 2021), one of the
strategies most frequently implemented by the misophonic patient is the avoidance of the afore-
mentioned situations, which would progressively lead to social isolation. By means of strategic
dialogue (Nardone, 2004), the patient can be made aware of the ineffectiveness of the attempted
avoidance solution, which, in fact, does not help them solve the problem, and thus lead them to
work on sound desensitisation.
The second Duke Center protocol used with misophonic patients is the Unified Protocol for
Transdiagnostic Treatment of Emotional Disorders (Barlow et al., 2017), which focuses more on
the emotional reactions triggered by trigger sounds; this protocol is based on the observation that
these reactions lead to a reduction in activities and situations in which there is a risk of hearing
them, which is why it uses sound desensitisation techniques.
The progress of the psychological support interviews, the possible use of Duke’s techniques
and those of CIPPS, will be constantly monitored to verify their effectiveness, not excluding the
possibility of introducing, in the future, other instruments that prove to be suitable for the treat-
ment of misophonic symptoms and outlining an integrated intervention protocol between Duke’s
therapeutic approach and that of CIPPS.
Conclusions
The data collected so far would seem to confirm what is reported in regards of the symptoms
characterising misophonia, the emotional and behavioural reactions of the patients, the possible
comorbidity with other disorders, both psychological, such as anxiety and depression, and or-
ganic, such as tinnitus. It will certainly be necessary to increase the number of patients to whom
administer the DMQ and the DMI, as to collect statistically significant data in order to proceed
with a more in-depth analysis that may include the use of other tools to investigate the presence of
psychological disorders, thus enhancing the accuracy of our methodology. At the same time, the
importance is also emerging of reinforcing the strategies that misophonic patients themselves put
in place, following the teachings of Milton Erickson, whose hypnotherapeutic model focuses on
identifying the patient’s strengths, reinforcing them, and conveying confidence so that they can
identify new ones. The team’s intervention has been based on this therapeutic principle since the
first interviews. It is believed, both from what is reported in the literature and what is emerging
from findings, that reactions to misophonic symptoms depend very much on the person who gives
them out. Therefore, it may be important to work not only on an individual level but also on the
OF PSYCHOLOGY
IN THE 21st CENTURY
Vol. 16, No. 1, 2022
system in which the misophonic subject lives, both with psychotherapeutic and psychoeducational
46
interventions. As some studies report it becomes important, in order to reduce the emotional and
behavioural reactions to misophonic sounds, to be able to make a psychoeducational intervention
on the whole system: the misophonic patient is put in a position to talk about their difficulties with
the family system, or rather with the person who emits the trigger sound and together, with the
guidance of the therapist, to build ways of managing the problematic behaviour.
Declaration of Interest
The authors declare no competing interest.
Notes
This scientific article is the result of a joint work by the authors.
M. Zachary Rosenthal is the scientific supervisor.
Maria Annarumma is the author of the paragraph: Introduction.
Francesco Sessa is author of the paragraphs: The methodology of the International Centre of Psy-
chology and Strategic Psychotherapy: listening desk, interviews, checklist; conclusions.
Iris Consalvo is the author of the paragraphs: Misophonia: trigger sounds, emotional and be-
havioural responses; Etiological hypotheses of misophonia; Hearing disorders, Misophonia and
differential diagnosis
Valerio De Masi is author of the paragraphs: DMQ Duke Misophonia Questionnaire and DMI
Duke Misophonia Interview
Luana Pagano is author of the paragraphs: The check-list: data collection, first interventions and
results; Future perspectives.
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future directions: Part I. Definitions and manifestations. American Journal of Audiology, 23, 402–419.
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https://doi.org/10.1002/jclp.22098
Received: April 18, 2022 Revised: May 28, 2022 Accepted: June 14, 2022
Cite as: Rosenthal, Z. M., Annarumma, M., Sessa, F., Consalvo, I., De Masi, V., & Pagano, L. (2022).
Misophonia: Symptoms, comorbidities and perspectives of intervention. From theory approach
to integrated clinical practice research. Problems of Psychology in the 21st Century, 16(1), 36-48.
https://doi.org/10.33225/ppc/22.16.36
Zachary M. Rosenthal Associate Professor, Director Center for Misophonia & Emotion Regulation Duke
University Medical Center & Duke University, Duke University Medical Center, U.S.A.
E-mail: mark.rosenthal@duke.edu
Maria Annarumma Associate Professor, Department of Humanities, Philosophy and Education,

(Corresponding author) University of Salerno, Italy.
E-mail: mannarumma@unisa.it
Francesco Sessa Psychologist-Psychotherapist, Didactic Director of International Centre of Psychology

and Strategic Psychotherapy of Salerno (CIPPS), Italy.
E-mail: f.sessa@cipps.it
Iris Consalvo Psychologist and Psychotherapist in Training at International Centre of Psychology

E-mail: i.consalvo@cipps.it
Valerio De Masi Psychologist and Psychotherapist in Training at International Centre of Psychology

E-mail: v.demasi@cipps.it
Luana Pagano Psychologist and Psychotherapist in Training at International Centre of Psychology

E-mail: l.pagano@cipps.it
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HOW TO BE A DIGITALLY SAVVY RESEARCHER . . . . . . . . . . . . . . . . . . . . 4

CLINICAL DIFFERENCES IN MANIFESTATIONS OF SELF-DESTRUCTIVE BEHAVIOR IN

TO BE YOUNG, ALIENATED AND UNEMPLOYED: SOCIAL IDENTITY, ATTITUDES AND

MISOPHONIA: SYMPTOMS, COMORBIDITIES AND PERSPECTIVES OF

INSTRUCTIONS FOR AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

JOURNAL OF BALTIC SCIENCE EDUCATION . . . . . . . . . . . . . . . . . . . . . . 51

HOW TO BE A DIGITALLY SAVVY

Expand Your Online Presence

Expand Your Network

Academic Social Networking Sites

•• ResearchGate. ResearchGate was founded in 2008 in Berlin, Germany. ResearchGate

‘Mass Market’ Social Media Platforms

Comprehensive Networking Strategy

Professional Online Behaviour

To study clinical differences in manifestations of self-destructive behavior in patients with

Instruments and Procedures

Nosological units Gr1 PermSDB Gr2 ImpSDB Total

Motivational attitudes of patients Gr1 PermSDB Gr2 ImpSDB

14 Motivational attitudes of patients Gr1 PermSDB Gr2 ImpSDB

Attempts to overcome feelings of conflict in the family (… «got conflicts…», «…

Looking at these examples, we see a difference in motivational statements in different groups

Cite as: Bashynskyi, O. (2021). Clinical differences in manifestations of self-destructive behavior in

Oleksandr Bashynskyi PhD Student, Department of Psychiatry, Psychotherapy and Medical

TO BE YOUNG, ALIENATED AND

Anastasia Kitiashvili, Tamar Abashidze, Irine Zhvania

with others is employment. Unemployment status is likely to prevent unemployed individuals

The Context of Georgia

Instrument and Procedures

1. Inferior status - superior status

Reasons for Becoming a NEET Youth

In-depth interview respondents noted:

About 62.8% came to regret their decision with time.

Reason for leaving school %

I needed to start a job because of my family. 45.8

Factors influencing decision making

Parental advice 3.5

Evaluation of the decision 27

Planning to continue my education

Yes, in VET 43.1

Should others terminate their education early?

According to the survey results, the study participants are unemployed.

Attitudes towards Education and Employment of NEET Youth

Very negative Negative Neutral Positive Very positive

Attitudes towards employment are positive, with a rating of 4 (SD=1.9)

Evaluation of the Social Status of NEET Group

1 Friendly 4.21 0.10 4.00 1.07 3.71 0.96

2 Happy 5.15 10.01 3.81 1.05 4.0 0.88

1. Inferior status - superior status

Social Identity of NEET youth

Happiness and Well-being

Participants have high self-esteem out of a maximum of 40 points (M = 30.92; SD=3.45)

Escaping of Youth from the Status of NEET

Self-esteem 24.47 58.280 <.01

Conclusions and Implications

The authors declare no competing interest.

Misophonia: Trigger Sounds, Emotional and Behavioural Responses

Misophonia is characterised by extreme sensitivity to specific human-generated sounds

Aetiological Hypotheses of Misophonia

Hearing Disorders, Misophonia and Differential Diagnosis

The Methodology of the International Centre of Psychology and Strategic

On 27 March 2021, an important collaboration between the CIPPS (International Centre of

The First Three Interviews

DMQ (Duke Misophonia Questionnaire) and DMI (Duke Misophonia

The Checklist: Data Collection, First Interventions and Results