Experiences of guilt and shame in patients with familial hypercholesterolemia: A qualitative interview study

ObjectiveTo explore patients’ experiences of guilt and shame with regard to how they manage familial hypercholesterolemia.MethodsWe interviewed 40 men and women diagnosed with heterozygous familial hypercholesterolemia. Data were analyzed by systematic text condensation inspired by Giorgi's phenomenological method.ResultsParticipants disclosed their condition as inherited and not caused by an unhealthy lifestyle. They could experience guilt or shame if they violated their own standards for dietary management, or if a cholesterol test was not favorable. Participants had experienced health professionals who they felt had a moralizing attitude when counseling on lifestyle and diets. One group took this as a sign of care. Another group conveyed experiences of being humiliated in consultations.ConclusionPatients with familial hypercholesterolemia may experience guilt and shame related to how they manage their condition. Health professionals’ counseling about lifestyle and diet may induce guilt and shame in patients.Practice implicationsHealth professionals should be sensitive to a patient's readiness for counseling in order to diminish the risk of unintentionally inducing guilt and shame in patients.     

Cultural diversity in causal attributions for illness: The role of the supernatural

We investigated cultural diversity in beliefs about the causes of illness and assessed the possibility that popular free-form methodologies (asking subjects to generate causes) inhibit minorities from expressing their belief in supernatural causes. As predicted, when asked to generate causes of illness and rate these in terms of their importance, whites and minorities did not differ in the number or type (natural vs supernatural) of causes they generated or in the importance rating they assigned to these. However, when these same subjects were provided with natural and supernatural causes to rate in terms of importance, minorities rated supernatural causes significantly more important than did whites, and more minorities than whites endorsed such causes. Cultural differences in causal attributions for illness are examined, and the role of methodology in determining such attributions is highlighted.     

The role of therapist self-disclosure in psychotherapy: A qualitative review

Over 90% of therapists self-disclose to clients (Mathews, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987; Edwards & Murdock, 1994), however, the implications of therapist self-disclosure are unclear, with highly divergent results from one study to the next. The goal of this paper was to review the empirical literature relevant to therapist self-disclosure, and provide the reader with a comprehensive understanding of the factors that affect, and are affected by, therapist self-disclosure. Findings are organized into an integrated model examining the who, what, when, why, and how of therapist self-disclosure. In addition, training implications and suggestions for future research are provided.     

A psycho‐educational intervention for depressed women: A qualitative analysis of the process

Yalom (1995) has stated that psycho‐educational interventions could be made more effective by incorporating a focus on the interpersonal process. A qualitative analysis is proposed to investigate the degree of fidelity with which a psycho‐educational intervention for women with depressive symptoms was delivered and to identify Yalom's significant therapeutic mechanisms operating in group therapy. The intervention consisted of six 2 two‐hour weekly sessions organized around educational material. Eight groups were conducted with 5 ? 19 participants each. A qualitative analysis was undertaken based on Kvale's (1996) technique of ‘categorization of meanings’ for the transcribed registers of audiotaped recordings. The analysis led to the definition of five major group process categories: establishment of rules, educational exchange, experiential exchange, reflexive work designed to achieve cognitive and behavioural change, and limitations on the exchange process. It showed that the facilitators largely adhered to the goals of the intervention, its strategies and model, and that the main limitations concerned facilitators' and participants'speaking for over‐long periods of time and facilitators' failure to cover all the material due to lack of time. The subsequent analysis identified four of Yalom's categories: installation of hope, didactic instruction, catharsis, and universality. In support of Yalom's assertion, we concluded that this exercise was useful in that it highlighted important therapeutic factors that could be more purposefully manipulated in the future.     

Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis

Background

Diffusion tensor imaging (DTI) is increasingly used in various diseases as a clinical tool for assessing the integrity of the brain’s white matter. Reduced fractional anisotropy (FA) and an increased apparent diffusion coefficient (ADC) are nonspecific findings in most pathological processes affecting the brain’s parenchyma. At present, there is no gold standard for validating diffusion measures, which are dependent on the scanning protocols, methods of the softwares and observers. Therefore, the normal variation and repeatability effects on commonly-derived measures should be carefully examined.

Methods

Thirty healthy volunteers (mean age 37.8 years, SD 11.4) underwent DTI of the brain with 3T MRI. Region-of-interest (ROI) -based measurements were calculated at eleven anatomical locations in the pyramidal tracts, corpus callosum and frontobasal area. Two ROI-based methods, the circular method (CM) and the freehand method (FM), were compared. Both methods were also compared by performing measurements on a DTI phantom. The intra- and inter-observer variability (coefficient of variation, or CV%) and repeatability (intra-class correlation coefficient, or ICC) were assessed for FA and ADC values obtained using both ROI methods.

Results

The mean FA values for all of the regions were 0.663 with the CM and 0.621 with the FM. For both methods, the FA was highest in the splenium of the corpus callosum. The mean ADC value was 0.727 ×10^-3 mm²/s with the CM and 0.747 ×10^-3 mm²/s with the FM, and both methods found the ADC to be lowest in the corona radiata. The CV percentages of the derived measures were < 13% with the CM and < 10% with the FM. In most of the regions, the ICCs were excellent or moderate for both methods. With the CM, the highest ICC for FA was in the posterior limb of the internal capsule (0.90), and with the FM, it was in the corona radiata (0.86). For ADC, the highest ICC was found in the genu of the corpus callosum (0.93) with the CM and in the uncinate fasciculus (0.92) with FM.

Conclusions

With both ROI-based methods variability was low and repeatability was moderate. The circular method gave higher repeatability, but variation was slightly lower using the freehand method. The circular method can be recommended for the posterior limb of the internal capsule and splenium of the corpus callosum, and the freehand method for the corona radiata.     

Social anxiety in anorexia and bulimia nervosa: the mediating role of shame

Objective: The close relationship between social anxiety and eating disorders has attracted considerable scholarly attention in recent years. Shame has been identified as the key emotional symptom in the link between social anxiety and social phobia. While shame is commonly recognized as a meaningful construct for understanding eating disorders, empirical research into this issue has been lacking. Thus, the objective of this study was to determine the strength of influence shame and social anxiety have in the psychopathology of anorexia nervosa and bulimia nervosa compared with other clinical groups. Furthermore, the issue of whether shame can account for clinical group differences in the experienced levels of social anxiety was examined. Method: The sample consisted of 120 female inpatients, divided into four groups of 30 according to individual diagnoses: anorexia nervosa, bulimia nervosa, anxiety disorders and depression. The Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS) and the Internalized Shame Scale (ISS) were used to measure the target constructs for this investigation. Results: Patients with anorexia and bulimia nervosa have higher scores in internalized global shame than patients with anxiety disorders and depressions. In contrast to anorectic patients, however, patients with bulimia also have higher scores than the other two groups in the area of social performance anxiety; they also differ significantly from the anxiety disorders in terms of interaction anxiety. Once shame was partialled out, group differences of social anxiety were shown to disappear. Discussion: Both shame and social anxiety have to be regarded as important influencing factors in anorexia and bulimia nervosa, with shame making a significant contribution to the explanation of social anxieties. The interaction between shame and social anxiety as well as its relevance for eating disorders are discussed. With regards to the therapeutic implications, it would seem reasonable not only to focus on treating shame affect but also to specifically adopt a therapeutic strategy targeting social anxiety fears. Copyright © 2006 John Wiley & Sons, Ltd.     

Body size stigmatization in preschool children: the role of control attributions

OBJECTIVE: The current study assessed preschool-age children's control attributions for weight and the relationship of these attributions to attitudes and behavioral intentions toward children of different body sizes. METHODS: Forty-two children (mean age = 5.2 years) were interviewed about the adjectives they attributed to figures of different sizes, their preference for size in playmates, and their beliefs about children's ability to control their own weight. RESULTS: Adjective ratings for obese figures were the most negative, with no differences found for thin and average figures; the heaviest figure was also chosen less often than other figures to be a playmate. Internal attributions of control for weight were related to less positive adjective ratings for the heavier figure but not to children's friendship selections. CONCLUSION: Results suggest that the relationship between body size stigmatization and control attributions are consistent with attribution theory for young children. Practical implications of these results and possible interventions are discussed.     

The Windkessel model revisited: A qualitative analysis of the circulatory system

In this paper, we derive a comprehensive computational model to estimate the arterial pressure and the cardiac output of humans, by refining and adapting the well-established equations of the Windkessel theory. The model inputs are based on patient specific factors such as age, sex, smoking and fitness habits as well as the use of specific drugs. The model's outputs correlate very strongly with physiological observations, with a low error of ～5% for the arterial pressure.     

Experiences of guilt and shame in patients with familial hypercholesterolemia: a qualitative interview study

OBJECTIVE: To explore patients' experiences of guilt and shame with regard to how they manage familial hypercholesterolemia. METHODS: We interviewed 40 men and women diagnosed with heterozygous familial hypercholesterolemia. Data were analyzed by systematic text condensation inspired by Giorgi's phenomenological method. RESULTS: Participants disclosed their condition as inherited and not caused by an unhealthy lifestyle. They could experience guilt or shame if they violated their own standards for dietary management, or if a cholesterol test was not favorable. Participants had experienced health professionals who they felt had a moralizing attitude when counseling on lifestyle and diets. One group took this as a sign of care. Another group conveyed experiences of being humiliated in consultations. CONCLUSION: Patients with familial hypercholesterolemia may experience guilt and shame related to how they manage their condition. Health professionals' counseling about lifestyle and diet may induce guilt and shame in patients. PRACTICE IMPLICATIONS: Health professionals should be sensitive to a patient's readiness for counseling in order to diminish the risk of unintentionally inducing guilt and shame in patients.     

Shame as a social phenomenon: A critical analysis of the concept of dispositional shame

An increased clinical interest in shame has been reflected in the growing number of research studies in this area. However, clinically orientated empirical investigation has mostly been restricted to the investigation of individual differences in dispositional shame. This study reviews recent work on dispositional shame but then argues that the primacy of this construct has been problematic in a number of ways. Most importantly, the notion of shame as a context‐free intrapsychic variable has distracted clinical researchers from investigating the management and repair of experiences of shame and shameful identities and has made the social constitution of shame less visible. Several suggestions are made for alternative ways in which susceptibility to shame could be conceptualized, which consider how shame might arise in certain contexts and as a product of particular social encounters. For example, persistent difficulties with shame may relate to the salience of stigmatizing discourses within a particular social context, the roles or subject positions available to an individual, the establishment of a repertoire of context‐relevant shame avoidance strategies and the personal meaning of shamefulness.     

The relationship of shame,social anxiety and depression: the role of the evaluation of social rank

This study explores the associations between shame, depression and social anxiety from the perspective of social rank theory (Price and Sloman, 1987 ; Gilbert, 1989 , 1992 ). Social rank theory argues that emotions and moods are significantly influenced by the perceptions of one's social status/rank; that is the degree to which one feels inferior to others and looked down on. A common outcome of such perceptions is submissive behavior. It is suggested that shame, social anxiety and depression are all related to defensive submissive strategies when individuals find themselves placed in unwanted low status/rank positions. In this study 109 students and 50 depressed patients filled in a battery of self‐report questionnaires designed to measure varied aspects of shame, guilt, pride, social anxiety, depression, and social rank (inferiority self‐perceptions and submissive behaviour). Results confirm that shame, social anxiety and depression (but not guilt) are highly related to feeling inferior and to submissive behaviour. It is suggested therefore that an understanding of the defensive behaviours of animals and humans who are located in unwanted subordinate positions may throw light on the underlying psychobiological mechanisms of these varied pathologies. Copyright © 2000 John Wiley & Sons, Ltd.     

An examination of hardiness throughout the sport-injury process: A qualitative follow-up study

Objectives. This qualitative follow-up study aimed to enhance the interpretability and meaningfulness of the findings that emerged from a quantitative study that explored the effect of hardiness on the prediction of, and response to, sport injury (i.e., Wadey, Evans, Hanton, & Neil, 2012). Design. Using theory-based and maximum-variation sampling to contextualize and provide an in-depth understanding of the previous findings, the participants comprised a purposeful sample of 10 athletes from the quantitative study (M age = 21.7; SD= 1.06). Methods. Data were derived through semi-structured interviews, and analysed and displayed using composite sequence analysis (Miles & Huberman, 1994). Results. The findings extended Wadey et al.'s (2012) study by identifying the perceived mechanisms by which athletes high and low in hardiness exacerbated or attenuated the impact of pre-injury negative major life events (i.e., a significant predictor of sport injury) and post-injury responses. Specifically, the findings demonstrate that athletes high in hardiness possessed a refined repertoire of problem- and emotion-focused coping strategies that they used pre- and post-injury. Those athletes low in hardiness used avoidance coping strategies that had long-term negative implications. Conclusions. These findings have important implications for the structure, timing, and content of hardiness interventions that aim to reduce rates of injury occurrence and expedite injured athletes' return to competitive sport. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT??: Although the personality trait of hardiness has received limited research attention in the context of sport injury, a recent study demonstrated that hardiness lowers the risk of, and promotes recovery from, injury (Wadey, Evans, Hanton, & Neil, 2012). Despite these encouraging findings, they fail to contextualize and provide an in-depth understanding of the mechanisms by which hardiness operates. WHAT DOES THIS STUDY ADD??: ? A number of personal and situational factors affected athletes' responses pre- and post-injury. ? Athletes high and low in hardiness used different coping strategies throughout the sport-injury process. ? These findings have implications for the structure, timing, and content of hardiness interventions.     

丧亲青少年哀伤过程的定性研究

目的:探讨丧亲青少年的哀伤过程,为青少年的哀伤咨询提供依据。方法:据理论抽样原则选取18名在青少年时期丧亲(父或母去世)的被访者进行深度访谈。采用主题分析方法分析数据,运用编码分析软件Atlas.ti 5.0对访谈资料进行分析。结果:丧亲青少年的哀伤过程有4个共同主题,即面对生活的巨变、体验丧亲的痛苦与失落、在哀伤中继续生活、重新诠释死亡。共同主题还分别有4个次级主题,即强烈的反应、否认与逃避、生活秩序的骤变、卷入家庭系统的重组;承受告别的痛苦、未完成事件的遗憾、强烈的思念与呼唤、承受死亡的真实;独自哀伤的需要、对哀伤的反思、寻找应对方式、哀伤的反复;将死亡合理化、与逝者建立联结、建立死亡的意义、哀伤的超越与转化。结论:青少年从哀伤到复原需经历四阶段的哀伤过程,其哀伤过程具有独特的阶段特征。对青少年进行哀伤咨询时应引导青少年接纳其哀伤过程的阶段性特点、尊重青少年哀伤的独特性,并同时处理家庭哀伤。     

Living with puerperal psychosis: A qualitative analysis

Objectives: To explore women's experiences of the relatively uncommon postnatal illness of puerperal psychosis, and to gain understanding into living through and past the illness. Design: An interview‐based study using grounded theory principles to analyse the qualitative data. Methods: Interviews were conducted with 10 women who had been diagnosed and treated for puerperal psychosis (defined according to DSM‐IV criteria, with onset within six weeks of childbirth) during the last 10 years. Results: Three main categories were identified from the interviews: puerperal psychosis as a separate form of mental illness, loss, and relationships and social rules. Further, two higher order concepts were identified, termed ‘living with emotions’ and ‘regaining and changing sel’. These concepts emerged across, and linked, the categories previously identified. Conclusions: Women felt that the illness took away the ability to experience normal emotions, as affective responses were viewed as potentially pathogenic. Although puerperal psychosis was described as a life‐changing experience, the women used feeling like their ‘old sense of self’ as a marker for recovery. Anger and frustration were directed towards health services because of their lack of provision of adequate information and support for the women and their families. More support may have alleviated the stresses placed on relationships and informed families about the nature of the illness. Further work is needed to establish the long‐term effects of suffering from puerperal psychosis.     

Predicting inept discipline: The role of parental depressive symptoms, anger, and attributions

Relations among parents' psychological difficulties (i.e., depressive symptoms, overt anger), dysfunctional attributions for child misbehavior, and inept discipline were investigated in a representative community sample of 451 mothers and 449 fathers. Depressive symptoms and anger were hypothesized to relate to discipline via their link with parents' attributions. Path analyses revealed that depressive symptoms predicted parent-centered causal attributions (i.e., stable, global, and dispositional), which, in turn, related to laxness. Depressive symptoms also predicted child-centered responsibility attributions (i.e., controllable, intentional, and negative), which, in turn, related to overreactivity. Anger predicted overreactivity directly. The patterns of relations were similar for fathers and mothers. The importance of addressing parents' psychological difficulties and dysfunctional attributions in interventions for families with disruptive children is discussed.     

The role of imagination in the disease process: Post-Cartesian history

A previous paper traced the pre-Cartesian history of the concept of imagination as a causal variable in physiopathology. The present paper continues that history, showing the prohibitive impact of mind-body dualism and sampling the views of some eighteenth- and nineteenth-century supporters of the theory. Contemporary research has produced abundant evidence supporting the historic belief that imagination has an arousal function and a direct link to physiopathology. This literature is surveyed and possible therapeutic applications are discussed.     

Ethnic variations in the caregiver role: a qualitative study

The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.     

初中生校园被欺凌行为与非自杀性自伤的关系:羞耻感的中介作用

目的:本研究拟从校园被欺凌和羞耻感两个方面来探究非自杀性自伤,旨在讨论①校园被欺凌行为,羞耻感与非自杀性自伤的人口学差异情况;②校园被欺凌行为,羞耻感与非自杀性自伤的关系;③羞耻感在校园被欺凌与非 自杀性自伤之间的中介作用.方法:选取初中生338名,以中学生羞耻感量表、Olweus儿童欺负问卷被欺凌分量表、青少年非自杀...