Addressing psychological aspects of physical problems through sandplay: A grounded theory study of therapists’ views

Objectives. This study aimed to explore therapists’ understanding of how people with a wide range of physical problems address the psychological aspects of these problems through sandplay, what happens for them in the process, what changes they experience and what sandplay can contribute to working with such people. Design. This exploratory qualitative study used grounded theory to systematically analyse the data and construct a substantive theory of therapists’ understanding of the processes and themes involved in sandplay therapy with people with physical problems. Methods. Semi‐structured interviews were carried out with nine sandplay therapists with the participants asked about their experiences of using sandplay to address physical problems. Results. The participants offered evidence of their clients’ ability to address their physical problems and the corresponding psychological issues through symbolic expression in the sand. The emergent theory suggested that such symbolic expression could facilitate access to feelings and experiences that can be difficult to address through verbal therapy alone, thus facilitating the process of integration and recovery. Conclusions. The theory suggests how therapists thought that clients may address their physical problems through sandplay and what is important in that process. There was also a suggestion that the focus and themes unfolding in sandplay process may vary depending on whether the clients present with somatisation, chronic illness, or terminal illness.     

Brief psychotherapy at the bedside: countering demoralization from medical illness

Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.     

Early treatment response as a predictor of ongoing weight loss in obesity treatment

Objectives. This study examined early treatment response in obesity treatment, defined as early change in body mass index (BMI) and early change in eating behaviour, as a predictor of ongoing weight loss in obese patients. Methods. We conducted a repeated measures analysis of eating behaviour, emotional factors (depression, stress, perfectionism) and BMI, over a 9 month period. Subjects were 344 females, aged 18–65 (mean = 41.8), with a BMI of at least 25 (mean BMI = 33.7), engaged in very‐low calorie (VLCD) or low‐calorie (LCD) diets. Results. Multi‐level modelling identified four significant predictors of ongoing weight loss (weight loss occurring between 5 weeks and 9 months after the start of treatment). These included: type of diet, early BMI change (start to 5 weeks), number of weigh‐ins and the early change in uncontrolled eating (start to 5 weeks). Estimates based on multi‐level modelling indicate that patients with strong versus weak early treatment responses would be expected to show large differences in ongoing weight loss. Conclusions. Early improvements in eating behaviour and weight appear to have additive effects in the prediction of ongoing weight change. Future research is required to identify the optimal rate of weight loss, whether there are critical periods for behaviour change, and factors which influence the likelihood of early behaviour change.     

Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain

Seventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of 'psychoneurosis' and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.     

Practitioner perfectionism: relationship to ambiguity tolerance and work satisfaction.

Perfectionism among psychological practitioners is a common phenomenon, but a neglected topic in the research literature. This article presents data indicating that perfectionism is negatively related to both tolerance of ambiguity and satisfaction of conducting psychotherapy in a sample of 197 doctoral-level, private-practice psychologists. Results demonstrated that high, socially prescribed perfectionism and low tolerance of ambiguity are associated with reduced enjoyment of conducting psychotherapy. Several methods to self-evaluate and moderate perfectionism in clinicians are offered.     

Why patients consult when they cough: a comparison of consulting and non-consulting patients.

BACKGROUND: Although it is the commonest symptom presented to general practitioners (GPs), little is known about why someone decides to consult with a cough. AIM: To describe the illness behaviour of patients with a cough. METHOD: Patients who had consulted a GP because of a cough, and a group of subjects who had recently had a cough but had not consulted, were interviewed in a qualitative study that investigated how they made sense of their illness. RESULTS: Consulting patients understood their cough to be abnormally severe, whereas non-consulting subjects regarded their cough as 'normal' and mild. Consulting patients thought the cough would interfere with social roles and non-consulting subjects did not. The consulting patients were much more likely to be worried about the cough than the non-consulting subjects. In particular, half of the consulting patients were worried about their hearts, whereas the non-consulting subjects were not. The two groups did not distinguish bacteria from viruses, and did not differ in beliefs about the role of antibiotics that they thought were needed for severe coughs. Both groups had concerns about pollution. CONCLUSIONS: For consulting patients, cough breached the taken for granted property' of health that the non-consulting subjects with a cough were able to maintain. Cough, for the consulting patients, was not a trivial illness.     

How do teenagers manage their food allergies?

Background The peak incidence of deaths from anaphylaxis associated with nut allergy occurs in teenagers and young adults. During adolescence, the management of food allergy shifts from being the responsibility of parents to that of the young person. This is a group who therefore need special attention in the clinic. Objective This study aimed to understand the practical challenges that teenagers with food allergy experience using a qualitative approach and generate potential interventions for tackling these. Methods Teenagers aged 1118 years with food allergy completed a questionnaire about their food allergy and underwent a focused, semi‐structured interview with open questions guided by a priori topic areas. Interviews were recorded, transcribed and analysed using a thematic approach. Results The study enrolled 18 teenagers with a median age of 15 years (10 females); the most common food allergens were peanuts and tree nuts. Three key themes emerged: avoidance of allergens, preparation for reactions and the treatment of reactions. The majority of teenagers reported eating foods labelled as ‘may contain’ an allergen as they perceive that they are actually very unlikely to contain an allergen. Many of the teenagers only carried their self‐injectable adrenaline when they thought they are particularly at risk of a reaction. Some do not know how to appropriately treat an allergic reaction. More than half believed that educating other students at school about the seriousness of food allergies would make it easier to live with their food allergy. Conclusions A significant number of teenagers demonstrate risk‐taking behaviour in the management of their food allergies. Teenagers also felt it would be helpful for their peers to be educated about food allergy. This novel strategy might help them to avoid trigger foods and enable teenagers to access help more readily if they suffer a reaction. Cite this as: H. Monks, M. H. Gowland, H. MacKenzie, M. Erlewyn‐Lajeunesse, R. King, J. S. Lucas and G. Roberts, Clinical & Experimental Allergy, 2010 (40) 1533–1540.     

Black health professional families: assessment of strengths and stability.

Despite pernicious racism, most black health professionals achieve professional success and most have stable marriages. A 19-item questionnaire was designed to assess this hypothesis following a lecture on the strengths and weaknesses of black health professional families to physicians, dentists, and their spouses (n = 38) at the 1990 annual meeting of the combined Old North State Medical and Dental Societies of North Carolina. Surprisingly, these families seemed eager to disclose feelings about themselves, their professions, and their marriages. Major preliminary findings were that these health professionals were more prone to indicate unhappiness than their spouses and less likely to see racism as an impediment to careers, and more willing to acknowledge that they would like to correct something in their lives.     

Perfectionism, psychosocial impact and coping with irritable bowel disease: a study of patients with Crohn's disease and ulcerative colitis

The current research examined trait perfectionism, perfectionistic self-presentation, coping styles and sickness impact in 51 patients with either ulcerative colitis or Crohn's disease. Our results confirmed that trait perfectionism and perfectionistic self-presentation were associated with greater sickness impact. Moreover, the link between perfectionism and the psychosocial impact of illness was still evident after controlling for neuroticism, optimism and the physical impact of the disease. Perfectionism was also associated with emotional preoccupation coping. The results suggest that perfectionism is a factor that is associated with maladaptive coping and it amplifies the reported impact of irritable bowel diseases.     

Second opinion behaviour among Japanese primary care patients.

BACKGROUND: Second opinion behaviour is often observed among Japanese primary care patients. These patients secretly visit university-affiliated hospitals without informing their doctors. Research to elucidate the psychosocial determinants of this behaviour in the Japanese primary care setting is needed. AIM: To describe the sociodemographic characteristics of second opinion patients (SOPs), and to determine the factors related to this behaviour. METHOD: Patients from the general medicine clinic answered our original questionnaire and a 30-item General Health Questionnaire (GHQ-30). A random sample of patients was questioned using the Diagnostic Interview Schedule. SOPs were defined as those patients who had visited another medical facility with the same complaint, and 'doctor-shopping' patients (DSPs) were defined as those patients who had visited two or more medical facilities with the same complaint. RESULTS: There were 420 SOPs among 1033 patients (41.0%). The multivariate analysis showed that residence and GHQ-30 were the significant differences between the SOPs and the first-visit patients (FVP) (P < 0.0005 for both factors). Also, the SOPs were anxious and sought advice from anybody, unlike the FVPs. Compared with the DSPs, they had a short duration of illness and they did not feel a worsening of their symptoms (P = 0.0001 for duration of illness; P = 0.006 for condition of illness). CONCLUSION: Our results showed that the SOPs who lived far from the medical school hospital felt anxiety and went to a university-affiliated hospital on the advice of anybody. Determining the reasons for this behaviour will require empirical studies regarding the nature of the patient's anxiety for illness.     

Haemodialysis patients' beliefs about renal failure and its treatment

Patients' beliefs about illness are important because they influence adherence and adjustment, but they are often surprising and idiosyncratic. Qualitative research can identify them in ways that are not shaped by psychological theory, but quantification is necessary if clinicians are to be informed about the beliefs that are likely to be prevalent in their patients. Qualitative analysis of interviews with 16 haemodialysis (HD) patients identified beliefs about end-stage renal failure (ESRF) and its treatment that were formed into a questionnaire, completed by 156 similar patients. Patients attributed ESRF to diverse factors including lack of self-care and inadequate medical care. Patients lacked a clear belief in the mechanism of action of dietary control, and its necessity was not readily acknowledged. The common view of haemodialysis as 'cleansing' extended to the reassuring belief that it would purge the body of disallowed food or drink. Many patients regarded haemodialysis and dietary control as externally imposed challenges that dominated life. The findings identify potential targets for educational intervention to improve adherence and adjustment and predictions about effects of patients' beliefs that can be tested in future prospective studies.     

大学生完美主义心理与父母养育方式的关系

目的 本研究旨在探究大学生的完美主义心理与父母养育方式的关系。方法 对100名工科大学生的完美主义心理5个维度和父母养育方式11个因素进行了测试。结果 发现学生完美主义的适应性雏度，即“条理组织度”与父、母的“温暖理解”这个因素呈正相关，与父、母的“惩罚严厉”、“过保护”、“过干涉”、“拒绝否认”等因素呈负相关。而完美主义的4个非适应性雏度只与父母教养方式的个别因素有关。结论 说明不良的教养方式不利于个体在完美主义的适应性方面的发展，但并不必然强化完美主义的非适应性方面。     

Psychological implications of mastectomy

The adjustment of a group of mastectomy patients to their operation was assessed at an interval of between 18 months and 5 years after surgery. They were found to be significantly more depressed and anxious than a control group of cholecystectomy patients; they tended to have lower self-esteem; and they described themselves as being more introverted in their behaviour. These differences were attributed to concern about both the loss of the breast and the possibility of recurrence of the cancer.     

The impact of treatment transitions between dialysis and transplantation on illness cognitions and quality of life - A prospective study

Objectives. Treatment transitions are frequent in end-stage renal disease (ESRD) but little is known about cognitive responses pre- to post-transplantation or after transplant failure. The purpose of this study was to examine changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on quality of life (QOL). Methods. In this longitudinal study, ESRD patients (N= 262) patients were followed up across treatment transitions over a 7-year observation window using the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, and measures of QOL. Study sample comprised the patients from this cohort who switched treatment modality (N= 60 post-transplantation; N= 28 transplant failure). Data were collected while on dialysis or transplantation and at 6 months post-treatment change. Results. Significant changes in QOL and illness perceptions were found in treatment transitions with opposite patterns of either improvement or deterioration following transplantation or transplantation failure. Pre- to post-transplantation, QOL improves and patients report less symptoms, lower consequences, and illness intrusiveness, more acute timeline and stronger control beliefs (ps < .01). QOL is diminished following transplant failure and patients report more symptoms, consequences, illness disruptiveness, more chronic timeline, and lower control. Changes in cognitions are associated with changes in QOL (R(2) = .469-.789). Conclusions. Treatment transitions marked significant changes in illness perceptions that were associated with changes in QOL. Interventions to prepare patients for treatment transitions and prevent increasingly negative patterns of illness perceptions with transplant failure may serve towards maintaining or improving adjustment outcomes. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT??: Illness cognitions have been shown to predict health outcomes and to change in response to changes in health status. Treatment transitions between dialysis and transplantation are frequent in end stage renal disease but their effect on illness representations has not been explored. WHAT DOES THIS STUDY ADD??: The paper described results of the first study to prospectively explore changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on QOL outcomes. The paper documents dynamic changes in illness cognitions when treatment modality is changed in line with the predictions of a dynamic reassessment of illness perceptions and coping behaviour as described in Leventhal's Common Sense Model of Illness Behaviour.     

The relationship between clinical perfectionism and nonsuicidal self-injury: The roles of experiential avoidance,self-esteem,and locus of control

Objectives

Perfectionism is linked to nonsuicidal self-injury (NSSI). Individuals with elevated perfectionism tend to avoid undesirable emotions and experience lower self-esteem, which are associated with NSSI. However, it is unclear if these mechanisms explain the link between clinical perfectionism and NSSI, and if locus of control is involved. We aimed to explore whether experiential avoidance and self-esteem would mediate the relationship between clinical perfectionism and NSSI, and if locus of control would moderate links between clinical perfectionism and both experiential avoidance and self-esteem.

Method

As part of a larger study, 514 Australian university students (M_age = 21.15 years, SD = 2.40; 73.5% female) completed an online survey of NSSI, clinical perfectionism, experiential avoidance, self-esteem, and locus of control.

Results

Clinical perfectionism was associated with NSSI history, but not with recent NSSI or past year NSSI frequency. Lower self-esteem, but not experiential avoidance, mediated links between clinical perfectionism and NSSI history, recent NSSI, and NSSI frequency. More external locus of control was associated with NSSI, experiential avoidance, and lower self-esteem, but locus of control did not moderate pathways between clinical perfectionism and experiential avoidance or self-esteem.

Conclusion

University students reporting elevated clinical perfectionism may have a tendency to experience lower self-esteem which is associated with NSSI history, recency, and severity.     

'I always seem to be there'--a qualitative study of frequent attenders.

BACKGROUND: Much is still unknown about the consultation behaviour of frequent attenders, including why they consult as often as they do and why they consult in the patterns that they do. AIM: To determine why frequent attenders to general practice consult in the patterns that they do. METHOD: A qualitative study based on semi-structured interviews. Twenty-eight frequent attenders were purposively sampled from three practices; 13 exhibited a 'burst and gap' pattern of attendance and 15 exhibited a 'regular' pattern of attendance. RESULTS: A two-part model is proposed. The first part encompasses each individual decision to consult and is based around eight questions that may be asked as part of the decision-making process (these concern the perception of the general practitioner's [GP's] role, past experience of symptoms and consulting, comparison with others' consulting, relationship with the GP, balancing fears, lay consulting, individual reasons, and whether it was a symptom that they would not normally consult for). The second part determines the pattern of consulting and has four major themes: predominantly medical reasons for attending, experience of what happens during the consultation, accessibility of the GP, and periods of not consulting. Two further themes are proposed: 'multiplicity', whereby the reasons for consulting lead to further consulting for related and unrelated problems, and 'passivity', whereby consulting seems to be out of control. CONCLUSIONS: The reasons underpinning each individual decision to consult were complex. The control that GPs were perceived to have over the pattern of consulting, for example concerning prescribing, review visits, and in addressing further help-seeking behaviour, may provide more possibilities for developing intervention strategies than targeting frequent attenders themselves. An understanding of the processes behind the consulting behaviour of frequent attenders may lead to more functional consultations and better clinical care as a result.     

英语学差生学业情绪变化发展的追踪

目的考察愉快等8种学业情绪的发展特点,为把握特殊群体学生学业情绪的变化规律提供实证依据。方法采用大学生学习情绪问卷中文修订版,对陕西某高校52名英语学差生进行4次追踪测量。结果①学业情绪随时间变化不显著(F≤2.03,P0.05),总均值在2.05~3.84之间,变化幅度在0.07~0.34之间,变化曲线呈多样性;②男生(F≤1.76,P0.05)、女生(F≤0.95,P0.05)的学业情绪随时间变化不显著;女生的愉快、希望体验高于男生,男生的自豪及消极情绪体验高于女生;③农村(F≤2.57,P0.05)、城镇学生的学业情绪随时间变化不显著(F≤0.39,P0.05);城镇与农村学生的希望体验相同,城镇学生自豪体验高于农村学生,农村学生愉快体验及消极情绪高于城镇学生。结论学业情绪在短期内随时间变化保持稳定。     

The expanding family of -RFamide peptides and their effects on feeding behaviour

Neuropeptides terminating in -Arg-Phe-NH(2) (-RFamide) were first discovered in molluscan nervous systems, but were soon recognized to occur widely throughout the invertebrates. Progress in characterizing members of the family in vertebrates has been slower. In mammals, however, it is now clear that there are at least five genes encoding members of the family, and at least five G-protein-coupled receptors at which they act. The tissue distribution of the peptides and their receptors is wide and there are likely to be many different functions. One of the emerging themes from recent research is that these peptides are involved in control of feeding behaviour both in invertebrates and in vertebrates. This would seem to be a remarkable example of conservation of chemical structure and biological function throughout nervous system evolution.