Discursive and Psychosocial? Theorising a Complex Contemporary Subject

This article outlines one tradition of qualitative research in social psychology, that of discourse analysis and discursive research. It proposes that the tradition offers an alternative conceptualisation of a psychosocial subject to accounts which draw on psychoanalytic theorising. The article reviews some of the problems around conceptualising a subject in discursive terms, then sets out some resolutions. It outlines a narrative-discursive approach to subjectivity and proposes that this is consistent with a psychosocial project to explore the person as inseparable from their social contexts. The narrative-discursive conceptualisation admits of agency and change, avoiding over-complete accounts of subjectification, while retaining the critical and political focus of the discursive tradition. It is also consistent with sociological theorisations of the subjects of late capitalism and neo-liberalism. The article discusses an example of narrative-discursive analysis from research on identities of residence and relationships to place.     

Children’s Psychosocial Problems Presenting in a Family Medicine Practice

Primary care physicians have an important role in identifying, treating, and referring children with psychosocial problems. However, there is a limited literature describing whether and how family physicians address psychosocial problems and why parents may not discuss children’s problems with physicians. The current study examined how family physicians address psychosocial problems and reasons that parents do not discuss children’s psychosocial problems with physicians. Results indicated that there are a variety of reasons involving parents, their perceptions of physicians, and the number of psychosocial problems reported, that may lead to fewer discussions of psychosocial problems.     

Patterns of Adolescents’ Romantic Activities: Associations with Psychosocial Adjustment

Using data on 15 year-old adolescents’ (N?=?770) romantic socializing, dating, and romantic relationships, we identified four clusters of romantic involvement: abstaining (9.2% of adolescents), socializing with relationships (20.3% of adolescents), socializing with dating (20.8% of adolescents), and socializing (49.7% of adolescents). We then tested if depressive symptoms, externalizing behavior, or social dissatisfaction differed between adolescents in the different romantic involvement clusters. Externalizing behavior and social dissatisfaction, but not depressive symptoms, differed between the clusters. Adolescents in the abstaining or socializing clusters reported less externalizing behavior than those in the other two clusters. Adolescents in the abstaining cluster reported greater social dissatisfaction than those in the other three clusters, which did not differ from each other. Finally, we found that gender did not moderate the associations between youths’ pattern of romantic involvement and their psychosocial adjustment.     

Swimming against the Stream?: Mindfulness as a Psychosocial Research Methodology

In this article, we extend psychosocial research methodology by integrating a breaching experiment, influenced by ethnomethodological sociology, with aspects of mindfulness practice, influenced by Buddhist traditions. We offer an empirical investigation of what happens when researcher-participants subtly “swim against the stream” of normative public social conduct in a capital city setting. Our qualitative analysis explores a single case from a corpus of 172 first-person retrospective accounts of standing still and doing nothing in a busy, public place. We investigate the qualitative aspects of how one researcher-participant arguably adopted a mindful, beginner’s mind orientation toward the flow of psychosocial consciousness. We empirically investigate this psychosocial orientation of mindfulness by integrating Wetherell’s concept of affective-discursive practice with James’ stream of consciousness. Mindfulness offers a specific, embodied reorientation toward psychosocial flows. We discuss the methodological implications and limitations of this reorientation for psychosocial research.     

Does Defensiveness Account for the Relationship Between Religiosity and Psychosocial Adjustment?

Religiosity has been related to positive psychosocial adjustment across a large number of studies. Some researchers question, however, whether this relationship is an accurate finding, observing that there are many potential confounds that have not been controlled for, such as defensiveness. This study examined whether defensiveness accounted for the relationship between religiosity and psychosocial adjustment. Two samples of religious individuals were assessed on religiosity (Duke University Religion Index), defensiveness (measured using the denial of distress and repressive defensiveness subscales from the Weinberger Adjustment Inventory [WAI]), and psychosocial adjustment (Depression subscale from the WAI, the Perceived Stress Scale, and the Sarason Social Support Scale). In both studies it was found that religiosity was related to positive psychosocial adjustment as well as higher levels of defensiveness. Defensiveness, however, did not account for the relationships between religiosity and psychosocial adjustment. These findings add to the research literature by eliminating a potential confound of the relationship between religiosity and psychosocial adjustment.     

Sphincter of Oddi dysfunction: Does Psychosocial Distress Play a Role?

Sphincter of Oddi dysfunction (SOD) is a functional gastrointestinal disorder characterized by pancreatobiliary-type of pain in the absence of organic abnormalities. The aim of this study was to investigate specific psychosocial predictors of functional outcome in a group of patients consecutively referred to a gastroenterological department for biliary-type of pain. Based on medical examination patients were divided into functional (SOD) and organic groups. Self-administered questionnaires regarding demographic characteristics, psychological distress (Symptom Check-List-90–R, [SCL-90-R]), severity of acute and chronic stress, level of subjective well-being and satisfaction with health were completed. The analyses were based on the logistic regression approach. In this sample, SOD patients were older than organic patients and more likely female. Logistic regression analysis showed that higher acute stress (i.e., main effect) was associated with a decreased likelihood of functional (SOD) outcome, whereas the combination of acute stress with chronic stress and the combination of acute stress with higher severity of psychopathology (i.e., interaction effect) was associated with an increased likelihood of functional (SOD) outcome. These findings suggest stressful life events in combination with certain psychological symptoms can play a role in the symptom presentation of patients with sphincter of Oddi dysfunction.     

A Qualitative Study of Community–University Partnerships That Support Psychosocial Occupational Therapy

Community partner voices are important to understand because they provide the contexts in which occupational therapy (OT) students research community-identified needs and together, create evidence-based occupation-focused programs while developing clinical reasoning skills in a natural context. The purpose of this study is to understand how community partners experienced partnerships that support community-based research in psychosocial settings. This retrospective study explores the perspectives of community partners that hosted OT students for two-semester service-learning project over 3 years. Findings revealed partners value effective communication with faculty and students, spending time observing, listening, and developing meaningful relationships with clients and staff.     

Impulse Control Disorders in Parkinson’s Disease: A Psychosocial Perspective

Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterised by motor symptoms. However, another feature of PD which is receiving increasing attention is the phenomenon of impulse control disorders (ICDs), such as pathological gambling. To date, research into ICDs in PD has centred on a biomedical model of cause, related to the effects of dopamine replacement therapy. However, there are several areas of discrepancy in the current biomedical account of ICDs in PD. In addition, we argue that social and psychological factors also need to be considered to achieve a more complete understanding of the phenomenon. We present a novel conceptual model which combines biomedical and psychosocial factors in the genesis of ICDs in PD and use the model to identify a number of potential treatment intervention points and to highlight important outstanding questions concerning the inter-relationship between psychosocial and biomedical factors in the genesis of ICDs in PD.     

Differential Associations Between Relational and Overt Aggression and Children’s Psychosocial Adjustment

Although much research has focused on the association between childhood aggression and negative psychosocial adjustment, the link between the subtypes of aggression and adjustment is less clear, particularly for relational aggression. The current study examined whether overt and relational aggression in childhood (M = 10.4 years, SD = 1.1) are differentially associated with four psychosocial adjustment outcomes (i.e., academic performance, social problems, depression, and delinquency). Results indicated that relational aggression was negatively associated with academic performance, while overt aggression was positively associated with delinquency. Additionally, findings suggested gender differences in the link between aggression subtypes and social problems. Specifically, overt aggression was positively associated with social problems for boys and relational aggression was positively associated with social problems for girls. Neither subtype of aggression was uniquely associated with depression. Thus, this study suggests that psychosocial outcomes may differ depending on the form of aggression that is utilized.     

Psychosocial Variables as Predictors of Psychological Stress–Induced Ischemia in the Laboratory

This study examined ischemic reactivity to a psychological stress protocol and whether psychological variables could reliably classify individuals as ischemic reactors. Participants were 54 male Veterans Administration patients who had or were suspected of having CAD. Psychological inventories were administered prior to a psychological stress protocol consisting of a surgical video, the Stroop Color–Word task, an arithmetic task, and discussion of a stressful event. Cardiac functioning was evaluated using an ECG Holter monitor and 23.53% of participants were classified as reactors. Mean differences between reactors and nonreactors were found for State Anger, Health Locus of Control—Powerful Others (MHLC-PO), and Depression. State Anger and MHLC-PO emerged as significant predictors of reactor status in logistic regression analyses. Models based on individual scale items suggested three items could be used to achieve higher classification rates. Implications for revising screening procedures for determining risk and possible mechanisms underlying psychological stress–induced ischemia are discussed.     

Psychosocial Stress and Cardiovascular Risk: What is the Role of Daily Experience?

We describe an ecological momentary assessment (EMA) protocol designed to measure daily life experiences along several psychosocial dimensions (Social Conflict, Task Demand, Decisional Control, Negative Affect, and Arousal) hypothesized to be relevant for cardiovascular disease risk. In a large community sample, these assessments have been administered in conjunction with ambulatory blood pressure (ABP) monitoring and measures of subclinical cardiovascular disease. Several results have emerged that support the promise of this approach. First of all, each of these dimensions of experience appears to be a trigger for cardiovascular activation, with movement on each scale being associated with significant within-person changes in heart rate and blood pressure in the natural environment. Second, there appear to be individual differences in physiological responsiveness to these dimensions of daily experience, with such differences being associated in some cases with laboratory-based assessments of cardiovascular reactivity, as might be expected. Third, EMA ratings are associated in several instances with (between-person) stable individual differences in ABP readings. And finally, we have found that some of the characteristics defined by our EMA ratings are related to measures of subclinical atherosclerosis. Such effects appear to be mediated, in part, by ABP. The advantages of using EMA measures for capturing the effects of psychosocial stressors are highlighted by comparing the predictive validity of these daily life assessments to traditional global self-reports. We conclude by describing future plans for use of this type of assessment protocol for helping us to characterize psychosocial characteristics relevant to cardiovascular disease risk. Personality and social processes during daily living may have an important impact not only on psychological functioning but also on physical health and disease. In this article we review our recent work involving the assessment of daily experience as a means of better understanding the role of psychosocial stress in cardiovascular disease risk. First, we outline the rationale for our interest in daily experience sampling for examining these processes, and we describe the methods we have adopted for this purpose. Next, we review findings from a recent study in which we have used these approaches to examine the role of psychosocial stress on ABP and atherosclerosis in a community-dwelling sample. We compare our approach to more traditional (global self-report and laboratory-observation) methods for examining these relationships in humans, and we discuss potential future directions for use of daily experience sampling in studies of health and behavior.     

What Makes Crohn's Disease Patients Difficult to Manage? The Role of Psychosocial Factors

Most GI clinicians face the problem of a small group Crohn's Disease (CD) patients who function poorly and consume inordinate amounts of service with poor outcome. This study examines the hypothesis that psychosocial factors differentiate the CD patients who function poorly from the typical CD patient. A prototypal sample of CD patients with problems functioning, more typical CD patients (not selected for having problems in functioning), and healthy controls each completed a battery of validated psychosocial measures of disease-specific quality of life, coping skills, social support and life stress, perceived medical symptoms and life history factors. Chart data on hospital admissions, ER, GI, Surgeon, and GP visits were also collected. The CD patients with problems functioning reported more symptoms (GI and non-GI) and had many more ER, GI, and GP visits than the typical group. Psychologically, those with problems functioning had poorer quality of life and were more likely to cope using emotional discharge and support seeking. They experienced significantly more stress and reported a more chaotic family history. No differences on an experimental method of information processing biases were found between the CD groups, however. These results indicated that patients with problems functioning, selected by GI staff because they were best-case examples of functional difficulties, shared little with a matched group of typical CD patients. These patients likely require psychological as well as medical intervention to best manage their illness.     

Persisting or Withdrawing? An Insight into the Psychosocial Processes Underlying Sustained Engagement

The study explored the roles of commitment, emotional stress, and interpersonal relationships in sustaining individuals' engagement in collective action. Two collective action cases, differing in duration, issue, and territorial rootedness, were analyzed. The processes underlying sustained engagement were probed in 32 semistructured interviews conducted with antiglobalization activists (N = 13) and opponents to a high‐speed railroad (N = 19). Our findings showed that collective action can be stressful, but that there are proximal and distal factors that can counterbalance the disruption and sustain engagement. The proximal factors are embedded in the circumstances of involvement, and these factors concern interpersonal relationships, organizational mechanisms, and the psychological interface between the individuals and the concrete collective action environment. The distal factors are related partly to the individual and partly to the broader community from which the individual absorbs general values and norms. Copyright © 2011 John Wiley & Sons, Ltd.     

Do Personal Dispositions Affect the Relationship Between Psychosocial Working Conditions and Workplace Bullying?

There is scarce research on the interaction between psychosocial working conditions and being a target of workplace bullying with individual characteristics as a moderator. We therefore examined 3,363 employees from 60 Danish workplaces to test whether sense of coherence moderates the relationship between the job demand-control model and bullying. This work is exploratory in nature, as no previous study to assess this moderation was found. Hierarchical linear regressions showed that demand-control model was significantly associated with bullying. Sense of coherence displayed a significant though practically negligible moderating effect. This suggests that negative psychosocial working conditions are associated with bullying independently of personal characteristics, at least in terms of sense of coherence.     

Longitudinal Associations Between Fathers’ Heavy Drinking Patterns and Children’s Psychosocial Adjustment

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.     

From Constraints to Opportunities? Provision of Psychosocial Support in Portuguese Oncogenetic Counseling Services

Although available guidelines for familial cancer risk counseling clearly state the need to provide adequate psychosocial assessments and support, this feature of care is only available in part for individuals and families in oncogenetic counseling protocols in Portugal. The purpose of this study was to examine the psychosocial aspects of oncogenetic counseling provided by a sample of Portuguese genetics professionals. We sought to ascertain perceived need for the provision of psychosocial services and ways to enhance the psychosocial focus in service delivery. A qualitative study was designed; semi-structured focus groups and individual interviews were performed with 30 professionals from Portuguese healthcare institutions where oncogenetic counseling is offered. Findings suggest: current practice is aligned with the teaching model, with a mainly information-based focus; use of psychosocial counseling techniques and psychosocial support is limited throughout the genetic counseling timeline; there is a limited workforce of adequately trained psychosocial professionals, who are disadvantaged by structural and organizational constraints. These factors are considered to be serious barriers for psychosocial delivery. Development of multidisciplinary teams working in oncogenetics, and need for further counselling skills and training for genetics healthcare professionals were identified as priorities. Implications for practice and policy are discussed. Portuguese genetic counselors who have recently completed their training, may therefore contribute to enhanced psychosocial services delivery.     

Why does ADHD Confer Risk for Cigarette Smoking? A Review of Psychosocial Mechanisms

Research has documented that adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking, but less attention has examined why this risk exists. The current paper reviews the literature on different psychosocial mechanisms [self-medication hypothesis, social factors (social modeling, social impairments), cognitive factors (attitudes, coping skills), and psychological variables (ADHD symptom dimensions, comorbidity)] that might explain this increased smoking risk. Results of the review suggest that, while the self-medication hypothesis has some theoretical merit, it has not been adequately examined among adolescents and young adults with ADHD. Further, cognitive and social factors may be important mechanisms that help to explain the association between ADHD and cigarette smoking, but research in these areas is sparse. Finally, a larger body of literature suggests that different psychological aspects of ADHD (e.g., comorbidity, symptom dimensions) are related to smoking. Interpretation of findings of many of these studies was hindered due to significant methodological problems and the lack of a guiding theoretical orientation. Potential theories that might facilitate future work in this area are discussed. Future research should continue to explore these important psychosocial mechanisms as well as gene–environment interactions in examining the link between ADHD and cigarette smoking.     

Specific Psychosocial Issues of Individuals Undergoing Genetic Counseling for Cancer – A Literature Review

Approximately 25 % of individuals undergoing genetic counseling for cancer experiences clinically relevant levels of distress, anxiety and/or depression. However, these general psychological outcomes that are used in many studies do not provide detailed information on the specific psychosocial problems experienced by counselees. The aim of this review was to investigate the specific psychosocial issues encountered by individuals undergoing genetic counseling for cancer, and to identify overarching themes across these issues. A literature search was performed, using four electronic databases (PubMed, PsychInfo, CINAHL and Embase). Papers published between January 2000 and January 2013 were selected using combinations, and related indexing terms of the keywords: ‘genetic counseling’, ‘psychology’ and ‘cancer’. In total, 25 articles met our inclusion criteria. We identified the specific issues addressed by these papers, and used meta-ethnography to identify the following six overarching themes: coping with cancer risk, practical issues, family issues, children-related issues, living with cancer, and emotions. A large overlap in the specific issues and themes was found between these studies, suggesting that research on specific psychosocial problems within genetic counseling has reached a point of saturation. As a next step, efforts should be made to detect and monitor these problems of counselees at an early stage within the genetic counseling process.     

Occupational Therapists' Perception of the Tree Theme Method™ as an Intervention in Psychosocial Occupational Therapy

This study investigated how occupational therapists experience utilization of the Tree Theme Method, an intervention based on creative activities and life-story telling and making. The Tree Theme Method is comprised of five sessions in which the therapist asks the client to paint symbolic trees, with specific themes representing their present life situation, childhood, adolescence, adulthood, and the future. Nine occupational therapists in mental health care were asked about their experiences when using the Tree Theme Method. The informants formed two focus groups and each group was interviewed twice. Qualitative content analysis was used to identify five categories including: (1) therapeutic frames, (2) therapist requirements, (3) client requirements, (4) the therapeutic relationship, and (5) the Tree Theme Method as a multi-dimensional process. Overall the informants were satisfied with the intervention with some variation as to therapists' perception about the helpfulness of the tool. The Tree Theme Method was experienced as a structured method of starting a therapeutic process and initiating a therapist–client relationship. The therapeutic attitude, self-knowledge, and expert knowledge seemed to be important prerequisites for the therapists when using the Tree Theme Method intervention.