Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

Moderating Role of Perceived Social Support between Perceived Parenting Styles and Relational Aggression in Adolescents

This study examined the moderating role of perceived social support between perceived parenting styles and relational aggression (RA). A sample (N = 400) was selected through stratified sampling from public and private schools and colleges. Adolescents (n = 200 boys and n = 200 girls) completed (a) Demographic Performa, (b) Early Memories of Upbringing for Children to measure perceived parenting styles, (c) Social Support Questionnaire to measure perceived social support, and (d) Diverse Adolescent Relational Aggression Scale to measure RA. Statistical analyses showed that perceived social support moderated the relationship between perceived parenting styles and RA. Findings indicated that perceived social support strengthens the negative relationship between perceived father’s Overprotection parenting and RA. Results also showed that perceived social support strengthens positive relationship between perceived father’s Anxious Rearing parenting and RA. Moreover, perceived social support strengthens the positive relationship between perceived mother’s Rejection parenting and RA. Results help in implementing interventions to promote the consolidation or increment of sources that constitute adolescents with concrete and feasible actions in the cultural, educational, and counseling implications.     

Melancholy and happiness

This paper explores an under-theorised phenomenon – the experience of melancholy as an enhancer of happiness. Drawing from philosophy and literature, I define melancholy as an experience that combines the pleasure of feeling sad with sober self-reflection. Despite expectations to the contrary, two potentially positive outcomes of melancholy are identified – insightful pensiveness, and emotional connectedness with loss and pain. These outcomes can enhance happiness as understood in key texts of contemporary Anglo-American philosophy, and, consistent with findings in psychology, also have important implications for wider debates in social policy and welfare practice. First, the pensiveness associated with melancholy can make unique contributions to personal insights, and help develop and fulfill ‘authentic happiness’ and ‘informed desires’. These contributions oppose hedonist accounts of happiness, but are conducive to enhancing happiness properly understood. Second, melancholy can also provide a psychologically safe arena for experiencing loss and pain, where a person can more positively accept the limits of the human condition. This acceptance enhances her happiness, as she is better able to live ‘in the moment’ and so derive satisfaction from her presently-orientated activities and commitments.     

‘Meaning-dawning’ in Wittgenstein’s Notebooks: a Kierkegaardian reading and critique

In this paper, I am going to propose a new reading of Wittgenstein’s cryptic talk of ‘accession or loss of meaning’ (or the world ‘waxing and waning’ as a whole) in the Notebooks that draws both on Wittgenstein’s later work on aspect-perception, as well as on the thoughts of a thinker whom Wittgenstein greatly admired: Søren Kierkegaard. I will then go on to argue that, its merits apart, there is something existentially problematic about the conception that Wittgenstein is advocating. For the renunciation of the comforts of the world that Wittgenstein proposes as a way of coping with the brute contingencies of life seems only to come as far as what Kierkegaard calls ‘infinite resignation’, and this falls far short of the joyful acceptance of existence that appears necessary for inhabiting what Wittgenstein calls a happy world. That is to say, I will show that what Wittgenstein’s proposal lacks is a way of reconnecting with the finite after one has renounced it – the kind of transformation of existence achieved by the person Kierkegaard calls the ‘knight of faith’.     

The correlations of socioeconomic status,disease activity,quality of life,and depression/anxiety in Chinese patients with rheumatoid arthritis

This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ² analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.     

Engagement with meditation as a positive health trajectory: Divergent narratives of progress in male meditators

Objective: Studying personal narratives can generate understanding of how people experience physical and mental illness. However, few studies have explored narratives of engagement in health positive behaviours, with none focusing on men specifically. Thus, we sought to examine men’s experiences of their efforts to engage in and maintain healthy behaviours, focusing on meditation as an example of such behaviour.

Design: We recruited 30 male meditators, using principles of maximum variation sampling, and conducted two in-depth interviews with each, separated by a year. Main outcome measures: We sought to elicit men’s narratives of their experiences of trying to maintain a meditation practice.

Results: We identified an overall theme of a ‘positive health trajectory,’ in particular, making ‘progress’ through meditation. Under this were six main accounts. Only two articulated a ‘positive’ message about progress: Climbing a hierarchy of practitioners, and progress catalysed in other areas of life. The other four reflected the difficulties around progress: Progress being undermined by illness; disappointment with progress; progress ‘forgotten’ (superseded by other concerns); and progress re-conceptualised due to other priorities.

Conclusion: Men’s narratives reveal the way they experience and construct their engagement with meditation – as an example of health behaviour – in terms of progress.     

Creating a qualitative typology of electric vehicle driving: EV journey-making mapped in a chronological framework

‘Range anxiety’ is considered a barrier to market acceptance of electric vehicles (EVs), but perceptions of inadequate recharging infrastructure and limited battery range may be part of a more complex set of consumer concerns; experiences and practices of existing EV drivers – with reference to wider transport and energy systems – need to be understood in greater detail. Qualitative material from semi-structured interviews [n = 88] is used to formulate a chronological Typology of Electric Vehicle Driving which synthesises drivers’ decisions, actions and dynamic considerations before, during and after a journey. The typology outlines and tabulates spatio-temporal elements specific to driving an EV; describes adaptations and compromises in household routines and travel habits; draws out how or when drivers engage with external digital information sources – i.e. smartphone apps, social media – during journey-making; plots their intervention in behavioural changes; and could inform development of infrastructure, tools or services, policy or interventions to support EV uptake.     

Examining a negative halo effect to anabolic steroids users through perceived achievement goals,sportspersonship orientations,and aggressive tendencies

We investigated the social image of anabolic steroids (AS) users grounding our analysis on the achievement goal theory of Nicholls. Our main goal was to explore how an athlete’s acceptance of AS use would impact on the way that athlete will be perceived by others. Non‐AS‐using participants reacted to one of two scenarios portraying a male athlete either accepting or refusing to engage in drug use behavior. The results suggested that the acceptance of anabolic steroids yielded an unfavorable social image – perceivers inferred a predominant ego orientation to characterize the AS‐user’s motivation as well as weaker sportspersonship and a stronger proclivity for reactive aggression than instrumental aggression. Moreover, the analyses did not yield significant gender or interaction effects. Finally, those findings are commented in view of methodological shortcomings and of the perspectives that they may offer for future research concerning the motivational aspects of the social perceptions of drug use in sport.     

Transitioning from a hospital rehabilitation programme to home: Exploring the experiences of people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is difficult to diagnose and is characterised by burning pain in one or more limbs. Treatment is palliative not curative and focuses on improving function. This requires patients to make long-term changes to their behaviour. As with all such regimens, adherence is often poor. This study explored the lived experience of 10 patients who had returned home after completing a two-week in-patient treatment programme. The interviews focused on how they coped with the transition from hospital to home, and on the things that they considered had facilitated or hindered this transition. Battling for Control was an overarching theme that connected the four superordinate themes: ‘Gaining Momentum’ that facilitated the implementation of treatment advice, ‘Distance from the pool of expertise’ that detailed the barriers to adherence experienced; ‘It helped me realise it was not all in my head’ that detailed a facilitative process, and the ‘nag list’ that was a technique patients’ used to garner support. This article offers insights into the transition experience. A key outcome is the recognition of the need to better prepare patients for their transition back home.     

Relationships Among Disease,Social Support,and Perceived Health: A Lifespan Approach

We examined the relationship between the cumulative presence of major disease (cancer, stroke, diabetes, heart disease, and hypertension), social support, and self‐reported general and emotional well‐being in a community representative sample of predominantly White and African American respondents (N = 1349). Across all ages, greater presence of disease predicted poorer reported general health, and predicted lower emotional well‐being for respondents 40 and above. In contrast, social support predicted better‐reported general and emotional well‐being. We predicted that different types of social support (blood relatives, children, friends, community members) would be relatively more important for health in different age groups based on a lifespan or life stage model. This hypothesis was supported; across all ages, social support was related to better reported general and emotional health, but sources of support differed by age. Broadly, those in younger age groups tended to list familial members as their strongest sources of support, whereas older group members listed their friends and community members. As a whole, social support mediated the effect of disease on reported well‐being, however, moderated mediation by type of support was not significant. The results are consistent with a lifespan approach to changing social ties throughout the life course.     

Pity: a mitigated defence

The aim of this article is to offer a mitigated moral justification of a much maligned emotional trait, pity, in the Aristotelian sense of ‘pain at deserved bad fortune’. I lay out Aristotle's taxonomic map of pity and its surrounding conceptual terrain and argue – by rehearsing modern accounts – that this map is not anachronistic with respect to contemporary conceptions. I then offer an ‘Aristotelian’ (albeit not Aristotle's) moral justification of pity, not as a full virtue intrinsically related to eudaimonia but as a positive moral quality that has instrumental value in developing and sustaining a certain intrinsically valuable state of character – namely compassion. The justification offered is mitigated in the sense that it does not elevate pity to a virtuous disposition, constitutive of the good life; yet it does offer a crucial counterweight to Aristotle's own denunciation of pity.     

The Hepatitis C treatment experience: Patients’ perceptions of the facilitators of and barriers to uptake,adherence and completion

Objective: This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program.

Design: Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC).

Main outcome measures: To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion.

Results: Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system.

Conclusion: To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies.     

THE CRISIS OF HISTORICISM: AND THE PROBLEM OF HISTORICAL MEANING IN NEW TESTAMENT STUDIES

The rapid rise of varieties of historicism in Germany, during the mid‐ to late‐nineteenth century, and subsequently in England and America, resulted in a radical transformation of the principles of coherence and methods of analysis within biblical studies. 1 This paper will argue that the foundational ‘subject/object’ metaphysics of historicism has been subverted over the past century. For this reason, historical positivism should no longer be accorded the status of ‘normative paradigm’ and ‘gatekeeper’ over and against other interpretive approaches. This paper next lays out five principles for a renewed practice of historical inquiry. It argues, first, that historical inquiry continues to serve a vital function within biblical studies in its ability to call attention to historical difference, and, thereby, to contribute to a strategy of resistance to ideology and to totalizing theories; second, that the traditional appeal to historical ‘context’ and ‘author’ in the interpretation of texts continues to be a useful practice – despite the provisional and constructed nature of both – as a way of taking into account extra‐lingual reference and of avoiding presentism; third, that the substitution of new ‘grand narratives’ of Christian origins in place of the (quasi‐theological) ‘historical’ narrative of traditional Christianity – under the claim of historical objectivity – should be abandoned because the very concept of ‘origins’ is the result of a literalizing of a metaphor. Such totalizing narratives always reduce history's inherent polycentricism. Fourth, I will argue that the continued use of historicism in the antiquarian attempt to reconstruct the past, disconnected from both a quest for social justice and a desire for personal self‐creation, represents a form of thought that alienates scholars from themselves and from their real material contexts. Finally, and following on the previous point, this paper submits that the practice of historical analysis has an ethical dimension by virtue of the fact that the personhood of the biblical historian is indissolubly linked to other dimensions of life including the social and ethical aspects of life. These added dimensions complicate the making of choices, which is implicit within all practices of interpretation. These five principles are here suggested as points of departure for the reconceptualization of the scope and function of historical inquiry within the discipline of New Testament studies.     

Better No Longer to Be

Abstract

David Benatar argues that coming into existence is always a harm, and that – for all of us unfortunate enough to have come into existence – it would be better had we never come to be. We contend that if one accepts Benatar’s arguments for the asymmetry between the presence and absence of pleasure and pain, and the poor quality of life,² one must also accept that suicide is preferable to continued existence, and that his view therefore implies both anti-natalism and pro-mortalism³. This conclusion has been argued for before by Elizabeth Harman – she takes it that because Benatar claims that our lives are ‘awful’, it follows that ‘we would be better off to kill ourselves’ (Harman 2009: 784). Though we agree with Harman’s conclusion, we think that her argument is too quick, and that Benatar’s arguments for non-pro-mortalism⁴ deserve more serious consideration than she gives them. We make our case using a tripartite structure. We start by examining the prima facie case for the claim that pro-mortalism follows from Benatar’s position, presenting his response to the contrary, and furthering the dialectic by showing that Benatar’s position is not just that coming into existence is a harm, but that existence itself is a harm. We then look to Benatar’s treatment of the Epicurean line, which is important for him as it undermines his anti-death argument for non-pro-mortalism. We demonstrate that he fails to address the concern that the Epicurean line raises, and that he cannot therefore use the harm of death as an argument for non-pro-mortalism. Finally, we turn to Benatar’s pro-life argument for non-pro-mortalism, built upon his notion of interests, and argue that while the interest in continued existence may indeed have moral relevance, it is almost always irrational. Given that neither Benatar’s anti-death nor pro-life arguments for non-pro-mortalism work, we conclude that pro-mortalism follows from his anti-natalism, As such, if it is better never to have been, then it is better no longer to be.     

Conversational perspective of therapeutic outcomes: The importance of preference in the development of discourse

Major theme: Evaluation of therapeutic outcome. Logical development of the theme: We suggest a way for practitioners and researchers to assess if they are on track in conversing towards client preferred goals. We offer a critique of more conventional approaches to studying therapeutic progress, suggesting how a discursive (i.e. focused on interaction and language use) lens can address these limitations. Through this lens we examine therapeutic progress evident in ‘preference work’, where clients demonstrably indicate, imply, agree and disagree with where the therapeutic conversation is heading. Such ‘preference work’ offers a form of evidence of within‐session outcomes in a process of reaching larger client preferred outcomes. Authors’ point of view: We present the results of conversation analysis – a qualitative approach to the study of therapy – to illustrate our discursive perspective on therapy progress and change. Implications: we suggest a way for practitioners to assess if they are on track in conversing towards client preferred goals. We propose that our interactional perspective may significantly contribute to bridging practice and research in therapy.     

Conflicting social paradigms of human freedom and the problem of justification

In recent work, Rawls, Nozick, and the ‘democratic‐socialist’ theory of Markovi? and Gould, attempt to ground rival models of just economic relations on the basis of conflicting interpretations of human freedom. Beginning with a philosophical conception of humans as essentially free beings, each derives a different system of basic rights and freedoms: (1) the familiar democratic civil and political rights of citizenship in the West (Rawls); (2) the classical bourgeois market freedoms ‐ ‘life, liberty, and property’ (Nozick); and (3) democratic socialist rights of self‐management of the work‐place (Gould and Markovi?). I argue that each of these theorists implicitly assumes a different but ungrounded ’social paradigm of human agency’ concerning the particular forms of human choice which are singled out as most important for a free, human life. None of these theories contains the methodological resources for showing why the forms of human agency it ‘emancipates’ are more important than the forms it suppresses or ignores. In order to overcome this impasse and provide a way of evaluating such rival paradigms of free agency, I elaborate a methodology based on the idea that a free society must provide its members with ‘equality in the social bases of self‐respect’. I use this methodology to argue that all three of the above conceptions are blind to problems of human agency, freedom, and dignity posed by the modern phenomena of welfare dependency, unemployment, and a self‐stultifying division of labor.     

Applications cliniques en psychologie de la santé

The aim of the present article is to present recent and validated clinical applications in the field of health psychology, in particular regarding pain and chronic disease management. Techniques such as acceptance and engagement therapy, mindfulness meditation and positive emotions enhancement have proved to be successful. Mindfulness is an attribute of consciousness long believed to promote well-being. It is commonly defined as the state of being attentive to and aware of what is taking place in the present. By this way, mindfulness meditation learns to patients with chronic pain to reduce their pain sensation. Moreover, encourage patients to have positive emotions, such as gratitude, is efficient in long term well-being. Prospective studies reveal that optimism, coping strategies such as positive reframing and acceptance, and social support yield less distress for patients with chronic disease. Similarly, psychosocial interventions that foster optimistic appraisals, build coping strategies, and bolster social support are benefit for patients. Other methods such as Cognitive Behavioral Stress Management (CBSM), enable to significantly enhance quality of life, adaptation to illness and chronic disease patient compliance. This 10-week group CBSM intervention that includes anxiety reduction (relaxation training), cognitive restructuring, and coping skills training is tested among women with breast cancer and HIV patients. The intervention reduces reports of thought intrusion, anxiety and emotional distress. Furthermore, biofeedback through Heart Rate Variability appears to be an important component of the development of patient potential in terms of cognitive and emotional resources enabling better coping with stressful situations and hence maintaining optimal health conditions. Biofeedback treatment intervention on pain and quality of life is helpful in the rehabilitation of patients with chronic pain. Limits of these applications are discussed as well as future research directions.     

Spirituality,the opiate of scholars of religion?

This review discusses Craig Martin’s approach to religious individualism and more widely the ways in which social scientists can make sense of individuals’ identities, beliefs and practice, as these seem more volatile and eclectic than ever. In particular, it is interested in the ‘critical’ study of religion developed in Capitalizing Religion. This review underscores the convergence between this book and other recent works regarding epistemological weaknesses affecting the contemporary study of religion (and in particular the ‘paradigm of spirituality’). It discusses Martin’s original contributions – in particular, a critical analysis of the ideological origins and biases underlying the categorisation of freely chosen spirituality vs. coercive religion. Finally, this review tries to further Capitalizing Religion’s argument by drawing on my own empirical work on the popularisation of meditation, yoga and kabbalah, sharing Martin’s critical approach and interest for the ways in which social structure and cultural norms affect individuals’ religious life.