Integrating Sleep Management into Clinical Practice

Although the basic function of sleep remains a mystery, insufficient sleep is associated with mood disturbance, fatigue and daytime lethargy, cognitive impairments, daytime behavior problems, academic problems, use of stimulants, work absenteeism, lost work production and an increase in healthcare utilization. The International Classification of Sleep Disorders distinguishes 90 different disorders, many of which can be effectively treated, but when left untreated can be costly in terms of quality of life, health and healthcare cost. Over the past 50 years we have become more effective in measuring sleep and have honed our treatments to better address the sleep disorders that most impact us. This article will focus on the three sleep disorders for which patients most frequently seek care, including insomnia, obstructive sleep apnea syndrome and restless leg syndrome.     

Developmental Therapy: Integrating Developmental Processes into the Clinical Practice

The facilitation of development may be considered the primary goal of counseling and therapy. Developmental theory, however, remains relatively divorced from direct clinical work. Developmental therapy is oriented toward identifying how to use basic developmental theory in clinical consultation. Developmental therapy differs from life span developmental psychology in emphasizing specific processes of change, growth, and development rather than outcomes and life stages. Thus, developmental therapy supplements life span theory and provides specific suggestions for clinical-counseling interventions that may be used to assess the developmental level of a client on a specific task, select counseling skills and theory to match client cognitive-developmental level, and obtain feedback on the effectiveness of the intervention that will enable one to change counseling style to meet client needs. Basic to developmental therapy is a modern adaptatio of Platonic and Piagetian constructs that allows the systematic integration of counseling and therapy theory. Implications of the model for training and practice are discussed.     

Integrating Counseling Research and Practice

The current research-practice gap in the counseling profession poses a number of significant challenges to practitioners, researchers, and the profession as a whole. This introduction to the special feature, “Counseling Outcome Research: Implications for Practice,” identifies the important issues regarding the systematic integration of counseling research into practice.     

癌痛治疗中的辅助用药

辅助镇痛药物最初的用途都不是镇痛,但对癌痛患者却能起到缓解疼痛、降低麻醉药品用量、减轻大剂量麻醉药品带来的药物不良反应的作用。尤其适用于那些对阿片类药物不敏感或不仅对阿片类药物敏感的癌病病人。遗憾的是临床上通常在阿片类药物镇痛效果不理想的时候才考虑添加辅助用药,癌痛治疗还存在用药过于单一的弊端。因此,为了加强止痛治疗效果、优化治疗策略,必须充分重视癌痛治疗中的辅助用药。     

Forgiveness,Reconciliation, and Mechila: Integrating the Jewish Concept of Forgiveness Into Clinical Practice

The professional literature diverges in defining the role of forgiveness and reconciliation in counseling regarding how forgiveness and reconciliation are conceptualized from a professional and secular perspective. The Jewish conceptualization of forgiveness is multifaceted; mechila, the forgiveness of debt, is particularly important in providing a framework for forgiveness when the issue of reconciliation is involved. The authors offer an explanation of the Jewish conceptualization of forgiveness and discuss a way to infuse the concept of mechila into counseling practice on a broader level with all clients.     

The Future of Psychology in Pain Management

Pain treatment facilities have proliferated in recent years and psychology has enjoyed considerable success in the clinical and research arenas of pain management. However, changes in the health care environment present significant challenges to the future of psychology in pain management. This article discusses concerns in three important areas of pain treatment that psychologists must address if they are to maintain a strong presence in this field: (1) evaluating and treating patients in the pain treatment setting, (2) evaluating and enhancing the efficacy of pain treatment, and (3) applying pain treatment services to other patient populations. With appropriate attention to these issues, psychology can continue to thrive in pain treatment settings.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性.老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗.目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观.本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生.     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性。老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗。目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观。本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生。     

Learning from Physical Pain to Help with the Management of Emotional Pain

There may be important similarities between chronic emotional pain and chronic physical pain. Both forms of chronic pain may promote negative beliefs about the self and the future. Chronic emotional pain and chronic physical pain both serve to disrupt patients’ focus from their actions and goals. Techniques used for the treatment of physical pain may be translated into the treatment of emotional pain. Four core strategies are reviewed including: (1) reducing catastrophic interpretations, (2) increasing tolerance by promoting acceptance, (3) cultivating positive expectations, and (4) remaining flexible in movements and attitudes. Patients can learn to tolerate limitations while pursuing their goals. Clinicians can help patients to reduce emotional pain by making a series of small changes in their thoughts and behavior.     

Integrating Terror Management Theory into Fear Appeal Research

Fear appeal communications have sustained the interest of researchers for over a half century. The dominant paradigm guiding fear appeal research asserts that differences in level of fear lead to differences in the persuasiveness of a message. Research grounded in the level of fear perspective has produced equivocal results, failed to explain why fear appeals sometimes backfire, and has not provided an a priori explanation for who may reject fear appeal messages. By emphasizing differences between individuals’ responses to the fear of death versus the fear of physically or socially undesirable consequences, terror management theory (TMT) offers a complementary theoretical perspective that may overcome the shortcomings of extant fear appeal research. This article reviews extant theoretical approaches to fear appeal research and summarizes the central tenets of TMT. A comparison of extant theories to TMT suggests that incorporating TMT into future fear appeal research may improve both the explanatory and predictive power of fear appeal theories.     

A Cognitive-Behavioral Approach to Chronic Pain Management

More than one third of Americans suffer from recurring or persistent pain. Because this condition can result in depression, social isolation, disruption of intimate relationships, and prolonged disability, chronic pain sufferers may seek counseling. This article provides counselors with an introduction to the role of psychosocial processes in the experience of pain and offers assessment and intervention recommendations based on a cognitive-behavioral therapy approach to pain management.     

Pain Assessment and Management in the Long-Term Care Setting

The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings.     

Brief Psychological and Hypnotic Interventions in Chronic Pain Management

This article will explore how brief psychological approaches using hypnosis and imagery can be used with patients with chronic pain, predominantly in a Primary Care setting, although much that is discussed here could be applied in the Secondary sector. Chronic pain is defined as pain which endures for more than 6 months and may last for months or years. It serves no physiological purpose and persists after the time that ‘normal’ healing would be supposed to have taken place. Chronic pain may also range from that of cancer or arthritis, to that which seems to have no single or obvious physical causation. Teaching self-hypnosis and use of imagery can give these patients tools that they can use to help themselves, not only with pain, but also with the emotional distress that so often accompanies and exacerbates it. Unlike medication, self-hypnosis has only positive side effects and can give back some measure of control to patients who feel helpless and hopeless.     

Identity-Related Dysfunction: Integrating Clinical and Developmental Perspectives

Recent changes to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders highlight the importance of identity dysfunction within several psychiatric diagnoses. Despite a long-standing tradition of identity research and theory in the developmental literature, there is limited work establishing intersections between clinical and developmental conceptualizations of identity problems. The relative lack of integration between decades of clinical and developmental work is unfortunate, and likely limits progress in both areas. In this commentary, the authors argue for greater interdisciplinary collaboration and highlight contributions from developmental and clinical theories, which, if integrated, could enhance identity scholarship. The developmental psychopathology perspective is introduced as an ideal framework to promote these goals.     

Clinical Judgment and Clinical Significance in Psychotherapy Practice

The use of outcome measurement in psychotherapy practice is briefly discussed, as is Jacobson and Truax’s (J Consult Clin Psychol 59:12–19, 1991) conception of clinically significant change. A more flexible and user friendly application of clinically significant change compatible with clinical judgment is proposed for psychotherapy practice. Examples are given and a free Windows program is described for computing RC and estimating the probability associated with it.