Breakdown of Intimacy. Insights into the world of a depressive lock-in

Breakdowns are states in which the continuity of being was destroyed. A breakdown has happened but could not be experienced. It is not possible to observe these states because they are beyond our intuition. We have to paraphrase them as ‘shadow’, ‘non-existence’, or ‘black hole’. In these dynamics, the development of a Super-Ego precedes the development of the ego. Under such a Super-Ego, the unthinkable turns into omniscience – no intimacy is left.

This process is demonstrated using the example of a treatment in which a patient regresses into a severe autistoid depression (major depression). In a depressive lock-in, all mental life collapsed and intrapsychic and interpsychic communication was not possible, neither of the depression nor of the panic. The ‘me’ is threatened with dissolution, the ‘not-me’ is flattened into a two-dimensional non-existence. For the analyst, it is nearly impossible to understand anything, to build up any empathy, i.e., to grasp the depression intuitively. Finally, intimacy gets lost – until it is possible to communicate this agony (e.g., by projective identification).     

AIDS counselling in the context of the terrence higgins trust

The Terrence Higgins Trust provides counselling and support services for people who are affected by HIV. Counselling involves enabling people to unlock feelings and find ways in which to deal with them. Counsellors need to be able to listen non-judgetnentally. To listen and really hear what the client is saying, and also to what is not being said.

‘Being there’ involves dealing with one's own feelings about disability, death, dying, sex, sexuality, anger and so on. Counsellors also have a responsibility to look after their own needs. This means getting regular supervision to discuss the work they are doing and their feelings about this.

Counselling people living with, or affected by HIV brings up feelings of helplessness, anger, fear, grief and despair, but with this comes joy, amazement and wonder at the power and magic in all human beings.     

Sex,germs, and health: pathogen-avoidance motives and health-protective behaviour

Objective: Recent work suggests that the psychology of pathogen-avoidance has wide-reaching effects on how people interact with the world. These processes – part of what has been referred to as the behavioural immune system – are, in a way, our ‘evolved’ health psychology. However, scholars have scarcely investigated how the behavioural immune system relates to health-protective behaviours. The current research attempts to fill this gap.

Design: Across two cross-sectional studies (N = 386 and 470, respectively), we examined the relationship between pathogen-avoidance motives and health-protective behaviour.

Outcome Measures: The studies used self-reported measures of attitude and intention as indicators of health-protective behaviour.

Results: Data collected in Study 1 revealed that pathogen-avoidance motivation related to participants’ attitude and intention towards sexually transmitted infections screening. High levels of pathogen-avoidance motivation were also related to having had fewer sexual partners, which partially mediated the effect of pathogen-avoidance variables on testing motivation. Study 2 extended these findings by showing moderate associations between pathogen-avoidance motivation and a broad range of health-protective behaviours, including but not limited to pathogen-related health concerns.

Conclusion: We argue that understanding and targeting pathogen-avoidance psychology can add novel and important understanding of health-protective behaviour.     

Experiencing menopause in the context of cancer: Women’s constructions of gendered subjectivities

Objective: Many women experience premature menopause following cancer treatment, accompanied by psychological distress, and poor health-related quality of life. In this qualitative study, we examined how women construct their gendered subjectivities – their sense of self as a woman – in the context of premature menopause after cancer.

Design: We analysed data from open-ended survey items and semi-structured interviews with women who had experienced cancer. Six hundred and ninety-five women completed the online survey and 61 took part in a semi-structured interview. A thematic decomposition was conducted to identify the subject positions associated with menopause taken up by the women.

Results: Three overall themes were identified: ‘The Incomplete Woman,’ ‘The Abject, Asexual Woman’ and ‘Out of Time and Social Isolation.’ Menopause was predominantly constructed as a negative experience, similar to older post-menopausal women and dissimilar to peers, contributing to experiences of social isolation. Menopause also signified the presence of a medically diagnosed cancer condition, and uncertainty around cancer prognosis.

Conclusion: It is important for cancer support group leaders and other service providers to be sensitive to women’s negotiation of menopause following cancer, in the context of broader cultural constructions, in order to provide appropriate information and support.     

The role of the affect heuristic and cancer anxiety in responding to negative information about medical tests

Objective: Little is known about the affective implications of communicating negative information about medical tests. This research explored how affective processes – particularly the Affect Heuristic and cancer anxiety – influence the way in which people respond to such information.

Design: Participants received different types of information about PSA screening for prostate cancer and magnetic resonance imaging (MRI) scans for migraine headaches. This was a 2 (Test harm information: present vs. absent) × 2 (Test benefit information: present vs. absent) × 2 (Test recommendation: present vs. absent) between-participants design.

Outcome Measures: Perceived risk, perceived benefit and general attitudes towards PSA and MRI testing, cancer anxiety, preferences to receive the tests vs. not.

Results: As predicted by the Affect Heuristic, test harm information reduced perceived test benefits. However, information about uncertain test benefit did not increase perceived test risks. Information about the test reduced cancer anxiety, indicating defensive coping. These variables – affect, anxiety, perceived risks and benefits – all uniquely predicted test preferences.

Conclusion: Affective processes play an important role in how people respond to and interpret negative information about medical tests. Information about harms and information about the lack of benefit can both make a test seem less beneficial, and will reduce cancer anxiety as a result.     

Psychic determinism: Leibniz and Freud

You ask me to say a number, any number, and I say ‘127’. Have I answered freely?

“Of course”, says Hume: no‐one compelled me—the fact that my choice was necessitated is irrelevant.

“Yes”, says Leibniz: my choice was not necessitated—the fact that it was determined ( = ‘inclined') is not enough to make it unfree.

“No”, says Freud: my choice was determined—the fact that it was not necessitated is not enough to make it free.

The paper examines the interplay between these answers.     

Interpersonally traumatised patients’ view of significant and corrective experiences in the psychotherapeutic relationship

Background: Clinical experience points to the importance of significant experiences in the therapy relationship for patients who have been interpersonally traumatised but the empirical research is limited.

Aim: The aim was to gain increased knowledge about how significant and potentially corrective experiences within the therapeutic relationship were described by patients in trauma-focused therapy and how the participants thought such experiences might have affected the therapeutic work.

Method: Five patients who were, or recently had been, in trauma-focused therapy were interviewed about their experiences of the therapy relationship. Thematic analysis was used to analyse the interviews.

Results: Four themes were identified: ‘Human contact’, ‘Validation’, ‘To face the painful’ and ‘Development of trust’. Positive experiences in the therapeutic relationship were sometimes seen as crucial for the therapeutic work and for patients’ improvement.

Conclusions: Previous findings about the significance of corrective experiences in psychotherapy were confirmed, particularly experiences of the therapist’s accepting stance, personal and human contact and encouragement. The therapist’s ability to evoke trust in the patient and her capacity to help patients to face painful material may be particularly important for traumatised patients.     

The perceptions of the causes of cardiac diseases: a taxonomy

Objective: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients’ characteristics.

Design: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation.

Primary outcome measures: Every participant filled in the B-IPQ and the HADS. The qualitative and quantitative analyses of the text using T-LAB identified the most frequent causal attributions and their co-occurrences.

Results: Among the patients, 26% did not recognise any causal attribution. The likelihood that the patients did not provide an answer was increased in older patients, females, patients with lower levels of education and higher levels of depression. Smoking and stress emerged as the most important attributions, followed by genetics, metabolic syndrome, work and nutrition. Four thematic clusters were identified: ‘work and stress’, ‘metabolic syndrome and hypertension’, ‘displeasures and body care’ and ‘heredity and other related diseases’.

Conclusions: This study suggests a classification of the causal attributions in patients with cardiac diseases and identifies thematic patterns and unknown attributions. The themes identified can serve as categories for future closed-ended questions.     

Self-reported overeating and attributions for food intake

Objective: We examined whether people’s attributions for their eating behaviour differ according to whether they believe they have eaten more, less or about the same as they normally would.

Design: Participants were served a small or large portion of pasta for lunch. Afterwards, they were asked to compare how much they ate in the study to how much they normally eat for lunch, resulting in three intake-evaluation categories: ‘ate less’, ‘ate about the same’ or ‘ate more’.

Main outcome measures: How much participants ate; the extent to which they attributed their food intake to an internal cue (i.e. hunger) and an external cue (i.e. the amount of food served).

Results: Participants served a large portion ate more than those served a small portion, but the magnitude of the portion-size effect did not vary across intake-evaluation categories. Furthermore, although participants in all groups indicated that their hunger influenced how much they ate, only those in the ‘ate more’ group indicated that the amount of food available influenced how much they ate.

Conclusion: People appear to be willing to explain their food intake in terms of an external cue only when they believe that they have eaten more than they normally would.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.     

A qualitative study exploring the experience of people with IBD and elevated symptoms of anxiety and low mood and the type of psychological help they would like

Background: People with inflammatory bowel disease (IBD) are at increased risk of developing anxiety and low mood. We sought to explore the experience of people with IBD and moderate–severe symptoms of anxiety/low mood to identify psychological processes which could be targeted in psychological interventions, as well as the kind of psychological support preferred.

Methods: Twenty-five participants with IBD and moderate–severe symptoms of anxiety/low mood were recruited for interview. Template analysis was utilised to analyse interview data. We explored the situations, cognitions and behaviour linked to symptoms of anxiety and low mood by people with IBD, as well as the kind of psychological help preferred.

Results: Two themes were identified within participants accounts of symptoms of anxiety; ‘under performance’ and ‘preventing an accident’. Two further themes were identified for symptoms of low mood; ‘lack of understanding’ and ‘stigma’. Expertise and understanding was the main theme identified for the type of psychological help desired.

Conclusion: The analysis highlights situations, cognitions and behaviour linked to anxiety and low mood by people with IBD and the type of psychological support desired. Our findings link to the knowledge and competencies set for psychological therapist working with long-term conditions.     

The mediating and moderating role of planning on mothers’ decisions for early childhood dietary behaviours

Objective: Examine the roles of action and coping planning on the intention–behaviour relationship for mothers’ decisions for their young children’s dietary behaviours.

Design: Prospective design with two waves of data collection, one week apart.

Main outcome measures: Mothers (N = 197, M_age = 34.39, SD = 5.65) of children aged 2–3 years completed a main questionnaire assessing planning constructs and intentions, and a one-week follow-up of the target behaviours – ‘healthy eating’ and ‘discretionary choices’.

Results: Intention was the strongest predictor of behaviour for both dietary behaviours. For healthy eating, intention moderated the indirect relationship between intention–behaviour via planning; coping planning was less important when intention was strong. Further, intention was not a direct predictor of behaviour when intention was relatively low. Action planning was not a direct predictor of either behaviour after accounting for intention and coping planning; action planning on behaviour was mediated by coping planning (only for healthy eating). Intention was not a direct predictor of coping planning; intention on coping planning was mediated by action planning. Neither type of planning predicted discretionary choices.

Conclusion: Current findings contribute novel information on the mechanisms underpinning the effect of action and coping planning on the intention–behaviour relationship.     

Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation

Background: Outcome research has highlighted the efficacy of internet-based cognitive behavioural therapy (iCBT). Some process research has examined users experiences of iCBT. Understanding the user experience provides valuable feedback to developers of internet-delivered interventions.

Aim: The present study aimed to evaluate user's experiences and engagement with the design features of an internet-delivered treatment programme for anxiety.

Methods: Semi-structured interviews were conducted with 7 participant users of the Space from Anxiety programme. A thematic analysis framework was employed to analyse the data collected.

Results: Identified themes related to participants engagement and adherence with the programme material, participant's experience of personal development through interaction with the programme content and participants experience of the social features employed in the programme. Another theme investigated the various attributes or conditions necessary for internet-delivered therapy to be helpful to an individual.

Conclusion: Considering the experiences of users of online interventions provides insight into what works for whom both in terms of technological features and the various skills and strategies that may compose the treatment intervention. Knowing more about what design features and strategies/components of the intervention are attractive and keep users involved can only enhance the delivery of effective internet-delivered interventions for anxiety disorders.     

Differential disgust responding in people with cancer and implications for psychological wellbeing

Objectives: Evidence suggests that disgust responses, known to negatively affect psychological wellbeing, may differ in people with cancer. We performed the first quantitative investigation of three discrete types of disgust trait – disgust propensity, sensitivity and self-directed disgust – in people diagnosed with a broad range of cancers (versus cancer-free controls), and explored their associations with psychological wellbeing.

Design: In a cross-sectional survey design, 107 participants with heterogeneous cancer diagnoses, recruited from cancer charities and support groups, were matched with cancer-free controls by age and gender.

Outcome measures: Measures of the three disgust traits were taken alongside measures of anxiety and depression.

Results: Disgust sensitivity and physical self-disgust were significantly higher in the cancer than control sample, while disgust propensity and behavioural self-disgust were lower. The disgust traits had a different pattern of associations to psychological wellbeing across the two groups, with disgust sensitivity predicting depressive symptoms to a significantly greater extent in the cancer than control group.

Conclusions: People with cancer differ from matched controls in their disgust responses and these responses have significant predictive relationships with aspects of their psychological wellbeing. The results suggest that emotion-based interventions may be useful for improving psychological wellbeing in people with cancer.     

Book Reviews

Caring for the SuicidalJOHN ELDRID London, Constable, 1988 304 pp., £7.95

Access to Agreement GWYNN DAVIS & MARIAN ROBERTSMilton Keynes, Open University Press, 1988 viii+ 163 pp., £25.00 (cased); £8.95 (paper)

Evaluating Services: Psychology and DisabilityROY MCCONKEY (Ed.) [Special Issue of the Irish Journal of Psychology (Dublin)], 1988 iil-388 pp., £12.00 (cased); £10.00 (paper)

Alzheimers: what it is, how to cope with itISOBELLE GIDLEY & RICHARD SHEARS Sydney, Unwin Paperback, 1987 XI+192 pp., £6.95

AIDS & AIDS Risk Patient Care HANS JAGERChichester, Ellis Horwood, 1988 224 pp., £29.95

Developments in Cognitive PsychotherapyWINDY DRYDEN & PETER TROWER (Eds)London, Sage, 1988 X+237 pp., £25.00     

The systematic identification of content and delivery style of an exercise intervention

Objective: This study explored the utility of using behaviour change taxonomies and checklists to systematically assess the content and delivery of behavioural support for physical activity delivered through an established exercise-referral scheme.

Design: An observation study was conducted whereby 22% of initial consultations were observed and audio-recorded, using quota sampling stratified by exercise-referral advisor.

Main outcome measures: Content was independently coded by two researchers, to assess; (i) completeness in delivering the programme protocol, (ii) behaviour change techniques delivered (defined using the CALO-RE taxonomy) and (iii) delivery style according to the Behaviour Change Counselling Index (BECCI).

Results: Protocol completeness was 63.6% (range 35.6–74.6%). The behaviour change techniques delivered most consistently were ‘providing information about where and when to perform the behavior’ (86%) and ‘setting outcome goals’ (82%). Other evidence-based techniques such as self-monitoring were infrequently observed. Variation in BECCI scores indicated that advisors could, but did not consistently, provide a client-centred service.

Conclusion: This study highlights how theoretically informed taxonomies can be useful in evaluating service delivery within applied practice, providing a meaningful way of assessing the completeness of protocol delivery relative to evidence. The provision of feedback to practitioners based on such objective criteria also facilitated positive academic-practitioner communication.     

Helps to Fostering Students' Spiritual Health [1]

Interviews with 98 teachers from a variety of schools were used to develop a definition of spiritual health, and to establish how these teachers thought spiritual health might best be fostered and what hindered its development in the school curriculum. A recurring theme, which seemed to be coming through the comments from teachers in this study, was the very important role that teachers play in helping students develop relationships. This was of vital importance as spiritual health was seen as being reflected in the quality of relationships that students develop with themselves, others, the environment, and with a Transcendent Other. The characteristics of teachers most frequently mentioned as desirable for the promotion of spiritual health were classified as follows:

? caring, sensitive, personal approach;

? concern for individuals;

? committed to personal beliefs and values.

Investigation of these teacher characteristics showed variation by gender, personal view of spiritual health, major curriculum concern, teacher and school type. Implications of these variations are discussed in this paper, together with the role of Spiritual Facilitator, to help nurture students' spiritual health.     

Planting the seeds of change: Directionality in the narrative construction of recovery from addiction

Objective: The dominant theoretical perspective that guides treatment evaluations in addiction assumes linearity in the relationship between treatment and outcomes, viewing behaviour change as a ‘before and after event’. In this study we aim to examine how the direction of the trajectory of the process from addiction to recovery is constructed in personal narratives of active and recovering users.

Design: 21 life stories from individuals at different stages of recovery and active use were collected and analysed following the principles of narrative analysis.

Results: Personal trajectories were constructed in discontinuous, non-linear and long lasting patterns of repeated, and interchangeable, episodes of relapse and abstinence. Relapse appeared to be described as an integral part of a learning process through which knowledge leading to recovery was gradually obtained.

Conclusion: The findings show that long-term recovery is represented as being preceded by periods of discontinuity before change is stabilised. Such periods are presented to be lasting longer than most short-term pre-post intervention designs can capture and suggest the need to rethink how change is defined and measured.     

Negotiating faith and identity in Muslim–Christian marriages in Britain

Marriage between Muslim men and Christian or Jewish women has been a recognized though controversial phenomenon through Islamic history. Qur'anic permission is given (Q 5:5) but the normative condition in Shari^ca is that Islam should predominate over another faith, particularly in the identification of children.

In Britain and other Western countries the prevailing cultural and legal context of autonomy in relationship formation and choice of marriage partner means that Muslim–Christian marriages may happen without conformity to religious rules or familial preference, for example in the case of Muslim women marrying non-Muslim men. Nevertheless, amongst those surveyed, Muslim identification remained strong even where marriages were deemed transgressive.

Amongst Christian partners, faith identification (of parents and children) was more likely to be treated as autonomous and personally negotiable in the context of marriage.

The experience of hybridity and liminality in these marriages may influence attitudes to faith itself and there was evidence of both ‘universalizing’ and ‘particularist’ faith responses amongst couples.