Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

Changing self-perception: success in independent living for individuals with chronic mental illness

Rates of rehospitalization of individuals with serious and persistent mental illness were compared prior to and after they were moved into 4-bed corporate foster homes. Results showed a significant drop in the number of rehospitalizations and in the total number of days hospitalized after moving into a 4-bed home. The data suggest that living in a 4-bed home-like environment may result in significantly fewer and shorter hospitalizations for these types of mentally ill individuals.     

Meaning in life for individuals with physical disabilities

What makes your life meaningful?" is a question previous researchers explored with people of various ages, but not of individuals who have significant physical impairments. In this study, 26 individuals with physical disabilities were asked to describe what makes their lives meaningful. Analysis showed human relationships were the most frequently reported source of meaning in life, the sources being family members, friends, and people in the community. The second most frequently cited meaning was service, specifically, helping and educating others, such as other people with physical disabilities.     

试析灵性生活对个体基督徒的意义

本文围绕着基督教灵性或灵修生活的界定、范围、构成要素、基本特征以及对于基督徒的影响与意义做出了系统的分析与评介,指出基督教的灵性实践如同其神学思辨一样对个体基督徒的宗教生活具有十分重要的意义。     

Age differences in coping with chronic illness

We examined the correlation between age and six coping strategies in a sample of 151 middle-aged and older chronically ill adults. Coping strategies included cognitive restructuring, emotional expression, wish fulfilling fantasy, self-blame, information seeking, and threat minimization. Older adults were less likely to use emotional expression or information seeking than were middle-aged adults in their efforts to cope with the illness. These strategies were related to age even when numerous illness characteristics (e.g., physical limitations) were used as control variables. Interaction effects showed that older adults who perceived their illnesses as highly serious were less likely than were others to cope by seeking information, reconstruing their illness as having positive aspects, or engaging in wishfulfilling fantasies, and more likely to cope by simply minimizing the illness's threat. Consideration of related research studies suggests that the age differences in emotional expression may be due to age-related shifts in the types of stresses experienced, whereas the age differences in information seeking may be more strongly linked to cohort phenomena.     

Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain

Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.     

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.     

Cognitive-behavioral treatment groups for people with chronic physical illness in Hong Kong: reflections on a culturally attuned model

This study describes and evaluates a cognitive-behavioral treatment group for people with chronic physical illness in Hong Kong. We developed a group protocol based on the understanding that Chinese people generally prefer a structured group format, expect group leaders to be active and directive, and are not used to expressing opinions and emotions in groups. The experimental and waitlist control groups had 38 and 35 participants, respectively. A standardized questionnaire was administered to all participants before and after the group treatment. Results suggest that members of the experimental group showed improvements in mental health, negative automatic thoughts, and negative emotions when compared to those in the waitlist control groups, and at the end of group treatment. Implications for designing and running a culturally attuned CBT group for Chinese people are discussed.     

The physical activity experiences of men with serious mental illness: Three short stories

ObjectivesAlthough a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users’ voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI).MethodsAn interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants’ voices.ResultsWe present three short stories in an effort to communicate participants’ personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness.ConclusionsFor us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions.     

Personality characteristics of individuals with chronic rheumatoid arthritis

MMPI profiles of 22 chronic arthritic patients were compared to 22 control pain (nonorganic) patients. While elevations were noted in the HS, D, and Hy scales for the rheumatoid patients, the over-all profiles differed from controls on the PA scale.     

Vicarious and operant experiences in the etiology of illness behavior: A replication with healthy individuals

The purpose of the present investigation was to replicate a previous study of diabetic patients on the role of parental modeling in the etiology of illness behavior. A random sample of healthy individuals were assigned to an avoidant model (AM) (i.e. parent reported to have avoided work. chores etc. when ill) or non-avoidant model (NAM) group. Subjects subsequently provided retrospective and current information concerning their illness-behavior experiences. The results indicated that individuals with an AM reported more responsibility avoidance when ill currently and as a child compared to the NAM subjects. Additionally. AM subjects reported receiving more positive reinforcement for current illness compared to NAM subjects. It was concluded that the process by which individuals learn to respond to illness may be similar in healthy and chronically-ill individuals but that positive reinforcement for illness may be more likely to be received by healthy individuals during acute illness than by chronically-ill individuals. The present study provides further preliminary support for the learningtheory model of illness behavior.     

Investitations of the ongoing stressful situations among those with chronic illness

This paper examines methods of adaptation among those faced with stress from chronic health problems. Studies of disabled older adults and those with muscular-skeletal disorders are described with special emphasis on the role of everyday life events, and the threats to well-being imposed by chronic stressors. Attention is paid not only to psychological distress as outcome of a failure to adapt, but also to indices of psychological well-being which provide evidence of the benefits for those who cope successfully with chronic illness. The paper examines evidence for the proposition that everyday stressors can influence physiological processes linked to disease course. The implications of these findings for social interventions are discussed from community and health psychology perspectives. Editor’s Note: Alex Zautra was honored at the 104^th annual meeting of the American Psychological Association in Toronto, Canada, in August 1996. Dr. Zautra received the 1996 Barbara Dohrenwend Memorial Award by the Society for Community Research and Action: the Division of Community Psychology of the American Psychological Association. This work was supported by biomedical grants to the first author from the Arthritis Foundation, and the National Institute on Arthritis and Muscular-Skeletal Diseases (R01 AR41687).     

The influence of silence upon clinet-perceived rapport

The effect of frequency of instances, length and overall amount of silence was investigated during nine trainee counsellors' interviews with a Standardized Client. Data on client-perceived rapport were collected each minute, allowing for comparison of overall interviews as well as during all stages of the inteviews. Results indicated that there were significanly more instances of silence and significantly greater overall amounts of silence in interviews rated as having higher levels of client-perceived rapport. In addition, there were clearly different pattersns of usage of silence during moderate versus very high rapport minutes during interviews. Suggestions are made for the integration of these findings into counsellor training courses where trainees often report anxiety regarding the occurence of silence. Issues for further research are discussed.