Anxiety induced by cardiac perceptions in patients with panic attacks: a field study

In panic disorder bodily sensations appear to play an important role as a trigger for anxiety. In our psychophysiological model of panic attacks we postulate the following vicious circle: individuals with panic attacks perceive even quite small increases in heart rate and interpret these changes as being catastrophic. This elicits anxiety and a further increase in heart rate. To evaluate this model we conducted a field study of 28 subjects with panic attacks and 20 healthy controls. A 24 hr ambulatory ECG was recorded and the subjects were instructed to report any cardiac perceptions during this period and to rate the anxiety elicited by these perceptions. The incidence of cardiac perceptions was about the same in both groups, but only subjects with panic attacks reported anxiety associated with such perceptions. Analysis of the ECGs revealed that in both groups heart rate accelerations preceded cardiac perceptions. Following cardiac perceptions, the healthy controls showed a heart rate deceleration, whereas the subjects with panic attacks had a further acceleration. This heart rate increase after cardiac perceptions was positively related to the level of anxiety elicited by the perceptions. These results provide clear evidence in support of the vicious circle model of panic attacks.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services. Methods: Three focus groups with adults with CHD (total of 14 participants aged 19-67) were conducted and thematic analysis was used to identify emerging themes. Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges. Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach

Objectives: There is an increasing amount of research being conducted regarding the psychosocial challenges associated with living with congenital heart disease (CHD), however little is known about how these challenges influence the type of psychosocial services patients want. This study investigated (1) the type of services patients want; (2) how they want to access these services; and (3) why they want these services.

Methods: Three focus groups with adults with CHD (total of 14 participants aged 19–67) were conducted and thematic analysis was used to identify emerging themes.

Results: Participants described wanting to access specific psychosocial services in three broad categories (counselling, connecting with other adults with CHD and psycho-education) and in three main formats (individual/group therapy, mentorship programmes and patient conferences). Reasons for wanting these services were grouped under two overarching themes, namely intrapersonal factors and interpersonal challenges.

Conclusions: Psychosocial challenges are part of the everyday lives of adults with CHD, yet they are rarely addressed as part of routine medical care. Patients themselves have clear opinions regarding the psychological services most appropriate to target their experiences of living with CHD.     

The experience of body dissatisfaction in men

Evidence suggests that the prevalence of body dissatisfaction (BD) is increasing amongst men. However, research has commonly examined the phenomenon in predominantly female groups. In view of this, the current study used a qualitative methodology to explore the experience of BD in men. Semi-structured interviews were conducted with 14 men. The data were analysed using Interpretative Phenomenological Analysis. Analysis yielded themes across four domains (societal, interpersonal, intrapersonal, and social presentation). Whilst participants exhibited a range of appearance concerns, there was commonality in the processes by which these were experienced and managed. These generic issues are the focus of the themes, and could usefully be incorporated into a new assessment tool. Findings are considered in relation to existing (cognitive behavioural, self-discrepancy, and sociocultural) theories, and implications for clinical practice and future research are discussed.     

Rebuilding security: group therapy with children affected by September 11

This article examines group therapy with children and adolescents impacted by the September 11 terrorist attacks on the World Trade Center, with a focus on the role of metaphor, enactment, and the creative arts therapies in trauma treatment. Attention is given to the importance of fantasies, family structure, and culture in determining how the child constructs and processes the events. Examples are derived from ongoing, trauma-focused groups with traumatically bereaved children who lost parents, as well as from ongoing drama therapy groups in which traumatic themes emerged.     

Family Conflict and Forgiveness Among Survivors of Suicide

This study explored the lived experiences of immediate family members who were left behind and their intra- and interpersonal struggles with other family members and their coping efforts to overcome these struggles. We used interpretative phenomenological analysis for data collection and analysis and conducted in-depth interviews with 11 participants in Korea. Two superordinate themes, with two ordinate themes in each, were identified: (a) family conflict after a family member’s suicide (“discordant grieving” and “suicide loss as a catalyst for family conflict”) and (b) forgiveness (“struggling to forgive other family members, the deceased, and themselves” and “the process and importance of forgiveness”). The implications of these findings are discussed.     

V for Volunteer(ing)��The Journeys of Undergraduate Volunteers

This article studies undergraduate students journeys in volunteering, and details the motivations of and challenges that these volunteers face during the journey. We conducted five focus groups on a total of 38 undergraduate volunteers, and obtained seven themes as we undertook an investigation of our three research questions. Our findings revolved around these seven themes, which ranged from motivations to experiences to challenges. Our findings have helped us understand the motivations and challenges that undergraduate volunteers have and face during the journey of volunteering. Some of these challenges are particular to a university setting, but some others can certainly be generalized to other settings. Recommendations for future research are also included.     

Accompagnement médical et communautaire dans un essai de prévention biomédicale : vers une nouvelle forme d’éducation ?

The recent implementation of innovative biomedical preventive approaches to combat the continued high prevalence of HIV among certain populations, has refocused attention on the question of support in the management of treatment adherence. What distinguishes these approaches from classic research on similar themes is that the populations concerned are not HIV positive. The objective of this study was to assess participant and physician satisfaction with medical and community support provided in the ANRS-IPERGAY trial. As part of this trial, individual interviews were conducted with physicians and with HIV-negative participants involved in the trial. Collective interviews and focus groups were also conducted with the participants. A content thematic analysis was performed on the full two corpuses’ data, with the aim of investigating discourse themes regarding the support offered as part of the trial. The discourse analysis of the HIV-negative participants and physicians underlined their satisfaction with many aspects of the medical and community support provided during the trial. The results were interpreted with respect to new forms of patient education necessary for the implementation of the medicalized prevention.     

Dreaming under fire: the psyche in times of continuous stress

Continuous stress and trauma are manifested in dreams, the study of which can expand our knowledge concerning unconscious reactions to trauma and efforts of coping with continuous traumatic situations. In our research we asked people living under continuous threat of rocket attacks to record their dreams and their associations to them during four consecutive weeks. We collected 609 dreams from 44 women and 18 men (age range 14-62). The dreams submitted were analysed according to the Jungian approach in the light of the information and associations presented by the subjects. Full dream series of dreamers from each group were analysed in an attempt to capture the depth-psychological experience of living and dreaming under fire. The most frequent themes found were: ‘concrete vs. symbolic', ‘togetherness', ‘active ego', ‘fear and anxiety', ‘shadow' and ‘personal issue'. The subjects were divided into three age groups. Differences between the occurrences of themes were examined. On the unconscious level our results showed that the adolescents group seemed to be the most vulnerable to the stress situation (preponderance of concrete dreams), the mature adults group was the least influenced by it (preponderance of symbolic dreams and of the ‘personal issue' theme) and the young adults group made the greatest psychological efforts for coping (preponderance of ‘active ego' theme). We noted few anima figures appearing in the men's dreams, while animus figures appeared in the women's dreams. In another study undertaken immediately after one of the recent wars in Gaza we collected dreams of Israelis living in the south of Israel who were under heavy daily rocket attacks, and dreams of Palestinians living in the West Bank. The most significant difference we found between the groups was a preponderance of symbolic dreams among the Palestinians, as opposed to a preponderance of concrete trauma dreams among the Israeli group living on the Gaza border. In both groups we found archetypal symbols of evil. In conclusion, dreams can help us detect emotional distress, even when subjects seem ‘ok'. Early detection and working with dreams can help prevent the severity of delayed PTSD.     

An Examination of the Biblical Evidence for Open Theism

Open Theist theologians argue that their view of divine foreknowledge and providence is the correct interpretation of the Bible, and suggest some biblical evidence to support this claim. Among these theologians, Gregory A. Boyd’s case is the most systematic, and also the most comprehensive and rigorous. Taking into consideration (1) the main philosophical claims of Open Theism and its main rivals, namely Calvinism and Molinism, and (2) Open Theist theologians’ interpretative principles for the Bible, the biblical evidence for Open Theism suggested by Boyd can be classified into three groups according to their strength. I will argue that the first group of themes has no evidential value for Open Theism, since these themes can be interpreted just as plausibly from a Calvinist or Molinist perspective. By contrast, the second group of themes has some evidential value and thus constitutes prima facie evidence for Open Theism, since these themes make most sense under an Open Theist interpretation. However, these themes also make some sense on a Molinist reading. The third group of themes, I argue, has most evidential value for Open Theism, since it seems hard to reconcile these themes either with Calvinism or Molinism.     

Personal experience in professional narratives: the role of helpers' families in their work with terror victims

This article describes research on the narratives of social workers who help terror victims, focusing on the relationship between the helpers' families and their work. Qualitative analysis of three training groups of social workers who are responsible for helping in the event of terror attacks in different parts of Israel, and of three debriefing groups for social workers after terror attacks, reveals that the helpers' families play a role in the narratives constructed by the helpers. Two main themes were identified. The first centers on the interaction between work and the family, and shows that in the situation of a terror attack, the conflict between the two disappears and the family often serves as a support system for the helpers. The second theme refers to the family dimension alone, and focuses on the dichotomy between vitality and loss. The way that family life events affect helpers'professional intervention is described. The findings are discussed in light of Conservation of Resources Theory, the fight-flight response to threat, and the concept of the family as a source of safety and risk taking.     

Developing a family-based depression prevention program in urban community mental health clinics: a qualitative investigation

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this deficit, we are developing the Protecting Families Program (PFP), a family-based multicomponent depression prevention program for mothers in treatment at urban community mental health agencies and their school-aged children. To inform intervention development and begin relationship building with the agencies, patient and staff focus groups were conducted in the participating agencies. Eighteen mothers with depression participated, and eight major themes were identified: (1) depression symptoms, (2) generational legacy, (3) parenting difficulties, (4) child problems, (5) social support, (6) stressful life events, (7) therapy and other helpful activities, and (8) desired treatment. In the focus groups with 10 mental health providers, the five major themes identified were parenting difficulties, lack of social support, life stress, current mental health practices, and intervention development. The findings support the multicomponent design of PFP, which focuses on increasing knowledge of depression, enhancing social support, and improving parenting skills. The study helped clarify many of the challenges of conducting research in a community mental health system.     

Parent Perspectives on the Use of Group Well-Child Care to Address Toxic Stress in Early Childhood

We sought to understand the experiences of parents who participated in Group Well-Child Care (GWCC) and Trauma-Informed GWCC (TI-GWCC). Three focus groups and design sessions with parents from either standard GWCC or TI-GWCC (N = 17) were conducted and synthesized into common themes using thematic analysis. Focus group themes included: (1) GWCC can empower parents to recognize toxic stress; (2) Parents identify ways that they role model behaviors for their child(ren); (3) Activities that facilitate reflection on attachment and anger management encourage intentional parenting practices. Our qualitative findings suggest that TI-GWCC supports the prevention of childhood adversity by creating connections between parents, helping families understand and identify toxic stress, and teaching parenting practices that mitigate stressors.     

A Study of Panic Attacks in University Students of Iran

This study examined the parameters of panic, fear, and avoidance among university students in Iran. Data were collected from 347 students using Farsi translations of the Panic Attack Questionnaire, Beck Depression Inventory, Taylor Manifest Anxiety Scale, State-Trait Anxiety Inventory, and Anxiety Sensitivity Index. Thirty-eight percent of participants reported panic attacks in the past year and 21.4% reported panic attacks in the past 4 weeks when prompted by a broad definition of panic. Men and those with unexpected panic reported greater panic severity whereas women with panic attacks reported greater situational fear and avoidance. Panickers who satisfied DSM-III-R panic disorder (PD) criteria reported greater lifestyle restriction and general psychopathology. The findings provide tentative support for cross-cultural similarity in panic phenomenology and the validity of DSM-III-R PD criteria among university students in Iran. The results are discussed by reference to nonclinical panic research and general themes of Iranian culture.     

Patterns of Thinking in Militant Extremism

ABSTRACT— Recurrent features of the thinking pattern (or mind-set) of violent militant extremists are delineated, discussed, and related to previous research and theory. We examined extremist groups from a diverse range of continents, cultures, and political and religious orientations. We compared statements by (and, to some degree, statements about) these groups and formulated 16 themes common to the militant-extremist mind-set. Among these themes are perceptions of a crisis involving violations of posited sacred values, along with justifications for the use of violence to remediate such problems. There are indications that such themes are not infrequent in the general population. For example, research participants failed to strongly disassociate themselves from the sentiments and framings found in the fanatical items, which undercuts the notion that militant-extremist thinking represents bizarre ideation. Militant-extremist thinking appears to represent a major, aggressive form of fanaticism affected by both dispositional and situational factors. Key themes in this thinking pattern might fit together to construct a potentially compelling narrative, which may be a key part of the ideological appeal of salient militant-extremist groups.     

Using Community Partnerships to Better Understand the Barriers to Using an Evidence‐Based,Parent‐Mediated Intervention for Autism Spectrum Disorder in a Medicaid System

Service use disparities have been noted to impede under‐resourced families' ability to access high‐quality services for their child with autism spectrum disorder (ASD). These disparities are particularly relevant for parent‐mediated interventions and may suggest a lack of fit between these interventions and the needs of under‐resourced community settings. This study used Roger's Diffusion of Innovations theory to guide community partnerships aimed at understanding the perceived compatibility, complexity, and relative advantage of using an evidence‐based, parent‐mediated intervention (Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid‐eligible parents, and three focus groups were conducted with 16 ASD providers operating within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT. However, primary themes emerged regarding the need to (a) reduce the complexity of written materials; (b) allow for a more flexible program delivery; (c) ensure a strong parent–therapist alliance; (d) involve the extended family; and (e) help families practice the intervention within their preexisting routines. Results are discussed as they relate to the design and fit of evidence‐based, parent‐mediated interventions for under‐resourced community settings.     

This Girl Can,can’t she? Perspectives from physical activity providers and participants on what factors influence participation

AimsThe present study used a multi-method approach to qualitatively explore whether the perceptions of young women and girls and exercise providers are aligned in terms of the factors that influence participation with the aim to better understand how these factors influence participation.DesignThematic analysis was used to synthesise focus groups and interview data within the intrapersonal, interpersonal, organisation, environmental, and policy levels of an ecological model.MethodsInterviews were conducted with 4 experienced exercise providers (2 men, 2 women). Focus groups were conducted with 21 young women and girls (M = 17.9, SD = 2.4) who had participated in one of the exercise interventions developed and delivered by the providers.ResultsThe perceptions of participants and providers were often disparate but revolved around the same themes especially at the intrapersonal and interpersonal levels. They expressed contrasting views regarding the importance of skill development and enjoyment, and the role of boys and instructors. At the organisational level, both participants and providers agreed that schools offer opportunities as well as barriers to engagement in physical activity and exercise. At the environmental level, urbanisation, safety, culture, and social media appeared as main themes where the perspectives of participants and providers complemented each other. Finally, at the policy level the main themes were derived from providers and concerned issues around programme funding. Participants provided valuable commentary about a nationwide campaign to promote physical activity to females.ConclusionsIn order to provide engaging physical activity and exercise for young women and girls it is necessary to align the needs and expectations of participants and providers at the intrapersonal and interpersonal levels. For sustainable exercise provision that impacts young women and girls, it is essential to align funding strategies and deliverables between exercise providers, local and national stakeholders.     

Factors influencing drinking behavior in alcoholic panickers and non-panickers

Male alcoholics who (a) experienced panic attacks prior to abusing alcohol, (b) experienced panic attacks subsequent to abusing alcohol, and (c) had not experienced panic attacks were compared on three sets of measures: the Panic Attack Questionnaire, the Restrained Drinking Scale, and the Inventory of Drinking Situations. The results showed that two groups of Ss who experienced panic attacks were more likely than non-panickers to use drugs other than alcohol, began drinking at an earlier age, had a greater proportion of parents with panic and alcohol related problems, had higher drinking restraint scores, and drank in more situations. The Ss who experienced panic attacks prior to abusing alcohol were more likely than the other groups to drink in situations similar to those related to agoraphobic fears. It was postulated that alcoholics who experience panic attacks, especially those who experienced panic attacks prior to abusing alcohol may be using alcohol to reduce anxiety or fear related to panic attacks.     

Emotions,Risk Perceptions,and Precautionary Behavior Under the Threat of Terror Attacks: A Field Study Among Israeli College Students

The current study uses the unique data from a natural experiment conducted in a college located in southern Israel that was exposed to rocket attacks in 2008. The study examines the relationships between the negative emotions, the perceptions of risk to oneself, the precautionary actions, and the intentions of 290 students who were exposed to terror attacks while on campus. In addition, we compared the emotions, the risk perceptions, and the precautionary behavior between the two groups: those who lived within the range of the rockets and were also exposed to rocket attacks at home and those who lived outside the range of the rockets. The results show that the risk perceptions were affected mainly by the emotion of fear while the students were on campus. In particular, fearful people became more pessimistic about their general and personal risks from terror but not about routine risks. The results also reveal that those who lived outside the rocket area (and had less or no experience with terror attacks) were more likely to take precautionary actions during their stay in the campus and were more pessimistic about continuing their studies in college in the coming year than those living in the area, who had more experience with terror attacks. Copyright © 2011 John Wiley & Sons, Ltd.