“Sharing in people's pain is not an easy thing to do”: Cognitive Behavioural Therapists' understandings of compassion in the workplace

Objectives

Compassion is central to the aim of improving patient care and staff well-being within healthcare systems. To inform service development, explorations of experiences and meanings of compassion are needed. This study explored cognitive behavioural therapists ' understandings of compassion within their work environment.

Design

A qualitative study was conducted using semistructured interviews and interpretative phenomenological analysis (IPA).

Methods

Data were obtained from five practicing cognitive behavioural therapists.

Results

Two superordinate themes were developed, each with two subordinate themes. CBT therapists reported entering the profession with intrinsic motivation to care for others. They further developed an interest in compassion with exposure to clients and ongoing professional development in compassion-focused therapy (CFT). Compassionate work environments helped to facilitate compassionate practice; however, for many, workplaces were perceived to lack compassion. Challenges were encountered when negative workplace interactions left therapists feeling fatigued, distressed and demoralised. There was a desire for recognition and to be seen as more than a “work machine,” the experience of which was a threat to retaining therapists within the profession.

Conclusions

Current recruitment and training processes are producing staff with skills and motivation to deliver compassionate care. However, lack of compassion within workplaces can be a barrier to actioning these skills and motivations. Research needs to focus on how to effectively implement and run systems that are compassionate for both staff and clients. To provide compassionate care, staff need work environments that show compassion to them. These findings provide some insights into and practical suggestions regarding how this can be achieved.     

Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress

Background/Objective

There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months’ follow-up. Participants’ PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.     

Posttraumatic Growth: Spouses’ Relationship Quality and Psychological Distress

While research links interpersonal processes to posttraumatic growth (PTG; Calhoun &; Tedeschi, 2006a Calhoun, L. G., &; Tedeschi, R. G. (2006a). Expert companions: Posttraumatic growth in clinical practice. In L. G. Calhoun, &; R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research &; practice (pp. 291–310). Mahwah, NJ: Lawrence Erlbaum. [Google Scholar]), little is known about whether partners’ PTG has consequences for people’s (i.e., actors’) relationship functioning and psychological distress. Sixty-one married couples who had experienced severe flooding completed measures of PTG, perceptions of spouses’ PTG, relationship quality, and psychological distress 6 and 12 months following the event. Partners’ increased PTG predicted actors’ increased perceptions of partners’ PTG, which predicted actors’ increased relationship quality, which, in turn, predicted actors’ decreased psychological distress. Thus, partners’ PTG can benefit spouses’ evaluations of their relationship and, ultimately, actors’ psychological well-being.     

A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit

This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child’s admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child’s illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents’ subjective ICU experience may be greater associated with PTG than the objective reality.

     

Have You Ever Googled a Patient or Been Friended by a Patient? Social Media Intersects the Practice of Genetic Counseling

Patients and healthcare providers are becoming increasingly connected via social media, bringing new opportunities and challenges. Direct connection can occur between patients and providers using online tools such as Facebook and LinkedIn. In addition, providers can gather information about patients using a search engine such as Google, referred to as patient-targeted Googling (PTG). An online 54-item survey was used to gain information on (1) how and to what extent genetic counseling students and genetic counselors connect directly with patients via social media sites, and (2) gather information on providers using PTG. Four hundred genetic counseling students and genetic counselors participated in the survey. The majority of respondents (88.9%; n?=?344/387) find it is never or rarely acceptable to interact with current patients via social media sites; however, 27.7% (n?=?110/397) have visited a patient’s social media site. Gathering information for patient care was the most commonly reported reason (76.8%; n?=?43/56). Thirty-three percent (n?=?130/394) have considered searching online or actually searched online for information about a patient. Curiosity was the most common reason (92.7%; n?=?114/123); although, respondents also used PTG to obtain contact information and to prepare for patient sessions. Our study supports the need for development and dissemination of professional guidelines to serve as a valuable resource for practicing genetic counselors and genetic counseling training programs.     

Physical activity and posttraumatic growth: A systematic review of quantitative and qualitative studies

ObjectivesThis systematic review aimed to examine the relationships between physical activity and posttraumatic growth (PTG) following a highly stressful life event.DesignA systematic review was conducted to identify eligible articles. A meta-analysis was conducted for quantitative studies and a meta-ethnographic synthesis was conducted for qualitative studies.MethodAfter systematic searches of five databases and literature screening, 20 quantitative studies and 12 qualitative studies were included in the final review. A meta-analysis of 14 quantitative studies was conducted to examine association between leisure-time physical activity and PTG. A meta-ethnographic synthesis of 10 qualitative studies was conducted to examine the relationship between physical activity and the experience of PTG.ResultsThe meta-analysis revealed a positive, yet small, association between leisure-time physical activity and PTG (average correlation = 0.120; 95% confidence interval: 0.071 to 0.168; p < 0.001). The effect sizes did not differ by measurements of PTG and participants’ age and gender but were smaller in studies with a binary variable of physical activity, a sample of participants with moderate or advanced diseases, and a longer period since the stressful event. The meta-ethnographic synthesis identified potential processes linking physical activity and PTG, including perceptions of self, social experiences, philosophical re-evaluation, and health effects.ConclusionsThis review suggest physical activity is a behavioral factor that may facilitate PTG. It highlights methodological considerations for further research.     

Die Psychotherapieausbildung aus Sicht der Lehrkräfte

Background

A survey was carried out to ask the trainers and supervisors about their appraisal of the quality of the psychotherapy training and about ways to improve it 10 years after the inception of the “German psychotherapy law”.

Methods

Training institutes provided e-mail addresses and other contact information from over 5,000 trainers. The questioning was carried out mainly by on-line questionnaires and 2,196 data sets were used for analysis.

Results

Trainers showed overall satisfaction with the components of psychotherapy training and the skills of the training candidates. More knowledge transfer in the fields of therapy techniques and case studies and more cooperation with other professional groups were suggested. Trainers acknowledged redundancies between professional training and university studies and observed a heterogeneity of trainees, however, these were mostly considered helpful. Only half of the trainers were subject to evaluation of their work.

Conclusions

The quality of psychotherapy training could be improved by stronger emphasis on practical knowledge. Structural changes should be made to take the problem of redundancies and heterogeneities into account. Regular and continuous evaluation of the training should become an integral part of professional training and the results should have consequences.     

Beziehungsökologische Therapie bei Panikstörung

Background

In 2000/2001 the authors presented the theory and practice of the ecological approach to the psychotherapy of panic disorders. The aim of the present study was to investigate the psychotherapeutic effectiveness of its application, supplemented by cognitive behavioural elements. According to the ecological approach, panic disorder arises whenever external changes in the living conditions enforce changes in professional or interpersonal relationships, which had been previously postponed and/or avoided out of fear of their consequences.

Methods

A total of 24 therapies consisting of 11–20 sessions were examined. Patients were examined 5 times from the beginning of the therapy until at least 1 year after cessation. Standardized questionnaires for the diagnosis and severity of the panic syndrome were used including the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Scale (HAMA), the Symptom Checklist (SCL) 90-R and a relationship questionnaire.

Results

In the subjects’ self-evaluation 67% had recovered or showed only mild symptoms 1 year after therapy compared to 75% in the evaluation by the therapists. Effect sizes before and after therapy varied between 0.78 and 2.73 and all were significant. In addition, we developed a questionnaire on relationships, according to the ecological hypothesis. This showed that more than 80% of the subjects experienced essential changes in their relationships prior to the onset of the panic disorder requiring further developmental changes, which could be mastered with increasing success in the course of therapy.

Conclusions

Compared to other studies the combination of ecological and cognitive-behavioural approaches in this study resulted in impressive symptom and therapy reduction in less than 20 sessions.     

A Systematic Review: Non‐Suicidal Self‐injury in Australia and New Zealand's Indigenous Populations

Objective

To undertake a systematic review of non‐suicidal self‐injury (NSSI) prevalence, patterns, functions, and behavioural correlates for the Indigenous populations of Australia (Aboriginal and Torres Strait Islanders) and New Zealand (NZ; Maori).

Method

We searched the following electronic databases: PubMed, MedLine, Scopus, Web of Science, ScienceDirect, PsycInfo, and PsycArticles, CINAHL, and the Informit Health and Indigenous Peoples collections. Studies were included for review if they were published within the last 25 years and reported on NSSI in Australia and NZ's Indigenous populations.

Results

Seven studies were included, six of which came from Australia. The prevalence of NSSI in Australia ranged from 0.9% up to 22.50%; statistics varied by the different samples, types of prevalence, and relationship to alcohol. Several studies found that Aboriginal and Torres Strait Islander peoples had higher rates of NSSI than other Australians, but that this was not significantly higher. Two studies indicated that NSSI was linked to alcohol use, incarceration, and a younger age. The one NZ study was of injury and not specifically NSSI.

Conclusions

Findings are limited due to a small pool of literature. Cultural variations in NSSI presentation should be considered when working with Indigenous populations. Further research is required to help determine what cultural variations may exist.     

Posttraumatic Growth Following Trauma: Is Growth Accelerated or a Reflection of Cognitive Maturation?

Over the past two decades, there has been an exponential increase in studies investigating posttraumatic growth (PTG) in samples exposed to various traumatic experiences. The prevalence of PTG following trauma has been variable, and mixed findings have emerged pertaining to factors associated with PTG. To date, however, there has been a notable paucity of research that has considered the PTG phenomenon in relation to lifespan developmental, cognitive, and humanistic theories. The objective of this review is to evaluate the prominent theory of PTG proposed by Tedeschi and Calhoun (1996 Tedeschi, R. G. & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) in context of the theories of Erikson and Maslow, as well as Frankl's theory of meaning-making postadversity. Methodological issues are also considered to inform the advancement of future research in this field.     

Psychische Beschwerden und Störungen von Studierenden

Background

Psychological distress among students is receiving growing attention in the scientific community as well as in the general public. There are counseling services available in student societies and universities which address psychological distress among students but scientific research in this area is rudimentary and poorly represented.

Problem in question

In order to present the prevalence, extent and type of psychological disorders in students and the alterations over time, an investigation was carried out to show which psychological complaints and disorders were present in students who consulted a psychotherapeutic counseling center. These data were compared with the psychological complaints of a student field study population. Furthermore, alterations in the psychological complaints and disorders of students over periods of 10 and 15 years will be presented.

Methods

The prevalence and change over time of psychological syndromes in students were identified by a comparison between an unselected sample of counseling center clients and several student field samples from the previous 15 years. The type of distress and severity of symptoms were measured with a Symptom Checklist (SCL-90-R), the Psychosocial Complaints List (PSB), the Satisfaction With Life And Studies Scale (LSZ), the diagnostic assessment according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the Complaints Severity Score (BSS) and Global Assessment of Functioning (GAF).

Results

Previous results of investigations which showed that 20–25% of students suffer from psychological disorders could be confirmed in this study. However, 60–65% of the clients of a counseling center suffered from clinically relevant psychological disorders, which is significantly higher. The most common disorders were depressive moods, lack of self-confidence and exam anxiety, which can mostly be diagnostically assigned to adjustment, depression and anxiety disorders. The comparison with previous studies showed that the types and severity of psychological distress among students have remained stable over the last 15 years, with the exception of test anxiety which increased by 51% from 1993 to 2008. With respect to alcohol abuse, considerably less impairments were found than had been assumed based on the earlier investigations.

Conclusions

Psychological complaints and disorders are frequently found among students and they cause individual suffering as well as economic expenses. Noticeable was the obvious increase in clinically relevant exam anxiety. Psychological-psychotherapeutic counseling centers make an important contribution to screening, clinical assessment, primary health care and prevention of severe mental disorders among students and have shown a continuously increasing number of cases in recent years. Further studies especially in a process-outcome design of the mostly eclectic counseling centers are needed and possibilities will be presented.     

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.

Design: An online, retrospective survey was conducted with 161 women.

Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.

Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.

Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.     

Posttraumatic Growth and Sexual Violence: A Literature Review

Posttraumatic growth (PTG) is the positive psychological growth that a person might experience after enduring a traumatic event. PTG is a relatively new area of research identified by researchers because it represents a shift in thinking. Rather than focusing on the negative consequences of trauma, it explores the potential for positive outcomes associated with trauma. Although PTG is well documented across different types of traumas, it is unclear how this kind of growth stems from sexual violence, specifically. This review provides an overview of the literature concerning PTG that is associated with sexual violence. Results across the literature indicate that sexual violence is consistently associated with PTG. However, given the inconsistency in research designs, assessment, and operational definitions used to study PTG, many researchers suggest that it might be difficult to determine how and when PTG occurs. This study provides a literature review of the research on PTG in the aftermath of sexual violence. Important implications for future directions and trauma-based therapy are discussed and include the identification of relevant predictors, the importance of context, and how service providers might benefit from a better understanding of PTG.     

The Origins and Legacy of the Civil Rights Act of 1964

Purpose

This paper provides a historical review of the origins and legacy of the 1964 Civil Rights Act through the lens of the African American Civil Rights and the Women’s Rights Movements.

Design/Methodology/Approach

The historical narrative was developed using psychological, historical, and legal source material.

Findings

While the Civil Rights Act did not immediately change the landscape of equality in the American workplace, it signaled a fundamental shift in the treatment of racial and gender diversity. In concert with other social, legal, and political shifts, it paved the way for progress on issues like affirmative action, pregnancy discrimination, and sexual harassment.

Implications

Without an understanding of the historical development and consequences of the Civil Rights Act, it is easy to lose sight of how the act has shaped the understanding of equality in the American workforce. Further, the way in which rights movements evolved alongside each other illuminates a need to focus not only on equality between majority and minority groups but also on issues of equality among minority groups.

Originality/Value

Previous reviews of the Civil Rights Act and rights movements tend to focus narrowly on one issue or group, and approach that concern from a single academic discipline. In contrast, we provide a review of the roots and consequences of the Civil Rights Act based on the developments of two rights movements, and draw from sources in psychology, history, political science, and legal perspectives to provide a broader picture of this landmark legislation.     

Verhaltenstherapie-Kompetenz-Checkliste

Background

Quality control in psychotherapy is a pivotal goal in clinical practice and research and requires to define and measure good practice. The Behavior Therapy Competency Checklist (BTCC) allows (a) good clinical practice in behavior therapy to be defined, (b) measurement of the quality and (c) support for training of therapists.

Methods

In this study 182 tape recordings of routine treatment sessions of 14 behavior therapists were evaluated by 4 independent observers using the BTCC.

Results

The most frequent therapeutic interventions were homework assignments (71.4%) and modification of cognitions (41.6%). Macro-behavioral analysis (19.5%), or problem solving (19.5%) were rare interventions. The average BTCC quality score for all interventions was 3.4 on a scale from 1 (insufficient) to 7 (very good).

Conclusions

The BTCC allows an analysis of problems of therapists and can help to improve therapist education, supervision or intervision. It is also possible to use the scale as self-rating after a single session in order to control one’s own treatment behavior. A patient version allows a contrast between therapist and patient perspectives on the treatment process.     

No pain,no gain: cross-lagged analyses of posttraumatic growth and anxiety,depression, posttraumatic stress and prolonged grief symptoms after loss

Background and objectives: Major negative life-events including bereavement can precipitate perceived positive life-changes, termed posttraumatic growth (PTG). While traditionally considered an adaptive phenomenon, it has been suggested that PTG represents a maladaptive coping response similar to cognitive avoidance. To clarify the function of PTG, it is crucial to establish concurrent and longitudinal associations of PTG with post-event mental health problems. Yet, longitudinal studies on this topic are scarce. The present study fills this gap in knowledge.

Design: A two-wave longitudinal survey was conducted.

Methods: Four-hundred and twelve bereaved adults (87.6% women) filled out scales assessing PTG and symptoms of depression, anxiety, prolonged grief, and posttraumatic stress at baseline and 6 months later.

Results: The baseline concurrent relationships between all symptom levels and PTG were curvilinear (inverted U-shape). Cross-lagged analyses demonstrated that symptom levels did not predict levels of PTG 6 months later, or vice versa.

Conclusions: Findings suggest PTG after loss has no substantive negative or positive effects on mental health. Development of specific treatments to increase PTG after bereavement therefore appears premature.     

Posttraumatic growth after childbirth: A prospective study

A growing body of research has examined the potential for positive change following challenging and traumatic events, this is known as posttraumatic growth (PTG). Childbirth is a valuable opportunity to extend previous work on PTG as it allows the role of different variables to be considered prospectively. The aim of this study was to prospectively examine correlates of PTG after birth, including sociodemographic and obstetric variables, social support and psychological distress, using a prospective, longitudinal design. A total of 125 women completed questionnaires during their third trimester of pregnancy and 8 weeks after birth. At least a small degree of positive change following childbirth was reported by 47.9% of women; however, average levels of growth were lower than generally reported in other studies. A regression model of age, type of delivery, posttraumatic stress symptoms during pregnancy and general distress after birth significantly predicted 32% of the variance in growth after childbirth. The strongest predictors of growth were operative delivery (β 0.23–0.30) and posttraumatic stress symptoms in pregnancy (β 0.32). These findings emphasise the importance of assessing pre-event characteristics when considering the development of PTG after a challenging event.     

Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction

People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population.

Purpose

This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations.

Methods

A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client.

Results

Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged.

Discussion/Conclusion

Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use.