Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.     

Diagnosis and clinical management of headaches

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.     

Where Has All the Psyche Gone? Searching for Treatments That Focus on Psychological Issues

The field of psychotherapy can be aided by adopting an integrative model that follows a comprehensive biopsychosocial perspective. Unfortunately, recent advances in the field of psychopharmacology have appeared to overshadow the gains that can be made through psychotherapy. Psychotherapists need to protect the psyche that lies at the core of their treatment. Psychotherapy can promote changes in cognitive processes that help to reduce psychiatric symptoms and enhance adaptive functioning. Psychotherapists should not neglect the role of biological or social factors in the etiology or treatment of mental illness. Many clients benefit from a comprehensive biopsychosocial model and interdisciplinary collaboration among mental health professionals. Psychotherapists can maintain a strong emphasis on psychological functioning, while colleagues from other fields focus on the biological and social aspects of mental illness. Furthermore, it seems important for psychotherapists to emphasize the unique qualities of psychotherapy that are distinct from the social support that is provided from a close and confiding friendship.     

Characteristics of Children Presenting to a Behavioral Treatment Program for Pediatric Headache

This study examined headache characteristics and psychological variables associated with pediatric headache in a specialty treatment clinic. Children were referred by pediatric neurologists to a hospital-based pediatric behavioral medicine clinic for behavioral treatment in conjunction with medical management of the pain. Headache typology of the children indicated that 1/3 of the sample reported at least daily headaches, and a large percentage of patients described experiencing headaches that lasted for more than a day (26%). Child and parent report of pain revealed a fairly high level of correspondence for headache activity. Regarding other psychological characteristics, children in this study endorsed higher than expected levels of somatization even after adjusting for headache symptoms. Compared with children's report, parents' report showed only slightly higher levels of secondary gain experienced by children because of pain. Gender differences were not found. The implications of these findings for improving our understanding of pediatric headache are discussed.     

Psychotherapierichtlinien: seit 40 Jahren Bewährung in der Praxis

Looking back at 40 years application of psychotherapy guidelines, a positive balance can be drawn. Benchmarks of the guidelines are the biopsychosocial conception of psychic disturbances requiring treatment and the congruent expertise procedure. The latter is considered by many psychotherapists as unreasonable and by the health insurances as not effective enough because of a rejection quota of only 5%. Nevertheless, it proved to be useful in historical, therapeutic and textual aspects. The biopsychosocial conception of psychic disturbances according to the psychotherapy guidelines is an important counterbalance to the objectifying view and evaluation of psychic processes. This concept implies also a complementary view of the ill compared to somatic medicine which allows a better comprehension and understanding of the individual suffering. The most important modification in the psychotherapy guidelines was the inclusion of behavior therapy as the guideline therapy. It succeeded in surpassing the hallmark of (higher) effectivity by offering shorter therapies and objectifiable verification, as an important complementary object-view into psychic processes. Meanwhile, however, this object-view threatens to displace the ?subject-view“ of the psychotherapy guidelines, especially supported by new developments in evidence-based medicine.     

Evolution of the biopsychosocial model: prospects and challenges for health psychology.

Although advances have been made in specifying connections between biological, psychological, and social processes, the full potential of the biopsychosocial model for health psychology remains untapped. In this article, 4 areas that need to be addressed to ensure the continued evolution of the biopsychosocial model are identified and a series of recommendations concerning initiatives directed at research, training, practice and intervention, and policy are delineated. These recommendations emphasize the need to better understand and utilize linkages among biological, psychological, social, and macrocultural variables. Activities that facilitate the adoption of a multisystem, multilevel, and multivariate orientation among scientists, practitioners, and policymakers will most effectively lead to the kinds of transdisciplinary contributions envisioned by the biopsychosocial perspective.     

Social and clinical factors in the frequency of ambulatory patients visiting a therapeutic club of a psychiatric clinic

Extramural psychiatric facilities such as therapeutic clubs are of major importance for the continuous aftercare of patients with qualitative or quantitative communicative difficulties. This contribution reports on social and clinical factors affecting the frequency with which outpatients of a psychiatric clinic attend such a club. The main objective of the club was to secure most frequent attendance among patients living without partners and who are not or only partly able to practice a vocation (regardless of the nosological and syndromatological diagnosis). This target was achieved. Attendance was less satisfactory among patients who had suffered from serious psychic disorders entailing frequent hospitalization and patients who, during their last stay at hospital, had received only somatic but no sociotherapeutic and psychotherapeutic treatment.     

Integrating mind and body: Graduate psychology education in primary behavioral health care

Extensive research supports the biopsychosocial model, but the current health care system generally operates according to a model of mind-body dualism. Integrated primary behavioral health care offers an alternative to this dualism. This paper describes the University of Louisville Graduate Psychology Education (GPE) program, a pre-doctoral integrated primary behavioral health care training program. This program emphasizes four shared psychosocial determinants that have been associated with physical health status: Victimization and potentially traumatic stress exposure, emotional functioning, social relationship functioning, and illness representations. It does so within the broader context of providing care for individuals who are underserved and economically disadvantaged. The initial phase of the program is evaluated and implications for graduate psychology education and patient care are discussed.     

Soziale Phobie

Social anxiety is characterised by overwhelming fears in social interactions or performance situations. Its life-time prevalence is high (about 13%) and relapses are quite common. Social anxiety disorder is a chronic disease with a high impairment for the persons afflicted. Cognitive-behavioural, psychodynamic and neurobiological models have promising implications for psychotherapy and pharmacological treatment. Neurobiological approaches have identified risk factors and possible somatic mechanisms. Cognitive-behavioural models explain the development of dysfunctional beliefs and the maintenance of social anxiety. Psychodynamic approaches refer to a disturbed self-concept and underline the importance of prior negative interpersonal relationships. Manualised treatments exist for the cognitive-behavioural approach and a manual for psychodynamic psychotherapy was recently developed. This paper presents the different approaches (neurobiological, cognitive-behavioural, psychodynamic) to social anxiety disorder and possible implications for therapy are discussed.     

The biopsychosocial approach to chronic pain: scientific advances and future directions

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.     

The existential dimension in psychiatry: an enactive framework

ABSTRACT

In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.     

A social relational critique of the biomedical definition and treatment of ADHD; ethical practical and political implications

Attention deficit hyperactivity disorder (ADHD), its existence and treatment, is a contentious matter. The dominant view in medicine considers that ADHD is a psychiatric disorder. My position is to challenge this from a social relational orientation. I explore here a critique of the psychiatric disease model of causation and treatment, particularly the use of medication. A series of prejudices based on a political and social constructionist orientation are offered to address the ethics, politics and practice implications of the practitioner critical of the biomedical model of diagnosis and treatment especially the use of medication. This device is employed in order to invite critical reflection and further debate in a field dominated by the medical and genetic arguments in support of ADHD as a psychiatric disease. The implications of more open debate are explored, together with directions for more politically and ethically informed practice with children and their families.     

A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease

Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.     

Appraisal, coping, health status, and psychological symptoms

In this study we examined the relation between personality factors (mastery and interpersonal trust), primary appraisal (the stakes a person has in a stressful encounter), secondary appraisal (options for coping), eight forms of problem- and emotion-focused coping, and somatic health status and psychological symptoms in a sample of 150 community-residing adults. Appraisal and coping processes should be characterized by a moderate degree of stability across stressful encounters for them to have an effect on somatic health status and psychological symptoms. These processes were assessed in five different stressful situations that subjects experienced in their day-to-day lives. Certain processes (e.g., secondary appraisal) were highly variable, whereas others (e.g., emotion-focused forms of coping) were moderately stable. We entered mastery and interpersonal trust, and primary appraisal and coping variables (aggregated over five occasions), into regression analyses of somatic health status and psychological symptoms. The variables did not explain a significant amount of the variance in somatic health status, but they did explain a significant amount of the variance in psychological symptoms. The pattern of relations indicated that certain variables were positively associated and others negatively associated with symptoms.     

Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Viewing alcoholism in women from a biopsychosocial perspective reveals a unique set of circumstances and challenges that women alcoholics face when compared with men. Biologically, women react differently to alcohol ingestion than do men. Women reach higher blood alcohol levels and sustain more somatic and cognitive damage than men when consuming equivalent amounts of alcohol. Psychosocially, women alcoholics face societal rebuke and chastisement of a greater magnitude than do men. Finally, barriers to treatment faced by women, such as the need for child care, cost of treatment, familial opposition, denial of alcoholism, and inadequate diagnostic training of physicians, must be overcome to create successful treatment approaches for the female alcoholic. Obstacles to and implications for treatment are also discussed.     

How do trigger factors acquire the capacity to precipitate headaches?

This study tested two contrasting theories of how trigger factors acquire the capacity to precipitate headaches. The sample consisted of 110 participants, of whom 48 suffered from regular headaches. Participants were exposed to a validated headache trigger factor for one of five exposure durations. The trigger used was "visual disturbance" (flicker, glare and eyestrain) induced by a very bright, stroboscopic light. Response to the stimulus was measured by participant ratings of the degree of visual disturbance and head pain caused by the stimulus. As expected, the headache sufferers experienced more visual disturbance and head pain in response to the stimulus than the non-headache individuals. Longer exposure to the stimulus was associated with a subsequent reduction in pain ratings in response to the stimulus. This desensitization effect supported an avoidance model of how trigger factors acquire the capacity to precipitate headaches. The findings of this study have implications for the etiology of headache disorders. Also, the findings imply that the traditional clinical advice that the best way to prevent migraine and headache is to avoid the factors that trigger them, may be counterproductive, as any short-term gains may be more than wiped out by decreased tolerance for the trigger factors.     

Group life shapes the psychology and biology of health: The case for a sociopsychobio model

Engel presented a compelling case for a biopsychosocial model of health. This challenged a biomedical model that he saw as reductionistic, physicalistic, and exclusionist. Yet despite its laudable goals and popularity, the biopsychosocial model can be faulted for being incremental, imprecise, and individualistic. Ultimately, this means it is no less reductionist than the biomedical model which it sought to supplant. In this paper, we present a reformulation of this model that foregrounds the capacity for social groups—and the social contexts in which those groups are embedded—to structure psychology and, through this, biology and health. This sociopsychobio model argues that the three elements of Engel's framework are not fixed and immutable but rather dynamic and interdependent. The model is consistent with a range of recent approaches to health that have focused on the important role that social class, social inequality, social structure, and social networks play in shaping health outcomes. In this paper, though, the concrete value of this reformulation is illustrated through a discussion of recent research that focuses on the role of group memberships and associated social identities in shaping the psychology and biology of stress. This review underlines two key points that are central to the general case for a sociopsychobio model of health. First, that groups are a force in the world that shape the psychology and biology of their members (as well as members of other groups) in ways that cannot be reduced to those group members' functioning as individuals. Second, that groups provide their members with a basis for seeking to change the world rather than simply accepting it. In this, group life is not merely an appendage to psychology and biology but is instead a basis for collective experiences that have the potential to unleash new expressions of both.     

The impact of daily stress on health and mood: psychological and social resources as mediators

This study examined daily stress processes among 75 married couples across 20 assessments during a 6-month period. The somatic and psychological effects of common everyday hassles were investigated. Overall, there was a significant relationship between daily stress and the occurrence of both concurrent and subsequent health problems such as flu, sore throat, headaches, and backaches. The relationship of daily stress to mood disturbance was more complex. The negative effects of stress on mood were limited to a single day, with the following day characterized by mood scores that were better than usual. Furthermore, striking individual differences were found in the extent to which daily stress was associated with health and mood across time. Participants with unsupportive social relationships and low self-esteem were more likely to experience an increase in psychological and somatic problems both on and following stressful days than were participants high in self-esteem and social support. These data suggest that persons with low psychosocial resources are vulnerable to illness and mood disturbance when their stress levels increase, even if they generally have little stress in their lives.     

Étude exploratoire des stresseurs relatifs aux maladies somatiques chroniques : identification des dimensions et analyse des liens avec la qualité de vie

What are the subjective stressors common to the somatic chronic diseases and do those perceptions influence the quality of life of the patients? Sixty-six adult subjects suffering from a chronic pathology (diabetes, respiratory insufficiency, heart disease, asthma) participated to this exploratory research. Qualitative then quantitative analysis showed 4 domains of perceived stress in the chronic disease: physical repercussions, social and relational consequences, decrease of the biopsychosocial resources and fear and anxiety. These domains are moderately correlated justifying existence of a hierarchical factorial structure. The inventory has satisfactory psychometric properties (construct validity and internal consistency). The four scales correlated fairly with assessment of quality of life (PQVS). Better predictors are physical repercussions of the disease and fear and anxiety.     

Contemporary Perspectives on Stress Management: Medication,Meditation or Mitigation

Stressful life events can increase the risk for developing a variety of physical disorders and emotional problems. A biopsychosocial approach can help mental health professions to better understand and more effectively treat disorders that are related to severe negative life events. Biological approaches focus on suppressing emotional reactions, usually through a reliance on psychopharmacological interventions. Psychological approaches usually focus on the cognitive processes that translate stress into distress. Psychological interventions focus on changing the negative attitudes and maladaptive behaviors that aggravate most stressful situations. Social interventions focus on improving social support and involvement with agencies to confront limited finances, unemployment, and housing problems. In these times of economic crisis and severe financial hardship, psychological and social intervention strategies appear more useful than biological treatments.