The Sources of Meaning and Meaning in Life Questionnaire in the Norwegian Context: Relations to Mental Health,Quality of Life,and Self-Efficacy

The Sources of Meaning and Meaning in Life Questionnaire (SoMe) offers dimensional measures of meaningfulness, crisis of meaning, and 26 sources of meaning. It allows for a clearer understanding of the variety of existential orientations, which are known to be linked to both mental and physical health. The Norwegian version of the SoMe was validated by testing 925 randomly selected individuals who were representative for the Norwegian population. Reliability scores were satisfactory; factor analyses suggested a 6-factor structure of the sources of meaning scales. Expected patterns of associations with mental health and quality-of-life factors attested the instrument’s construct validity: Meaningfulness showed positive relationships to all quality-of-life factors. There was no relationship with anxiety but negative relationships with depression and distress. Crisis of meaning established a strong positive relationship with anxiety, depression, and distress and a negative relationship with quality-of-life factors. Criterion validity was documented by expected differences in meaningfulness and crisis of meaning between groups with and without presence of depression disorder. Self-efficacy correlated strongly with sources of meaning from the dimension “accomplishment” and moderately negatively with sources of meaning from the dimension “vertical selftranscendence.”     

Existential themes in the treatment of people at suicide risk. Understandings and practices of specialist healthcare professionals

ABSTRACT

This qualitative study focuses on the ways in which existential themes were understood and addressed in therapeutic relationships with patients who had attempted suicide. Health care professionals (HCP) from Norway specialist healthcare participated in focus groups. The interviews were transcribed and analysed by systematic text-condensation through a four-step procedure. We found that the HCPs emphasised the context-specific functions of their departments. They considered these conversations essential but demanding. They indicated existential themes of hope/hopelessness, loneliness, meaning, life/death, shame, religion and suicide. The HCPs’ understandings of themes deemed to be existential and how they should be addressed were primarily based on clinical experience. This appeared to exacerbate the pressure on their personal involvement, leading to the question of whether patients’ existential needs are tackled or instead disappear into a conversational vacuum. The study suggests that HCPs' professional competence of existential themes pertaining to patients at suicide risk needs to be strengthened.     

Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis

Individuals decide to use healthcare when the expected benefits outweigh the perceived costs. One of these cost factors in this decision can be stigma. So far, it has not been researched how former soldiers of the German Armed Forces with a service-induced mental illness perceive stigma and how it influences their healthcare use. As stigma is shaped by the socio-cultural context, the setting of the potential healthcare use must be considered. Narrative interviews were conducted with 33 former soldiers with mental health problems. The data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. The relationship between stigma and healthcare use was analyzed. Occupational discrimination and social exclusion were experienced in both in the military and civilian context, but stigma functioned differently in each context. In the military context, former soldiers’ self-stigma of mentally ill individuals being weak was in stark contrast to their internalized military standards. This contrast let them avoid disclosure and subsequent healthcare use. In civilian context, the participants perceived 2 different stigma costs: mental illness stigma and former soldier stigma (i.e., stigmatization because of their military past). Both were perceived as barriers to healthcare use. A model, illustrating these different stigma costs in the different contexts, was developed. Further research on the link between stigma and healthcare use of this group is urgently needed.     

The illness reframing process in an ethnic-majority population of older people with incurable cancer: variations of cultural- and existential meaning-making adjustments

Increasing numbers of older people in Western countries are living with incurable cancer as a chronic disease, receiving palliative care from specialised healthcare contexts. The study's aim was to understand variations of cultural- and existential meaning-making adjustments in a Norwegian majority population of older people with incurable cancer. Semi-structured interviews from 21 participants, aged 70–88, were analysed according to three identified types of belief frames: atheistic/humanistic, religious, and spiritual. Kleinman's medical anthropology cultural framework was adapted and applied deductively together with a reframing metaphor concept in a four-part analytic process. Independent of the differences among the types of belief frames and heterogeneous illness reframing processes, changes in the existential cultural dimension seemed to facilitate psychosocial adjustments in relation to illness, daily living, relationships, and surroundings. The results point to the need for collecting and assessing the function of this type of patient information for better understanding the patient's framework of interpretation, and for identifying treatment-planning resources.     

叙事取向团体辅导对大学生自我认同的干预研究

自我认同的发展与大学生心理健康水平及其今后的社会适应关系密切。本研究用叙事取向团体辅导对大学生自我认同进行干预。结果发现,叙事治疗强调的好奇、尊重、珍惜的态度,为成员创设了安全、温暖、支持的团体氛围;外化和解构使成员与问题拉开距离,探讨问题的影响力;寻找并丰厚特殊意义事件,让成员看到自身的正向力量和资源;局外见证人团队,进一步巩固成员身上的正向力量。结论：叙事取向团体辅导是促进大学生自我认同发展的有效途径。     

Existential and religious issues when admitted to hospital in a secular society: Patterns of change

Situated in a secular culture, this study examined the relationship between four dimensions of health and a number of existential, religious, and spiritual/religious practice variables in questionnaires sampled from 480 Danish hospital patients. Illness dimensions were: self-rated health, severity of illness, illness duration, and recent changes in illness. The results indicated the youngest age group (<36 years) to be the most active on all existence/religious/practice variables. Small overall correlations were found between the illness dimensions and existential/religious/practice variables, but results had underlying complex patterns. The dimension of severity of illness showed the most consistent results in the expected direction: the worse the illness, the more existential/religious/practice activity, but very different patterns were found for men and women. Men generally had low levels of existential/religious/practice issues, when illness was not severe, but levels heightened when illness turned worse. The opposite was the case for women who had overall higher levels, when illness was not severe, but unexpectedly lost interest and activity when the illness grew worse, especially regarding the religious faith variables. When illness turned to the better, women (re)gained religious faith. The illness duration of 1–3 months showed to be the most sensitive period for the existential/religious/practice variables involved. The patients’ experience of change in existential/religious/practice issues and the actual measured change pattern did not always follow each other. The findings might contribute to clinical reflection and planning in health care settings in secular societies like in Scandinavia.     

“Bipolar groupthink”: Assessing groupthink tendencies in authentic work groups

Research on regressive group processes such as Janis’ (1982) “groupthink” phenomenon has rarely focused on work groups in authentic settings. In this study, teams from six different organisations (n=308) were studied by using a groupthink questionnaire constructed in accordance with the symptoms of groupthink described by Janis. It was hypothesised that groupthink could be described as a bipolar construct identifying either an omnipotent or a depressive variant of a group’s delusions about its own and other groups’ features. The questionnaire showed reasonably good reliability as a whole and a factor analysis identified three factors in line with the proposed theoretical model in which the two different types of groupthink can be distinguished. We propose that any group might have a tendency or predisposition to react in either of the two directions during provocative circumstances. The six different organisations exhibited different types of groupthink to a varying degree. A religious sect was the one most characterised by omnipotent groupthink, while a technological company and a psychiatric team seemed to be the ones with most features of depressive groupthink.     

Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

Creating mother and baby therapy groups in prison: emotional valuation

Mothers in prison are at high risk of depression and other mental health issues and yet access to therapeutic services is limited. This paper describes the development by the author of two prison therapy groups: one for pregnant women, the other for mothers and their babies. Called the ‘Born Inside’ project, both groups are currently held in Bronzefield Prison, Surrey. The theory and principles behind the project are discussed, as well as the processes and practicalities involved in providing the therapy and specialised support to the women and their vulnerable infants. In addition, principles of forensic psychotherapy in relation to this specific prison population are described, and the situational and emotional challenges faced are illustrated through narratives of group members.     

The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England,UK: Interviews with members of a family support group

Abstract

Background: Transgender and non-binary children and young people and their parents in England, UK are poorly served across a range of healthcare settings. Whilst UK equalities legislation and international guidance on transgender healthcare pathways protects this group from discrimination and mandates an affirmative approach, services in England are not keeping pace.

Aims: This study aims to draw on the experiences of transgender and non-binary children, young people and their parents in a support group in England in order to investigate their experiences of healthcare provision, and to develop some ideas for improvement.

Method: Data was collected with participants in a family support group which offers a parent helpline service, social groups for children and parents, and training for schools and other organizations. 65 parents and children from 27 families from the family support group attended participatory workshops where they were given a range of briefs: “health,” “family,” “friends,” and “education.” Their participation involved being asked to define their own interview questions and collect data by interviewing each other. Their interview notes constituted the raw data. Data was coded inductively by the author with respondent checking as a second stage.

Results: Results constitute the views of a small group of people, so cannot be generalized. However, they do illustrate some of the issues which may arise. Participants’ experiences elicited five key themes: professionals’ perceived lack of clinical and therapeutic knowledge; mental distress caused by excessive waiting lists; professionals’ stereotyped gender assumptions; direct discrimination within healthcare settings; and a lack of attention to parent and child voice, especially in terms of school-based experiences and where a patient had a diagnosis of autism.     

Time-limited group psychotherapy: Has cinderella found her prince?

The time-limited group psychotherapy treatment format is in demand in a healthcare delivery system that is increasingly concerned with effective and efficient methods for treating acute mental health problems and maintaining patients in the community. The empirical literature provides strong support for the positive outcome of relatively brief treatment. A larger service delivery system ensures a flow of patients who can be managed in a variety of types of groups. This will require the group clinician to become comfortable working in conjunction with a larger system and knowledgably delivering different types of treatment while continuing to use the group itself as a major source of therapeutic power.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

群体决策过程中的信息取样偏差

一般认为,决策群体的优势是能综合各个成员拥有的不完整信息,形成对所有决策备择方案的无偏差的认识,从而作出最佳选择。但“群体讨论中的有偏差信息取样模型’认为,群体在决策中往往表现出倾向于讨论两种信息：(1)各成员讨论前都拥有的信息;(2)支持成员在讨论前所偏好的信息。该实验通过模拟人员选拔决策形式的实验室实验,对这一模型的假设进行验证。研究结果表明,大多数群体选择了一开始受到大多数成员支持的候选人,而非实际的最佳人选;群体讨论非但未纠正,反而加强了成员对候选人原有的歪曲印象。     

团体咨询成员的相互共情及其与效果的关系——社会关系模型在团体咨询研究中的应用

研究旨在探讨团体成员的相互共情及其与团体效果的关系。共收集10个团体,53名成员的数据,运用社会关系模型分析。结果发现：1.成员自评相互共情得分较高,但互评相关不显著;2.共情水平与会谈效果正相关,与团体反治疗性因素负相关;3.被共情水平与不信任负相关;4.共情准确性与团体治疗性因素正相关。结论：成员自评相互共情水平较高,但互评不匹配。成员自评共情水平越高,会谈效果越好,受团体反治疗性因素阻碍更少。越被准确评估情绪效价的成员,从治疗性因素中获益更多。     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

The Effectiveness of Schema Therapy Integrated with Rehabilitation on Cognitive Emotion Regulation and Existential Anxiety in Patients with Congestive Heart Failure

Patients with congestive heart failure (CHF) are faced with various physical and psychological stressful factors, which ?leads to decreased quality of life. Considering the relationship between cognitive emotion regulation (CER) and existential anxiety with early maladaptive schemas, one of the methods capable of assisting the rehabilitation of the patients with CHF is the schema therapy. The current study aimed at determining the effectiveness of schema therapy integrated with rehabilitation on CER and existential anxiety in patients with CHF. The study was a true experimental with pretest/posttest design and a control group. The study sample was consisted of 25 patients with CHF in Guilan Province, Iran, 2017, selected by the convenience sampling method and assigned into two groups (one experimental and one control). To collect the data, cognitive emotion regulation questionnaire (CERQ) and existential anxiety inventory (EAI) were used before and after the intervention. A ten-session young schema therapy was implemented for the experimental group. Two-way ANOVA was used for data analysis and Cohen’s d test measured effect extent. The results of analysis showed that the group schema therapy integrated with rehabilitation improved CER and existential anxiety in patients with CHF (p?<?0.001). According to the findings of the research, schema therapy can improve the cognitive and emotional symptoms in patients with CHF.     

Influence of mental practice on development of voluntary control of a novel motor acquisition task

The purpose of this investigation was to assess whether mental practice facilitates the development of voluntary control over the recruitment of the abductor hallucis muscle to produce isolated big toe abduction. A sample of convenience of 15 women and 20 men with a mean age of 28.8 yr. (SD=5.7) and healthy feet, who were unable voluntarily to abduct the big toe, were randomly assigned to one of three groups, a mental practice group, a physical practice group, and a group who performed a control movement during practice. Each subject received neuromuscular electrical stimulation to introduce the desired movement prior to each of five practice bouts over a single session lasting 2 hr. Big toe abduction active range of motion and surface electromyographic (EMG) output of the abductor hallucis and extensor digitorum brevis muscles were measured prior to the first practice bout and following each practice bout, yielding seven acquisition trials. Acquisition is defined as an improvement in both active range of motion and in the difference between the integrated EMG of the abductor hallucis and extensor digitorum brevis muscles during successive acquisition trials. Seven members of both the mental and physical practice groups and one member of the control group met the acquisition criteria. Chi-square analysis indicated the group difference was statistically significant, suggesting mental practice was effective for this task.