Predictors of quality of life enjoyment and satisfaction in individuals living with HIV and AIDS in a resource-constrained setting in South Africa

The burden of HIV disease is concentrated in sub-Saharan Africa, particularly in South Africa (SA). Whilst there have been many studies conducted on the biomedical and socio-psychological aspects of HIV and AIDS, insufficient attention has been paid to the quality of life of those infected with the virus. The primary purpose of the study was to determine the predictors of quality of life enjoyment and satisfaction (Q-LES) among individuals infected with HIV. A battery of questionnaires, which included the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), were administered to 121 participants. Data was analysed using SPSS. Of the total sample (n = 121), 74% were females. The study found that a large proportion (49.5%) of the sample within the age group 25–49 years old experienced psychological distress. Those who were not on antiretroviral treatment (ART) were significantly affected (66%). Psychological distress was significantly prevalent among HIV positive individuals and also the strongest predictor of Q-LES among these individuals.     

The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa

This article reports a clinical case study of “Grace”, a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace's experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.     

Why We Should Avoid the use of the Term “Post-Abortion Syndrome”: Commentary on Boulind and Edwards (2008)

Boulind and Edwards (2008) present a case study of Grace, a women suffering, in their words, from post-abortion syndrome (PAS). In this commentary I argue that while Boulind and Edwards' (2008) report is useful in terms of documenting the therapeutic processes engaged in, they would have been better served in not hanging the distress experienced by Grace on the diagnostic category of post-abortion syndrome. Reasons for this are that: PAS is not a recognised category of diagnosis, despite having been initially proposed in 1981; applying a PTSD framework to abortion is questionable; PAS focuses attention on the abortion itself in isolation from the fact that abortion occurs in the context of severely problematic pregnancies and other important socio-cultural stressors; PAS, in the very manner in which it is formulated, invokes to a very complex politics of the foetus. Boulind and Edwards (2008) are careful in their documentation of the complexities of the case, and thus their use of PAS is unfortunate.     

Effect of Relaxation Therapy in Reducing Blood Pressure of Essential Hypertension Patients

The study investigated the effect of relaxation therapy on arterial blood pressure of Patients with essential hypertension. Ten known essential hypertension patients (males = 3; females = 7, age range 41–70, mean age 57.2 years, SD = 9.93 years) were sampled randomly from Medical outpatient department of the State owned University teaching Hospital in Ebonyi State South East, Nigeria. These Participants were exposed to 30 minutes relaxation therapy and their blood pressures were taken before and after the treatment. Using matched t test to compare baseline and post treatment scores, result showed that relaxation therapy progressively decreased both diastolic and systolic blood pressure readings of the Participants. The study concluded that Relaxation therapy can transiently lower the systolic and diastolic blood pressure.     

A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Recording therapy sessions: What do clients and therapists really think?

Aims: Recording therapy sessions has become part of routine practice amongst trainee psychotherapists. To date most research has focused on the benefits of recording sessions to support clinical supervision. There are few data about the benefits or risks for clients. This study aimed to explore the views of clients who had had their therapy sessions recorded and therapists who had recorded sessions. Design: Five clients and 25 therapists completed a qualitative survey, the results of which were analysed using thematic analysis. Findings: All clients and several therapists reported that the recording devices are soon forgotten. Both therapists and clients reported the benefits of recording as being purely for the therapist with none identified for clients. Conclusions: It was observed that clients perhaps did not always understand how recordings were used, suggesting the need for clearer practice guidance.     

An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.     

Psychosomatic Health: The Body and the Word

Abstract

Why do men get firsts and women gets seconds? This question is currently being debated by some in Oxford University, but not elsewhere, where men's educational under-achievement - in secondary-school league tables, for instance (see, e.g., Phillips 1993) - is more often a matter of concern. Stephen Frosh (1998) has considered both issues in terms of the way young men are constructed and construct themselves through performing and acting on prevailing stereotypes about men and masculinity. These stereotypes include recklessness, not caution, which Maryanne Martin (1998) says contributes to men getting firsts at Oxford by virtue of this trait being rewarded by Oxford University's tutorial and examination system.

In the following pages I too will talk about the equation of men with recklessness. Or, more accurately, I will talk about the way in which men and women act on nightmares and dreams that often glorify men, not least as reckless heroes, in large part because, despite the gains of feminism, glory is still more often men's than women's prerogative in male-dominated society, of which Oxford University is a prime example. I too will consider how this might contribute to men more often getting firsts, and to women more often getting seconds in finals in Oxford. I will end with some implications of my findings for therapy - at least, for the kind of therapy I do as a Freudian therapist. I will therefore begin with Freud.     

Cognitive Analytic Therapy: time and process

Cognitive Analytic Therapy (CAT) is an increasingly popular brief therapeutic approach for use with a variety of types of clinical problem. This paper outlines the key components of CAT and demonstrates its use by case examples. The history of CAT is traced, particularly the concept of Reciprocal Roles which was developed from Object Relations Theory. It is suggested that CAT has considerable potential as a collaborative, active therapy, with particular application to difficult patients such as those with borderline personality disorder. Some of the differences from other psychodynamic therapies are described, and an assessment of its future role is provided.