Men’s experience of a guided self-help intervention for hot flushes associated with prostate cancer treatment

Up to 80% of men who receive androgen deprivation therapy report hot flushes and for many these are associated with reduced quality of life. However it is recognised that there are a number of barriers to men’s engagement with support to manage symptoms and improve quality of life. This qualitative study was embedded within a larger randomised controlled trial (MANCAN) of a guided self-help cognitive behavioural intervention to manage hot flushes resulting among men receiving androgen deprivation therapy. The study aimed to explore the engagement and experiences with the guided self-help intervention. Twenty men recruited from the treatment arm of the MANCAN trial participated in a semi-structured interview exploring acceptability of the intervention, factors affecting engagement and perceived usefulness of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed using a Framework approach. Over two thirds of respondents (69%) reported reading the intervention booklet in full and over 90% reporting practising the relaxation CD at least once a week. Analysis of the interviews identified three super-ordinate themes and these related to changes in hot flush symptomatology (learned to cope with hot flushes in new ways), the skills that participants had derived from the intervention (promoting relaxation and reducing stressors), and to a broader usefulness of the intervention (broader impact of the intervention and skills). The present study identified positive engagement with a guided self-help intervention and that men applied the skills developed through the intervention to help them undertake general lifestyle changes. Psycho-educational interventions (e.g. cognitive behaviour therapy, relaxation, and positive lifestyle elements) offer the potential to be both effective and well received by male cancer survivors.     

Neglecting neglect: some thoughts about children who have lacked good input,and are ‘undrawn’ and ‘unenjoyed’

This paper looks at emotional neglect in the early years of life, and postulates some probable long-term sequelae of such neglect. It argues that there is a continuum of neglect; ranging from the severest form, as seen in institutional orphanages, to milder variations. A range of theoretical and research traditions, including developmental psychology, attachment theory and neuroscience are used, alongside psychoanalytic ideas, to attempt to delineate some of the key features and patterns that arise. A question is raised as to whether we have sufficient diagnostic categories or theoretical ideas to make sense of neglected children. Thought is given to the very specific clinical challenges of working with children who are neglected, and how the clinical task might differ from working with children who have suffered other forms of early damage, such as physical abuse. It is argued that these children suffer a multiple, overdetermined form of neglect; their initial neglect because of the form of caretaking they did (or did not) receive being compounded by their inability to use help and then also the tendency of professionals to similarly neglect these children, who can be difficult to relate to and hard to ‘warm’ to.