Meaning in life and violations of beliefs and goals: reciprocal relations among individuals with congestive heart failure

Background and objectives: In the context of highly stressful experiences, violations of beliefs and goals and meaning in life may have a reciprocal relationship over time. More violations may lead to lowered meaning, whereas higher meaning may lead to lowered violations. The present study examines this relationship among congestive heart failure (CHF) patients.

Design: A cross-lagged panel design was used.

Methods: CHF patients (N?=?142) reported twice, six months apart, on their meaning in life and the extent to which CHF violates their beliefs and goals.

Results: Overall, results were consistent with a reciprocal relationship, showing that greater goal violations led to negative subsequent changes in meaning, whereas greater meaning led to favorable subsequent changes in violations of beliefs and goals.

Conclusions: Meaning in life and violations may contribute to one another, and therefore, in understanding the adjustment process, it is important to consider their interrelationship. The results are also broadly informative regarding the experience of meaning, showing that disruption of beliefs and goals may undermine meaning.     

‘If I leave home,who will take care of mum?’ Intergenerational transmission of parental trauma through projective identification

Using the construct of projective identification and integrating it with the body of literature on intergenerational transmission of unsymbolized parental trauma, I describe the case of an adult daughter that illustrates intergenerational transmission of unsymbolized parental trauma. It is suggested that the daughter has unconsciously identified with the disavowed feelings of anxiety projected into her by her mother. The daughter’s projective identification of her mother’s unresolved past traumas prevent her from leaving the parental home for the first time, despite being 35 years old. In turn, it is thought that the mother’s unconscious grasping onto her daughter is an attempt to avoid the confrontation of her own unprocessed fears implanted into her by her own mother, thus linking three generations of disavowal. As a way of extending the exiting theory, it is proposed that when there are long-term and inexplicable experiences of anxiety that coalesces around the intergenerational transmission of parental trauma, the term ‘intergenerational transmission of traumatic anxiety’ can be used to describe it.     

Enhancing treatment effectiveness through social modelling: A pilot study

Objective: Medical treatments take place in social contexts; however, little research has investigated how social modelling might influence treatment outcomes. This experimental pilot study investigated social modelling of treatment effectiveness and placebo treatment outcomes.

Design: Fifty-nine participants took part in the study, ostensibly examining the use of beta-blockers (actually placebos) for examination anxiety. Participants were randomly assigned to observe a female confederate report positive treatment effects (reduced heart rate, relaxed, calm) or feeling no different.

Main outcome measures: Heart rate, anxiety and blood pressure were assessed, as were symptoms and attributed side effects.

Results: Heart rate decreased significantly more in the social modelling compared to control condition, p = .027 (d = .63), and there were trends towards effects in the same direction for both anxiety, p = .097 (d = .46), and systolic blood pressure, p = .077 (d = .51). Significant pre-post placebo differences in heart rate, anxiety and diastolic blood pressure were found in the social modelling group, ps < .007 (ds = .77–1.37), but not the control condition, ps > .28 (ds = .09–.59).

Conclusions: Social observation of medication effectiveness enhanced placebo effectiveness in heart rate, and showed a trend towards enhancing treatment effectiveness in both anxiety and systolic blood pressure. Social modelling may have utility in enhancing the effectiveness of many active medical treatments.     

Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries

The objective of this study is to investigate cognitive and attentional function in adolescents and young adults with operated congenital heart disease. Previous research has indicated that children with congenital heart disease have deficits in broad areas of cognitive function. However, less attention has been given to survivors as they grow into adolescence and early adulthood. The participants were 18 non-syndromic adolescents and young adults with tetralogy of Fallot and d-transposition of the great arteries that required cardiac surgery before the age of 5 years, and 18 healthy, unaffected siblings (11–22 years of age for both groups). Cases with congenital heart disease and their siblings were administered Wechsler Intelligence scales and reported attention problems using the Achenbach System of Empirically Based Assessments. Cases were compared to both healthy siblings and established norms. Cases performed significantly lower than siblings on full scale IQ and processing speed, and significantly lower than norms on perceptual reasoning. Cases also reported more attention problems compared to both siblings and norms. Effect sizes varied with medium-to-large effects for processing speed, perceptual reasoning, working memory, and attention problems. Findings suggest that neurocognitive function may continue to be affected for congenital heart disease survivors in adolescence and young adulthood, and that comparisons to established norms may underestimate neurocognitive vulnerabilities.     

构建科学的冠心病介入治疗临床决策

临床决策已成为临床医学的重要内容,但目前还为许多冠心病介入医生所忽视。阐述了临床决策的概念,分析了冠心病介入治疗决策中存在的问题及原因,探讨了如何构建科学的冠心病介入治疗决策,为冠心病介入治疗合理应用提供科学的决策方法。     

心脏移植的理性审视--浅谈哲学思想对于临床工作的重要性

心脏移植实现了人类长期以来渴望生命再生的梦想,并成为一种治疗终末期心脏病的有效方法.心脏移植的发展史、心脏移植术式的选择、抗排斥和抗感染相互关系的处理、抗排斥方案的制定以及对异种心脏移植的探索等各个方面无不体现哲学辩证法的光辉.为了造福更多的终末期心脏病患者,要理性地审视心脏移植有关问题.     

慢性心力衰竭与恶性肿瘤发病机制的理论比较

阐明慢性心力衰竭的病理生理机制对制定防治策略具有重要的作用.根据"内因"与"外因"的辩证关系,借鉴时肿瘤发病机制的一些认识,从另外一个角度对慢性心力衰竭的发病机制进行细致的剖析,以期为临床防治提供一个全新的方向.     

重新构建先天性心脏病的学科新模式

现有先天性心脏病防治模式存在明显不足.为了更加有利于患者的治疗及先心病的学科发展,建议重新构建先心病学科新模式,将先心病独立成科,内外科融为一体,使先心病学科向专业化发展.     

Posttraumatic Growth in the Context of Heart Disease

The concept of positive consequences arising as a result of coping with traumatic experiences, such as life-threatening illness, represents an emerging area of empirical study in the stress and health literature. This study investigates three specific psychosocial variables (personality, social support, and coping) in relation to posttraumatic growth in a population of individuals coping with heart disease. The results indicate that Extraversion was the most significant predictor of growth, and there is evidence that Problem-Focused Coping partially mediated this relationship between Extraversion and posttraumatic growth. The role of Social Support Satisfaction in predicting growth remains unclear. Findings emphasize the importance of personal and environmental factors in psychological interventions aimed at improving the adjustment and posttraumatic growth of heart patients. Directions for future research are proposed.