Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

‘Rehabilitation' in schizophrenia: A psychoanalytic viewpoint

This is a study which investigates some difficulties people with schizophrenia have in the long term; looks at some of the psychoanalytical theories concerning the difficulties they have in keeping an internal caring maternal imago; the consequences for them; how the NHS can help by providing an external caring maternal imago.     

The Role of Schools in Building the Resilience of Youth Faced with Adversity

This study explored factors related to risk, resilience and health amongst South African teenagers. Grade nine students (N = 472; males = 210, females = 262, age range = 12 to 18 years) at seven schools in the Western Cape participated in the study. The California Healthy Kids Survey, which includes risk and resilience modules, was utilized. Focus group interviews were also conducted with the students to determine their needs and support at school. Questionnaires relating to the health promoting schools framework were administered to teachers. Quantitative and qualitative research methodologies were employed. The results indicated that the students were engaged in a variety of risk behaviors that threatened their well-being and that their external and internal assets were limited. A multi-faceted approach to reducing risk and enhancing resilience, involving family, peer, school and community support within a health promoting schools framework, is advocated.     

A 9-YEAR-OLD WITH CONVERSION DISORDER, SUCCESSFULLY TREATED WITH PSYCHOANALYSIS

This paper outlines the successful psychoanalytic treatment of a latency-aged boy with severe conversion disorder. Details of clinical treatment are presented. As no tested treatment has yet been found that reliably treats chronic conversion in children, this case is of importance in demonstrating the usefulness of psychoanalysis as treatment for severe psychopathology. The patient's unconscious fantasy constellations that gave rise to this syndrome are highlighted.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

Presurgical MMPI-2 Cluster Profiles Predict 1-Year Low-Back Surgery Outcomes

The primary purpose of this study was to examine whether empirically derived cluster profiles based on scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) predicted outcomes of surgery at 1 year for patients with low-back pain. On the basis of hierarchical cluster analysis of presurgery MMPI-2 scores for 60 patients, three interpretable and significant subgroups were formed. These consisted of a pathological/neurotic type, a double V-code type, and a normal type. The patents in the normal type were significantly more likely to report beneficial outcomes of surgery in terms of disability and pain than those in the other 2 types. These findings extend previous research and suggest (1) low-back surgery candidates are heterogeneous in their psychological profiles, and (2) MMPI-2 profiles are predictive of low-back surgery outcome. Future research should focus on identifying physiological substrates for these distinct profiles and investigating the effectiveness of presurgical psychological interventions based on profile type.     

明清商人伦理形成之内在冲突及其特征

明清商人在传统儒家伦理化和制度歧视的历史背景下,有着自己内在的心理冲突,正是这种内在冲突促使明清商人形成了其特有的伦理特点及其伦理的历史命运,这对当前中国转型期间的经济伦理建设亦有借鉴意义。     

对以边沁、密尔为代表的功利主义的分析批判

边沁的功利主义为苦乐原理、效果论和功利原则这样三个理论基点所构成。这是一个有着内在逻辑困境的三原理。苦乐原理由于没有进行内在的质的区分,为密尔所修正,但密尔的修正突出了苦乐原理与效果论的内在不一致;同时,密尔以自我牺牲来补充功利主义,又暴露了功利主义原则的内在矛盾。还有,密尔以平等权利来为功利主义的最大幸福原理辩护,恰恰表明功利原则并非是可以成为一个理论的基础性原则或终极原则。斯马特的行动功利主义则进一步暴露了功利主义的非正义性特性。功利主义的这样三个典范表明仅仅诉诸功利原则无从走出内在逻辑困境。布兰特援引认知理论以及道义论原则,笔认为这才使功利主义从其困境中走出。     

儒家的宗教性及其与西方基督教精神之比较

本文力图从一个中西学术界争论颇多的问题———“儒家是否是宗教”的问题中发掘出问题背后所隐含的中西宗教文化交流的时代契机。作者首先对儒家“宗教性”的概念进行定义 ,然后从哲学、道德和超越性三方面阐释了儒家宗教性的具体体现 ,并比较分析了传统向度意义上的儒家和西方基督教在宗教精神方面的不同 ,包括超越意识、终极性宗教存在、对“人”的认识以及对“心灵”的认识。最后探讨了儒家与基督教对话的可能性和必要性。