Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.     

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

Background/ObjectiveAfter an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.     

Brief cognitive behavioral intervention for children and adolescents with persistent post-concussive symptoms: A pilot study

This study aims to evaluate the efficacy of a brief cognitive behavioral intervention program for children and adolescents experiencing persistent post-concussion symptoms. A total of 31 patients aged 10 to 18 years participated in the intervention. The median time since injury at treatment onset was 95 days though the range was large (23–720 days). Treatment was on average four sessions in duration. Sessions included concussion education, activity scheduling, sleep hygiene relaxation training, and cognitive restructuring. Outcomes were measured using symptom reports on the Sports Concussion Assessment Tool – Third Edition (SCAT-3) and parent-reported quality of life on the Pediatric Quality of Life Inventory (PedsQL). Mixed-effects models revealed that symptom reports did not decrease prior to the initiation of this treatment, though significant symptom improvement occurred following treatment. Quality of life scores significantly improved across domains, with the largest gains made in the emotional and school domains. Participant characteristics including age, sex, maternal education, and previous mental health problems were not found to be significantly related to treatment outcomes. Contrary to predictions, length of time since injury was not related to symptom changes. The primary limitation of this study is that it lacks randomization and an experimental control group. The results suggest that brief cognitive behavioral intervention may be a promising treatment for children and adolescents experiencing persistent post-concussive symptoms and warrants further investigation.     

孤芳自赏还是乐于助人?员工自恋对亲社会行为的影响

本研究通过整合自恋双元理论和特质激活理论, 探讨欣赏型自恋、敌对型自恋对员工亲社会行为的影响机制, 深入分析了员工关系趋近型动机和关系回避型动机的中介作用以及任务相互依赖性的调节作用。通过对来自员工-同事二阶段配对的235份数据进行分析, 结果发现: 欣赏型自恋对员工亲社会行为具有显著的正向影响, 敌对型自恋对员工亲社会行为具有显著的负向影响; 关系趋近型动机在欣赏型自恋与员工亲社会行为之间发挥着中介作用, 关系回避型动机在敌对型自恋与员工亲社会行为之间没有发挥中介作用; 任务相互依赖性不仅正向调节欣赏型自恋与员工关系趋近型动机的直接效应, 而且还正向调节着欣赏型自恋通过关系趋近型动机对亲社会行为的间接效应。     

Les préjudices professionnels des jeunes victimes de dommages corporels. La reconnaissance jurisprudentielle du préjudice professionnel des jeunes victimes. Partie 1

Compensation for professional damages in respect of young victims who remain disabled following an accident or assault remains problematic for personal injury compensation practitioners. However, such professional damages, recognized in principle by the Dintilhac group, were confirmed by the Court of Cassation in terms of full compensation for damages, both for loss of future earnings (PGPF), and professional incidence (IP). Though the burden of proof lies with the victim, experts have a major role to play in assessing these losses by setting out the foreseeable impact of the after-effects on the victim's professional activities, and on his or her professional potential before and after the injury, along with limitations in terms of the jobs the victim is subsequently able to do.     

Reducing covert self-injurious behavior maintained by automatic reinforcement through a variable momentary DRO procedure

Covert self-injurious behavior (i.e., behavior that occurs in the absence of other people) can be difficult to treat. Traditional treatments typically have involved sophisticated methods of observation and often have employed positive punishment procedures. The current study evaluated the effectiveness of a variable momentary differential reinforcement contingency in the treatment of covert self-injury. Neither positive punishment nor extinction was required to produce decreased skin picking.     

A syndrome of errant sexuality – and the self

Abstract

Sexual activity can be viewed as a service for the self. Addictive, perverse and aversive devices mostly build an aggregate. I will present self-psychological and other views for understanding such an aggregation of errant sexuality. In the course of the development of culture, sexuality has developed a variety of functions. Self-psychology views sexual activity as a device for establishing and/or repairing coherence and vitality of the self. In the present paper, I will posit perverse action as being part of a conglomerate – consisting of addictive, perverse and aversive features as different but interdependent appearances of sexual life. Fundamental to developing and sustaining deviant sexuality, as perverse activity, is sexualisation. A vertical split is often described. The individual psychodynamic may be featured by addictive and aversive attributes. Addictive, perverse and aversive behaviours are viewed as part of narcissistic behaviour disorders. Self-psychologically informed features of treatment concentrate on the anxieties of being empty and destructive, and thus being unable to engage in an intimate relationship. The healing process consists of helping the client to establish a stronger self, able to build up and maintain relationships with sufficiently sustaining self-object qualities.

Triebel A.

Sexualität kann als Aktivität im Dienste des Selbst angesehen werden. Süchtige, perverse und aversive Verrichtungen bilden meistens ein Aggregat. Ich will selbstpschologische und andere Gesichtspunkte darstellen, um eine solche Ansammlung umherirrender Sexualität zu verstehen. Im Verlauf der Entwicklung der Kultur hat Sexualität eine Vielzahl von Funktionen entwickelt. Selbstpschologie sieht sexuelle Aktivität als eine Maßnahme, um die Kohärenz und Vitalität des Selbst zu etablieren und/oder wieder herzustellen. In der vorliegenden Arbeit will ich perverse Handlung als Teil eines Konglomerats darstellen – bestehend aus süchtigen, perversen und aversiven Zügen als verschiedenartige aber interdependente Erscheinungen sexuellen Lebens. Grundlegend für die Entwicklung und Aufrechterhaltung devianter Sexualität, wie perverser Aktivität, ist die Sexualisierung. Oft wird eine vertikale Spaltung beschrieben. Die individuelle Psychodynamik kann durch süchtige und aversive Attribute gekennzeichnet sein. Süchtige, perverse und aversive Verhaltensweisen werden als Teil von narzißtischen Verahltensstörungen angesehen. Selbstpsychologisch informierte Merkmale der Behandlung konzentrieren sich auf Ängste, leer und destruktiv zu sein und somit unfähig, sich in einer intimen Beziehung zu engagieren. Der Heilungsprozeß besteht in der Hilfe, ein stärkeres Selbst zu etablieren und die Fähigkeit, Beziehungen mit genügend tragenden Selbst-Objekt Qualitäten aufzubauen und zu erhalten.

Tribel A. Un síndrome de Sexualidad Errante-y del Self

La actividad sexual puede ser vista como al servicio del self. Adicciones, perversiones y mecanismos aversivos la mayoría de la veces conforman un agregado. Presentaré el punto de vista de la psicología del Self y otros para la comprensión de la incorporación de la sexualidad errante. En el curso de desarrollo de cultura sexual se han desarrollado una variedad de funciones. La psicología del Self contempla la actividad sexual como un mecanismo para el establecimiento de la coherencia y/ o la reparación y vitalidad del Self. En este trabajo propondré la acción perversa como una parte de un conglomerado, consistente en un futuro adictivo, perverso y aversivo, como partes diferentes pero interdependientes apariencias de la vida sexual. Fundamentalmente para el desarrollo y sostenimiento de la desviación sexual. A menudo se describe una escisión vertical. La psicodinamia individual puede ser representada por atributos adictivos y aversivos. Comportamientos adictivos, perversos y aversivos son vistos como parte de trastornos de comportamiento narcisista. La psicología del self informa sobre tratamientos concentrados en las ansiedades de sentirse vacíos y destructivos y por tanto incapaz de unirse en una relación intima. El proceso de cura consiste en ayudar a establecer un self más fuerte, capaz de construir y mantener relaciones con sostenimiento suficiente de las cualidades del Self-objeto.     

A preliminary study of a traumatic injury prevention program

Abstract

This study examined the long-term impact of a five component spinal cord injury prevention program presented to adolescents. A sample of 445 teenagers who attended a junior high school in which an educational intervention was presented three years earlier and a control group of 379 students who had not been exposed to the intervention completed a questionnaire assessing their safety knowledge, attitudes, and self-reported behaviors. Total scores on the questionnaire between treatment and control groups differed significantly. Students in the treatment group reported significantly more frequent seat belt use, stronger belief that seat belts were important to their safety, lower likelihood of riding with friends who had been drinking, higher rates of friends' use of seat belts, greater awareness of the age group most likely to be injured, and increased knowledge that they could prevent spinal cord injury.     

The role of centrality to self-concept in moderating the associations between injury perceptions and outcomes

Abstract

Objectives: To test the centrality of injury to self-concept as a moderator of the associations between injury perceptions and outcomes.

Methods: Two concurrent studies on samples of injured individuals.

Measures: The centrality of injury to one’s self concept was measured by the degree of self-injury separation (PRISM); injury perceptions were measured by the injury perception questionnaire; and outcomes by standard scales of self-assessed health, physical, emotional and social functioning, vitality, depression, anxiety and somatisation. Regression analyses examined the significance of adding the interactions between injury centrality and injury perceptions to explained outcome variance, beyond their separate contributions.

Results: Both injury centrality and injury perceptions significantly explained variance in patients’ functioning and well-being. Injury centrality moderated the associations between various injury perceptions and outcomes, especially pronounced for emotional representations of the injury. As hypothesised, the effects of injury perceptions on outcomes were stronger among patients for whom the injury was central to their self-concept compared to patients who perceived the injury as peripheral to their self-concept.

Conclusions: ‘Centrality to the self’ is a moderator of the impact of perceptions on outcomes of injuries. The findings suggest ways to tailor interventions to sub-groups of injured patients based on injury centrality to their self-concept.     

The relationship between post-trauma problem reporting and carer quality of life after severe head injury

Abstract

Head injury is a significant cause of death and disability. This study examined the quality of life of carers of individuals following severe head injury from the acute neurosurgical care period to one year post discharge from hospital. The contribution of patterns of problem reporting by patients and their carers to quality of life was examined. Carer psychosocial adjustment and individual quality of life evaluations were significantly poorer than general population levels and did not change over a one year period. However, significant increases in the number of problems reported were noted over time. No significant differences were found between patients and carers in the numbers of problems identified at each of three assessments, although the level of agreement about problems identified was quite low. Female patients reported significantly more problems than male patients. Carer problem reporting was found to significantly predict carer quality of life and psychosocial functioning to a greater extent than patient problem reporting, a pattern which emerged after the patient had been discharged from hospital. The study demonstrates increasing problem profiles and differing perceptions of patients and carers over time. Combined with a lack of improvement in carer quality of life over a one year recovery period, this highlights the need for longer-term professional support and advice services aimed at both patients and carers.