Chapter 8: “Always Green and Full of Sap”: Facilitating Wholeness in Aging

SUMMARY

Wholeness in aging is difficult to define, especially in the face of physical disability or catastrophic illness. How one meets the challenges of aging depends upon numerous physical, emotional, and spiritual factors. Rehabilitation may play an important role in restoring wholeness to those with physical disabilities. Likewise, a physical fitness program may lessen some of the effects of aging, helping the older person maintain a higher quality of life. The lived theologies of the older patients and their caregivers also interact, providing an important ground of connection in rediscovery of wholeness as well. Ultimately, our most important role as healthcare providers is to help our older patients regain and maintain this multidimensional wholeness even in times of physical challenge.     

Psychotherapy without the self–a Buddhist perspective,by Mark Epstein

This article seeks to explore how John Rolland's Family Systems Illness Model can be utilized by counselling psychologists working with individuals or families experiencing medical problems. Based on systemic theory the model provides a psychosocial typology of illness and examines how the demands of an illness over time can provide a number of hurdles to be overcome by the client and his/her family. Specific examples and techniques are described to illustrate how the application of the model can be used to guide the interventions employed in a counselling session. the model applies a biopsychosocial approach to health care, and the applicability of this within a British NHS healthcare setting is discussed with the conclusion that such an approach may be in its infancy in this country. Limitations and ideas for expansion of the model from chronic physical illness into spheres of mental health are discussed.     

Hispanic use of juramentos and Roman Catholic Priests as auxiliaries to abstaining from alcohol use/misuse

This self-administered mail survey study conducted along the US–Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priests indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

新世纪预防医学发展方向的浅议

现代预防医学所面临的主要研究内容从传统的传染性疾病向以社会、环境等因素所导致的疾病转移,不仅需要研究人类的生物属性,而且在人类的社会属性以及和种因素对人群健康的影响、消除和控制这些方面有更为广泛的研究任务,并且需要从预防的理论、技术加以拓展。     

Methodological Considerations in the Neuropsychological Study of Central Nervous System Underarousal with a Specific Emphasis on Coma

Several obstacles exist that impede the scientific study of pathological underarousal (stupor and coma). For instance, there is a lack of a clear, rational, standardized taxonomy with which to describe the phenomenon. Moreover, there is considerable confusion of the construct of arousal with other neurobehavioral constructs. The field also suffers from a general lack of acceptably reliable and valid instruments, especially measures of long-term outcome. Additionally, current treatments for chronic pathological underarousal are frequently presumptive and applied haphazardly, and thus do little to elucidate the process of recovery. It is suggested that biomedical and neuropsychological approaches to the study and treatment of pathological underarousal are complementary and that it is useful to view pathological underarousal as a behavioral, as well as a medical, phenomenon.     

Psychological Interventions and Genetic Testing: Facilitating Informed Decisions About BRCA1/2 Cancer Susceptibility

Genetic testing for inherited cancer susceptibility, based on the recently identified. BRCA1 and BRCA2 genes, will soon be available on a large scale. However, at present, genetic test results do not lead to clearly indicated diagnostic or preventive measures, and the nature of the psychological impact of BRCA1/2 testing is still largely unknown. This uncertainty, combined with preliminary evidence suggesting significant individual differences in reactions to genetic susceptibility feedback, constitutes a unique challenge for any individual contemplating such testing. We outline the nature of this challenge and then propose an intervention strategy designed to help individuals make deeply processed and psychologically well-informed decisions with regard to their genetic susceptibility. The intervention is guided by recent research findings and theory on the cognitive–emotional processing of cancer-risk information. Specifically, the goal is to prepare the individual for genetic testing by (1) cognitively and emotionally activating, or preliving, the individual's potential reactions to testing feedback; (2) facilitating accurate appraisal of the individual's cognitive–emotional reactions; and (3) enabling the individual to process these reactions through the use of well-established clinical techniques.     

Understanding and Treating Pain in Ethnically Diverse Patients

A revolution has taken place during the past 25 years in the understanding and treatment of chronic pain. Psychologists have contributed tremendously to this revolution. However, the primary psychological models of pain treatment have failed to adequately integrate the empirical findings and theoretical understanding of the role of ethnic factors. The goal of this paper is to address this problem by demonstrating the importance of understanding ethnic factors in treating pain, providing an overview of ethnic factors in pain, and proposing guidelines for Clinical Psychologists who treat pain patients from ethnically diverse backgrounds.     

Depth of Field: Using photographs and narratives to explore and reflect on ageing

The learning landscape of the higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practise in today’s complex healthcare systems, including responding to changing demographics of population ageing. In this educational case study, we will share how we (a group of education, medical and nursing academics) developed ‘Depth of Field: Exploring Ageing’ a digital, consumer-driven, interprofessional reflective learning resource that uses photographs, narrative and small-group work to strengthen reflective capacity in current and/or future health professionals.