Temporal dimensions of the self-concept: Entrapped and possible selves in chronic pain

Abstract

The purpose of this qualitative study was to explore temporal aspects of chronic pain patients' conceptions of their selves; what they were in the past, how they were functioning at the present and what they thought about their potential and future. In-depth interviews with 21 chronic pain patients were performed and analysed. The main results of the analysis included four higher-order conceptual patterns: “the body and I”, “maintaining the consistency of past self”, the “entrapped self”, and “projected selves, defined by others”. These results are presented in a systems-oriented model illustrating the temporal dynamic between the perceived functioning self, the body and others, such as health care personnel and significant others. The mechanisms of the process of how selves are developing in the chronisation or healing process of pain are finally discussed. A clinical implication of these findings might be that with an enlarged insight of the temporal dynamic and the importance of interactive and social factors in shaping positive possible selves, health care personnel can contribute more effectively in stew-arding the chronic pain patient toward health-promotive ends and a concomitantly higher quality of life.     

Rethinking ‘Don't Blame the Victim’

SUMMARY

The psychology of victims and the dynamics of victimhood have been largely ignored by scholars and clinicians. While in past years the tendency has been to blame victims, more recently the tide has turned. It is now politically incorrect to explore the role of victims in violent systems, as exploring the psychology of victims has become synonymous with blaming the victim. While shying away from blame, this article will explore the familial and cultural origins of victimhood, victims' characteristics, their relationships with the perpetrators, and it will offer a victim typology. As we move from btame to a more complex understanding of violent systems, the perpetuation of these systems in our culture, and the role victims play in these systems, we provide ourselves with better tools to predict and prevent further victimization.     

The Pain of Dying

SUMMARY

Dying can be a painful and difficult business. Fears, hopes, losses, questions, and uncertainty result in a form of pain that lies beyond the therapeutic reach of science and pharmacology. Efforts to preserve and prolong life or to make things better can sometimes result in this pain being overlooked or remaining unheard. To search the deepest part of oneself is the journey that beckons us all as we are dying. Within this space resides the source of our own suffering but also the seeds for healing. This exploration has a momentum of its own but requires conditions not often found within the biomedical paradigm. If this model of care remains the only source of hope for those with a life-threatening illness, ‘the pain of dying’ may not be addressed.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

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.     

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.