A collaborative family-systemic approach to treating chronic illness: irritable bowel syndrome as exemplar

This article describes an evolving collaborative relationship between a family therapist and a physician focused on the treatment of irritable bowel syndrome, a highly prevalent disorder which has several psychological characteristics. We began with a unique approach utilizing (1) simultaneous treatment by both specialists; (2) a focus on the relationship context of illness. This approach draws on family systemic theory and practice as well as a circular model of mind and body interaction. Because the intervention was significantly helpful to patients, the premises which informed it were then incorporated into a five session group treatment model. Results and clinical report support the efficacy of a collaborative systemic approach between a medical specialist and family psychologist in treating adult chronic illness.     

Patterns of Coping Among Persons with HIV Infection: Configurations, Correlates, and Change

This study examines coping in response to HIV infection, using longitudinal data from a nationally representative sample (n = 2,864) of HIV-infected persons. We investigated configurations of coping responses, the correlates of configuration membership, the stability of coping configurations, and the relationship of coping to emotional well-being. Four coping configurations emerged from cluster analyses: relatively frequent use of blame-withdrawal coping, frequent use of distancing, frequent active-approach coping, and infrequent use of all three coping strategies (passive copers). Passive copers had few symptoms, high levels of physical functioning, and high emotional well-being; blame-withdrawal copers had the opposite pattern. Of those completing a second interview 1 year after baseline, 46% had the same coping configuration. Increases in the number of HIV-related symptoms raised the probability of blame-withdrawal coping at follow-up, whereas decreases raised the probability of passive coping. Infrequent use of coping responses at baseline was related to greater emotional well-being 1 year later. This result, in conjunction with the high levels of emotional well-being in the passive cluster, suggests that high levels of distress can induce blame-withdrawal coping whereas coping efforts are minimal when social support and emotional well-being are high. Results highlight issues in ascertaining the causal direction between coping and psychological outcomes, as well as in specifying the nature of stressful situations with which people are coping.     

The Interplay Among Risk Factors for Suicidal Ideation and Suicide: The Role of Depression, Poor Health, and Loved Ones' Messages of Support and Criticism

When individuals who receive social support are in poor physical or mental health and are criticized or made to feel unwanted, they may perceive themselves as a burden. Poor physical health and depression were hypothesized to exacerbate the harmful effects on suicidal ideation of receiving critical negative messages and of receiving social support. These hypotheses were tested using secondary analyses of data from a sample of 533 unemployed married individuals who were assessed shortly after job loss, and 6 months later. The results of our analyses supported the hypotheses and demonstrated that for participants with poor health or high level of depressive symptoms an increase in critical messages and social support (from Time 1 to Time 2) predicted increased suicidal ideation. This relationship was not observed for non- depressed participants in good health. The results are discussed in terms of their implications for suicide prevention.     

The shame of being undone by illness and the power of support through the body of Christ

This paper examines shame that arises from living with a body that has been undone by cancer or other serious illness. It draws on first-person narratives and social-scientific studies of cancer patients to explore how bodies undone by illness often cease to conform to cultural standards of health as well as gendered expectations of bodies, and how experiences of shame arise from those shifts in how sick bodies appear and perform. Analysis of narratives by and qualitative data about those who are seriously ill also reveals how the undoing of the body by illness often precipitates an undoing of one's sense of self that leads to experiences of shame over an inability to fill roles and expectations in ways that were possible in life before serious illness. The paper then utilizes biblical and theological resources to explore ways religious communities can make space for those living with serious illness to lament what it's like to be undone by illness, to hold them up amid their experiences of vulnerability through public lament and acts of accompaniment, and to affirm their worth in the eyes of God and in the body of Christ.     

Plague God Image in the Clinic1

This paper selects four dreams before and during COVID-19 which constellated the Plague God image in Chinese culture. The author argues that this shows evidence that the origins of the modern psyche, although hidden, are preserved and living within the ancient anima mundi.     

Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Perceived control over the medical procedure and its association with adjustment to a low-control situation: the case of infertility

Illness perceptions were shown to be related to emotional and physical outcomes, as proposed by Leventhal’s self-regulation model. These perceptions include the illness identity, its timeline, consequences, causes, and controllability, which later research found to include self-control and treatment control. The current study aimed to examine the role of a third type of perceived control: Control over the treatment procedures. We hypothesized that this type of control would be important for women undergoing infertility treatments, which are characterized by high uncertainty and low personal control. The sample included 194 Israeli women who were undergoing infertility treatments, 70% recruited in hospitals and the remainder in a fertility counseling center and website. All participants were married religious Jewish women, which added to the stress inherent in infertility. Study measures included the Illness Perception Questionnaire-Revised (IPQ-R), adapted to infertility, with an additional subscale assessing control over the procedure, and infertility-specific distress and well-being scales. Exploratory and confirmatory factor analyses supported the factor structure, including the distinct new subscale. A structural equations model showed that perceived consequences were most strongly related to distress and well-being. The three types of control were positively intercorrelated but differed in their associations with distress and well-being: Self-control over the problem and treatment control were unrelated to either measure while self-control over the procedure was related to greater well-being. These findings suggest that when control over the condition or the treatment outcomes is impossible, individuals may still benefit from control over external factors such as their health care. Healthcare providers can support them by seeking ways to increase their control over their treatment procedures, which may contribute to better psychological adjustment. Future studies should examine the role of perceived control over the procedures in other low-control situations (e.g., newly diagnosed cancer; aging-related declines).     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.