THE SECOND SPHERE AND THE STORY OF NO STORY

The author discusses Roy Schafer's ideas of the second self and second reality, as well as his consistent theme of storyteller and story. The latter theme is also explored in the context of more recent psychoanalytic influences, such as Bionian thought, trauma theory, the French approach, and the interpersonal perspective. To illustrate the idea of the nonstory in today's clinical encounters, the author presents two clinical vignettes.     

Psychological and behavioural effects of bone density screening for osteoporosis

Abstract

To examine the psychological effects of bone density measurement, 298 women were assessed two weeks before the bone density scan, immediately before the scan, after the results, a week later and three months later. For the group as a whole, ratings of anxiety and perceived vulnerability were lower at the three month follow-up than at the initial assessment. Women who received a low bone mineral density (BMD) result were more anxious and reported more osteoporosis-preventive behaviours at the three month follow-up than women who received a high BMD result; these differences had not been apparent at the initial assessment Women with low BMD results had higher ratings of perceived vulnerability after the scan, although for some of these ratings there were group differences before the scan. Women with a low BMD result showed a decrease in ratings of the seriousness of a below-average result, which may reflect minimization of the health threat     

Busy lifestyles and mammography screening: Time pressure and women’s reattendance likelihood

Time pressure is often cited as a reason for non-attendance at mammography screening, although evidence from other areas of psychology suggests that time pressure can improve performance when barriers such as time pressure provide a challenge. We predicted that time pressure would negatively predict attendance in women whose self-efficacy for overcoming time pressure is low, but positively predict attendance when self-efficacy is high. Time pressure was operationalised as the self-reported number of dependent children and others, and average number of working hours per week. Australian women were surveyed after being invited to attend second or subsequent screenings at a free public screening service, and subsequent attendance monitored until six months after screening was due. The majority (87.5%) attended screening. Women with more dependent children and higher self-efficacy showed greater attendance likelihood, and women with fewer non-child dependants and lower self-efficacy were less likely to attend. Working hours did not predict attendance. Findings provide partial support for the idea that time pressure acts as a challenge for women with high self-efficacy.     

Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour

Abstract

This paper reports on a study carried out to identify predictors of uptake of cervical screening among 142 women (59% response rate) in inner London. Two social cognition models were used: The Health Belief Model (HBM; Becker, 1974) and the Theory of Planned Behaviour (TPB; Ajzen, 1991) and in addition anticipated affect following non-attendance for screening was assessed. The TPB emerged as by far the superior model for predicting screening intentions, explaining 51% of the variance in comparison with only 4% explained by the HBM variables. However, neither model was able to predict a significant amount of variance in uptake of screening three months later. Possible reasons for the poor prediction of this type of behaviour are discussed.     

A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples

The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands’ support of their wives’ CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples’ ability to view CRCS as having benefit for the marital relationship.     

Psychological consequences of positive results in cervical cancer screening

Abstract

This study was carried out to assess the psychological impact of abnormal cervical smear results. Existing literature contain only uncontrolled studies or controlled studies with non-standardised measures. Subjects were recruited from women attending two general practices for routine cervical smears over a six month period. A comparison was made between women with positive results who were referred for colposcopy, with mild abnormalities who were asked to return for a repeat smear in six months, or negative smear results. Psychometric assessment by postal questionnaire was carried out one week after receiving the result. The measures used were the 28-item General Health Questionnaire (GHQ-28), Spielberger State Anxiety (STAI), and a measure designed specifically for use in the study, the Cervical Screening Questionnaire (CSQ). Results indicated that women with positive smear test results who were referred for colposcopy had significantly higher scores on GHQ (p<.01) STAI-S (p<.05) and CSQ (p<.001) than women with mild abnormalities or negative results. Significant differences between the groups with mild abnormalities and negative results were found on the CSQ (p<.05). These findings suggest that positive results on cervical screening are associated with a significant psychological impact including a range of specific concerns about gynaecological health and cancer, increased anxiety and impaired well-being. Even mildly abnormal results, which involve a recommendation for early repeat screening, cause raised concern about cancer for the recipients. The procedures for providing smear results should be organised to minimise the level of distress.     

Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract

Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

The Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in the diagnosis of subcortical vascular dementia and Alzheimer’s disease

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer’s disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group’s differences were evaluated using the Quade’s rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).