Psychological aspects of scuba diving injuries: Suggestions for short-term treatment from a psychodynamic perspective

Dive medicine is described as an area of practice in which psychologists may choose to expand their clinical service and research activities. The author argues that most research studying risk behavior and sports take into account biological, behavioral or cognitive approaches, while ignoring unconscious conflict in risk-taking and injury management. The present paper uses a psychodynamically-oriented, interview-based approach to studying psychological reactions to decompression sickness in three experienced scuba divers. Brief interventions and their outcomes are described.     

Ego development in the face of death: How being HIV positive affects movement through Erikson's adult stages of development

Erikson's epigenetic model of psychosocial development posits that each of eight stages unfolds in a particular sequence, and each becomes the primary issue of concern at specified times in the life cycle. Erikson does not address, nor could any empirical studies be located, exploring how the emergence of these eight stages might be affected by a diagnosis of terminal illness. The purpose of this study was to understand how an HIV-positive diagnosis affected movement through Erikson's stages of development. In-depth interviews were conducted with a sample of 18 HIV-positive men and women under 45 years of age. Analysis of the qualitative data revealed three findings regarding Erikson's stages: (1) The fifth stage of idenitity versus role confusion was revisted and the sense of self is redefined; (2) the three adulthood stages of intimacy versus isolation, generativity versus stagnation, and ego integrity versus depair were dealt with simulataneously and, in most cases, resolved favorably; and (3) intimacy and generativity enabled and supported the resolution of the tasks of identity and ego integrity.     

Organizational downsizing and stress-related illness

Epidemiological evidence of physical correlates of stress for midlevel workers threatened by organizational restructuring, reorganization, and downsizing was obtained for seamen in the U. S. merchant fleet, an industry which has lost 75% of its jobs in a working lifetime. Illness reports of 22,763 seamen were analyzed to ascertain the relationship between job-related and situational stress factors and the occurrence of eight stress-related diseases (cardiovascular disease, hypertension, heart attack, psychoneurosis, suicide, peptic ulcer-gastritis, arthritis, and asthma). Rank difference was revealed as the primary determinant of disease occurrence rate. The licensed group, midlevel managers in both deck and engine departments, showed a significantly higher percentage of stress related illness than did the unlicensed group. Licensed deck personnel showed higher rates of cardiovascular disease, heart attack, psychoneurosis, suicide, and asthma. Licensed engine personnel showed higher rates of heart attack and asthma. Explanations for high stress levels among licensed personnel center around declining job opportunity due to downsizing and end-of-career anxiety. Other factors include the burdens of supervisory responsibility in an era of eroding management authority, accommodation to technological and situational change, and general aging of the merchant marine workforce.     

人体系统的非优性与疾病的时空特征

人体系统并非完美,生命抛物线是由生理年龄、社会年龄、人体熵三大要素在非线性作用下相干的结果,从而呈现一种复杂的网状“大Ｘ构架”。每一个交叉点都具有阶段性态变的意义和对生命质量的表征。疾病是人体系统非优的必然。熵压决定了熵的退行性运动,从而也决定了生命时间的有限性。疾病是熵增过程造成机体不同程度封闭的结果。每次疾病都是对熵的增压,造成机体的物质丢失、时间丢失与跳跃,出现熵运动方面的引力偏折,从而在局     

Prevention, solution-focused therapy, and the illusion of mental disorders

Therapy theorists' criticism of the lack of specific mechanisms in the prevention of mental disorders is examined from the perspective of solution-focused therapy (SFT), which argues that solutions can be unrelated to problems, and that it is not even necessary to know what a problem is in order to solve it. It is suggested that the shift of attention from problems to solutions in SFT offers a conceptual framework within which the criticism is not relevant, and from which theorists of therapy and prevention can share a common outlook. This outlook involves a focus on encouraging productive, useful, positive behavior, with a corresponding deemphasis on an skepticism about current conceptualizations of mental disorders.     

The Role of Family Processes and Coping Strategies in the Relationship Between Parental Chronic Illness and Childhood Internalizing Problems

Sixty-nine families (father, mother, and one child) in which the father had hemophilia, approximately half of whom were HIV positive, were assessed in an examination of the relationship between parental chronic illness, family functioning, child coping strategies, and child adjustment. Latent variable path analyses with partial least-squares estimation procedures (PLS) were used to test a model of the relationship between parental chronic illness, family process variables, child coping strategies, and child internalizing behavior problems. The severity of the father's illness predicted family process variables, which predicted the coping style of the child. The use of more avoidant coping strategies was associated with more internalizing problems.     

Training young parents to identify and report their children's illnesses.

We developed a comprehensive training program to teach young parents what symptoms to look for to judge the severity of their children''s illnesses, what to do at home to comfort their children, and when to consult their children''s physician or take them for emergency treatment. Three pairs of subjects received training that included written handouts, verbal instructions, modeling, positive practice, and verbal reinforcement. Skill acquisition was assessed by a behavioral test in which parents assessed, treated, or reported a simulated illness in a child. Written materials when used alone did not improve the parent''s ability to identify and report children''s illnesses. Modeling and role-playing followed by positive practice were successful in teaching these parents skills that were maintained for 3 months without additional training or instruction.     

Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.