‘So many women suffer in silence’: a thematic analysis of women’s written accounts of coping with endometriosis

Abstract

Objective: To understand women’s experiences of coping with endometriosis, and impact on their lives.

Design: Women accessed an online questionnaire through a U.K.-based endometriosis charity website.

Methods: Thirty-four women, aged 22–56 years, with self-reported medically-diagnosed endometriosis, 30 of whom were White, responded to open-ended questions, analysed using inductive thematic analysis.

Results: Participants spoke about their lives being a constant struggle, where they tried to maintain their personal and working lives whilst dealing with long-term pain. Women had to ‘battle’ for an accurate diagnosis, and had limited faith in health professionals. Coping strategies included avoidance of social events to conserve energy (self-pacing), and avoiding taking painkillers to retain alertness. Women did not feel able to be honest with family and friends about their symptoms, and felt socially isolated and misunderstood.

Conclusions: Implications for health professionals are discussed, including the need for earlier diagnosis and taking women’s symptoms more seriously at referral; understanding the need to conserve energy in the context of long-term pain; that not taking pain medication may be an active choice to retain alertness; and that avoiding being honest with friends and family and subsequent feelings of isolation may be common experiences relevant to designing treatment programmes.     

Health-related behaviours and their correlates in a general population sample of 45-year old women

Abstract

Preventive strategies for menopausal women to reduce the risks for osteoporosis and cardiovascular disease has been the focus of considerable attention, but understanding of mid-aged women's behavioural risk factors for these diseases is meagre. The current study describes a range of health-related behaviours and their psychosocial correlates, in a sample of 45-year old women, recruited from five general practices and assessed by postal survey (N=106, response rate 60%). Results suggest that health promotion for this group might best focus upon increases in regular exercise, calcium intake and breast awareness, and decreases in cigarette and caffeine consumption. The behaviours assessed were generally not inter-related. However, several associations were identified between behaviours and health and psychosocial variables. The main ones were the association between menopausal status and smoking, and the relationship between body weight, self-esteem and physical exercise. It is argued that the menopause transition can be an opportunity for preventive work.     

The PDQ-8: Development and validation of a short-form parkinson's disease questionnaire

Abstract

The Parkinson's Disease Questionnaire (PDQ-39) is a disease specific measure of health status which covers eight dimensions of ill-health, and contains 39 questions. The development of the questionnaire has been outlined in full elsewhere and is briefly outlined in this paper. Psychometric techniques are used here to derive a single index figure from the PDQ-39, transformed to a score range from 0 (good health) to 100 (poor health). A sub-set of items is then selected from the PDQ-39 to create a shorter form version, the PDQ-8. Each item selected is the one most highly correlated with the overall domain score to which it contributes: in cases where more than one item correlated equally strongly with the total then the item which received the highest completion rate was selected. The items were summed together and transformed onto a score from 0 to 100. The results gained from the single index gained from the PDQ-39 are compared with that gained from the PDQ-8, and are found to be remarkably similar. The use of the PDQ-8 is recommended over the PDQ-39 where a shorter form measure is required and where a single index measure of overall health status is acceptable or desirable.     

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

Impaired Consonant Trigrams Test (CTT) performance relates to everyday working memory difficulties in children with Autism Spectrum Disorders

Individuals with Autism Spectrum Disorders (ASD) often struggle with complex tasks, such as those requiring divided attention (simultaneously completing two independent tasks) that also place high demands on working memory. Prior research shows that divided attention is impaired in adults and children with ASD and is related to ASD and comorbid attention deficit/hyperactivity disorder (ADHD) symptoms, but the impact on everyday functioning is unclear. Because ADHD symptoms are associated with poor divided attention and working memory performance in children with ASD, we also examined ADHD symptoms as moderators of divided attention performance. We examined performance on the Consonant Trigrams Test (CTT) between high-functioning 8- to 13-year-olds with ASD (n?=?28) and typically developing controls (n?=?18) matched on age and IQ. In the ASD group, we also correlated performance with ADHD symptoms and behavior ratings of everyday working memory. CTT performance in children with ASD was significantly worse than in matched controls. A significant correlation between CTT performance and everyday working memory was observed, but CTT performance was not related to comorbid ADHD symptoms in the ASD group. Divided attention with high working-memory demands is a relative weakness in children with high-functioning ASD; this weakness relates to everyday functioning, and it is independent from ADHD symptoms. That ADHD symptoms are not associated with divided attention performance is inconsistent with one prior investigation, which likely results from using different divided attention tasks in the two studies.     

‘Make sure you keep our house safe!’ Thematic analysis of a children's psychotherapy group

This paper describes a systematic thematic analysis of one particular latency-aged children's group and includes a discussion about potentially helpful outcomes measures. The impetus for our small, practice-based qualitative research project came from the two papers by Reid (1999) and Canham (2002) about children's psychotherapy groups, particularly Canham's (2002) paper, ‘Group and gang states of mind’. Canham and Reid used Bion's theories of group functioning as the basis of their technique with children's groups. We felt that it would be an interesting follow-on from Reid and Canham's findings to explore in some detail the specific therapeutic factors involved in a shift from paranoid–schizoid to depressive functioning in group therapy. We hoped that this might give us some helpful clinical indications as to the circumstances in which group rather than individual psychotherapy and parallel parent work should be considered as the treatment of choice. The paper concentrates exclusively on group work with latency-aged children, therefore referring mainly to the limited number of papers published about psychoanalytic group therapy with this age group.     

An adolescent and his imaginary companions: from quasi-delusional constructs to creative imagination

In this paper I shall describe the psychotherapeutic treatment of a 14-year-old boy, who suffered from mild Asperger's syndrome. This adolescent had a multiplicity of imaginary friends, which protected him from catastrophic feelings of loneliness and deadness, but at the same time interfered with the possibility of establishing meaningful relations with human beings. As the relationship with the therapist gradually gained the vitality and importance originally invested in his parallel fantasy world, the imaginary companions simultaneously faded away. His imagination then became more closely connected to inner reality and to creative processes. The psychoanalytic literature on imaginary companions is reviewed, and it is suggested that the concept of a self-protective device could be usefully applied to understanding the functions that this fantasy performed for the patient.

Dans cet article, l'auteur décrit le traitement psychothérapeutique d'un garçon de 14 ans qui présentait une forme atténuée du syndrome d'Asperger. Cet adolescent avait une foule d'amis imaginaires, ce qui, tout en le protégeant contre le sentiment catastrophique de solitude et de morne tristesse, l'empêchait d'établir des rapports authentiques avec des êtres humains. Au fur et à mesure que sa relation à sa thérapeute était investie de la vitalité et de l'importance initialement accordées à son monde fantasmatique parallèle, ses compagnons imaginaires s'effaçaient. Son imagination était alors davantage en contact avec sa réalité intérieure et avec sa créativité. Passant en revue un certain nombre de textes psychanalytiques sur les compagnons imaginaires, l'auteur suggère que le concept d'un dispositif d'auto-protection pourrait aider à comprendre le rôle que jouait pour son patient cet univers fantasmatique.

In questo articolo l'autrice descrive il trattamento psicoterapeutico di un ragazzo di 14 anni con sindrome di Asperger in forma leggera. Questo ragazzo aveva una molteplicita' di amici immaginari che lo proteggevano da sentimenti catastrofici di solitudine e senso di morte, ma che allo stesso tempo interferivano con la possibilita' che egli stabilisse delle relazioni significative con altri esseri umani. Con l'intensificarsi della relazione con la terapeuta, che gradualmente acquisi' la vitalita' ed importanza originariamente investiti nel suo mondo di fantasia parallelo, simultaneamente i compagni immaginari scomparvero. La sua immaginazione divenne allora piu' strettamente connessa con la realta' interna e con i processi creativi. Nell'articolo viene passata in rassegna la letteratura psicoanalitica sui compagni immaginari, e si avanza l'ipotesi che il concetto di manovra protettiva per il se' potrebbe essere utilmente applicato alla comprensione delle funzioni che tale fantasia fungeva per il paziente.

In diesem Artikel werde ich die psychotherapeutische Behandlung eines 14-jährigen Jungens beschreiben, der an leichtem Asperger Syndrom litt. Dieser Jugendliche hatte eine Vielzahl von imaginären Freunden, die ihn vor katastrophalen Gefühlen der Einsamkeit und Leblosigkeit schützten, aber gleichzeitig die Möglichkeit, bedeutsame Beziehungen mit Menschen herzustellen, beeinträchtigten. Als die Beziehung mit der Therapeutin allmählich die Vitalität und Bedeutung erlangte, die ursprünglich in seiner parallellen Phantasiewelt investiert war, verblassten gleichzeitig die imaginären Begleiter. Seine Phantasiewelt war dann näher mit seiner inneren Realität und kreativen Prozessen verbunden. Es wird die psychoanalytische Literatur über imaginäre Begleiter rezensiert und vorgeschlagen, dass das Konzept einer selbst-schützenden Vorrichtung nützlich zum Verstehen der Funktionen angewendet werden kann, die diese Phantasie für den Patienten erfüllten.     

Dreaming up the patient in supervision: from the concrete to the symbolic*

This paper discusses the importance of parallel processes within the therapeutic and the supervisory context of therapy with an eight-year-old boy diagnosed with Asperger’s syndrome. During the first months of the therapy, through powerful projective identification, the therapist found herself in the ‘clothes’ of the ‘dead mother’. She was unable to think and feel in the sessions. Deadness could not be symbolised – it was enacted in the sessions. The therapeutic encounter had to start elsewhere: the supervisor’s reverie brought to life the patient’s material in the context of the supervision, allowing thinking to occur, first within the supervisory relationship and only then in the therapeutic relationship. In the context of supervision, the encounter of two mentally alive people could contain anxieties, metabolise them and open the way to mental connections. This encounter facilitated the development of creative thinking of both the therapist and the young patient in the consulting room, which allowed the child to become the subject of his existence and to evolve.     

The Attention Demands of Movements

The probe technique has been employed extensively to measure the attention demands of movement control. Inherent in any RT paradigm is the potential confounding effect of anticipation. Experiment 1 studied this problem by varying probe frequency (or, conversely, catch-trial frequency) for three independent groups of subjects performing the same movement. Probe frequencies of one-third and two-thirds produced V-shaped curves of probe RT plotted against probe position within the movement, while a three-thirds condition was described by a negatively sloped linear function. Because of the different shaped curves it was recommended that a two-thirds frequency be adopted by all researchers in this area. Experiments 2 and 3 looked at the effects of movement length and movement time on the attention demands of movement. Shorter (11-cm) movements were more attention demanding in the middle of the movement than the longer (50-cm) movements, but movement time had no effect.     

Sensorimotor Impairment of Speech and Hand Movement Timing Processing in Parkinson’s Disease

Models of motor control have highlighted the role of temporal predictive mechanisms in sensorimotor processing of speech and limb movement timing. We investigated how these mechanisms are affected in Parkinson’s disease (PD) while patients performed speech and hand motor reaction time tasks in response to sensory stimuli with predictable and unpredictable temporal dynamics. Results showed slower motor reaction times in PD vs. control in response to temporally predictable, but not unpredictable stimuli. This effect was driven by faster motor responses to predictable stimuli in control subjects; however, no such effect was observed in the PD group. These findings indicated the relationship between PD pathology and sensorimotor deficits in temporal predictive mechanisms of timing processing during speech production and hand movement.