Objectives: In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by ...mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. Methods: A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. Results: Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons "behind the symptoms." The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. Conclusions: In this review, the participants pleaded for "flexibility" in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.
Hyperspectral X-ray detectors, which provide the full energy spectrum detected by each individual pixel, have become available for use in lab-based facilities. The addition of spectral information ...currently comes at the cost of low overall acceptable flux rates, and can introduce countrate nonlinearity at higher energies. Neither of these drawbacks are desirable for transmission imaging and tomography. In this paper a new data processing software chain is presented for the SLcam, a pnCCD-based hyperspectral camera prototype, allowing for more control over the conversion from raw frames to hyperspectral images. Complementary to the processing software, a set of live data visualisations was developed to aid in monitoring ongoing experiments and to allow for preliminary data processing on-the-fly. The combination of these software elements forms the first step towards general applicability of hyperspectral imaging at laboratory tomography setups.
Drug free Therapeutic Communities (TC’s) for addiction developed outside the medical and mental health care. Although these programs have proven to be effective, the why and how of the treatment ...process stays misunderstood. This ‘Black Box of the TC's’ threatens their continued existence and has led to a call for qualitative research. To investigate the treatment process, the first author fully immersed herself in the Belgian TC ‘Trempoline’ for 3 weeks. The full participation strongly affected research possibilities: record equipment was taken away and the exigent day’s schedule left few moments to note. Paradoxically, such frustrating experience proved to be an integral part of the treatment process. The data-set was analyzed with thematic analysis. This resulted in a model consisting of 5 main themes which clarifies how the TC-program (themes 2 and 4) influences its residents (themes 1, 3, 5) (see figure 1). figure 1 The frustrating but at the same time holding environment reactivates the residents’ drowned emotional life. By applying symbolization-tools they learn to deal with the increasing tension in a mentalised way instead of acting out their discontent. We conclude that a TC tackles the disruptive affect-regulation in people suffering from addiction by triggering and developing their mentalisation process.
Introduction The concept of alexithymia refers to problems in experiencing and regulating affects; clinical study as well as empirical research suggests that alexithymia is related to cold and ...socially inhibited interpersonal functioning. However, empirical studies frequently use only self report questionnaires. Objectives/aims This study investigates the relation between alexithymia and self-reported interpersonal problems. By using an interview measure of alexithymia next to a questionnaire, we want to avoid artificially high correlations due to shared method variance and thus get a clearer picture of the link between alexithymia and interpersonal style. We hypothesize that alexithymia will be related to a cold, but not to a dominant or submissive interpersonal style. Method The Toronto Structured Interview for Alexithymia (TSIA) was administered by a trained researcher to 74 psychiatric inpatients, who also filled out the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-64). Dimensional affiliation and dominance scores of the IIP-64 were computed and Pearson correlations between TSIA, TAS-20 and IIP-64 dimensional scores were calculated. Results As hypothesized, we observed no significant correlation between TSIA, TAS-20 and the dominance dimension of the IIP-64 and a significant correlation between the affiliation dimension and TSIA and TAS-20. Conclusions Our results support previous research and confirm that alexithymia is related to a cold interpersonal style. Since our findings converge for both measurements of alexithymia, the link between alexithymia and interpersonal style can not be explained by shared method variance. The measurement of only self-reported interpersonal problems is a limitation of this study.
Introduction An increasing amount of outcome research supports the efficacy of Short Term Psychodynamic Psychotherapy (STPP) for a wide range of psychological disorders, reporting effect sizes in ...meta-analyses between 0.50 and 1.40 (for review see Shedler, 2010). Mapping mechanisms of change in the STPP process can be considered the major challenge of STPP for the decades to come. Objectives/aims This study focuses on STPP with Obsessive-Compulsive (OC) patients and tests the hypothesis that the progressive elimination of OC symptoms throughout an STPP process is correlated to a parallel process of change at the level of interpersonal characteristics. Method Mixed quantitative-qualitative analyses of data of Short Term Psychodynamic Therapies with four OC patients are presented. Repeated Measures analyses are performed to study intra-subject associations between intensity of OC symptoms (measured by General Health Questionnaire, GHQ-12, and Obsessive-Compulsive Inventory, OCI-R) and interpersonal characteristics (measured by Inventory of Interpersonal Problems, IIP-32). Results Observed associations between evolutions in general interpersonal characteristics and general complaints were significant yet inconsistent across the patients. Qualitative analyses, however, revealed similarities on the level of specific interpersonal characteristics, in this respect that all patients struggled to escape the suffocating impact of parental figures and/or romantic partners. Conclusions Rather than elaborating a general interpersonal style (cfr. Desmet et al., 2008), the results suggest that a progressive elaboration of parent-child and partner relationships is a crucial characteristic of the STPP process with OC patients. Limitations of the study are the small sample size and the absence of contrast- and control groups.
The idea to devote a special issue on the Assessment of Emotional Functioning and Emotional Competence arose during the preparation of the 10th European Conference on Psychological Assessment that ...took place from the 16th until 19th September 2009 in Ghent. The conference theme was "The assessment of emotions and emotional competencies". Emotions have become a cross-cutting theme of research across theoretical and applied domains in psychology. The academic interest is especially voiced by scientific journals focusing on emotion, such as 'Motivation and Emotion', 'Cognition and Emotion', and more recently 'Emotion'. Moreover, there has been a long-standing interest in emotions in the applied domains, especially in clinical psychology.
This article studies recalled parental bonding, adult attachment style, and personality disorders in child molesters and reports on the findings of two separate studies. The first study examines ...differences between a group of 84 child molesters and 80 matched normal control subjects. This study found that the antisocial and the schizoid personality disorders are typical for the molester group, and that at an interpersonal level this group can be typified by recollections of an uncaring father and mother, recollections of an elevated level of autonomy emanating from the father, and insecure current attachment patterns. The second study compares a subgroup of personality-disordered child molesters to a subgroup without personality disorders. This study revealed that recollections of the role of the father in parenting are decisive. The personality-disordered group reports that the father was both more uncaring and granted more autonomy. Regarding current adult attachment style, an avoidant and anxious-ambivalent attachment style characterised the disordered subgroup. We argue that the results can be useful for treatment. Since recalled parental experiences play a role in the development of personality disorders and child molestation, psychotherapists should integrate interpersonal tools into treatment, especially in therapeutic work with child molesters who received less parental sensitivity and suffer from personality disorders.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction Research indicates that subjective tinnitus severity varies among tinnitus patients. One of the variables held responsible for these differences is depression. However the relationship ...between depression and tinnitus severity was never investigated more in depth. Objectives If depression is responsible for differences in subjective tinnitus severity two conditions need to be fulfilled. First, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group, and second, there should be evidence for a substantial relationship between depressive symptoms and tinnitus severity which can not be explained due to method and content overlap. Aims In this study we investigated whether tinnitus severity is a depression related problem. Methods 136 consecutive help-seeking tinnitus patients were seen by a psychologist and an audiologist. All patients filled in the Beck Depression Inventory (BDI-II), the Tinnitus Handicap Inventory (THI), and underwent psychoacoustic measurement (pitch and loudness). Results Mean scores indicate the presence of no or minimal depressive symptoms. There was only a positive correlation (p < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis revealed that only the somatic depression subscale significantly predicted tinnitus severity. Conclusions Tinnitus does not seem to be a depression-like problem. There is no substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artefact due to content overlap between de THI and the somatic subscale of the BDI-II.
Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. ...Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one’s own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.
Purpose
Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown.
Methods
...In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis.
Results
Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (
n
= 12, 18%) and poor (
n
= 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (
P
= 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (
n
= 12, 18%) or without (
n
= 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former.
Conclusion
Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.
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