The recommended treatment for
dual diagnosis
- the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no ...integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if
Enactive Psychiatry
may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice.
Self-focused thoughts may be both adaptive and maladaptive. We asked 67 patients who had received a colon-cancer diagnosis within the past 1–7 months to complete measures of rumination, reflection, ...intrusive and avoidance symptoms and depressive symptoms. At 8 months follow-up they completed the same measures. Higher rumination at time 1 was associated with more symptoms at both times 1 and 2. Reflection at time 1 did not show any associations with symptoms at time 1 and 2. However, time 1 reflection predicted higher time 2 avoidance symptoms, while controlling for time 1 avoidance symptoms. This suggests that while reflection may not be as maladaptive as rumination, it may still under some circumstances be associated with increased symptoms.
Rumination is related to depression as well as to anxiety and anger. However, since these negative emotions are interrelated, it is not known whether rumination is independently related to each of ...these emotions. Previous studies have suggested an association between rumination and poor sleep quality or sleep disturbances, and between negative emotions and sleep disturbances. However, since rumination and negative emotions are linked, it is difficult to know if both negative emotions and rumination are associated with sleep quality. The purposes of this study were to investigate how rumination is related to different negative moods and whether rumination and negative mood may be independently associated with subjective sleep quality at a non-clinical level. Subjects were 126 students, who completed questionnaires measuring rumination, mood and sleep quality. The results showed that rumination was independently associated with angry and depressive mood. There were significant associations between rumination, negative mood and subjective sleep quality. Rumination was found to be significantly associated with subjective sleep quality even after controlling for negative mood.
•Narrative identity was moderately stable over 1 year.•Narrative identity was less stable that personality traits over 1 year.•Chapters were more stable components of narrative identity than ...memories.•No age differences in narrative identity stability over 1 year.
We examined 1-year stability of life story chapters and memories. In addition, we examined age differences in stability. At baseline and 1 year later, 70 emerging, 60 middle-aged, and 59 older participants described up to 10 chapters and 10 memories (in counterbalanced order). Participants self-rated chapters/memories on emotional tone, self-change connections, and self-stability connections. Chapters/memories were content coded for stability between time 1 and 2 and for emotional tone. Chapters were significantly more stable than memories. However, there were no significant differences between chapters and memories regarding stability of associated emotional tone, self-change connections, and self-stability connections. We found few age differences in stability. The results suggest that chapters may play a central role in the stability of narrative identity.
The aim of this paper is to present our experiences from a shared working group (SWG) with patient representatives and researchers. The SWG collaborated on developing a psychosocial cancer ...rehabilitation intervention for women treated for breast cancer and men treated for prostate cancer and on the planning of an effect study of this intervention.The SWG included five patient representatives (three women treated for breast cancer and two men treated for prostate cancer), four researchers and a research assistant. The SWG met four times during the year where the intervention was developed. Data material for the present evaluation study comprises meeting documents, transcriptions of interviews with two patient representatives and three researchers from the SWG, and the primary investigator's field notes.The collaboration between patient representatives and researchers informed both the intervention and the research planning and was rewarding for the involved participants. The well-structured organization of the collaboration had a positive impact on the outcome. In addition, clear goals and clarification of expectations were important. Challenges were encountered in keeping continuity between meetings and carrying out homework as intended. It was crucial for the collaboration that patient representatives had specific knowledge, interest and motivation for the project.Involving patient representatives in the research process heightened the relevancy of the research and the quality of its contents. The SWG gave patient representatives and researchers a better mutual understanding. Overall, the conclusion is that the benefits obtained by involving patient representatives exceeds the additional costs this involves.
The aim of the paper is to present experiences of researchers collaborating with patients in a shared working group comprising patient representatives and researchers. Experiences are deduced from the evaluation of the work in the working group, which collaborated on developing a psychosocial cancer rehabilitation intervention for women treated for breast cancer and men treated for prostate cancer and the planning of a randomized controlled trial that investigates the effect of this intervention.
Five patient representatives (three women treated for breast cancer and two men treated for prostate cancer), four researchers and a research assistant participated in the shared working group. The shared working group met four times during the year the intervention was developed. Data material for the present evaluation study was collected from meeting documents, transcriptions of interviews with two patient representatives and three researchers from the shared working group, and the primary investigator's field notes. The data analysis was guided by Sandelowski's qualitative description strategy.
The collaboration between patient representatives and researchers informed the intervention and the research planning and was rewarding for the involved participants. The well-structured organization of the collaboration had a positive impact on the outcome. Also, clear goals and clarification of expectations were important. Challenges were encountered in ensuring continuity between meetings and carrying out homework as intended. It was considered crucial for the collaboration to recruit patient representatives with specific knowledge, interest and motivation for the project. The direct costs related to the shared working group, including meals, transportation and salary for the research assistant, were small. However, the indirect costs in terms of time spent on planning patient-involving elements of, organizing meetings and evaluation were substantial and demanded a significant amount of extra work for the primary investigator.
Involving patients in the research process heightened the relevancy of the research and the quality of the research contents. The shared working group influenced both patient representatives and researchers and gave them a better mutual understanding. Overall, the conclusion is that the benefits obtained by involving patients exceed the additional costs related to patient involvement.
Det er et udbredt empirisk fund, at ældre personer ikke rapportererlavere livstilfredshed end yngre. Faktisk vil man kunne mødemange 80-årige, som oplever færre negative følelser end mange20-årige. ...Da et langt liv uundgåeligt medfører tab, en aldrendekrop svækkes, og sygdom bliver mere udbredt med alderen, forekommerdette paradoksalt: Hvorfor er alderdommen ikke forbundetmed dårlig livskvalitet og negative følelser? En mulig forklaringpå dette kan være, at man gennem voksenlivet tilegner sig enstadig mere velfungerende evne til at håndtere sine følelsesmæssigereaktioner på de belastninger, man møder. At der sker en udviklingi evnen til adaptiv emotionsregulering. En sådan udviklingkan måske accelereres, når en ny livssituation opstår, og der stillesekstra store krav til emotionsregulering.I denne longitudinelle spørgeskemaundersøgelse blev firegrupper af mænd fulgt i fem måneder. Deltagerne var fædre(n=97) omkring fødslen af deres første barn, mænd med testikelkræft(n=33) lige efter diagnosen, mænd, der blev pensioneret(n=79), og en kontrolgruppe af mænd (n=92), der ikke oplevedestørre livsændringer.Resultaterne viser, at gruppernes psykologiske trivsel udvikledesig forskelligt. Kræftpatienterne fik det bedre, fædrene fikdet dårligere, mens pensionisters og kontrolpersoners trivselvar uændret. I alle grupper sås ændringer i emotionsreguleringsstrategier,og grupperne adskilte sig signifikant i udviklingenaf accept, positiv revurdering og perspektivering. Der vardog ikke et gennemgående mønster i ændringerne, og der varikke aldersforskelle i udviklingen af strategier. Så samlet setgiver studiet ikke et klart svar på, om livstransitioner er forbundetmed udvikling af emotionsregulering.
It is empirically well established that older adults do not report lower lifesatisfaction levels than younger adults. Many 80-year-old individuals experiencefewer negative emotions than 20-year-olds do. Why is old age notassociated with low quality of life and negative affect when most peopleexperience loss, reduced physical functioning and disease over the course oflife? An improved ability to manage distress and regulate the emotionalresponse to life stressors in late life could explain this paradox of ageing. Ifadults continuously develop adaptive emotion regulation, such developmentmay accelerate during periods of change where the individual meet newchallenges and established strategies may be inefficient.In this longitudinal questionnaire study, men answered monthly questionnairessix times about their psychological well-being and emotion regulationstrategies while undergoing a life transition. The participants included firsttimefathers (n=97), men diagnosed with testicular cancer (n=33), men whoretired (n=79), and a control group of men who did not experience any significantlife events (n=92).Results showed that psychological well-being developed differentlywithin the groups during the observation period. Well-being in cancerpatients improved, while for fathers it declined, and it did not change forretirees and controls. All groups changed in reported use of emotion regulationstrategies, and the groups differed in changes in acceptance, positivere-appraisal, and perspective. However, the pattern of change was inconsistent,and there were no age differences in the development of strategies. Inconclusion, the study did not provide a clear picture of potential developmentin emotion regulation during life transitions.
Individuals interpret events in positive and negative ways, creating positive and negative meaning in their life stories. We hypothesized that higher trait anxiety measured 10years earlier would ...predict more negative meaning-making in life stories and that negative meaning-making would be related to more concurrent depressive symptoms. Participants were 272 women who had undergone fertility treatment and completed measures of trait anxiety 10years earlier. In the present study, they described five life story events and rated these on emotional tone and meaning-making. A path analysis showed that higher trait anxiety predicted more negative meaning-making 10years later and that negative meaning-making predicted more concurrent depressive symptoms after adjusting for baseline depressive symptoms, trait anxiety, and education. The results suggest that life stories are important to well-being.
•Meaning-making may be both positive and negative.•High trait anxiety predict negative meaning-making in life stories 10years later.•Meaning-making predicted depressive symptoms after control for trait anxiety.
Cross-sectional studies have suggested an association between rumination and subjective health. The aim of the present study was to investigate in a longitudinal design whether rumination was related ...to self-reported physical health. A total of 96 young (age range 20-35) and 110 elderly (age range 70-85) participants completed questionnaires measuring rumination, negative affect, life events, and self-reported physical health at baseline and at 1-year follow-up. Multiple linear regressions showed a significant association between self-reported physical health at time I only for the elderly and negative affect mediated the association. At follow-up, rumination was significantly associated with self-reported physical health only for the young and the association was only partly mediated by negative affect. In conclusion, rumination is associated with poorer self-reported physical health, but the association depends on the age of the individual as well as time span studied.
Purpose
Cannabis use in the context of psychosis has been shown to have a negative impact on prognosis and yet it is difficult to treat. Recent randomized controlled trials all have negative findings ...and novel approaches is sought after. This paper aims to use an embodied cognition framework to add to the understanding of cannabis use in psychosis.
Design/methodology/approach
The paper presents longitudinal, qualitative data on two individuals diagnosed with schizophrenia and using cannabis at least twice weekly prior to inclusion in the study. Factors influencing cannabis use were mapped in dialogue with the participants. Each participant was interviewed six times over the course of a year. The analysis was informed theoretically to describe processes maintaining or ameliorating cannabis use over time.
Findings
This study shows that a systems approach for understanding changes in cannabis use is meaningful; the richness of observations add to the understanding of differences in outcomes. Findings suggest that reductions in cannabis use in psychosis could be dependent on synergistic effects between contextual conditions. Attending closer to the experience of patients may help inform future interventions. However, interventions focusing on single mechanisms may be futile, if an array of individual, formative experiences are a prerequisite for change. A systemic understanding of dual diagnosis calls for tailored, individualized interventions.
Originality/value
The research tests a novel systemic perspective on cannabis use in psychosis by applying it to qualitative longitudinal data. Adding a systemic perspective may help develop future interventions addressing cannabis use in psychosis, which has long been considered a “hard problem” in dual diagnosis treatment.
2020 saw the rapid onset of a global pandemic caused by the SARS‐CoV‐2 virus. For healthcare systems worldwide, the pandemic called upon quick organization ensuring treatment and containment measures ...for the new virus disease. Nurses were seen as constituting a vital instrumental professional component in this study. Due to the pandemic's unpredictable and potentially dangerous nature, nurses have faced unprecedented risks and challenges. Based on interviews and free text comment from a survey, this study explores how ethical challenges related to “being a nurse” during the COVID‐19 pandemic was experienced and understood by Danish hospital‐based nurses. Departing from anthropologist Jarett Zigon's notion of moral breakdown, the study demonstrates how the rapid onset of the pandemic constitutes a moral breakdown raising ethical demands for nurses. Analytically we identify three different ethical demands experienced by the nurses. These ethical demands are Nursing and societal ethical demands, Nursing and personal ethical demands, and Nursing and conflicting ethical demands. These demands represent not only very different understandings of ethical demands but also different understandings of ethical acts that are seen as necessary to respond to these demands.
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