1,721,026 research outputs found
Cancer patients' experiences of using complementary therapies: polarization and integration
No full textObjective: The use of complementary therapies by people with cancer is commonplace. In a recent synthesis of 26 qualitative studies of patients' experiences of complementary therapy use after a diagnosis of cancer, the emergent theme of ‘polarization’ was the most notable barrier to a positive experience of complementary therapies. In this paper, we explore the two synthesis concepts of ‘polarization’ and ‘integration’, and their relationship to health service policies and guidelines on integrated services.Methods: A systematic literature search and a meta-ethnography to synthesize key concepts.Results: The majority of patients who used complementary therapies after a diagnosis of cancer wanted to be certain that the therapies were not interfering with their conventional cancer treatment. They valued the therapies in wider terms including: taking ‘a niche of control’, relieving symptoms, improving wellbeing, and promoting reconnection and social interaction. The emergent theme of ‘polarization’ suggested that conventional physicians who are perceived to be poorly informed or negative about complementary approaches induce patient anxiety, safety concerns, and difficulties in access. They may compromise their therapeutic relationship and, rarely, they may trigger patients to abandon conventional medicine altogether. In contrast, integrated advice and/or services were highly valued by patients, although some patients preferred their complementary health care to be provided in a non-medicalized environment.Conclusions: Our findings suggest that the current polarized situation is unhelpful to patients, detrimental to therapeutic relationships and may occasionally be dangerous. They indicate that complementary therapies, in a supportive role, should be integrated into mainstream cancer car
Communication participation of adult aided communicators with cerebral palsy; a discourse analytic approach.
No full textThe field of augmentative and alternative communication (AAC) has evolved since the 1970s, consequently there now exists a group of adults with cerebral palsy (CP), in the UK, who are life-time users of AAC prescribed as an intervention for their complex communication impairments.
Ten adults, aged between 20-55 years, participated in conversations about their unique life experiences and aspirations, using AAC, including voice output communication aids (VOCAs). The ability and opportunity to interact and communicate personal accounts has significance for conceptualizing outcomes of intervention. Clinical practice informed this research project. A qualitative research design was employed to explore questions about the extent to which adult aided communicators talk about their lives, aspirations and opinions; the past life experiences participants talk about and finally how they talk about their quality of life. Conversational-styled, semi-structured interviewing using literature-guided questions yielded rich interactional data. A discourse analytical approach to the 34 interviews was taken.
Findings identified a number of ordinary interactional features and discourses. Aided communicators used multimodal communication to interact and converse, positioning through their contributions as assertive speakers and engaged recipients. Interactional turns were managed with participants using unaided communication signals as conversational continuers. Participants demonstrated how to manage others who speak on their behalf. Examples of interactional repair were noted when participants pre-empted breakdown. Managing novel utterances was a feature with unexpected responses challenging the listener’s position.
Participants constructed VOCA-mediated utterances to share long-term memories, worries, satisfaction with life, and aspirations. Aspirations included community ambitions and creating fulfilling daily lives. Some participants expressed frustration but balanced this against a position of contentment. Some participants also demonstrated personal responsibility and positioned themselves through their talk as contributors to communities.
Recommendations for clinical practice are suggested that include the provision of adult clinical services and interaction focused intervention for adult aided communicators with cerebral palsy
The experience of using complementary therapies after a diagnosis of cancer: a qualitative synthesis
No full textThis article describes a qualitative synthesis of published research on cancer patients’ experiences of complementary therapies. We conducted a systematic search for qualitative studies on this subject published between 1998 and 2007. Twenty-six refereed journal articles met the inclusion criteria. These 26 articles were repeatedly read by the research team and key concepts emerging from them were identified. Differences and variations were examined in association with treatment, therapy type and by stage of cancer (early stage, mid-treatment, advanced cancer, palliative care and long term ‘survivors’). Six overarching concepts were located, which describe the key aspects of patients’ experiences of the use of complementary and alternative medicine after a diagnosis of cancer: Connection; Control; Well-being; Transformation; Integration; and Polarization. These are described in a ‘line of argument’ synthesis, and differences associated with treatment type and stage of disease are noted. The findings are presented in a table showing the six concepts according to treatment type and stage; as a composite story; and in a diagrammatic model showing the individual, practitioner and organizational levels. The synthesis identified various specific ways in which complementary therapies supported cancer patients, as well as occasional negative effects. The most notable barrier was the perceived polarization of complementary therapies and biomedicine; patients reported better experiences in integrated setting
Mindfulness-based stress reduction as an intervention for insomnia symptoms
Full text link*LITERATURE REVIEW*
Abstract Background: Insomnia is an increasing public health epidemic, affecting healthy, sub-clinical and clinical populations. Cognitive Behaviour Therapy for insomnia (CBT-I) is the most evidence-based treatment endorsed by the National Institute of Clinical Excellence (NICE) which provides guidance to health and social services in England. Research has demonstrated, however, that CBT-I has low or uncertain efficacy within various populations including those with coexisting health problems and clinical diagnoses. Furthermore, CBT-I is not accessible to most people due to poor prioritisation within services and a paucity of clinicians skilled in insomnia treatment. There is an urgent need to develop alternative interventions for this persistent and highly debilitating complaint. Acceptance based approaches to insomnia including mindfulness-based stress reduction (MBSR) provide an alternative model for holistic treatment of sleep distress. Objectives: This review summarises and synthesises the available literature investigating the effectiveness of MBSR as a treatment for insomnia in community and clinical populations (with some specific populations excluded). Method: Systematic review of all relevant quantitative and qualitative literature to date using PsycINFO, PsycARTICLES and Web of Knowledge databases. Results: 13 relevant articles were included (3 abstracts): randomised control trials (RCTs), experimental, quasi-experimental and qualitative studies. Conclusions: Overall, the limited research in this area was assessed to be of moderate quality and to provide preliminary evidence that MBSR offers an effective intervention for insomnia symptoms and disorder in various populations. The review highlighted the paucity of research specifically MBSR AND INSOMNIA SYMPTOMS 10 investigating the acceptability of MBSR as an insomnia treatment, particularly for more complex presentations. It is possible that MBSR provides holistic and bi-directional benefits for sleep and emotional well-being, however, further research is required to determine how participants experience the course process in relation to their sleep. Keywords: Insomnia, CBT-I, MBSR.
*EMPIRICAL PAPER*
Abstract: There is an urgent need to improve the availability and acceptability of interventions for insomnia. Low-levels of help-seeking and high levels of functional impairment are often characteristic of individuals with unremitting complaints. Ambivalence about the significance of insomnia and/or a helpless resignation can be further compounded by lack of available treatments and socio-cultural attitudes towards sleep. Insomnia is often complicated with coexisting mental and physical health problems, a syndromal presentation. Theoretical and empirical evidence suggests that eight-week, mindfulness-based stress reduction (MBSR) programmes may offer a holistic intervention to relieve emotional disturbance that may underlie the complaint. This research sought to understand the experience of MBSR for individuals in the community with persistent insomnia, to gain insight into its acceptability. Methods: Holloway and Jefferson’s psychosocial method was used which posits the ‘defended subject’ as key to data construction and analysis (2013). Defences, free associations, researcher-interviewee dynamic, textual information, cultural and sociological knowledge all contributed to an understanding of the ‘whole’ of the experience of interviewees as communicated within Free Association Narrative Interviewing. Results: Results indicate that for highly defended individuals with insomnia, MBSR can be a challenging intervention to engage with and to embody. Barriers to acceptability included: limited insight into emotional distress, (unconscious) relational secondary gains to insomnia, limited understanding of sleep as a physiological process, restricted understanding or misconceptions about mindfulness prior to participation, resistance to acknowledging insomnia MBSR AND INSOMNIA SYMPTOMS 66 as a mental health complaint and practical issues of delivery. Researcher-interviewee dynamics suggested significant unmet relational needs of many interviewees. An exceptional case was discussed where relational distress was not understood to underlie insomnia and where significant benefits to sleep were reported from MBSR. Conclusion: The methodology enabled novel insights into the challenges for highly defended individuals with complex insomnia for accessing MBSR. By contrast, it is possible that for less complex but acute and recurrent insomnia, MBSR is more readily acceptable. Study limitations, future research needs and recommendations for improving the acceptability of MBSR for complex cases of insomnia are discussed
Investigating attachment narratives in couple therapy for depression
No full textObjective: The Exeter Model is an integrative systemic-behavioural and systemic-empathic couple therapy for treating people with depression. ‘Attachment narratives’ is a component of the systemic-empathic approach, which seeks to help the couple understand how past relationships impact on the current relationship with the aim of rebuilding trust and security between the couple. This study sought to examine how attachment narratives in this Model are used by therapists.
Method: Narrative Analysis was employed to explore attachment narratives in three couples who had completed therapy in an outpatient clinic where one member of the couple had been referred with depression.
Results: Analysis highlighted four specific ways in which therapists used attachment narratives. These consisted of: therapist enabled stories of past relationships to be foregrounded; attachment theory employed to build hypothesis about attachment styles based on past relationships; therapist helped the couple understand how attachment styles maintain unhelpful cycles of relating and introduced alternative relationship narratives enabling improved trust and security. Analysis also demonstrated the structuring of these attachment narratives across the therapy sessions.
Conclusion: This study shows that through the therapist paying attention to attachment styles, awareness of unhelpful cycles of relating within couples can be highlighted, and adjustments to how the couple can relate to each other suggested. This exploratory study serves to better inform the use of the Exeter Model
Was this rape? Exploring women’s use of an online rape and sexual assault forum: A qualitative analysis
Full text linkEvidence suggests that few women disclose, seek help or report their experiences of rape or sexual assault (RSA) to police, which may leave them vulnerable to Post-Traumatic Stress Disorder (PTSD). However, some women may disclose and seek help or support anonymously online. Through conducting a thematic analysis of 212 messages posted by women in an online RSA support forum, I identified two key themes relating to women’s possible motivation for using the forum: to seek validation as a victim of RSA and for others to bear witness to her story. Themes relating to the possible functions of the forum were serving as a jury, assigning blame, encouraging disclosure or help-seeking, and providing emotional support. These findings suggest that women whose experiences of RSA do not match stereotypical depictions may use online forums to anonymously seek out validation that their experiences qualify as RSA. Moreover, the findings suggest that online platforms may provide women with a safe and supportive environment in which to develop a coherent narrative of their experiences of RSA, which in turn may assist some women’s recovery from the trauma of RSA. Future research might explore if NHS online support or psychological interventions are therapeutic for this population
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
In the mind of the mother: mental representation of the internal space of the mother, self and therapist in borderline states
No full textPeople with Borderline Personality Disorder (BPD) have a particular difficulty in forming and maintaining close relationships. The Relational Affective Model (Mizen, 2014) proposes that intimate relationships activate claustro-agoraphobic anxieties as the person alternately seeks and flees emotional closeness. The therapeutic relationship is a specialised kind of intimate relationship in which claustro-agoraphobic anxieties are likely to be activated in a process which psychoanalysis understands as transference. The understanding and working through of this transference is the mutative factor proposed in psychodynamic therapies. This study explored participants’ mental representation of the internal psychic space of the other.
Ten people with a diagnosis of BPD were asked to describe themselves and significant others, including their therapist in order to understand more about (1) their mental representations of the internal space of the other; (2) their relationship with their therapist with reference to internal space. and (3) the implications for the Relational Affective Model and clinical understanding of BPD.
Using a mixed qualitative methodology four broad but distinct ways of describing internal space states emerged: positive, negative, nondescript and merged, which I have termed Alpha, Omega, Non-Alpha and Merged.
Case study analyses for the four participants who provided interviews at the beginning and end of their treatment were conducted to attempt to highlight any changes in the internal space states identified.
A thematic analysis of therapist descriptions indicated participants were positively engaged with their therapist. Negative internal space (Omega) descriptions of self and mother did not transfer to the relationship with the therapist in the early stages of therapy. The implications for the Relational Affective Model are considered
‘I didn’t fit the stereotype of autism’: A qualitative analysis of women’s experiences relating to diagnosis of an autism spectrum condition and mental health
Full text linkAutism spectrum conditions are generally perceived to affect males, with the majority of studies quoting the ratio of four males being diagnosed with autism for each female. The potential implications of this for women on the spectrum or seeking a diagnosis are wide-ranging, including healthcare professionals’ disbelief in autism in women leading to difficulties obtaining a diagnosis and misdiagnosis of other mental health conditions. In this study, a grounded theory methodology was applied to data from fifteen online blogs to explore the experiences of adult women on the autism spectrum of diagnosis of autism, and of mental health issues. The study yielded two grounded theory models: of diagnosis of autism and of mental health, which are linked through misdiagnosis of and comorbid mental health conditions. The findings suggest that there is a need for clinicians to be aware of the unique presentation of autism in women, and of the additional mental health issues which women with autism commonly experience. Additionally, targeted autism-specific interventions may be required, focussing on the core difficulties of autism as opposed to the resultant emotional and mental health difficulties
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