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Die Beziehungserfahrungen von Krebspatient:innen und deren Veränderung durch existenzielle Psychotherapie: Einfluss auf die psychische Anpassung am Lebensende
No full textPatients' emotional and behavioral reactions to the numerous losses caused by cancer and its medical treatment have been studied using constructs of psychological and existential distress. Only little attention has been given to potentially adaptive processes, such as death acceptance and strong interpersonal relationships. Although relational aspects are prominent in constructs of existential distress, the role of patients' relationships is understudied, possibly due to the complexity of assessing subjective relational experiences. The paradigm of attachment theory has been proven useful in understanding interindividual differences in patients' reactions to cancer. Knowledge about underlying associations between attachment, perceived relatedness in interpersonal relationships, and psychological adaptation, especially in those patients who are particularly prone to feelings of isolation, may support the development of psychosocial interventions addressing patients' attachment and relational issues.
The research goals of this dissertation were (A) to investigate the value of death acceptance as an outcome of psychological adaptation, (B) to determine the impact of interpersonal relationships as operationalized by perceived relatedness on psychological adaptation, and (C) to identify the contribution of attachment avoidance as an underlying factor of psychological adaptation.
Adult cancer patients from two prospective studies were investigated. The first study had a longitudinal design and included 307 participants (n = 153 at 12-month follow-up) with mixed tumor diagnoses at early and advanced stages of their disease. The second study recruited 206 patients with advanced cancer and high distress to test the efficacy of a supportive-expressive psychotherapy in a randomized controlled trial at three- and six-month follow-up (n = 152, n = 125). Statistical analyses were based on empirical data from validated self-report questionnaires and included multinomial regression, multiple linear regression, and moderator regression analyses as well as mixed models and a mediated path model. Sessions of a patient's supportive-expressive therapy were analyzed qualitatively using the explication technique of content analysis.
The research goals were addressed in three quantitative and one qualitative publications. Publication 1 showed that mean death acceptance was moderate and did not change within one year. High death acceptance was predicted by older age, male gender, and a stage IV diagnosis. It was found to be a protective factor against high anxiety and high demoralization after one year. Publication 2 showed that mean perceived relatedness was high and significantly decreased within one year. Although it was a strong predictor for lower demoralization after one year across all tumor stages, there was no association between perceived relatedness and death acceptance. Publication 3 showed that mean attachment avoidance was high and did not change over the course of the psychotherapy. The relationship between higher death anxiety and lower demoralization and anxiety after six months was mediated by attachment avoidance. This effect was not found for the relationship between perceived relatedness and existential distress. Publication 4 illustrated these findings clinically. The avoidant pattern of a brain tumor patient during therapy was characterized by his need for self-reliance, emotional detachment, and withdrawal from interpersonal relationships. The term "avoidance" subsumed several defense mechanisms: denial of feelings of dependency, isolation of affect and displacement of overwhelming death-related distress, repression of feelings of guilt and shame, and projective identification to regulate interpersonal relationships. Yet, the patient benefited from the reliable therapeutic alliance, which helped him to express some of his emotional burden.
The present work showed that (A) death acceptance was of limited value as an outcome of psychological adaptation, (B) perceived relatedness had a strong predictive impact on psychological adaptation, and (C) attachment avoidance contributed to existential distress through its negative influence on relationship experiences at the end of life. These results stress the value of studying patients' attachment and relational issues separately and comprehensively. They also indicate that attachment is most likely an inherent characteristic that may serve either as a source of persistent vulnerability or as a protective factor against the distress caused by cancer, resulting in a limited advantage in explicitly targeting attachment security in psychosocial interventions. In health care settings, care providers may effectively work towards a (therapeutic) alliance, which takes into account patients' individual dependency needs. In order to improve the measurement of perceived relatedness, which was shown to be an important construct, instruments should reflect current positive and negative relational experiences as well as complex mutual processes. By supporting patients to expand their emotional flexibility, they may be enabled to express painful feelings. Thus, a joint mourning process acknowledging the losses associated with cancer may be initiated.In Folge einer Krebserkrankung und deren Behandlung erleiden Patient:innen zahlreiche Verluste. Die damit verbundenen emotionalen Reaktionen und Verhaltensweisen werden mit Konstrukten psychischer und existenzieller Belastung erfasst. Potentiell adaptiven Prozessen, wie der Akzeptanz des Todes oder zwischenmenschlichen Beziehungen, wurde dabei bislang nur wenig Aufmerksamkeit geschenkt. Obwohl Konstrukte existenzieller Belastung einzelne Aspekte zwischenmenschlicher Beziehungen berücksichtigen, ist die Bedeutung der Beziehungserfahrungen von Patient:innen für die psychische Anpassung an eine fortgeschrittene Krebserkrankung nicht ausreichend erforscht. Dies liegt womöglich an der Komplexität der zu messenden subjektiven Erfahrungen. Das Paradigma der Bindungstheorie hat sich als hilfreich erwiesen, interindividuelle Unterschiede in den Reaktionen der Krebspatient:innen zu verstehen. Ein tieferes Verständnis der zugrundeliegenden Zusammenhänge zwischen Bindungsmustern, wahrgenommener Bezogenheit in zwischenmenschlichen Beziehungen und psychischer Anpassung kann die Entwicklung psychosozialer Interventionen fördern. Insbesondere Patient:innen, die zu Einsamkeitsgefühlen neigen, könnten von Interventionen, die Bindungs- und Beziehungsprobleme thematisieren, profitieren.
Die Forschungsziele dieser Dissertation waren (A) die Bedeutung von Todesakzeptanz als einen Endpunkt psychischer Anpassung zu untersuchen, (B) den Einfluss zwischenmenschlicher Beziehungen, operationalisiert durch wahrgenommene soziale Bezogenheit, auf die psychische Anpassung zu bestimmen und (C) den Beitrag von Bindungsvermeidung als zugrundeliegenden Faktor für die psychische Anpassung zu ermitteln.
In zwei prospektiven Studien wurden erwachsene Krebspatient:innen untersucht. Für die erste Längsschnittstudie wurden 307 Patient:innen (n = 153 zur Katamnese nach zwölf Monaten) mit verschiedenen Tumordiagnosen in frühen und fortgeschrittenen Stadien ihrer Erkrankung eingeschlossen. Für die zweite Studie wurden 206 psychisch hochbelastete Patient:innen mit einer fortgeschrittenen Krebserkrankung eingeschlossen, um in einer randomisiert-kontrollierten Studie die Wirksamkeit einer supportiv-expressiven Psychotherapie nach drei (n = 152) und nach sechs (n = 125) Monaten zu testen. Die empirischen Daten für die Auswertung wurden aus Selbsteinschätzungsfragebögen gewonnen. Zu den durchgeführten statistischen Analysen gehörten multinomiale, multiple lineare, und moderierte Regressionen sowie Mixed Model-Analysen und ein Pfadmodell mit Mediation. Die Therapiegespräche eines Patienten wurden qualitativ mit Hilfe der Explikationstechnik inhaltsanalytisch ausgewertet.
Die Forschungsziele wurden in drei quantitativen und einer qualitativen Publikation beantwortet. Publikation 1 zeigte, dass die mittlere Todesakzeptanz in der Stichprobe moderat war und sich innerhalb eines Jahres nicht veränderte. Ein höheres Ausmaß an Todesakzeptanz war signifikant mit höherem Alter, männlichem Geschlecht und einer Stadium IV-Erkrankung assoziiert. Es schützte gegen stärkere Angst und hohe Demoralisierung nach einem Jahr. Publikation 2 zeigte, dass die mittlere wahrgenommene soziale Bezogenheit in der Stichprobe hoch war und nach einem Jahr signifikant abgenommen hatte. Obwohl wahrgenommene soziale Bezogenheit ein starker Prädiktor für geringere Demoralisierung nach einem Jahr war, bestand kein Zusammenhang zwischen wahrgenommener sozialer Bezogenheit und Todesakzeptanz. Publikation 3 zeigte, dass die mittlere Bindungsvermeidung in der Stichprobe hoch und über den Verlauf der Psychotherapie stabil war. Bindungsvermeidung mediierte die Beziehung zwischen stärkerer Todesangst und niedrigerer Demoralisierung und Angst nach sechs Monaten. Dieser Zusammenhang bestand zwischen wahrgenommener sozialer Bezogenheit und existenzieller Belastung nicht. Publikation 4 illustrierte diese Ergebnisse klinisch. Das vermeidende Bindungsmuster eines Patienten mit Hirntumor war in der Therapie gekennzeichnet von dem Bedürfnis nach Eigenständigkeit, emotionaler Distanz und dem Rückzug aus Beziehungen. Der Begriff Bindungsvermeidung subsummierte mehrere Abwehrmechanismen: Verleugnung zur Abwehr von Gefühlen der Abhängigkeit, Affektisolation und Verschiebung zur Abwehr überwältigender todesbezogener Ängste, Verdrängung zur Abwehr von Schuld- und Schamgefühlen, projektive Identifikation zur Regulierung von Beziehungen. Dennoch profitierte der Patient von der zuverlässigen therapeutischen Beziehung, die ihm half, einen Teil seiner emotionalen Belastung auszudrücken.
Die Ergebnisse der vorliegenden Arbeit zeigen, dass (A) die Bedeutung von Todesakzeptanz als Endpunkt für psychische Anpassung eingeschränkt war, (B) wahrgenommene soziale Bezogenheit einen starken Einfluss auf die psychische Anpassung hatte, und (C) Bindungsvermeidung aufgrund ihres negativen Einflusses auf Beziehungserfahrungen zu existenzieller Belastung am Lebensende beitrug. Sie unterstreichen den Wert von bindungs- und beziehungsrelevanten Aspekten für das Verständnis psychischer Anpassung am Lebensende sowie die Notwendigkeit einer unabhängigen Erhebung dieser Aspekte. Weiter deuten die Ergebnisse daraufhin, dass Bindung eine inhärente Eigenschaft ist, die eine Quelle anhaltender Vulnerabilität oder ein Schutzfaktor vor den durch Krebs verursachten Belastungen sein kann. Damit ist jedoch der Nutzen, Bindungssicherheit in psychosozialen Interventionen direkt zu bearbeiten, eingeschränkt. Für die klinische Praxis bedeutet das, dass Behandler:innen versuchen sollten, eine (therapeutische) Beziehung aufzubauen, die das individuelle Bedürfnis ihrer Patient:innen nach Autonomie oder Abhängigkeit berücksichtigt. Zur Verbesserung der Erhebung des Konstrukts der wahrgenommenen sozialen Bezogenheit, dessen Wichtigkeit diese Arbeit untermauert, sollten Instrumente entwickelt werden, die positive und negative Erfahrungen sowie die wechselseitigen Prozesse in Beziehungen messen. Indem die emotionale Flexibilität der Patient:innen in der Behandlung gefördert wird, kann es gelingen, schmerzhafte Gefühle auszudrücken, krebsbedingte Verlusterfahrungen anzuerkennen und so einen gemeinsamen Trauerprozess zu initiieren
Demoralisation and its link with depression, psychological adjustment and suicidality among cancer patients: A network psychometrics approach
No full textBackground: Demoralisation is a clinically significant problem among cancer patients with a prevalence of 13%–18%. It is defined by difficulty in adjusting to a stressor, wherein the person feels trapped in their predicament and experiences helplessness, hopelessness, loss of confidence and loss of meaning in life. Demoralisation has a strong link with the desire for hastened death and suicidal ideation among the medically ill. This study explored whether a group of symptoms could be identified, distinct from depression, but consistent with adjustment difficulties with demoralisation and linked to ideation of death and suicide.
Methods: Exploratory Graph Analysis, a network psychometrics technique, was conducted on a large German study of 1529 cancer patients. Demoralisation was measured with the Demoralisation Scale II and depressive symptoms with the PHQ-9.
Results: A network of symptoms, with four stable communities, was identified: 1. Loss of hope and meaning; 2. Non-specific emotionality; 3. Entrapment; 4. Depressive symptoms. The first three communities were clearly distinct from the PHQ-9 depressive symptoms, except for suicidality and fear of failure. Community 1, Loss of hope and meaning, had the strongest association with thoughts of death and suicide. Hopelessness, loss of role in life, tiredness, pointlessness and feeling trapped were the most central symptoms in the network.
Conclusions: Communities 1 to 3 are consistent with poor coping without anhedonia and other classic depression symptoms, but linked to suicidal ideation. For people facing the existential threat of cancer, this may indicate poor psychological adjustment to the stressors of their illness
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
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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