Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol

BACKGROUND: Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery.

METHODS/DESIGN: This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined.

DISCUSSION: This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce.

Phenomenology and the online : the importance of studying experience

 Phenomenological research into the online experience offers real value to Internet Studies and Digital Humanities scholars for three key reasons. Firstly, as an explicitly qualitative approach, it offers a way to gain insights into the experience of going online that are not identified by those who study behaviour alone. Secondly, as phenomenological studies focus on the individual rather than the collective, the resulting small sample size means that the investment required in terms of time spent with participants is minimised. Finally, the interpretation that emerges through the phenomenological research process produces categorisations that could form the basis on which larger scale, Big Data, quantitative research projects could be built.
This paper will explore the above ideas through the lens of my doctoral research, which uses hermeneutic phenomenology to investigate the experience of persona construction by artists on the fringes of the traditional art world, specifically craftivists, tattoo artists, street artists, and performance poets. By incorporating the interpretive categorisations that have come from my early discussions, I will demonstrate the strength of a phenomenological approach to investigating the experience of using the world and social media to present the self to the world.

Is Merleau-Ponty's position in phenomenology of perception a new type of transcendental idealism?

It has recently been suggested that Merleau-Ponty’s position in Phenomenology of Perception is a unique form of transcendental idealism. The general claim is that in spite of his critique of “Kantianism,” Merleau-Ponty’s position comes out as a form of transcendental idealism that takes the perceptual processes of the lived body as the transcendental constituting condition for the possibility of experience. In this article I critically appraise this claim. I argue that if the term “idealist” is intended in a sufficiently similar sense to Kant’s usage of the term in naming his position as a “transcendental idealism” then it is a misrepresentation to subsume Merleau-Ponty’s position under that term. This is because Merleau-Ponty rejects the transcendental metaphysics of the reflecting subject that underpins transcendental idealism. In its place he advocates a methodological transcendentalism that, whilst being anti-realist, is not idealist. Thus to call his position “a new kind of transcendental idealism,” as Sebastian Gardner has, is to misunderstand the significance of his existentialist break with what he sees as the “intellectualism” of this position.

"Your job no longer exists!" from experiences of alienation to expectations of resilience - a phenomenological study

We have entered the age of the contingent or temporary worker, the consultant and the subcontractor. Workers are expected to be pliable and tractable; to “fit in.” Being made redundant is also an area where modern workers are expected to be flexible and resilient. However, when these so-called “flexible” workers are told their job no longer exists, the accompanying sense of rejection and alienation can be excruciating. Stories of being made redundant were collected during an exploratory, qualitative study, using Heideggerian phenomenology as the methodological vehicle to capture the lived experiences of those affected. Focused, in-depth interviews were conducted with the ten respondents; nine men and one woman. The stories shared suggest that being made redundant is an alienating experience with respondents sharing feelings of powerlessness, shock, betrayal, shame and social isolation. Unfortunately, those having experienced redundancy were also not as resilient as is routinely assumed. They did not “bounce back” unchanged, but reported significant negative outcomes including fear for the future, underemployment, family disruptions and an erosion of trust. Recommendations are made orienting organisations towards a more human process of redundancy.

The body keeps the score

American animator Robert Breer has been credited in introducing the first visual bomb to cinema in his loop film Image by Images I (1954), Two abstract animated films by Robert Breer are examined: 69 (1968 5 minutes) and Fuji (1974 10 minutes). Using Merleau-Ponty’s phenomenological perspective, though these films are not representational or photographic in the traditional sense it is argued that they are still able to talk to us about real experiences because ‘the lived perspective, that which we actually perceive, is not a geometric or photographic one.’(Merleau-Ponty, 1964b: 14) 69 provides a metaphor for a system that collapses and Fuji as an articulation of that embodied seeing required for train travel. It is argued that Breer’s work in its explorations of style ahead of content is research into an act of viewing that offers a contemporary simulation of the impact of a traumatic experience on the body. Just as one cannot grab each object in the landscape at the speed of train travel nor can one grab or understand each frame that is presented to the retina of a Robert Breer film. What is required to attain “stillness” is a more dissociated way of looking that allows the images to wash over you. Such a “stillness” may be more about suppression than contemplation and could involve a process of metamorphosis.

Ego boundaries, shamanic-like techniques, and subjective experience : an experimental study

The subjective effects and therapeutic potential of the shamanic practice of journeying is well known. However, previous research has neglected to provide a comprehensive assessment of the subjective effects of shamanic-like journeying techniques on non-shamans. Shamanic-like techniques are those that demonstrate some similarity to shamanic practices and yet deviate from what may genuinely be considered shamanism. Furthermore, the personality traits that influence individual susceptibility to shamanic-like techniques are unclear. The aim of the present study was, thus, to investigate experimentally the effect of shamanic-like techniques and a personality trait referred to as "ego boundaries" on subjective experience including mood disturbance. Forty-three non-shamans were administered a composite questionnaire consisting of demographic items and a measure of ego boundaries (i.e., the Short Boundary Questionnaire; BQ-Sh). Participants were randomly assigned to one of three conditions: listening to monotonous drumming for 15 minutes coupled with one of two sets of journeying instructions; or sitting quietly with eyes closed for 15 minutes. Participants' subjective experience and mood disturbance were retrospectively assessed using the Phenomenology of Consciousness Inventory (PCI) and the Profile of Mood States-Short Form, respectively. The results indicated that there was a statistically significant difference between conditions with regard to the PCI major dimensions of visual imagery, attention and rationality, and minor dimensions of imagery amount and absorption. However, the shamanic-like conditions were not associated with a major reorganization of the pattern of subjective experience compared to the sitting quietly condition, suggesting that what is typically referred to as an altered state of consciousness effect was not evident. One shamanic-like condition and the BQ-Sh subscales need for order, childlikeness, and sensitivity were statistically significant predictors of total mood disturbance. Implications of the findings for the anthropology of consciousness are also considered.

Communication and meaning : the first year experience of off-campus study

The substantive field of the thesis is the sociology of distance education. The issues investigated centre on the relationship between off-campus students and the institutions of higher education with which they enrol, in which the first year experience is construed as an encounter between the students’ personal contexts and institutional cultures. A theoretical framework is constructed which synthcsises elements of phenomenology, hermeneutics and feminist theory. The author reports research into the way a small sample of people experienced off-campus study. The students selected resided in Victoria, Australia, and were enrolled with one of two Victorian tertiary institutions: the (then) Gippsland Institute of Advanced Education and Deakin University. Using a case study approach, the subjective experiences of the students were studied by means of a series of interviews which took place at their homes or places of employment in the period January 1988 to November 1989. Methodological issues relating to the application of hermeneutic principles to the use of interviews in educational research are explored. The results of the interpretation of the interview material are presented in terms of an integrationist model of socialisation. The thesis argued is that certain theoretical and practical issues in distance education are best understood as social and cultural phenomena rather than as technical problems. The implications of the findings about the effects of gender and culture on student experience are discussed in relation to the issues of access and equity, student support, and models of teaching and learning.

The phenomenology of being-meditative

This thesis addresses the experience of being-meditative using a philosophical perspective. It discloses the ontological dynamics of meditative-Dasein and reveals the meditative modes of being-at-rest, a cultural and social mode of being, whose perceptual intentionality is unified by the authentic Care for Being, thereby enabling a Homecoming.

Exploration of nurses' lived-experiences and understandings of the concept of healing

Explores nurses' understandings of the concept of healing, within the context of a nurse/patient relationship. Hermeneutic phenomenology is the research methodology and story-telling the means of data collection. From these descriptions, new understandings have been sought and therapeutic possibilities actively explored.

Locke, Kierkegaard, and the phenomenology of personal identity

Personal Identity theorists as diverse as Derek Parfit, Marya Schechtman and Galen Strawson have noted that the experiencing subject (the locus of present psychological experience) and the person (a human being with a career/narrative extended across time) are not necessarily coextensive. Accordingly, we can become psychologically alienated from, and fail to experience a sense of identity with, the person we once were or will be. This presents serious problems for Locke’s original account of “sameness of consciousness” constituting personal identity, given the distinctly normative (and indeed eschatological) focus of his discussion. To succeed, the Lockean project needs to identify some phenomenal property of experience that can constitute a sense of identity with the self figured in all moments to which consciousness can be extended. I draw upon key themes in Kierkegaard’s phenomenology of moral imagination to show that Kierkegaard describes a phenomenal quality of experience that unites the experiencing subject with its past and future, regardless of facts about psychological change across time. Yet Kierkegaard’s account is fully normative, recasting affective identification with past/future selves as a moral task rather than something merely psychologically desirable (Schechtman) or utterly contingent (Parfit, Strawson).

The lived experiences of third culture kids transitioning into university life in Australia

This study presents a new orienting framework to aid in the understanding of how Third Culture Kids' (TCKs) transition into university life in Australia. The framework was developed after analysis of data from a qualitative phenomenological research project using data from 12 in-depth interviews with Australian TCKs aged 18-27 years who, had spent 3-18 years living in Africa, Europe and Asia and had been in Australia for seven months to nine years. After thematic data analysis was conducted four themes emerged from the data which resulted in the development of a TCK Transition into University Model. This model includes four stages; (a) preparedness prior to transition, (b) initial experience during transition, (c) adjustment during transition and (d) stabilisation. Each of the four stages provides information about participants' practical, social and emotional experience of the transition to university life in Australia. The key findings included participants who received preparation from their school and family prior to moving, had practical support in Australia and engaged in Australian social networks and university life experienced improved emotional health and made way for a positive transition. Participants who were socially isolated and had limited practical support experienced relatively poor emotional health and transitional hardships. The findings from this research suggest that a TCKs' emotional and mental health during transition is either negatively or positively affected by the preparation they received prior to moving, the practical stressors they encountered upon arrival and the social integration into Australian social networks and universities. Further qualitative research in the area of TCK transition experiences should consider including the narratives of TCKs from various geographic backgrounds, sexualities, abilities and ethnicities to diversify and build on the evidence base around the TCK phenomenon. © 2014 Elsevier Ltd.

Exploring Heideggerian hermeneutic phenomenology: a perfect fit for midwifery research

BACKGROUND: Heideggerian hermeneutic phenomenology has been used widely to understand the meaning of lived experiences in health research. For midwifery scholars this approach enables deep understanding of women's and midwives' lived experiences of specific phenomena. However, for beginning researchers this is not a methodology for the faint hearted. It requires a period of deep immersion to come to terms with at times impenetrable language and perplexing concepts. OBJECTIVES: This paper aims to assist midwives to untangle and examine some of the choices they face when they first come to terms with an understanding of this methodology and highlights the methodology's capacity to reveal midwifery authenticity and holistic practice. DISCUSSION: The illumination of a selection of various concepts underpinning hermeneutic phenomenology will inform midwives considering this methodology as suitable framework for exploring contemporary midwifery phenomena.

Hermeneutic phenomenology: a methodology of choice for midwives

Hermeneutic phenomenology has been used widely by researchers to understand lived experiences. This methodology asserts that individual people are as unique as their life stories. The practice of midwifery is underpinned by a philosophy that values women and the uniqueness of their child-bearing journey. The tenets of hermeneutics phenomenology align with those of contemporary midwifery practice, making it a useful research methodology for providing insights into issues relevant to the profession. The purpose of this paper is to unravel some foundational concepts of hermeneutic phenomenology and recommend it as a methodology of choice for midwives to apply to their application to midwifery-in-action.

Making a difference: the experiences of midwives working with women who use illicit drugs

AIM: This article describes the experiences of midwives who choose to work with pregnant womenwho use illicit drugs.BACKGROUND: Pregnant women who use illicit drugs present complex challenges for those whochoose to work with them. Society’s views on illicit drug use fluctuate from acceptance and harm minimizationto reprimand and retribution.METHOD: Qualitative interviews were conducted between June and August 2009 with 12 Australianmidwives. A thematic analysis method informed by hermeneutic phenomenology was applied to interpretthis data to explicate lived experiences and gain deeper understanding and meanings of this phenomenon.FINDINGS: Three major themes encapsulated the experience: making a difference, making partnerships,and learning to let go. The focus of this article, “making a difference,” included two subthemes of“working on the margins” and “transition and transformation.” The midwives were both rewarded andchallenged by the needs of women who use illicit drugs and by the systems in which they worked.CONCLUSIONS: The midwives acknowledged that their aspirations “to make a difference” was notalways sufficient when working with women who use illicit drugs. They also require the establishmentof maternity services that are compassionate and accessible, including woman–care provider partnershipsand continuity of the care environments.