“Intrinsic time” and the minimal self: reflections on the methodological and metaphysical significance of temporal experience

This book investigates the complex, sometimes fraught relationship between phenomenology and the natural sciences. The contributors attempt to subvert and complicate the divide that has historically tended to characterize the relationship between the two fields. Phenomenology has traditionally been understood as methodologically distinct from scientific practice, and thus removed from any claim that philosophy is strictly continuous with science. There is some substance to this thinking, which has dominated consideration of the relationship between phenomenology and science throughout the twentieth century. However, there are also emerging trends within both phenomenology and empirical science that complicate this too stark opposition, and call for more systematic consideration of the inter-relation between the two fields. These essays explore such issues, either by directly examining meta-philosophical and methodological matters, or by looking at particular topics that seem to require the resources of each, including imagination, cognition, temporality, affect, imagery, language, and perception.

Are self-administered or minimal therapist contact psychotherapies an effective treatment for irritable bowel syndrome (IBS): a systematic review.

OBJECTIVE: Irritable bowel syndrome is a highly prevalent gastrointestinal condition that is known to be associated with maladaptive psychological coping and is extremely costly to the health-care system. Psychotherapy has been found to improve both physical and psychological symptoms in IBS. However, it is unknown whether 'no therapist' or 'minimal therapist' contact self-help psychotherapy programs are effective treatments for IBS. Thus, this paper aims to determine whether 'no therapist' or 'minimal therapist' contact self-help psychotherapy programs are effective treatments for IBS. METHODS: A search of PubMed, SCOPUS, Cochrane Library, and Ebscohost research databases was conducted without language or date restriction in July 2012. RESULTS: Nine relevant publications were included in the final review, all of which were randomized controlled trials (RCTs) and included an intervention that was primarily self-administered. It was found that 'no therapist' contact self-help programs are likely to have poor results due to lack of engagement in the program, whilst 'minimal therapist' contact programs appear to produce positive results in terms of symptom relief. Trends towards 'minimal therapist' contact self-help programs having a positive impact on quality of life (QOL) and psychological outcomes were evident. CONCLUSION: 'Minimal therapist' contact psychotherapy programs have the potential to reduce healthcare seeking behaviour and potentially reduce healthcare costs. However, further studies need to be conducted to confirm this effect as there is poor standardisation in the measurements of the available studies.

Indigenous peoples, self-determination and international law

The article examines the re-emergence of indigenous rights in contemporary international law in the context of worldwide agitation by indigenous peoples for the adoption by the United Nations of a Declaration on the Rights of Indigenous Peoples. Two approaches to the protection of indigenous rights are considered: a minimal one that relies on existing human rights conventions, and an inspirational one that seeks a Declaration negotiated in partnership with states willing to recognise indigenous autonomy. Attention is given to judicial recognition of the right to self-determination as a right of free choice, and to the distinction between minority rights and indigenous autonomy. The importance of defining indigenous self-determination in a positive way is emphasised, and prospects for a new UN permanent indigenous forum overcoming the stalemate about indigenous rights are reviewed in terms of the need for greater dialogue.

The influence of object-image velocity change on perceived heading in minimal environments

When human observers move forward and rotate their eyes, a complex pattern of light flows across the retina. This pattern is referred to as retinal flow. A model has been proposed to explain how humans perceive their direction of self-movement (or heading) from (1) static depth, (2) direction of image motion, and (3) whether image velocity undergoes acceleration or deceleration (Wang & Cutting, 1999). However, findings from past research in which sparse or minimalist stimuli were used have suggested that not all of the information to which participants are sensitive is captured within the scope of this model. In particular it has been suggested that the magnitude or size of image velocity change may be of significance beyond simply whether image velocity could be categorized as speeding up (i.e., accelerating) or slowing down (i.e., decelerating). In two experiments, the influence of this factor on heading judgments under minimal conditions was investigated. Evidence was found in support of the idea that the rate of image velocity change can influence judgments of the direction of self-movement in minimalist conditions.

The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

Social control, self-control and psychosocial problems in adolescent males

‘Psychosocial problems’ are psychological problems that are regarded as resulting from the interaction between the adaptive capacities of individuals and the demands of their physical and social environments. Many different factors have been theoretically proposed, and empirically established, as predictors of a range of psychosocial problems in adolescents. However, a problem exists in that this literature appears to lack an integrative framework that has validity across the range of problems that are observed. The purpose of the current research is to propose and test a model that draws together three clusters of factors that are useful in predicting the incidence of adolescent psychosocial problems. These are family structural background factors, family functioning variables and control beliefs. Data were collected from 155 adolescent males aged between 12 and 19 by a single concurrent and retrospective self-report questionnaire. This included data about the respondent (age, involvements with mental health or juvenile justice agencies) and family structural background factors (days per week worked by mother/father, occupational status for mother/father, residential mobility, number of persons in the family home). The questionnaire also incorporated the Parental Bonding Instrument (Parker, Tupling & Brown, 1979) to quantify the levels of perceived parental care and overprotection, and an adaptation of the Parental Discipline Style Scale (Shaw & Scott, 1991), to assess punitive, love withdrawing and inductive discipline practices. In addition, the (Low) Self-control Scale (Grasmick, Tittle, Bursick & Arneklev, 1993) and the Locus of Control of Behaviour Scale (Craig, Franklin, & Andrews, 1984) were used to collect data concerning adolescents’ perceived behavioural self-control and locus of control. Finally, selected sub-scales of the Child Behavior Checklist Youth Self-Report (Achenbach, 1991b) were used to collect data on the incidence of social withdrawal, somatisation, anxiety and depression, aggression and delinquency among the respondents, and in aggregated form, the incidence of ‘total problems’ and internalising and externalising behaviours. Results indicated family structural background factors, family functioning variables and control beliefs possess limited predicted validity and that the usefulness of the proposed model varies between specific psychosocial problems. Family functioning variables were generally stronger predictors than family structural background factors, particularly for internalising behaviours. Of these, levels of parental care and overprotection were generally the strongest predictors. Perceived self-control and locus of control were also generally strong predictors, but were particularly powerful with respect to externalising behaviours. The strength of predictive relationships was observed to vary between specific internalising and externalising behaviours, suggesting that individual difference variables not assessed in the current research were differentially influential. Finally, the parental and individual characteristics that predicted maximal levels of adjustment (defined in terms of minimal levels of internalising and externalising behaviours) were explored and the correlates of various parenting style typologies (Parker et al., 1979) were investigated. These results strongly confirmed the importance of family functioning and control beliefs with respect to the prediction of internalising, externalising and well-adjusted behaviours. In all analyses, substantial proportions of the variance in the incidence of problem behaviours remain unexplained. The findings are examined in relation to previous research focused on (familial) social control and (individual) self-control with respect to psychosocial problems in adolescents. In addition, methodological considerations are discussed and the implications of the findings for clinical and community interventions to address problem behaviours, and for further study, are explored.

Who benefits most from participating in chronic disease self-management programs?

Objectives: To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.
Research Design: People with a wide range of chronic conditions attending self-management courses (N=1,341 individuals) were administered the generic Health Education Impact Questionnaire (HEI-Q). Data were collected before the first session (baseline) and at the end of courses (follow-up) resulting in 842 complete responses. The median (interquartile range) age was 64 (54 to 73) years and most participants were female (75%). Outcomes were categorized as Substantial improvement (Effect Size, ES ≥ 0.5), Minimal/No change (ES -0.49 to 0.49) and Substantial decline (ES ≤ -0.5).
Results: On average, one third of participants reported substantial benefits after attending a self-management course. Proportions of participants reporting substantial benefits ranged from 49% in Skill and technique acquisition to 27% in Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.
Conclusions: Given that the health of people with chronic diseases tends to decline, this evaluation is reassuring in that about one third of participants coming from a wide range of backgrounds receive substantial improvements in their self-management skills.

A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:

The development of a conceptual model and self-reported measure of occupational health and safety vulnerability

Injuries at work have a substantial economic and societal burden. Often groups of labour market participants, such as young workers, recent immigrants or temporary workers are labelled as being "vulnerable" to work injury. However, defining groups in this way does little to enable a better understanding of the broader factors that place workers at increased risk of injury. In this paper we describe the development of a new measure of occupational health and safety (OH&S) vulnerability. The purpose of this measure was to allow the identification of workers at increased risk of injury, and to enable the monitoring and surveillance of OH&S vulnerability in the labour market. The development included a systematic literature search, and conducting focus groups with a variety of stakeholder groups, to generate a pool of potential items, followed by a series of steps to reduce these items to a more manageable pool. The final measure is 29-item instrument that captures information on four related, but distinct dimensions, thought to be associated with increased risk of injury. These dimensions are: hazard exposure; occupational health and safety policies and procedures; OH&S awareness; and empowerment to participate in injury prevention. In a large sample of employees in Ontario and British Columbia the final measure displayed minimal missing responses, reasonably good distributions across response categories, and strong factorial validity. This new measure of OH&S vulnerability can identify workers who are at risk of injury and provide information on the dimensions of work that may increase this risk. This measurement could be undertaken at one point in time to compare vulnerability across groups, or be undertaken at multiple time points to examine changes in dimensions of OH&S vulnerability, for example, in response to a primary prevention intervention.

A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer : accrual, retention, and data collection issues

PURPOSE: To examine the acceptability of the methods used to evaluate Coping-Together, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary efficacy data. METHODS: Forty-two couples, randomized to a minimal ethical care (MEC) condition or to Coping-Together, completed a survey at baseline and 2 months after, a cost diary, and a process evaluation phone interview. RESULTS: One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from Coping-Together. Only 44 % of the cost diaries were completed, and 55 % of patients and 60 % of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of Coping-Together were noted for both patients and their partners. CONCLUSIONS: This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.

Impact of sport context and support on the use of a self-report measure for athlete monitoring

Athlete self-report measures (ASRM) are a popular method of athlete monitoring in high-performance sports. With increasing recognition and accessibility, ASRM may potentially be utilized by athletes from diverse sport contexts. The purpose of the present study was to improve understanding of ASRM implementation across different sport contexts by observing uptake and compliance of a newly implemented ASRM over 16 weeks, and investigating the perceived roles and factors influencing implementation. Athletes (n=131) completed an electronic survey at baseline and week 16 on their perceptions and experiences with ASRM implementation respectively. Despite initial interest, only 70 athletes attempted to use the ASRM. Of these athletes, team sport athletes who were supported by their coach or sports program to use the ASRM were most compliant (p < 0.001) with a mean compliance of 84 ± 21 %. Compliance for self-directed individual and team sport athletes was 28 ± 40 % and 8 ± 18 % respectively. Self-directed athletes were motivated to monitor themselves, and rated desired content and minimal burden as key factors for initial and ongoing compliance. Supported athletes were primarily motivated to comply for the benefit of their coach or sports program rather than themselves, however rated data output as a key factor for their continued use. Factors of the measure outweighed those of the social environment regardless of sport context, however the influence of social environmental factors should not be discounted. The findings of the present study demonstrate the impact of sport context on the implementation of an ASRM and the need to tailor implementation strategies accordingly. Key pointsAthletes perceive ASRM and the factors influencing implementation differently. Therefore, to encourage compliance, it is important to tailor implementation strategies to the athlete and their sport context to increase appeal and minimize unappealing factors.Athletes using an ASRM on their own accord typically favor a measure which meets their needs and interests, with minimal burden.Athletes using an ASRM under the direction and support of their coach or sports program typically favor feedback and a positive social environment.

Illness cognitions and coping self-efficacy in depression among persons with low vision

PURPOSE: To investigate the mediating role of coping self-efficacy (CSE) between two types of illness cognitions (i.e., acceptance and helplessness) and depressive symptoms in persons with low vision.

METHODS: This was a single-group, cross-sectional study. Patients with visual acuity < 6/12 in the better eye and at least minimal depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) were recruited from vision rehabilitation services and participated in telephone-administered structured interviews at one time point. Measures were the PHQ-9, CSE Scale, and Illness Cognition Questionnaire. Structural equation modeling (SEM) devised the causal flow of illness cognitions and their observed indirect effects on depressive symptoms via the CSE mediators: problem focused, emotion focused, and social support.

RESULTS: The study comprised 163 patients (mean age 62 years; 61% female), most with age-related macular degeneration (26%) and moderate vision impairment (44%, <6/18-6/60). Structural equation modeling indices indicated a perfect fit (χ2 < 0.001, P = 1.00), accounting for 55% of the variance in depressive symptoms. Lower levels of acceptance and higher levels of helplessness illness cognitions were associated with lower self-efficacy in problem-focused coping (β = 0.38, P < 0.001, β = -0.28, P < 0.01, respectively), which in turn was associated with greater depressive symptom severity (β = -0.54, P < 0.001).

CONCLUSIONS: Lack of acceptance and greater helplessness relating to low vision led to a lack of perceived capability to engage in problem-focused coping, which in turn promoted depressive symptoms. Third-wave cognitive-behavioral treatments that focus on acceptance may be efficacious in this population.