Incorporating cognitive-behavioral therapy with occupational therapy: A comparative study with patients with low back pain

This paper reports on the implementation of a psychoeducational program utilizing cognitive-behavioral principles. The efficacy of this psychoeducational treatment program in modifying dysfunctional attitudes in patients with chronic low back pain was examined using a two-group pretest posttest design with a follow-lip at 3 months Thirty patients (average age = 44.37 SD = 13.71) participated in the study, with 15 in the psychoeducational treatment group and 15 in the placebo control group. These two conditions were added on to an existing eclectic inpatient pain management program. After assessment on the IPAM (The Integrated Psychosocial Assessment Model), scores were reduced to multivariate composite scores on the factors of illness behavior depressed and negative cognitions, and acute pain strategies. Results of a group x time repeated measures analysis of variance for the three pain factors revealed a significant main effect for group (F(23,1) = 5.00 p < .04), tempered by a significant interaction between group and rime on the 'depressed and negative' pain factor (F(23,1) = 4.77 p < .04). Patients in the treatment group improved significantly over time and significantly more than the placebo control group patients at posttreatment. Results provide support for the program in increasing patients' feelings of control over their pain and the use of positive coping strategies, while reducing perceived helplessness, depression, disability, and pain intensity.

Women's health Australia: On the progress of the main cohort studies

More than 41,000 women aged 18-23, 45-50, and 70-75 years in 1996 are participating in the Australian Longitudinal Study on Women's Health (Women's Health Australia). Baseline surveys were conducted for all three cohorts in 1996, and the first follow-up survey of the mid-age group in 1998 has achieved a response rate exceeding 90%. The main findings so far reflect the large differences in the life experiences of the three cohorts. The young women report high levels of stress. The physical and mental health of those with young children is worse than for those without children, but confounding by sociodemographic characteristics may account for the differences. Two thirds of young women in the healthy weight or underweight range would like to weigh less, and early onset of dieting is associated with poorer physical and mental health. Most of the women in the mid-age group have multiple roles-in paid work, home duties, and caring for children and other dependents. The potential of the study to investigate the long-term impact of such busy lives on health outcomes is considerable. At this stage, the main health issues for these women relate to tiredness, weight gain, and menopause. The older cohort presents a picture of positive aging. These women are heavier users of health services than the mid-age and younger women, and they are also more satisfied with these services. Although their physical health is poorer, their mental health is better, and they report less stress than women in the other two cohorts. The follow-up survey of this group, planned for 1999, will focus on the coping strategies used by these women. An overall goal of the project is to understand the interactions among social roles, life events, and women's health in order to provide a basis for improved health policies and services. Analysis of these interactions, which relies on both quantitative and qualitative data, poses many challenges that will be addressed as the longitudinal data become available.

Effects of a program of intervention on parental distress following infant death

A longitudinal study of 144 patents (65 fathers, 79 mothers) was conducted to evaluate the effectiveness of a program of intervention in relieving the psychological distress of parents affected by infant death. Participants were assessed in terms of their psychiatric disturbance, depression, anxiety, physical symptoms, dyadic adjustment, and coping strategies. The experimental group (n = 84) was offered an intervention program comprising the use of specially designed resources and contact with a trained grief worker. A control group (n = 60) was given routine community care. Parental reactions were assessed at four to six weeks postloss (prior to the implementation of the intervention program), at six months postloss, and at 15 months postloss. A series of multivariate analyses of valiance revealed that the intervention was effective in reducing the distress of parents, particularly those assessed prior to the intervention as being at high-risk of developing mourning difficulties. Effects of the intervention were noted in terms of parents' overall psychiatric disturbance, marital quality, and paternal coping strategies.

What is an effective health consumer? A convergent interviewing approach

This study is part of a larger project on the measurement of effective health consumers in the context of musculoskeletal illness. This complex issue involves the progressive nature of the disease, invisibility of the illness and attendant impairments, complexity of decision-making and negotiation, and urgent need to translate emergent evidence about treatment and management to patients and health professionals. We conducted indepth interviews with patients, family members, general practitioners, specialist clinicians, and health consumer advocates (N = 84) about effective consumers in this context, using a process of convergent interviewing, with convergence conducted within and across groups and countries. The initial set of themes included information seeking and adaptation, decision-making, roles of patients, GPs, and specialists and communication between them, importance of pain and impact of depression, impact of the social environment (including the invisibility of the disease and the need for a normal life), and coping strategies.

Attachment and spousal caregiving

A community sample of 362 married couples participated in a study of attachment and spousal caregiving, which combined qualitative and quantitative components. The qualitative component focused on actual experiences of caregiving, assessed by participants' semi-structured accounts of a situation involving their role as caregiver for their spouse, Attachment styles and their underlying dimensions (comfort with closeness, anxiety over relationships) were related to the type of support provided, the coping strategies used in the situation, caregivers' feelings about the quality of their care, perceived effects on the couple bond, and the emotional tone of the accounts. The quantitative component tested a theoretical model of factors predicting willingness to provide care for the spouse if he or she should become dependent in later life. Measures of attachment and caregiving styles, attachment to spouse, and anticipated burden provided reliable prediction of willingness to care. The results support the conceptualization of attachment and caregiving as interrelated features of marital bonds, and they have important implications for patterns of family caregiving.

Loss as a universal concept: Review of the literature to identify common aspects of loss in diverse situations

It has long been recognized that loss and its associated grief are important elements of many adverse life events that affect the entire global population: death, disability, traumatic events, abuse., terminal and chronic illness, aging, addiction, unemployment, relationship breakdown, war, migration, and educational failure. While there is significant empirical evidence of the potential deleterious effects of specific situations of loss across the global community, systematic discussion concerning the common elements of loss that are associated with adverse life situations in general has been limited. This review of the theoretical and empirical literature concerning various losses and the recommendations for care of those affected by such losses identifies common aspects of situations of loss and common recommendations in the care of those confronted by such losses. These common themes of loss are described by simple summary statements that can be communicated to a broad audience, hence enhancing community education and, potentially, community-wide mental health promotion.

Short communication: Extended shifts in ambulance work: influences on health

Shiftwork is a major source of stress for many worker's. This study highlights the role that organizational and psychosocial variables play in alleviating the negative health effects of 10 and 14-h shifts. It examines the direct and mediated effects of coping strategies, social support and control of shifts on work/non-work conflict and subjective health. Participants are 60 ambulance workers, aged 22 to SS years. A structural equation model with good fit demonstrates complex effects of social support from various sources (supervisors, co-workers and family), coping and control on work/non-work conflict and subjective health., Conceptually, the research contributes to the development of a theoretical framework that can assist in explaining how key psychosocial and organizational variables influence the psychological and physical symptoms experienced by shiftworkers. Copyright (C) 2002 John Wiley Sons, Ltd.

Development of the HIV/AIDS stress scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS: hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS v ere interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms. reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal. and differs from control liability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.

Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors

Research has indicated a weak relationship between the degree of physical problems and quality of life in patients with chronic obstructive pulmonary disease (COPD). The importance of adaptive psychological functioning to maintain optimum quality of life has long been recognized, but there is a lack of empirical evidence concerning the nature of psychological factors involved in adjustment to COPD. Ninety-two males completed questionnaires to determine their coping strategies, levels of self-efficacy of symptom management and social support. Adjustment was measured in terms of depression, anxiety and quality of life. Symptom severity, socioeconomic status, duration of disease and age, which have been demonstrated to be of consequence in COPD, were used as control variables in hierarchical multiple regression analyses. Higher levels of catastrophic withdrawal coping strategies and lower levels of self-efficacy of symptom management were associated with higher levels of depression, anxiety and a reduced quality of life. Higher levels of positive social support were linked to lower levels of depression and anxiety, while higher levels of negative social support were linked to higher levels of depression and anxiety. To maximize quality of life in patients with chronic obstructive pulmonary disease, psychological factors need to be carefully assessed and addressed.

Adesão ao tratamento por cuidadores de crianças e adolescentes soropositivos para o HIV

Objetivou-se investigar o padrão de adesão ao tratamento por cuidadores de crianças e adolescentes HIV positivos e identificar as estratégias de enfrentamento adotadas diante de estressores da soropositividade. Participaram 30 cuidadores e utilizou-se entrevista semiestruturada, Escala Modos de Enfrentamento de Problemas e prontuário clínico, este como fonte de dados secundários. Os cuidadores foram classificados em Grupo Adesão e Grupo Não-Adesão com base em seus relatos sobre condutas de uso dos medicamentos antirretrovirais e outros critérios. Vinte e cinco cuidadores foram incluídos no Grupo Adesão. Não se observaram diferenças significativas quanto ao enfrentamento entre os grupos, excetuando a busca de práticas religiosas/pensamento fantasioso. Os resultados dão subsídios para intervenções visando reduzir impactos psicossociais da soropositividade a cuidadores, crianças e adolescentes. ______________________________________________________________________________ ABSTRACT

Análise fatorial de uma medida de estratégias de enfrentamento

O objetivo do estudo foi investigar a estrutura fatorial da Escala Modos de Enfrentamento de Problemas - EMEP, na versão adaptada para a população brasileira por Gimenes e Queiroz (1997), para mensurar estratégias de enfrentamento em relação a estressores específicos. A amostra foi composta por 409 adultos de ambos os sexos, onde 252 consideraram como estressor um problema atual que estivesse ocasionando estresse, enquanto 157 foram pessoas portadoras de enfermidades crônicas, que responderam à escala com base no problema de saúde que estavam apresentando. Foram extraídos quatro fatores pelo método dos eixos principais, rotação ortogonal: estratégias de enfrentamento focalizadas no problema, estratégias de enfrentamento focalizadas na emoção, práticas religiosas/pensamento fantasioso e busca de suporte social. A análise dos achados nas duas sub-amostras, diferenciadas quanto aos estressores dominantes, sugere possibilidades positivas de aplicação em contextos de pesquisa e de intervenção profissional, em especial a atuação clínica voltada para manejo do estresse junto a diferentes clientelas. _______________________________________________________________________________ ABSTRACT

A mamografia: experiência psicológica, atitudes e comportamentos do técnico de radiologia facilitadores da colaboração da mulher

RESUMO: A mamografia é o método de diagnóstico mais eficaz para deteção precoce de carcinoma da mama. A realização periódica deste exame tem vindo a ser associada a melhores prognósticos como deteção da doença em fases mais precoces e redução de mortalidade. Contudo, a mamografia não é encarada como mais um exame complementar de diagnóstico e constitui, para a maioria das mulheres, uma situação de ameaça. Na verdade, muitas mulheres referem ter experienciado ansiedade, dor ou desconforto durante a realização deste procedimento. Por outro lado, uma percentagem elevada de mulheres falha na realização periódica de mamografias. Este artigo pretende abordar as reações psicológicas associadas ao exame de mamografia e enfatizar a forma como os técnicos de radiologia podem melhorar o atendimento das mulheres que realizam este exame. O papel do técnico de radiologia no fornecimento de informação antes do exame, na criação de uma atmosfera agradável e empática e na utilização de estratégias de confronto para redução de dor e desconforto e na promoção do controlo e autonomia da paciente são alguns dos aspetos abordados.

Trajetórias de vida de sucesso em indivíduos com passado de vivência prolongada em contexto institucional

Dissertação de Mestrado em Psicologia da Educação, especialidade em Contextos Comunitários.

Preditores da qualidade de vida na epilepsia

A epilepsia é uma das patologias neurológicas mais comuns em todo o mundo, com repercussões importantes na Qualidade de Vida (QDV) dos indivíduos. Deste modo, o objetivo do tratamento ultrapassa a remissão total das crises epiléticas, dado que também prioriza a QDV do indivíduo com epilepsia. A QDV tem vindo a ser associada a alguns fatores modificáveis, importantes para a sua promoção. Assim, pretende-se com o presente estudo identificar se a Adesão à Terapêutica, as Estratégias de Coping e a Espiritualidade são preditores da QDV de indivíduos com epilepsia. O SF-36 v1.0, a Medida de Adesão aos Tratamentos, o COPE-R e a Escala de Avaliação de Espiritualidade em Contextos de Saúde foram administrados a 94 indivíduos com diagnóstico de epilepsia entre quatro e 49 anos. A relação entre as variáveis foi analisada através do modelo de regressão linear múltipla. Os resultados revelam que a Adesão à Terapêutica, a Esperança/Otimismo predizem positivamente a QDV. Já as estratégias de Coping Desinvestimento Comportamental, Expressão de Sentimentos e Religião predizem-na negativamente. Estes resultados são importantes para os profissionais de saúde, na medida em que a identificação de preditores modificáveis da QDV sugere pistas para intervenções que promovam a QDV de indivíduos com epilepsia.

Preditores da adesão à medicação na epilepsia: estudo longitudinal

Introdução: A não adesão à medicação na epilepsia é prevalente, pelo que a compreensão dos fatores associados deve ser promovida. Objetivos: Analisar a capacidade preditiva das estratégias de coping e da espiritualidade em relação à adesão à medicação ao longo do tempo. Metodologia: Foram avaliados 60 indivíduos através de um Questionário Sociodemográfico e Clínico, a Medida de Adesão aos Tratamentos, o COPER e a Escala de Avaliação de Espiritualidade em Contextos de Saúde, em dois momentos. Resultados: A espiritualidade Momento 1 não se relacionou com adesão à medicação no Momento 3, e as estratégias de coping: Desinvestimento Comportamental e Aceitação no Momento 1 predizem negativamente a adesão à medicação no Momento 2. Conclusão: A relação entre a adesão à medicação, estratégias de coping e espiritualidade varia em função do tempo, o que deve ser considerado ao nível da intervenção.