Summary Giancarlo Trombini presents the continuation of his research on the question of which criteria can be used to assess the progress of therapy in an objectively verifiable way and to make the decision on the completion of therapy. In the first phase of his research, the phenomenological criterion of a qualitative change in the patient’s relations toward the positive and higher complexity was proposed for this purpose. In terms of the working method in analytic therapy, (...) this meant concretely: attention should be paid to what development is shown in the comparison of the relationships that occur in the dream narrative and in the subsequent associations. This criterion was therefore given the name manifest dream/association comparison (MDAC)—comparison between the manifest dream and the subsequent associations. The idea can easily be transferred to those therapy methods, which do not primarily work with reports of dream memories and subsequent associations—also, in other ways of working, it is possible to pay attention, in the way suggested by Trombini, to the qualitative development of the relationships which are thematized by the clients in the course of an hour. To this first criterion, another phenomenological criterion is now added in the present article: that of the “concluding therapeutic turn” (CTT). If the patient’s development reaches this turn in the course of the therapy in one session, this indicates, according to Trombini, that the therapy can soon be concluded. The fulfillment of this criterion can be recognized by the fact that in the sequence of dream narration and subsequent associations in a session, a relational dynamic toward the positive and higher complexity becomes recognizable and that is, at the same time, connected with a reconciliation of the three temporal reference systems (past, present, and future). The achievement of this CTT indicates that the patient is aware of the changes made in therapy and makes it evident to the therapist that the therapy is nearing completion. (shrink)

Background: Depression is the largest cause of mental ill health worldwide. Although interventions such as Dance Movement Therapy (DMT) may offer interesting and acceptable treatment options, current clinical guidelines do not include these interventions in their recommendations mainly because of what is perceived as insufficient research evidence. The 2015 Cochrane review on DMT for depression includes only three RCTs leading to inconclusive results. It is therefore, necessary to also look beyond such designs in order to identify and assess the (...) range of current evidence. Methods: We therefore, conducted a systematic review of studies that aimed to explore the effectiveness in the use of DMT with people with depression. This led to a qualitative narrative synthesis followed by a subgroup analysis and a sensitivity analysis. In all meta-analyses a random effects model was used with Standardised Mean Differences (SMD) to accommodate for the heterogeneity of studies and outcome measures. Results: From the 817 studies reviewed, eight studies met our inclusion criteria. 351 people with depression (mild to severe) participated, 192 of whom attended DMT groups while receiving treatment as usual (TAU) and 159 received TAU only. Qualitative findings suggest there was a decrease in depression scores in favour of DMT groups in all studies. Subgroup analysis performed on depression scores before and three months after the completion of DMT groups suggested changes in favour of the DMT groups. When sensitivity analysis was performed, RCTs at high risk of bias were excluded, leaving only studies with adult clients up to the age of 65. In these studies, the highest effect size was found favouring DMT plus TAU for adults with depression, when compared to TAU only. Conclusions: Based on studies with moderate to high quality, we concluded that DMT is an effective intervention in the treatment of depression with adults. Furthermore, by drawing on a wide range of designs with diverse quality, we were able to compile a comprehensive picture of relevant trends. Despite the fact that there remains a paucity of high-quality studies, the results have relevance to both policy-making and clinical practice, and become a platform for further research. (shrink)

Tumor‐infiltrating lymphocyte (TIL) therapy is a promising approach for treating refractory or advanced solid cancers by using autologous TILs harvested from cancer tissues. Despite the heterogeneity of cancer, TIL therapy can potentially produce a positive therapeutic response, including complete remission.After decades of research on lymphocyte functions, culture/expansion methods, therapeutic protocols, and multiple clinical trials, TIL therapy has finally reached a stage where it can be formally approved for clinical use.TIL therapy is expected to hold a unique (...) position among anti‐cancer therapeutic options as a standard intervention. To successfully introduce TIL therapy into clinical settings, there is a need to expand therapeutic indications and set up the best protocols for cancer tissue sampling and manufacturing, and related clinical trials. Moreover, studies on next‐generation TIL therapy have already begun, and post‐approval real‐world data will promote and support further research. (shrink)

Changing technology, and the pervasive demand created by a greater need in the population for access to mental health interventions, has led to the development of technologies that are shifting the traditional way in which therapy is provided. This study investigated the efficacy of a behavioral couples therapy program conducted via videoconferencing, as compared to face-to-face. There were 60 participants, in couples, ranging in age from 21 to 69 years old. Couples had been in a relationship for between (...) 1 to 49 years. The 30 couples were randomly allocated to the face-to-face or videoconferencing group. They all took part in Couple CARE—a couples behavioral education program which promotes self-change in order to increase relationship satisfaction. The six session manualized intervention was offered in an identical manner to all clients, in each condition. Data analysis was based on several questionnaires completed by each couple at pre, post and 3-months follow-up. Results showed that therapeutic alliance ratings did not differ between groups, but increased significantly over time for both groups. Additionally, the results indicated improvements in relationship satisfaction, mental health, and all other outcome scores over time, which did not differ based on condition. This study uniquely contributes to the literature exploring the use of technology to provide therapy. Specifically, the study provides evidence for couples therapy via videoconferencing as a viable alternative to face-to-face interventions, especially for those couples who may not have access to the treatment they require. It is anticipated that the results of this study will contribute to the field of online therapy, and add to fostering confidence in agencies to allow expansion of services conducted via videoconferencing. (shrink)

University of North Carolina at Greensboro Most approaches to the philosophy of the natural and social sciences are basedon completed scientific investigations. However, there are many importantcases in science in which testing is incomplete. These cases are termed suspendedtrials and are particularly significant in biomedical and allied health fields. Initially,the authors' interest in suspended trials was piqued by a controversialmethod for assisting autistic children known as facilitated communication. Thisarticle examines facilitated communication and other examples of suspendedtrials from the perspective of (...) an economics of science and game theory. Themodel is consistent with recent evolutionary approaches to the philosophy ofthe natural and social sciences and with recent contributions to an economicunderstanding of science. Key Words: clinical trials • innovative therapies • economics of science • suspended trials • facilitated communication • economics of clinical research. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional (...) challenges. `Wise Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

The aims of this study were to examine the effectiveness of a range of smartphone apps for managing symptoms of anxiety and depression and to assess the utility of a single-case research design for enhancing the evidence base for this mode of treatment delivery. The study was serendipitously impacted by the COVID-19 pandemic, which allowed for effectiveness to be additionally observed in the context of significant community distress. A pilot study was initially conducted using theSuperBetter app to evaluate the proposed (...) methodology, which proved successful with the four finishing participants. In the main study, 39 participants commenced, with 29 finishing the intervention phase and completing post-intervention measures. At 6-month follow-up, a further three participants could not be contacted. This study used a digitally enhanced, multiple baseline across-individuals single-case research design. Participants were randomly assigned to the following apps:SuperBetter,Smiling Mind,MoodMission,MindShift, andDestressify. Symptomatology and life functioning were measured at five different time points: pre-baseline/screening, baseline, intervention, 3-week post-intervention, and 6-month follow-up. Detailed individual perceptions and subjective ratings of the apps were also obtained from participants following the study’s completion. Data were analyzed using visual inspection, time-series analysis, and methods of statistical and clinical significance. Positive results were observed for all apps. Overall, more favorable outcomes were achieved by younger participants, those concurrently undertaking psychotherapy and/or psychotropic medication, those with anxiety and mixed anxiety and depression rather than stand-alone depression, and those with a shorter history of mental illness. Outcomes were generally maintained at 6-month follow-up. It was concluded that a diverse range of evidence-based therapies offered via apps can be effective in managing mental health and improving life functioning even during times of significant global unrest and, like all psychotherapies, are influenced by client features. Additionally, this single-case research design is a low-cost/high value means of assessing the effectiveness of mental health apps.Clinical Trial Registration: The study is registered with the Australian and New Zealand Clinical Trials Registry, which is a primary registry in the World Health Organization Registry Network, registration number ACTRN12619001302145p. (shrink)

Therapists and related theorists and practitioners of mental health tend to hold one of two broad views about how to help patients. On the one hand, some maintain that, or at least act as though, the basic point of therapy is to help patients become clear about what they want deep down and to enable them to achieve it by overcoming mental blockages. On the other hand, there are those who contend that the aim of therapy should instead (...) be to psychologically enable patients to live objectively desirable lives, say, ones that involve developing their inherent talents or exhibiting an authentic/strong/integrated self. In this chapter, I argue that neither of these prominent approaches is complete. Contra the former, sometimes what patients want deep down is not something to promote, and, against the latter, it can sometimes be reasonable for patients to want to sacrifice their own objective interests and for therapists to assist them in this regard. I argue that the category of meaningfulness does well at accounting for these counterexamples to the two dominant approaches, while capturing the kernels of truth in them. The proper aim of therapy, I suggest, is to enable patients to live meaningfully. (shrink)

Obsessive–compulsive disorder is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion (...) for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD, and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances, by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments. (shrink)

I analyze the historical background and philosophical considerations of Karl Bühler and his student Karl Popper regarding the crisis of psychology. They share certain Kantian questions and methods for reflection on the state of the art in psychology. Part 1 outlines Bühler’s diagnosis and therapy for the crisis in psychology as he perceived it, leading to his famous theory of language. I also show how the Kantian features of Bühler’s approach help to deal with objections to his crisis diagnosis (...) and to aspects of his linguistic theory. Part 2 turns to Popper’s dissertation, completed in 1928 under Bühler. I analyze Popper’s disapproval of Schlick’s physicalism in psychology, as well as Popper’s attempt to extend Bühler’s Kantian strategy to the domain of the psychology of thinking. In conclusion, I indicate how these approaches to the crisis in psychology differ from Thomas Kuhn’s notions of crisis and revolution, which are still all too popular in current philosophical discussions of psychology. (shrink)

_Aims:_ Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related (...) outcomes. _Methods:_ The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t -tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome. _Results:_ Participants showed statistically significant improvements (all p d = 0.45), sleep interference ( d = 0.61), and sleep efficiency ( d = 0.32). Significant improvements in insomnia severity and sleep interference were also observed at 9-month follow up. Small to medium effect sizes were observed across the sleep outcomes. Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance. _Conclusion:_ This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties. Further research is needed to determine how to improve the impact of this treatment for co-morbid pain and sleep difficulties, possibly using a randomized-controlled trial design. (shrink)

A concern for evidence can be viewed as a fundamental aspect of human existence. The biological structure of our bodies evolved during over thousands of years in which survival was predicated on a capacity to interpret small signs, such as crushed grass, smells, and sounds as evidence of the whereabouts of prey. The emergence of modern science and medicine was built on the ability to learn about what counted as evidence for what, and to observe it reliably. Evidence is information (...) that matters. Drinking a glass of water because one feels thirsty is not evidence, unless there is a suspicion of an underlying condition for which water intake is a symptom. Appraisal of evidence is a complex task. It relies on the... (shrink)

A clinical trial on mitochondrial replacement therapy is currently being conducted and if this technique proves effective, National Health Service England will fund MRT through the highly specialised services funding stream. This paper considers whether MRT should be publicly funded by the NHS. Given the current financial pressure the NHS is experiencing, a comprehensive discussion is essential. There is yet to be a thorough discussion on MRT funding, perhaps because this is a small-scale issue and presumed to be covered (...) by the HSS budget. However, the source of funding has not been confirmed due to the trial’s incompletion. Upon its completion, reasoned decisions need to be made over the allocation of scarce NHS resources. It is therefore important to consider the following arguments in advance. Three arguments given against NHS funding of MRT will be evaluated. The first argument against NHS funding examines the HSS overspending its budget in an underfunded NHS, suggesting funding must be carefully reprioritised. Second, the ethical issue of allowing public access to a technique with insufficient evidence behind it will be explored. The final point considers the option of privately funding MRT and how this would affect the treatment’s development. After illustrating the weaknesses of such arguments, it will be concluded that MRT should be funded by the NHS. (shrink)

The purpose of the present study was to evaluate the effectiveness of a physical activity intervention program designed to enhance levels of engagement in PA. Despite robust evidence supporting the beneficial effects of PA on overall health, only about 22% of individuals engage in the recommended minimum amount of PA. Recent surveys suggested that most individuals express intentions to be physically active, though the psychological state of amotivation dismissed these struggles. In the current study, we pilot-tested a new intervention program, (...) aimed at enhancing engagement in PA among sedentary individuals. The intervention was based on two behavioral change and motivational psychological frameworks: Self-Determination Theory and Acceptance and Commitment Therapy. During a 14-week intervention program, 94 sedentary Israeli college students were randomly assigned into one of three groups: SDT and ACT-based intervention, traditional intervention, and a non-treatment group. Prior to and following the intervention, participants completed the Behavioral Regulation in Exercise Questionnaire-3 to examine motivation to exercise and the International Physical Activity Measurement IPAQ to evaluate their training frequency. Results showed that the SDT and ACT-based intervention group exhibited a significant increase in motivation to exercise between time 1 and time 2, while the other two groups showed insignificant differences in motivation to exercise. Furthermore, neither of the groups showed significant differences in their training frequency per week. However, those in the SDT and ACT-based groups reported an increase in activity intensity from time 1 to time 2 compared to the two other groups. Further, exercise psychology consultants and scholars can use the intervention protocol and utilize these findings to improve PA behaviors and promote health in the general population. Limitations, future directions, and implications are discussed in detail. (shrink)

BackgroundNew disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future.MethodsPatients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available (...) knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences.ResultsA substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs.ConclusionsMost of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells. (shrink)

Background We report a randomised controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow. Methods Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved $\sim$40 hour-long sessions 2-5 times per week. Training involved either theta/beta (...) or sensorimotor-rhythm regimes, adapted by adding a novel 'inverse-training' condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests. Setting Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki. Randomisation We randomly allocated half the sample then adaptively allocated the remainder to minimise baseline differences in prognostic variables. Blinding Waiting-list control design meant trial was not blinded. Participants 54 adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. 44 had ADHD diagnoses, 10 had ADD. Measurements Symptoms were assessed by computerised attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded. Results Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis. Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere. Trial Registration "Computer Enabled Neuroplasticity Treatment (CENT)", ISRCTN13915109. Partly funded by Finnish science agency TEKES, project #440078. (shrink)

This article describes an equine-assisted experiential therapy approach and presents treatment outcomes in 31 participants in an equine-assisted, experiential therapy program. Participants completed psychological measures prior to treatment, immediately following treatment, and 6 months after treatment. Reported reductions in psychological distress and enhancements in psychological well being were significant immediately following treatment and were stable at 6-month follow-up. The article discusses the clinical implications and limitations of the present study and directions for further research.

In this essay I consider the question of whether Elliot D. Cohen has justified sufficiently the metaphysical basis for his Logic-Based Therapy as presented in his paper on “The Metaphysics of Logic-Based Therapy (IJPP, this issue). Although Cohen discusses four different foundations of his cognitive theory, I focus only on one. It is the most important basis of his theory, viz., that human beings logically deduce the cognitive-behavior com­ponents of their emotions from premises. First, I question Cohen’s analysis (...) of the emotion rules we use to deduce evaluations of actions from. Second, I challenge Cohen’s view that we deduce our evaluations from emotion rules. Although I do not think my challenges completely undermine Cohen’s theory, they do raise serious concerns for a theory faced with a preponderance of causal therapies. (shrink)

Mammalian synthetic biology holds the promise of providing novel therapeutic strategies, and the first success stories are beginning to be reported. Here we focus on the latest generation of mammalian transgene control devices, highlight state‐of‐the‐art synthetic gene network design, and cover prototype therapeutic circuits. These will have an impact on future gene‐ and cell‐based therapies and help bring drug discovery into a new era. The inventory of biological parts that are essential for life on this planet is becoming increasingly complete. (...) The postgenomic era has provided encyclopedic information on gene‐function correlations and systems biology is now delivering comprehensive details on the dynamics of biochemical reaction networks in living organisms. The time has come to reassemble these catalogued items and design new biological devices and systems with novel and useful functionality in a rational and systematic manner. This is the premise of synthetic biology, a constructive systems biology discipline likely to become the life science revolution of the 21st century. (shrink)

The aim of this exploratory study was to examine client demographics and expectations, reasons for use, sensations during treatment, and perceived outcomes of Pranic Healing, an energy healing system lacking in scientific documentation but whose use in the general population is becoming more widespread internationally. This study consisted of a cross-sectional survey of adults (18+ years of age) receiving care from 12 Pranic Healing practices in four different states in the U.S. (N = 179) completing online questionnaires. Closed-ended response sets (...) were analyzed descriptively, while qualitative data were analyzed using content analysis. Reasons to use the therapy included physical, mental/emotional, and metaphysical issues, dissatisfaction with conventional care, and overall well-being. Expectations of care included enhanced abilities, cure or relief, or unsure. Respondents were more likely to cite a specific problem from which they needed alleviation than to cite overall health or wellness as their goal. Sensations experienced were reported to be of a relaxing nature and not, as was hypothesized, of an energizing nature. Results show that those who use Pranic Healing fit the sociodemographic profile of CAM (complementary and alternative medicine) users in the United States, that their reasons for use are not homogeneous, and that preliminary descriptive data from a selective subsample of respondents indicated that some respondents are experiencing positive outcomes attributed to this modality. (shrink)

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This (...) study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach, offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that ADIT was acceptable for patients with complex/major depression, that they were likely to refer to ADIT in the future that the use of arts was likely to improve accessibility the use of arts was likely to improve outcomes and that offering ADIT was an effective use of mental health resources.Discussion: Phase I of this intervention development study demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol. (shrink)

Eye movement desensitization and reprocessing therapy is a well-established therapeutic method to treat post-traumatic stress disorder. However, how EMDR exerts its therapeutic action has been studied in many types of research but still needs to be completely understood. This is in part due to limited knowledge of the neurobiological mechanisms underlying EMDR, and in part to our incomplete understanding of PTSD. In order to model PTSD, we used a biologically inspired computational model based on firing rate units, encompassing the (...) cortex, hippocampus, and amygdala. Through the modulation of its parameters, we fitted real data from patients treated with EMDR or classical exposure therapy. This allowed us to gain insights into PTSD mechanisms and to investigate how EMDR achieves trauma remission. (shrink)

Although many philosophers have, throughout history, regarded themselves as answering the skeptic, the question arises whether answering the skeptic is the thing to do. If not, the question becomes how else to respond to her. Wittgenstein-inspired stances are, in general, therapeutic. In this article I focus on the problem of other minds in order to analyze and compare the different shapes such therapeutic stances may have. I begin by showing how crucial resisting the temptation to answer the skeptic was for (...) John McDowell’s early formulations of disjunctivism in the 1980s. In his article “Criteria, Defeasibility, and Knowledge” I identify substantial positions such as the rejection of highest common factor views, the diagnosis of the connection between such highest common factor views and an conception of appearances, as well as the proposal of a non-Cartesian, or modest, approach to indistinguishability for a subject. Whatever his success in these other enterprises, McDowell continues to regard both the temptation to answer the skeptic and a substitute therapeutic stance as epistemologically motivated. But if skepticism is more than an intellectual conundrum, as maintained by Stanley Cavell, the source of such temptation has to be considered in a completely different light. (shrink)

What does it mean to ‘drop out’ of therapy? Many definitions of ‘dropout’ have been proposed, but the most widely accepted is the client ending treatment without agreement of their therapist. However, this is in some ways an external criterion that does not take into account the client’s experience of therapy, or reasons for ending it prematurely. This study aimed to identify whether there were more meaningful categories of dropout than the existing dropout definition, and to test whether (...) this refined categorisation of dropout was associated with clinical outcomes. This mixed-methods study used a subset of data from the IMPACT trial, which investigated psychological therapies for adolescent depression. Adolescents were randomly allocated to a treatment arm (Brief Psychosocial Intervention; Cognitive-Behavioural Therapy; Short-Term Psychoanalytic Psychotherapy). The sample for this study comprised 99 adolescents, aged 11-17 years. 32 were classified as having dropped out of treatment and participated in post-therapy qualitative interviews about their experiences of therapy. For 26 dropout cases, the therapist was also interviewed. 67 cases classified as having completed treatment were included to compare their outcomes to dropout cases. Interview data for dropout cases were analysed using ideal type analysis. Three types of dropout were constructed: ‘dissatisfied’ dropout, ‘got-what-they-needed’ dropout, and ‘troubled’ dropout. ‘Dissatisfied’ dropouts reported stopping therapy because they did not find it helpful. ‘Got-what-they-needed’ dropouts reported stopping therapy because they felt they had benefitted from therapy. ‘Troubled’ dropouts reported stopping therapy because of a lack of stability in their lives. The findings indicate the importance of including the perspective of clients in definitions of drop out, as otherwise there is a risk that the heterogeneity of 'dropout' cases may mask more meaningful distinctions. Clinicians should be aware of the range of issues experienced by adolescents in treatment that lead to disengagement. Our typology of dropout may provide a framework for clinical decision-making in managing different types of disengagement from treatment. (shrink)

Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years (...) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities, socioemotional functioning, psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key. (shrink)

Background 300 million operations and procedures are performed annually across the world, all of which require a patient’s informed consent. No standardised measure of the consent process exists in current clinical practice. We aimed to define a core outcome set for informed consent for therapy. Methods The core outcome set was developed in accordance with a predefined research protocol and the Core OutcoMes in Effectiveness Trials methodology comprising systematic review, qualitative semi structured interviews, a modified Delphi process and consensus (...) webinars to ratify outcomes for inclusion in the final core outcome set.. Participants from all key stakeholder groups took part in the process, including patients and the public, healthcare practitioners and consent researchers. Results 36 outcome domains were synthesised through systematic review and organised into a consent taxonomy. 41 semi-structured interviews were performed with all consent stakeholders groups. 164 participants from all stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed Round 2. 11 outcomes met the ‘consensus in’ criteria. 6 met ‘consensus in’ all stakeholder groups and were included directly in the final core outcome set. 5 remaining outcomes meeting ‘consensus in’ were ratified over two consensus webinars. 9 core outcomes were included in the final core outcome set: Satisfaction with the quality and amount of information, Patient feeling that there was a choice, Patient feeling that the decision to consent was their own, Confidence in the decision made, Satisfaction with communication, Trust in the clinician, Patient satisfaction with the consent process, Patient rated adequacy of time and opportunity to ask questions. Conclusion This international mixed-methods qualitative study is the first of its kind to define a core outcome set for informed consent for intervention. It defines what outcomes are of importance to key stakeholders in the consent process and is a forward step towards standardising future consent research. (shrink)

Difficulties in various cognitive functions are common observations in people experiencing anxiety. However, limited research has investigated the effects of psychotherapy on abnormal cognitive functioning. This study assessed whether psychotherapy-related reductions of anxiety result in improvements of cognitive functioning as well. Fifty-four participants with high self-reported anxiety, divided into two experimental groups (N = 28 and N = 26), and 27 non-anxious control participants (N = 27) completed a battery of memory tasks and anxiety questionnaires in three consecutive time points. (...) In experimental group 1, participants started systemic family therapy immediately after the first time point, while, in experimental group 2, participants begun the same type of therapy three months later at the second time point. The results showed that, compared to control participants, at the beginning of the experiment, participants in the experimental groups had significantly lower memory performance, along with higher anxiety. Psychotherapy had a beneficial effect on anxiety symptoms and cognitive performance, with significant changes occurring only after intervals of treatments. These results show that psychotherapy is effective not only in reducing anxiety symptoms but on cognitive functioning as well. This improvement might be linked to the release of cognitive resources previously absorbed by worrisome thoughts, facilitated by a heightened protection from interference. (shrink)

This study argues that the effect envisaged by the Christian sacrament of the sick consists of the healing of the rupture provoked by scientific medical procedures. The anointing of the sick re-establishes the fundamental unity of the human person as a symbolic completion of what other partial procedures may have begun to do as a result of illness : a symbolic completion that marks the Christian for the resurrection. We begin by highlighting the placebo as an ally of (...) the medical sciences, while noting that research on placebos points to the importance of ritual performance in treatment as well as the reformulation of the mind-body dualism. Then, in order to develop the dialectic between rite as therapy and therapy in its ritual aspects, we report on two complementary contributions : one from a specialist in ritual studies, Ronald L. Grimes, and the other from a theologian, Andrea Grillo. The utopian key of Gregory Baum is added, understood as a — reflexive — second-order discourse in relation to the first-order — symbolic, ritual and performative — articulation of the sacrament of anointing of the sick. The latter thus appears as a symbol of the future, that is, as an anticipation of eschatological salvation in the marking of the believer’s body for the resurrection. (shrink)

BackgroundThis pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.MethodsSeventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention (...) from a practitioner’s point of view.ResultsThis study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.ConclusionThis study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed. (shrink)

Research Ethics, Volume 18, Issue 2, Page 132-150, April 2022. Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to (...) explore their reasons for participation and experiences within the study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

It has been known for long time that the cosmic sound wave was there since the early epoch of the Universe. Signatures of its existence are abound. However, such an acoustic model of cosmology is rarely developed fully into a complete framework from the notion of space, cancer therapy up to the sky. This paper may be the first attempt towards such a complete description of the Universe based on classical wave equation of sound. It is argued that one (...) can arrive at a consistent description of space, elementary particles, Sachs-Wolfe acoustic theorem, up to a novel approach for cancer therapy, starting from this simple classical wave equation of sound. We also discuss a plausible extension of Acoustic Sachs-Wolfe theorem based on its analogue with Klein-Gordon equation to become Acoustic Sachs-Wolfe-Christianto-Smarandache-Umniyati (ASWoCSU) equation. It is our hope that the new proposed equation can be verified with observation data. But we admit that our model is still in its infancy, more researches are needed to fill all the missing details. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion (...) and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

`Hans Cohn has given us a personal and valuable statement about the theoretical underpinnings of his work as a psychotherapist. These can be little doubt about his contribution to our thinking practice is invaluable. Students will find Cohn's easygoing exposition of complex ideas enormously helpful' - Professor Emmy van Deurzen, Existential Analysis `One of the most important books published this year. This long-awaited book by the foremost expert on the relationship between Heidegger and psychotherapy, manages to encapsulate the essence of (...) Heidegger's thinking and make of understandable and relevant to therapists without losing any of the original meaning' - Counsellingbooks.com Anyone interested in modern philosophy is familiar with the name of Martin Heidegger but there is a serious gap in even the most complete accounts of his life and thought. This is Heidegger's association with, and influence on, psychotherapy. Hans C Cohn explores the role of Heidegger's thought in providing an alternative basis for psychotherapeutic practice to the dominant psychodynamic, humanistic and cognitive approaches, also focusing strongly on the practical therapeutic relevance of Heidegger's ideas. This book will be essential reading for students and teachers of modern philosophy, as well as existential psychotherapists, and all practitioners interested in existential approaches to therapy. (shrink)

This revised workbook is designed for patients' use as they work, either with a qualified mental health professional or on their own, to manage social anxiety. Based on the principles of cognitive-behavioral therapy, the treatment program described is evidence-based and proven effective. Complete with user-friendly forms and worksheets, as well as relatable case examples and chapter review questions, this workbook contains all the tools necessary to help patients manage their anxiety and improve their quality of life.

"Brilliant and innovative, Jacques Lacan's work lies at the epicenter of modern thought about otherness, subjectivity, sexual difference, the drives, the law, and enjoyment. This new translation of his complete works offers welcome, readable access to Lacan's seminal thinking on diverse subjects touched upon over the course of his inimitable intellectual career." This English edition is translated by Bruce Fink, in collaboration with Héloïse Fink and Russell Grigg.

Introduction: Resilience is a multidimensional and dynamic construct associated with positive growth and the capacity to transform stressful and negative factors into opportunities of personal development and self-improvement when faced with difficult experiences. The resilience process of each individual integrates multiple analysis levels, which range from genetic-environmental interactions to a complex process of adaptation between the individual and his/her family, friends, co-workers, society, and culture.Objective: To determine whether resilience improves in students of occupational therapy when exposed for the first (...) time to practice placement education.Methodology: Quasi-experimental, prospective, observational, multi-center study with a sample composed of students from the Degree of Occupational Therapy of the public universities of Málaga and Castilla-La Mancha. Two weeks prior to the beginning of the practice education period, the participants completed a questionnaire that included sociodemographic data and the area of their internships. They were also given the Spanish version of the Connor-Davidson's resilience scale. All these instruments were also completed 1 week after the end of the clinical practice.Results: There were statistically significant differences between the variables that make up resilience and the different internship areas. On the other hand, there was a significant improvement of global resilience after the clinical practice period, in both women and men, when the internship area was not considered.Conclusions: The results show that resilient students are more optimistic and work to improve a situation beyond doing simply what is expected of them, knowing how to control their feelings. This is beneficial for students in practice education, since, during these, they face difficult situations that require a resilient pattern, which helps reduce stress and the burnout syndrome. (shrink)

Objectives Prompt Mental Health Care (PMHC) is the Norwegian version of the England’s Improving Access to Psychological Therapies (IAPT). Both programs have been associated with substantial symptom reductions from pre- to post-treatment. The present study extends these findings by investigating symptom levels at 12 months post-treatment, as well as treatment outcome in relation to low- vs. high-intensity treatment forms. Design and Outcome Measures A prospective cohort design was used. All participants ( n = 1530) were asked to complete the Patient (...) Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 questionnaire (GAD-7) at baseline, before each session during treatment, at final treatment, and at 12 months post-treatment. Cohen’s d was used as effect size measure. Sensitivity analyses were conducted to examine the impact of the high missing data rates at post-treatment (≈44%) and 12 months post-treatment (≈58%). Results A large symptom reduction was seen from baseline to 12 months post-treatment for both PHQ ( d = −0.98) and GAD ( d = −0.94). Improvements observed at post-treatment were largely maintained at 12 months post-treatment (PHQ (Δ d = 0.10) and GAD (Δ d = 0.09). Recovery rates decreased only slightly from 49.5% at post-treatment to 45.0% at follow-up. Both low- and high-intensity treatment forms were associated with substantial and lasting symptoms reductions (−1.26 ≤ d ≤ −0.73). Sensitivity analyses did not substantially alter the main results. Conclusion The findings suggest long-lasting effects of the PMHC program and encourage the use of low-intensity treatment forms in PMHC like settings. (shrink)

Recent discoveries have suggested the concept that intracellular signals are the sum of multiple, site‐specified subsignals, rather than single, homogeneous entities. In the context of cancer, searching for compounds that selectively block subsignals essential for tumor progression, but not those regulating “house‐keeping” functions, could help in producing drugs with reduced side effects compared to compounds that block signaling completely. The Ras‐ERK pathway has become a paradigm of how space can differentially shape signaling. Today, we know that Ras proteins are found (...) in different plasma membrane microdomains and endomembranes. At these localizations, Ras is subject to site‐specific regulatory mechanisms, distinctively engaging effector pathways and switching‐on diverse genetic programs to generate different biological responses. The Ras effector pathway leading to ERKs activation is also under strict, space‐related regulatory processes. These findings may open a gate for aiming at the Ras‐ERK pathway in a spatially restricted fashion, in our quest for new anti‐tumor therapies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Experiencing Assistive Technology:A Pragmatist Inflection for Occupational TherapyNate Whelan-Jacksonshortly after i wake up, I put braces on my legs. I wear them throughout the day. Often, I don't notice them. If I'm walking on a flat surface, they often fade into the background of my consciousness. I make allowances without thinking about how they structure my gait and the space they take up. Rarely, I misjudge this, and occasionally (...) fall. In those moments, their presence is apparent, coming to the foreground of my experience as a problem, something I need to accommodate as I collapse. When they need to be repaired, I notice them all of the time. As a user of assistive technology, the way in which I experience the technology can swing from regarding them as part of my body, to an external tool, to an object in my environment. This experience is fluid, weaving moments where a sense of my embodiment includes the devices with moments where they are alien to me. Even when they are alien to me, I use them successfully (most of the time). Reading reports of the experiences of other users of assistive equipment, especially prosthetics, I do not seem to be alone in experiencing this fluidity with respect to these devices. These experiences raise questions for me. Is "successful use" sufficient as a goal as I learn and re-learn how to walk with them? Often, I prefer the experience of braces as part of myself: How might that be cultivated? Perhaps the fluidity of encountering them at times as tools and at times as part of myself is a strength, one that I might reasonably seek to develop. How might education or therapy accommodate and prepare for this feature of experience with assistive technology?Phenomenological analyses of symptoms of "phantom limbs," use of prosthetics, and even of physical impairment more generally, highlight the fluidity of disability experience, emphasizing the experience of having to continually revise ways of navigating our environments. For many disabled people, this precarious character of experience might demand that we learn to use new [End Page 60] assistive technologies. This education often takes place in the context of occupational therapy (hereafter OT), a form of therapeutic intervention using "occupations," or purposive tasks, to facilitate independence. In this process, persons might not just learn to make use of a technology or perform a task, but also to experience the technology in a variety of ways—for instance, as an obstacle, as a tool, or as a part of their bodies. Thus, OT becomes not only a locus for developing new modes of coping and performing daily tasks, but a site at which relationships to assistive technologies come to the foreground.Those relationships, in various theoretical models underlying OT, are often analyzed in terms of task performance, and different elements modified in order to complete a given occupation. A person might make changes in their own habits of moving (for instance, learning to move their legs a certain way to facilitate walking), the environment (e.g., modify furniture or a configuration of a room), or some combination thereof. However, some experiences of disability call into question features of popular models underlying OT, like the person-environment-occupation model. In particular, features of the situation, like the equipment, can occupy multiple roles, or even change roles, from person to environment or vice versa, within the context of performing daily tasks. I suggest that John Dewey's work on education and analysis of habits with relationship to a creature's broader environment provide a useful framework for articulating models of experiencing assistive technologies that appreciate their fluidity within experiences of disability. This model offers a helpful orientation for OT, one that offers an expansive account of the potential "ends" of OT, from re-molding habits to complete tasks to supporting plasticity in an individual's relationship to different elements of the model itself.Occupational TherapyBroadly, occupational therapy fosters independence through a number of means. Occupational therapists can aid in re-training how to perform everyday activities, construct exercises to strengthen or re-habituate new uses of muscles, make recommendations for changing features of home or... (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains (...) in CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

The first aim of the study was to identify when deliberate self-harm behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment. The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants (...) where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early and late responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority ceased their self-harming within the first year, and the average number of weeks was 15.5. Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT. (shrink)

This article reviews Stephen K. Levine’s 2019 book, Philosophy of Expressive Arts Therapy: Poiesis and the Therapeutic Imagination. The book, complete with poetry and anecdotes is connected to larger concepts in psychology, phenomenology and philosophy. The article summarizes the books contents and offers a review from the perspective of phenomenology and the expressive art practice.

Grafting embryonic brain tissue into the brain of patients with visual field loss due to cerebral lesions may become a method to restore visual function. This method is not without risk, however, and will only be considered in cases of complete blindness after bilateral occipital lesions, when other, risk-free neuropsychological methods fail.

On April 6, 2000, Dr. J. Craig Venter of Celera Genomics told a Congressional committee that his company finished its analysis of the human DNA and would have a completed map of the human genome by early summer, 2000. Scientists expect the completed human genome to revolutionize drug therapies through the creation of treatments tailored to specific genetic makeups. In order to create a map of the human genome, three billion letters of DNA that encode eighty thousand genes must be (...) identified and ordered. In March, 2000, Celera released a successful sequence of the fruit fly genome, and it employed the same methods in creating the human genome. (shrink)

This book deals with the psychotherapeutic factor that permeates the whole Epicurean philosophical program. It is the aim of this study to research and to rehabilitate its healing function. Since the Garden’s philosophy is a very systematic one, the question about the natural reality, φύσις, had to be addressed firstly. Anti-nihilism, materialism, eternal atoms, infinite void, perpetual movement, clinamen and the plurality worlds are key notions of the axiomatic and scientific Epicurus’ physics. Once we had gained clarity about those core (...) concepts, the central role of human beings in the system was to be discussed. As natural, yet exceptional, atomic compounds, men and women do have flesh and soul and are, therefore, completely mortal. Nevertheless, they possess numerous qualities, originating in their ψυχή, which render them unique: freedom, rationality and even a material community with the gods. According to Epicurus, there is a fourth element constituting the souls of both people and deities, so that a physical continuity and material formation are preserved through the entire nature. -/- Gods are studied from a naturalistic physiologic perspective and at the very same time they act exemplary and, freed from any providential, governing tasks, they provide a regula uitae in order to achieve a pleasant, authentic happiness. In fact, this research tries to demonstrate that complete curation is not to be linked to an eternal extra-corporeal soul, but arises from the removal of pain and fear, aponia and ataraxia. These two are the paramount pleasures, far distant from a gross hedonism. Ethics are, then, presented as a soothing practice, having a nuclear medical purpose. Taking this into account, it was necessary to explore the historical connections between philosophy and rational Hellenic medicine before Epicurus. After that, multiple therapeutic forms conceived or applied by the Samian philosopher were analyzed. The λόγος proved to be the unifying element among them and involved not only human reason but also analogy. Epicurus’ diagnose is very sad: we are in pain. To reverse that, he presented exercises such as meditation, confession, self-examination, laugh therapy, emotional intelligence, intrusive thoughts control, companionship, solidarity and friendship. There are still two additional therapies completing the above mentioned: an Epicurean thanatology, because we miss the point when considering (im)mortality and forget about sensation as the ground of any life; and an ars desidrandi, because we should accept only natural and necessary desires, instead of chasing whimsy dreams with vain hopes. All this will help us regain our primal bodily and mental health and happiness, our essential, frugal and glad wellbeing. (shrink)

This doctoral dissertation deals with the psychotherapeutic factor that permeates the whole Epicurean philosophical program. It is the aim of this study to research and to rehabilitate its healing function. Since the Garden’s philosophy is a very systematic one, the question about the natural reality, φύσις, had to be addressed firstly. Anti-nihilism, materialism, eternal atoms, infinite void, perpetual movement, clinamen and the plurality worlds are key notions of the axiomatic and scientific Epicurus’ physics. Once we had gained clarity about those (...) core concepts, the central role of human beings in the system was to be discussed. As natural, yet exceptional, atomic compounds, men and women do have flesh and soul and are, therefore, completely mortal. Nevertheless, they possess numerous qualities, originating in their ψυχή, which render them unique : freedom, rationality and even a material community with the gods. According to Epicurus, there is a fourth element constituting the souls of both people and deities, so that a physical continuity and material formation are preserved through the entire nature. Gods are studied from a naturalistic physiologic perspective and at the very same time they act exemplary and, freed from any providential, governing tasks, they provide a regula uitae in order to achieve a pleasant, authentic happiness. In fact, this research tries to demonstrate that complete curation is not to be linked to an eternal extra-corporeal soul, but arises from the removal of pain and fear, aponia and ataraxia. These two are the paramount pleasures, far distant from a gross hedonism. Ethics are, then, presented as a soothing practice, having a nuclear medical purpose. Taking this into account, it was necessary to explore the historical connections between philosophy and rational Hellenic medicine before Epicurus. After that, multiple therapeutic forms conceived or applied by the Samian philosopher were analyzed. The λόγος proved to be the unifying element among them and involved not only human reason but also analogy. Epicurus’ diagnose is very sad: we are in pain. To reverse that, he presented exercises such as meditation, confession, self-examination, laugh therapy, emotional intelligence, intrusive thoughts control, companionship, solidarity and friendship. There are still two additional therapies completing the above mentioned: an Epicurean thanatology, because we miss the point when considering (im)mortality and forget about sensation as the ground of any life; and an ars desidrandi, because we should accept only natural and necessary desires, instead of chasing whimsy dreams with vain hopes. All this will help us regain our primal bodily and mental health and happiness, our essential, frugal and glad wellbeing. By means of prudence and reflection, governing our body and cultivating our mind we will liberate ourselves and taste a durable, profound, stable joy, comparable to that of the gods. (shrink)

The conventional paradigm for developing new treatments for disease mainly involves either the discovery of new drug targets, or finding new, improved drugs for old targets. However, an ion channel found only in invertebrates offers the potential of a completely new paradigm in which an established drug target can be re‐engineered to serve as a new candidate therapeutic agent. The L‐glutamate‐gated chloride channels (GluCls) of invertebrates are absent from vertebrate genomes, offering the opportunity to introduce this exogenous, inhibitory, L‐glutamate receptor (...) into vertebrate neuronal circuits either as a tool with which to study neural networks, or a candidate therapy. Epileptic seizures can involve L‐glutamate‐induced hyper‐excitation and toxicity. Variant GluCls, with their inhibitory responses to L‐glutamate, when engineered into human neurons, might counter the excitotoxic effects of excess L‐glutamate. In reviewing recent studies on model organisms, it appears that this approach might offer a new paradigm for the development of candidate therapeutics for epilepsy. (shrink)

Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively (...) impact these symptoms. However, this approach has never been studied in eating disorders and it is unknown whether exposure to REST might worsen AN symptoms. To examine these possibilities we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the impact of REST on affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 minutes, approximately one week apart. We measured orthostatic blood pressure before and immediately after each session (primary outcome), in addition to collecting blood pressure readings every 10 minutes during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image was assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in blood pressure, anxiety and negative affect, heightened awareness of cardiorespiratory but not gastrointestinal sensations, and reduced body image dissatisfaction. The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance can be effectively extended to acutely ill AN populations. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)