Repression: finding our way in the maze of concepts

Using storytelling in undergraduate dental education: Students' experiences of emotional competence training

AIM

The aim of the study was to explore the use of storytelling as a teaching method for emotional competence interventions within undergraduate dental curriculum (dental and dental hygiene students).

MATERIALS AND METHODS

Students participated in five sessions related to emotional competence: one theoretical and four practical. During the latter, divided in small groups, students told individually two stories: a story about a clinical situation in which they had an emotional experience and a story concerning a patient's experience of the same emotion. Each session focused on a single emotion: happiness, fear, anger and shame. A questionnaire was used to collect perceptions about enjoyment, how stories were chosen, what was learned and if the sessions were stimulating in any way. A focus group was organised to collect reflections about the learning environment, process of learning and specific skill set developed during these sessions.

RESULTS

The majority of the students enjoyed listening, telling and preparing the stories. They reported to experience social support and feeling a sense of community during the sessions. The students believed that stories helped them to reflect on their clinical work and to regulate their emotional experiences more efficiently in clinical situations. Regarding the learning environment, the dental students pointed out the distinctiveness and dissimilarities between the dental and dental hygiene students, but also expressed that they had a desire to learn more about the other student group.

CONCLUSION

Storytelling used as part of an emotional competence course appears to have benefits for students' reflection about their role as dental health professionals. This teaching method was well-perceived by the students included in this study.

Social affective outcomes and brain injury in children and adolescents treated for brain tumours

In this Review we critically evaluate the empirical literature investigating the effect of paediatric brain tumours and their treatment on social affective function. We focus specifically on relations between social affective function and compromised brain structure and function associated with treatment for a paediatric brain tumour. We concentrate on emotion recognition and regulation, because these are core components of social affective function. First, we provide an overview of the literature in typically developing children and discuss the underlying brain networks thought to subserve emotion (ie, limbic system and supporting white matter microstructure). We then focus on how damage to brain structure and function after treatment for a paediatric brain tumour might be related to compromised emotion recognition and regulation-as well as broader social affective outcomes. On the basis of our review of the literature across typically developing children and those with a paediatric brain tumour, we suggest that structural changes to fronto-limbic tracts might interrupt social network neural communication in children and adolescents treated for brain tumours. A critical analysis of the reviewed literature suggests a relationship between social affective dysfunction and childhood-acquired injury to white matter microstructure. We argue that the knowledge synthesised regarding paediatric brain tumours could extend to other neurological disorders. Finally, we identify considerations for future investigation and recommend research practices to be adopted in forthcoming studies to establish causal links between brain structure and function to social affective processes.

"It's All about Calculations-But There Are No Definite Results"-Parental Adaptation and Coping during the First Month following Their Child's Diabetes Diagnosis

Diabetes-related habits established during the first few years after diagnosis are difficult to change. Therefore, the initial period after a child has been diagnosed with diabetes holds a unique potential for early interventions to adjust adverse patterns of diabetes self-management before they become firmly established. Family functioning is strongly related to glycemic levels, and attending to parents' needs at the time of diagnosis could therefore reduce psychological distress and improve glycemic levels in their children. This study aims to investigate parental adaptation to and coping with their child's diabetes diagnosis during the first month post-diagnosis. Twenty interviews with parents of children (0-18 years) with newly diagnosed type 1 diabetes were conducted and analyzed using systematic text condensation. Four themes were identified: (1) Removal of the safety net, when families experience that they are now on their own; (2) Hit by the realities, when parents realize the impact of living with diabetes; (3) Hang in there, when families mobilize resources to get them through a tough period; and (4) Toward a new normal, when parents begin to reestablish their life with diabetes in mind. This study generated unique insights into early parental adaptation and coping after their child was diagnosed with diabetes.

Strategies of adults for dealing with feelings of guilt – findings from a large web-based survey

Background

Feelings of guilt are common in adulthood. Depending on the situation, individuals need different strategies for dealing with these usually unpleasant experiences. The aim of this study was to provide comprehensive empirical information about such different guilt-related strategies used in adulthood.

Participants and procedure

A cross-sectional web-based survey was conducted (05/2019-04/2020) collecting autobiographical information on guilt expe-riences. Stated strategies for dealing with feelings of guilt were classified into inductively defined categories, and the fre-quency of the categorized strategies was calculated (total, gender-, age-specific). Associations between applied strategies and gender and age were analyzed using Cramér’s φ and V as appropriate.

Results

Analyzing statements of 579 participants (18-84 years), we differentiated 34 different categories of guilt-related strategies. The most frequently used strategies were “Self-reflection; contemplation; analyzing/reviewing things one feels guilty about” and “Repressing/ignoring/(actively) forgetting/not thinking about/bottling up the feelings of guilt”. Female and male partic-ipants showed a significantly different use only in the strategy of utilizing “Professional support/therapy/counseling” (10.57% vs. 3.67%; Cramér’s φ = .13, p = .001). Additionally, only a few differences were found with regard to age.

Conclusions

Adults use a broad variety of different strategies for dealing with feelings of guilt. Strategies regulating emotional responses to the problem causing feelings of guilt seem to be at least as important as strategies targeting the problem itself. Many strategies do not serve pro-social functions. Feelings of guilt are an issue relevant for mental health care since several of the adults with feelings of guilt utilize professional help, and an even higher number may need such help.

Tailoring Can Improve Consumers’ Hygienic Food-Handling Behavior to Reduce the Transmission Risk of Antimicrobial-Resistant Bacteria through Food

Antimicrobial-resistant (AMR) bacteria spread via food to humans and can seriously impair infection treatment. Hygienic food handling is an effective measure to avoid the transmission of bacteria. Therefore, we tested three types of interventions (tailored, generic, and no intervention) for their effectiveness in improving consumers’ hygienic food handling against the spread of antimicrobial-resistant bacteria through foods in a longitudinal randomized control trial. We based the determinants of hygienic food-handling behavior on the Health Action Process Approach (HAPA). The tailored intervention raised self-reported hygienic food handling, self-efficacy, and perceived likelihood of risk compared to no intervention. Moreover, interventions yielded different effects for participants with high vs. low intentions to improve their food-handling behavior. However, there were no differences between the tailored and generic interventions. More research is needed to find out whether including other behavior change techniques in the tailored intervention may increase the effect of tailoring.

Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients

Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients. Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report. Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping. Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.

Auricular acupuncture for breast cancer-related depression: A protocol for systematic review and meta-analysis

BACKGROUND

Breast cancer is a common disease in galactophore department. Patients with breast cancer are prone to depression, with the incidence of depression ranging from 13% to 23% and as high as 70% in patients with advanced stage. On the one hand, it is related to the physiological characteristics, personality characteristics, and social factors of women themselves. On the other hand, it is related to the common tumors of women, such as breast cancer, examination, and antitumor treatment. Due to the serious side effects of chemotherapy drugs, patients can always feel the presence of cancer. In addition, the mark of radiotherapy and fatigue make the psychological burden continue to have excessive economic burden, and lack of understanding from both social and family, discrimination and patients' own psychological endurance are all causes of breast cancer factors contributing to depressive symptoms in patients. Auricular acupuncture as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in patients who suffer from breast cancer-related depression for a long time, therefore, a systematic review is necessary to provide available evidence for further study.

METHODS

The following databases will be searched from their inception to August 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, VIP medicine information, and China National Knowledge Infrastructure. Primary outcomes: Score of depression symptoms. Additional outcomes: The overall effective rate. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.

RESULTS

The results of this study will systematically evaluate the effectiveness and safety of auricular acupuncture intervention for people with breast cancer-related depression.

CONCLUSION

The systematic review of this study will summarize the current published evidence of auricular acupuncture for the treatment of breast cancer-related depression, which can further guide the promotion and application of it.

OPEN SCIENCE FRA NETWORK (OSF) REGISTRATION NUMBER

September 11, 2020 osf.io/5b7yw. (https://osf.io/5b7yw).

Mental Health in the UK Police Force: a Qualitative Investigation into the Stigma with Mental Illness

Police work is a high-risk profession that can cause mental health conditions. With increasing sickness levels and falling police numbers, it is essential prompt mental health treatment be implemented. The study aims to explore institutional negativity and stigma in the police force towards mental ill health. Semi-structured interviews attended by five police officers with thematic analysis captured (i) police culture, (ii) the stigma of mental illness, (iii) disclosure of mental illness and (iv) breaking down barriers. Findings indicate police culture and attitudes to mental health may contribute to the causes of psychological illness, rather than the nature of the job itself. Increased education and awareness surrounding mental health have been shown to be fundamental in how an officer reacts to stress, but change is needed at a managerial level. Future research needs to explore the effects of mental health stigma on ethnicity and gender in the police force.

Coping with Pain in the Face of Healthcare Injustice in Patients with Sickle Cell Disease

To evaluate the pain coping strategies of patients with sickle cell disease (SCD) who experience healthcare injustice from either physicians or nurses during medical visits for pain management. It is unknown how patients' coping with pain relates to their experiences of healthcare injustice from physicians or nurses. This descriptive comparative study included adult outpatients with SCD who completed the PAINReportIt^®, Healthcare Justice Questionnaire^©, and Coping Strategies Questionnaire-SCD. Data were analyzed using independent t tests. Frequent coping strategies of patients who experienced healthcare justice from physicians were praying-hoping and from nurses were praying-hoping, calming self-statements, diverting attention, and increasing behavioral activity. In contrast, frequent coping strategies of patients who experienced healthcare injustice from physicians were catastrophizing and isolation and from nurses were isolation. Patients who experienced healthcare justice used different sets of pain coping strategies than those who experienced healthcare injustice during medical visits for pain management.

Social adjustment and repressive adaptive style in survivors of pediatric cancer

PURPOSE

The aim of the study was to explore the relationship between repressive adaptive style and self-reports of social adjustment in survivors of pediatric cancer compared to their siblings. We hypothesized that there would be a greater proportion of repressors among survivors of pediatric cancer compared to siblings, and that repressive adaptive style would be significantly associated with more positive self-reports of social adjustment.

METHODS

We utilized a cross-sectional approach. Seventy-seven families participated. Survivors of pediatric cancer (n = 77, 48% male; 8-18 years of age) and one sibling (n = 50, 48% male; 8-18 years of age) completed measures assessing repressive adaptive style and social adjustment. As well, one parent from each family completed a socio-demographic questionnaire. Questionnaire packages were mailed to eligible families who agreed to participate, and were mailed back to investigators in a pre-addressed, pre-stamped envelope.

RESULTS

Chi-square analyses revealed there was no significant difference in the proportion of repressors among survivors and siblings. Social adjustment scores were subjected to a two (group: survivor, sibling) by two (repressor, nonrepressor) ANCOVA with gender and age as covariates. There was a significant main effect of repressive adaptive style (F = 5.69, p < .05, η² = 0.05) with a modest effect. Survivors and siblings with a repressive style reported significantly higher social adjustment scores (M = 106.91, SD = 11.69) compared to nonrepressors (M = 99.57, SD = 13.45).

CONCLUSIONS

Repressive adaptive style explains some of the variance in survivors and siblings' self-reports of social adjustment. Future research should aim to better understand the role of the repressive adaptive style in survivors and siblings of children with cancer.

Repressive coping, stigmatization, psychological distress, and quality of life among behavioral weight management participants

Repressive coping has been associated with elevated risk of disease and negative health outcomes in past studies. Although a prior study of healthy men found that repression was associated with lower body mass index (BMI), no study has examined repressive coping among obese individuals. This study examined the relationship of repressive coping with BMI and obesity-relevant psychosocial factors among 104 overweight and obese participants in a behavioral weight management program. Participants completed questionnaires assessing repressive coping, stigmatization, psychological distress, and quality of life. BMI was objectively measured. Repressors reported lower stigmatization, anxiety, and depression as well as higher emotional and weight-related quality of life. Repressors and non-repressors had equivalent BMI and reported similar impairment in physical quality of life, but stigmatization moderated the relationship between repressive coping and physical quality of life (b=0.31, p=0.039), reflecting better physical quality of life among non-repressors with lower stigmatization. Obese individuals who engage in repressive coping may tend to underreport psychological symptoms, social difficulties, and impairments in quality of life. Higher physical quality of life among non-repressors with lower stigmatization may reflect a combined influence of coping and social processes in physical quality of life among obese individuals.

Effect of Alexithymia and Emotional Repression on Postsurgical Pain in Women With Breast Cancer: A Prospective Longitudinal 12-Month Study

Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism used to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs might predict pain after breast cancer surgery has not been assessed. The present study was conducted to assess the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing, and psychological adjustment were also assessed. Data were collected before surgery, and then at 2 days and 2, 3, 6, and 12 months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at 3 months, alexithymia at 3, 6, and 12 months, and body image and catastrophizing predicted acute or subacute pain at 2 months. In contrast, emotional repression was not predictive of pain. The generalized estimating equation approach was used and identified alexithymia as the only significant predictor of pain during the 12-month period after surgery. Alexithymia, but not emotional repression, predicted the development of persistent pain after breast surgery independently of anxiety and depression. Thus, alexithymia might be involved in mechanisms of pain chronicity.

PERSPECTIVE

This prospective study, conducted in women with breast cancer surgery, showed that alexithymia but not emotional repression predicted postsurgical pain. These results highlight the role of dysfunction in emotional processing in the development of postsurgical pain.

Cognitive Avoidant Coping Is Associated with Higher Carotid Intima Media Thickness Among Middle-Aged Adults

BACKGROUND

Cognitive avoidant coping (CAV) has been associated with elevated autonomic stress reactivity, thus presumably elevating risk for cardiovascular diseases. However, more direct evidence for this hypothesis is lacking.

PURPOSE

The purpose of this study was to relate carotid intima media thickness (IMT) to CAV in nonclinical participants.

METHODS

A total of 124 participants (61 women) with a mean age of 37.52 years (SD = 7.93, MIN = 30, MAX = 60) participated in the study. IMT was assessed by ultrasonic imaging and CAV via questionnaire (Mainz Coping Inventory; MCI).

RESULTS

Regression analysis revealed that although CAV was not significantly associated with IMT, there was a significant interaction of CAV and age. Whereas for younger adults, there was no significant relation for older individuals, CAV and IMT were significantly positively associated.

CONCLUSIONS

Findings suggest that CAV could constitute a risk factor for cardiovascular diseases with increasing age.

Type D personality is associated with social anxiety in the general population

BACKGROUND

Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample.

PURPOSE

The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population.

METHODS

A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7).

RESULTS

Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A.

CONCLUSION

In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.

Fact or artefact: an item response theory analysis of median split based repressor classification

OBJECTIVE

Many studies have investigated the phenomenon of repression. Repressors are defined as individuals who deny or avoid the experience of negative affect. A common method for the identification of repressors is a median split approach using questionnaires that measure anxiety and social desirability. The present study aimed to evaluate this most frequently used procedure using a psychometric model.

DESIGN

We applied item response theory using model assumptions comparable with those of the median split approach to detect repressors and examine the appropriateness of the median split procedure.

METHODS

A mixed sample of 655 students and members of the general public completed the two scales usually used to identify repressors, namely the Taylor Manifest Anxiety Scale and the Marlowe-Crowne Social Desirability Scale.

RESULTS

Employing item response theory mixture-model analyses, we were unable to replicate the median split solution on a latent level.

CONCLUSIONS

Our results did not support the identification of repressors via dichotomization of the two scales. The median split approach does not appear to detect repressors satisfactorily. The implications of the results for the conceptualization and assessment of repressors are discussed.

Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population

BACKGROUND

Type D is considered as a non pathological personality trait and propensity for mental distress. Its relationship with mental distress has been mainly studied in cardiovascular patients and with respect to depression. The knowledge about the relationship of Type D with mental disorders, psychosocial stressors and health care utilization in the general population is insufficient. Therefore the present study sought to determine the associations of Type D with mental distress, major psychosocial stressors, health status, and health care utilization in the general population.

METHODS

Cross-sectional analysis in a representative population based sample of n = 2495 subjects (mean age 49 years, range 14-92 years) of whom 33.1% had Type D personality.

RESULTS

Individuals with Type D had an increased risk for clinically significant depression, panic disorder, somatization and alcohol abuse. After adjustment for these mental disorders Type D was still robustly associated with all major psychosocial stressors. The strongest associations emerged for feelings of social isolation and for traumatic events. After comprehensive adjustment Type D still remained associated with increased help seeking behavior and utilization of health care, especially of mental health care.

LIMITATIONS

The main limitation is the reliance on self-report measures and the lack of information about the medical history and clinical diagnosis of the participants.

CONCLUSION

Type D identifies persons with severely increased risk for mental distress, major psychosocial stressors and increased health care utilization. As a frequent disposition, Type D is assumed to be of high relevance for health care.

Examining the Link Between Domestic Violence Victimization and Loneliness in a Dutch Community Sample: A Comparison Between Victims and Nonvictims by Type D Personality

The current study investigated whether differences in loneliness scores between individuals with a distressed personality type (type D personality) and subjects without such a personality varied by domestic violence victimization. Participants (N = 625) were recruited by random sampling from the Municipal Basic Administration of the Dutch city of 's-Hertogenbosch and were invited to fill out a set of questionnaires on health status. For this study, only ratings for domestic violence victimization, type D personality, feelings of loneliness, and demographics were used. Statistical analyses yielded main effects on loneliness for both type D personality and history of domestic violence victimization. Above and beyond these main effects, their interaction was significantly associated with loneliness as well. However, this result seemed to apply to emotional loneliness in particular. Findings were discussed in light of previous research and study limitations.

A longitudinal study of emotional experience, expressivity, and psychopathology in psychotherapy inpatients and psychologically healthy persons

The authors investigated changes of emotional experience and expressivity in 34 inpatients undergoing psychodynamic therapy and in 29 healthy persons who were assessed at parallel time intervals. Participants completed 2 measures of psychopathology (Symptom Checklist-90 Revised and Inventory of Interpersonal Problems-64) and took part in relationship episode interviews. The emotional experiences they reported and their nonverbal emotional expressivity during the interviews were assessed by independent raters. Regardless of when they were assessed, the patients reported a greater number of emotions and a greater variety of emotions. Psychopathology in the patient group decreased in the course of treatment, but there were no systematic changes in the emotional domain. The findings challenge the common notion of psychopathology being associated with impaired awareness and expression of emotions.

The Construct Validity of Social Inhibition and the Type-D Taxonomy

In contrast to the prognostic validity of the type-D personality, there is still little knowledge on the construct validity. In a sample of 102 healthy young adults the construct validity was analysed against the Big-Five dimensions, four of the 16 PF factors, and repressive emotion regulation. Social inhibition was associated with Apprehensiveness, and low scores in social competencies and self-deception. The three non-type-D clusters clearly differed; the restrained cluster emerged as opposite to the type-D cluster in nearly every personality dimension and type of emotion regulation. The article concludes that emotion regulation in socially inhibited persons deserves further investigation.

Repressive coping style: relationships with depression, pain, and pain coping strategies in lung cancer outpatients

Researchers have shown that coping style is related to pain and adjustment in people with chronic illness. This study was the first to examine how coping style related to pain, pain coping strategies, and depression in lung cancer outpatients. We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4±10.43 years, 88% Caucasian). As in prior studies, we classified patients into four coping style groups based on Marlowe-Crowne Social Desirability Scale and trait anxiety scores. The coping style groups were low-anxious (n=25); high-anxious (n=31); defensive high-anxious (n=21); and repressive (n=30). Compared to other coping style groups, the repressive group reported statistically significant lower mean scores for pain quality, pain catastrophizing, and depression. Assessing coping style by measuring personal characteristics such as social desirability and trait anxiety may help clinicians to identify vulnerable individuals with lung cancer who may be candidates for early and timely intervention efforts to enhance adjustment to pain.

Could repressive coping be a mediating factor in the symptom profile of individuals diagnosed with schizophrenia?

Despite a relatively high prevalence, and the enduring patronage of the disorder by psychiatry and the pharmaceutical industry, innovative conceptualization of schizophrenia in a client-empowering and quality of life-enhancing way appears to represent a vacuum within the clinical agenda, certainly taking second place to 'patient management'. However, against this bland background of medicalization of what is clearly a poorly understood and complex multifactorial syndrome, innovative treatment approaches aimed at symptom control, in particular, the stress vulnerability model (SVM), have been developed. However, the SVM is an incomplete model of patient experience and says little of aetiological note. One area of psychological function that may give further insight into the symptom experience associated with schizophrenia within the context of stress vulnerability concerns the mechanisms of repression. Ironically, the notion of repression will for many represent the epitome of nonevidence-based psychiatric theory and related psychodynamic therapy practice. However, more contemporary work within the psychological literature has aimed to make the concept both measurable and observable. No longer occluded by the context of psychoanalysis, cognitive science accounts of repression may be of value in facilitating understanding of the variability and predictability of symptoms of schizophrenia and may provide a dimension of therapeutic engagement allied to the SVM.

Repressive coping and alexithymia in idiopathic environmental intolerance

OBJECTIVE

To examine if the non-expression of negative emotions (i.e., repressive coping) and differences in the ability to process and regulate emotions (i.e., alexithymia) is associated with idiopathic environmental intolerance (IEI).

METHODS

The study included participants who had previously participated in a general population-based study and reported symptoms of environmental intolerance (n = 787) and patients with IEI (n = 237). The participants completed questionnaires assessing IEI, namely, a measure of repressive coping combining scores on the Marlowe-Crowne Social Desirability Scale (MCSDS) and the Taylor Manifest Anxiety Scale (TMAS), the Toronto Alexithymia Scale (TAS-20), and a negative affectivity scale (NAS). Multiple, hierarchical linear regression analyses were conducted using IEI variables as the dependent variables.

RESULTS

The TMAS and MCSDS scores were independently associated with the IEI variables, but there was no evidence of a role of the repressive coping construct. While the total alexithymia score was unrelated to IEI, the TAS-20 subscale of difficulties identifying feelings (DIF) was independently associated with symptoms attributed to IEI. Negative affectivity was a strong independent predictor of the IEI variables and a mediator of the association between DIF and IEI.

CONCLUSION

Our results provide no evidence for a role of repressive coping in IEI, and our hypothesis of an association with alexithymia was only partly supported. In contrast, strong associations between IEI and negative emotional reactions, defensiveness and difficulties identifying feelings were found, suggesting a need for exploring the influence of these emotional reactions in IEI.

Repressive coping style and its relation to psychosocial distress in males with erectile dysfunction

INTRODUCTION

There is evidence that repressive coping adversely affects medical conditions such as coronary heart disease, hypertension, and bronchial asthma. Erectile dysfunction (ED) is known to have a severe and lasting negative impact on health, quality of life, and partnership. Although ED may be eminently threatening for the self-image of affected men, a repressive coping style and its consequences for their mental health and partnership has not yet been investigated.

AIM

Based on the presumption that the male self-image is threatened by ED, we expected men with repressive coping strategies-although reporting the same degree of impairments regarding their sexual function-to describe themselves as more satisfied with: (i) their sexual relationship, to report (ii) a better quality of their partnership; and (iii) less distress (depression and physical complaints) as compared with those who do not use such strategies.

METHODS

Fifty-nine patients with ED from the outpatient unit of the Clinic of Urology, Pediatric Urology and Andrology of the University of Giessen were examined using standardized German versions of international questionnaires. Coping style was determined using a combination of the State Trait Anxiety Inventory (STAI) and the Marlowe Crown Social Desirability Scale (SDS-CM) measuring defensiveness.

MAIN OUTCOME MEASURES

Questionnaires measuring anxiety (STAI), depression (Center for Epidemiological Studies Depression Scale), social desirability (SDS-CM), quality of partnership (Partnership Questionnaire), and physical complaints (Complaint List) were administered.

RESULTS

Repressors did not differ from nonrepressors with regard to their self-reported sexual function (International Index of Erectile Function). However, they described themselves as less distressed (depression, physical complaints) and rated the quality of their partnership as higher.

CONCLUSION

Repressors tend to report their complaints in a manner that protects their self-worth. Clinicians therefore might have difficulties deciding whether and which treatment is necessary. Additional clinical information (e.g., interview together with the female partner) or questionnaires might prove useful sources of information on patients' coping style.

Psychological adjustment to chronic disease

This Review discusses physiological, emotional, behavioural, and cognitive aspects of psychological adjustment to chronic illness. Reviewing the reports of the past decade, we identify four innovative and promising themes that are relevant for understanding and explaining psychological adjustment. In particular, the emphasis on the reasons why people fail to achieve a healthy adjustment has shifted to the identification of factors that help patients make that adjustment. To promote psychological adjustment, patients should remain as active as is reasonably possible, acknowledge and express their emotions in a way that allows them to take control of their lives, engage in self-management, and try to focus on potential positive outcomes of their illness. Patients who can use these strategies have the best chance of successfully adjusting to the challenges posed by a chronic illness.