Experiences of receiving formal psychological support following lower limb amputation: a qualitative study

PURPOSE

This study sought to explore the experiences of receiving formal psychological support following non-vascular-related lower limb amputation.

MATERIALS AND METHODS

Semi-structured interviews were conducted with five individuals (3 males, 2 females, aged 38-56) with lower limb loss. Two had unilateral above knee amputations, one a unilateral below knee amputation, one a unilateral through-knee amputation, and one had bilateral above knee amputations. Four had trauma-related amputations, one had an amputation due to cancer. All had received formal psychological support related to their amputation. Interpretative phenomenological analysis was used for the analysis of the data.

RESULTS

Four themes were developed: (1) The need for psychological intervention-denial and acceptance; (2) "Safe space"-being valued, heard, and validated; (3) The importance of focus, transparency, and specialist knowledge; and (4) The most helpful techniques and approaches. Findings highlighted aspects of psychological support that were helpful and unhelpful.

CONCLUSIONS

The findings provide insights into how psychological support for people with lower limb amputation can be delivered or improved. These include: the importance of psychological support throughout rehabilitation; the benefit of transparency and collaborative goal setting in sessions; and participants' preference that those providing formal psychological support have limb loss specific knowledge.

Self-reported anterograde memory loss in older persons that is not validated on neuropsychological assessment: Considerations for a dissociative diagnosis

The past decade has witnessed amplified public awareness of age-related dementias. This has resulted in a dramatic rise in the number of older persons referred to memory clinics with a primary complaint of self-reported memory loss without an antecedent neurological event (e.g., stroke) who produce neuropsychological test profiles that lack evidence of such impairment. Since the latter part of the 19th century, a confusing array of changing terminology, criteria, and perceived causation have been ascribed to patients with unverified medical symptoms to implicate psychological causation. Such terms are often misperceived by laypersons as reflecting character flaws or malingering. Of import for clinical neuropsychologists, the 11th edition of the International Classification of Diseases added cognitive to symptoms eligible for a diagnosis of the modern formulation, dissociative neurological symptom disorder. One dissociative option for referrals with self-reported neurocognitive symptoms not validated on neuropsychological testing is functional memory disorder, conceived as a psychological disorder where emotional distress is plausibly related to the perceived memory loss but is of less severity than would warrant a major depressive or anxiety diagnosis. If evidence of psychological distress or behavioral impairment is not present the referral likely reflects the increased public awareness of age-related dementias interacting with the high base rate of self-perceived memory loss in the general population. In such cases, a dissociative diagnosis should be avoided as there is evidence of neither a medical nor a psychological disorder. A summary statement of not dementia or similar is likely sufficient to help the patient.

Perceived partial social integration, levels of distress and resilience, and COVID-19 vaccine rejection of Jewish and Arab citizens of Israel

Introduction

The present study examines the role of perceived partial social integration (PPSI) in determining the rejection of the COVID-19 vaccine of Jewish and Arab citizens of Israel.

Methods

The research hypotheses are examined using a relatively large sample of the Israeli public, including 208 Arab and 600 Jewish adults, who have responded to an anonymous questionnaire pertaining, among other issues, to partial social integration and the individual level of vaccine uptake.

Results

Higher levels of PPSI were found to be associated with higher levels of vaccine rejection, in both Jewish and Arab samples. The Arab minority group regards themselves as less socially integrated into the Israeli society and therefore rejects the COVID-19 vaccine to a greater extent than the majority group. The Arab respondents expressed a higher level of psychological distress and a lower level of resilience compared with the Jewish participants. The perceived partial social integration score significantly predicted the levels of distress and resilience of the Jewish but not the Arab sample.

Discussion

The study indicates that increasing the vaccination rates depends more substantially on trust in the authorities than on leveraging greater pressure on individuals that reject the vaccine. Increased trust in the authorities and regarding oneself as an integral component of society are two vital conditions for vaccine acquiescence. Insufficient social integration is a major reason for vaccine rejection.

The Discrepancy between Actual Performance and Self-Awareness among Adolescents with Executive Function Deficits

Adolescents with executive function deficits (EFD) struggle to perform complex daily activities and have difficulty being self-aware of their performance. This study aimed to compare actual performance with self-awareness of performance among adolescents with EFD before and after a metacognitive intervention. The participants consisted of 41 adolescents aged 10 to 14 years, previously diagnosed with EFD. All performed the Children’s Cooking Task (CCT), and completed the Behavioral Rating Inventory Executive Function—Self-Report (BRIEF-SR) and the Self-Awareness of Performance Questionnaire. Significant positive differences were found in the time duration and the total number of errors from the CCT and three BRIEF-SR subscale scores before and after the intervention. No significant differences were found in self-awareness of performance. After a cognitive intervention, adolescents with EFD improved their performance of a learned skill, but their self-awareness of their performance remained unchanged. These results may imply that EFD inhibits self-awareness development, and that self-awareness may not depend on task performance, but, rather, is influenced by other external factors. The article reports the secondary analysis from the results of the Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) intervention on human participants.

Psychological predictors of treatment adherence among patients with diabetes (types I and II): Modified information-motivation-behavioural skills model

Non-adherence to medical regimens among patients with diabetes is a well-recognized concern in health care. Modified information, motivation, behavioural skills (IMB) model by adding an emotion component to it was tested to explore predictors of treatment adherence among 1,125 Iranian patients with diabetes type I (T1D) and type II (T2D) and due to other medical conditions. The modified IMB model explained 35% of the treatment adherence with large effect-sizes f²  = 0.56 to 0.69. Self-compassion and interpersonal communication between staff and patients (ICSP) were significant predictors of treatment adherence among patients with T1D, T2D and diabetes due to other medical conditions, while both outperformed the other significant predictors of treatment adherence, i.e., illness perception and social support in all groups. Distress intolerance was a significant predictor of treatment adherence only in patients with T2D. In addition, patients, based on their type of diabetes, exhibited different patterns of illness perception in predicting treatment adherence. Among T2D patients and those with diabetes due to other medical conditions, gender (male; only in T2D) and being single were significant predictors of treatment adherence, while age and diabetes duration were not. Finally, the model demonstrated that above and beyond demographic features, self-compassion, interpersonal communication between patients and health care staff, distress intolerance, perceived social support and illness perception were significant predictors of treatment adherence among patients with diabetes.

Can the Concepts of Energy and Psychological Energy Enrich Our Understanding of Psychosocial Adaptation to Traumatic Experiences, Chronic Illnesses and Disabilities?

The aim of this paper is to familiarize the reader with the concept of psychological energy (PE), and the role it plays in deepening our understanding of psychosocial adaptation to traumatic life events and, more pointedly, the onset of chronic illness and disability (CID). In order to implement this aim, the following steps were undertaken: First, a brief historical review of the nature of energy, force and action, as traditionally conceived in the field of physics, is provided. Second, an overview of PE is presented, with a shared emphasis on both its historical underpinnings and its present conceptualizations in the fields of social, health and rehabilitation psychology. Particular emphasis is placed upon applications of PE in the domains of adaptation to stress, trauma and CID onset. Third, reviewed are measuring instruments that have been traditionally applied to the assessment of the nature, content and magnitude of PE and its dynamics. Finally, new perspectives are offered on the dimensional structure, processes and dynamics, assumed to undergird PE, its underlying conceptual similarities to physical energy, and its potential and deeper link to the process of psychosocial adaptation in the aftermath of experiencing trauma and CID.

Components of Unrealistic Optimism of College Students: The Case of the COVID-19 Pandemic

College students are among the most strongly affected populations by the coronavirus disease-2019 (COVID-19) pandemic because of uncertainty regarding academic success, future careers, and social life during their study period. Their mental health and behavior may dramatically be impacted. The study examined an unrealistic optimism of Israeli college students in assessing the health, security, and economic risks during the pandemic, and the contributions of these perceived risks to the prediction of psychological coping responses, such as well-being, and coping suppressing response of anxiety, expressed during this pandemic. Using social networks, a questionnaire was disseminated to students during the third lockdown that was implemented in Israel because of the pandemic. Depressive and anxiety symptoms, perceived threats, resilience, well-being, hope, and morale were measured using a structured quantitative questionnaire. First, we hypothesized that the three perceived risks would be inversely rated, so perceived health risk would be rated lowest, and perceived economic risk would be rated highest. The second and third hypotheses claimed that psychological coping responses articulated along this pandemic would be predicted by all these perceived risks, as well as the observance of pandemic precaution rules. The fourth hypothesis suggested that the three investigated perceived risks will positively and significantly correlate with each other. The results generally supported the hypotheses and indicated that the unrealistic optimism process was employed quite consistently by the participating students.

On the edge: The association between extreme values of proportional felt-age and functioning

The present study examined whether endorsing a felt-age that is extremely divergent from one's actual age (whether older or younger) is related to worse functioning four years later. Data were drawn from 4938 participants, who completed the 2008 and 2012 questionnaires of the Health-and-Retirement-Study (HRS). Participants were divided into four groups according to their reported proportional-felt-age: the normative-young (N = 2229), reported a normative felt-age at the median or younger; normative-old (N = 2226), reported normative felt-age at the median and older; and the extremely young and extremely old proportional-felt-age (upper and lower 5% of felt-age; N's = 242 and 241, respectively). These groups were compared on chronic medical conditions, depressive symptoms, activities of daily living (ADL), instrumental activities of daily living (IADL), functional limitations, and loneliness. While extremely younger proportional-felt-age participants did not reveal worse (or better) outcomes compared with the normative-young group, extremely old proportional-felt-age participants reported worse physical health, mental health, and functioning in cross-sectional, as well as longitudinal comparisons. Extreme values of older proportional-felt-age are usually not reported randomly and reflect less adaptive adjustment. The findings underscore the importance of studying participants at the extreme values of felt-age, especially extreme old proportional-felt-age, and the need for further inspection of the mechanisms underlying these evaluations.

The Duality of Human Experience: Perspectives From Psychosocial Adaptation to Chronic Illness and Disability—Historical Views and Theoretical Models

This article examines the current views on the duality of the human experience as portrayed within the process of coping with and managing traumatic life events, with a special emphasis on those views associated with the onset, or diagnosis, of chronic illnesses and disabilities (CID). In this article, experiential dualities are reviewed with a focus on (a) broadly defined modes of psychosocial adaptation to CID, such as coping versus succumbing, and disabled versus nondisabled selves; (b) models of denial, which often dichotomize its structure as reflecting complete or major versus partial or minor denial; and (c) models of personal growth following adversity and traumatic events, such as the onset or diagnosis of severe and life-threatening CID. Focus is placed on the dualities that dichotomize human functioning following traumatic experiences, along such categories as genuine or transcendent growth versus self-deception or illusory growth.

Repressive Coping Does Not Contribute to Anosognosia in First-Diagnosis Patients With Alzheimer Disease

Anosognosia is common in patients with Alzheimer disease (AD) even in early stages. Although neural correlates and the impact of cognitive dysfunctions have been described, possible psychodynamic processes such as a repressive coping style as described in other illnesses, have not been examined. Our study aimed to examine possible psychological influence factors on illness perception embracing a repressive coping style and cognitive functions in AD patients in the diagnostic process. Fifty-four subjects with mild AD diagnosed in our memory clinic were enrolled. Anosognosia was evaluated using a patient-caregiver discrepancy rating. All patients underwent comprehensive neuropsychological testing. In addition, characteristics of a repressive coping style were assessed. In total, 79.6% of our patients showed a lack of awareness at least to some degree. 33.3% of the patients were classified as repressors. Repressors and nonrepressors did not differ in cognition, or the unawareness score. Multivariate regression analysis showed that repressive coping style did not significantly contribute to anosognosia, but that verbal memory and naming ability had a strong influence. Although our data indicate that a high proportion of patients with mild AD show characteristics of repressive coping, this possible defense mechanism had no influence on the awareness of illness-related deficits measured by caregiver patient discrepancy.

Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance

The aim of this study was to analyze the relationship between sociodemographic/clinical characteristics, coping strategies and satisfaction with life in individuals with lower limb amputation. Sixty-three individuals with a lower limb amputation due to Diabetes and Peripheral Vascular Disease participated in the study and answered measures of coping strategies and satisfaction with life. Findings revealed high dissatisfaction with life. Acceptance and active coping were the most used coping strategies. Satisfaction with life was positively associated with active and planning coping, religion, acceptance and humour. There were differences in coping strategies according to gender, age, marital status, presence of residual limb pain, prosthesis use and mobility level. Results emphasize the differential role of coping strategies, for each individual. Psychosocial interventions need to take into consideration coping strategies during the process of rehabilitation and be specific regarding individuals` sociodemographic and clinical characteristics. This study may help design interventions that answer individuals with lower limb amputations given that coping strategies are a valuable resource in the promotion of satisfaction with life.

Self-management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis

OBJECTIVE

Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self-management strategies that HNC survivors use to overcome these posttreatment challenges.

METHODS

Twenty-seven individuals from 4 designated cancer centres in Ireland were interviewed about self-management strategies that helped them overcome challenges following HNC treatment. Interviews were audio-recorded, transcribed, and analysed using directed content analysis.

RESULTS

Twenty self-management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self-management strategy types were self-sustaining (used by 26 survivors), self-motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22).

CONCLUSIONS

The study identified strategies that helped HNC survivors to self-manage posttreatment challenges. This information could inform the design/development of self-management interventions tailored towards HNC survivors.

Predictors of perceived need for medical care in an inpatient rehabilitation unit: an update

Limited awareness of illness, or poor insight, has been associated with poor treatment outcomes and prognoses in both psychiatric and medical populations. We examined predictors of insight in a sample of 403 patients in an inpatient rehabilitation unit at a Midwest Veterans Affairs Medical Center. A multiple regression analysis revealed that age, depression, IQ, and a measure of judgment were significant predictors of acknowledgement of illness. Younger age, higher IQ, better judgment, and depression were associated with better insight. By identifying risk factors for poor insight, these findings have significant clinical implications for healthcare providers.

Recent trends in rehabilitation interventions for visual neglect and anosognosia for hemiplegia following right hemisphere stroke

This article highlights the most recent findings regarding the rehabilitation interventions for the syndromes of visual neglect and anosognosia for hemiplegia that occur following right hemisphere stroke. We review papers published in the past 4 years pertaining to therapeutic approaches for these two syndromes in order to identify the trends in the development of effective interventions. Overall, it appears well recognized that visual neglect syndromes and awareness syndromes frequently co-occur and both include complex, multifaceted impairments leading to significant difficulties in daily life functioning following stroke. Thus, the interventions for these syndromes must be multifaceted in order to address the complex interplay of cognitive-behavioral-emotional components. There appears to be a trend for using combination therapeutic interventions that address these components.

Denial of Chronic Illness and Disability: Part II. Research Findings, Measurement Considerations, and Clinical Aspects

The concept of denial has been an integral part of the psychological and disability studies bodies of literature for over 100 years.Yet, denial is a highly elusive concept and has been associated with mixed, indeed conflicting theoretical perspectives, clinical strategies, and empirical findings. In part II the author reviews empirical findings, measurement strategies, and clinical approaches associated with denial, with particular emphasis on rehabilitation-specific findings and implications. It focuses on empirical findings linking the use of denial to a number of psychosocial outcomes, measures that have been employed in the assessment of denial and, intervention strategies to manage denial. Part II concludes with a brief discussion of the implications generated by the current understanding of denial to rehabilitation practitioners and researchers.

Denial of Chronic Illness and Disability

Denial has been an integral part of the psychological and disability literature for more than 100 years. Yet, denial is an elusive concept and has been associated with mixed, indeed conflicting, theoretical perspectives, clinical strategies, and empirical findings. In this two-part article, the author provides an overview of the existing literature on denial that addresses the most prominent and rehabilitation-relevant features of it. Part I provides a generic yet clinically based discussion of denial and focuses on the following: historical perspective of denial, the definitions of denial, the types or forms of denial most often encountered in the literature, the functions served by denial, the indicators or markers most frequently associated with denial, the dynamics and processes inherent in the operation of denial, and the costs and benefits of denial.

The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties

OBJECTIVE

To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services.

DESIGN

We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure's internal consistency, interrater reliability, construct validity, and criterion validity.

SETTING

Acute inpatient rehabilitation in 3 metropolitan hospitals.

PARTICIPANTS

A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine's Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument.

RESULTS

The HRERS has good internal consistency (alpha=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=-.24, P<.01), higher ratings of denial of illness (r=-.30, P<.001), and self-rated negative affect (r=-.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01).

CONCLUSIONS

The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.

Illness Representation of Patients With Systolic Heart Failure

Studies have shown that individuals influence their health outcomes, both positively and negatively, through their illness representation. To date, no studies describe the illness representation of persons with systolic heart failure, a significant contributor of morbidity and mortality in older adults. The purpose of this study was to describe illness representation in heart failure. Twenty-two subjects with New York Heart Association class II or III systolic heart failure were recruited at a university-based heart failure clinic. Illness representation was measured using the revised Illness Perception Questionnaire. The means on each of the 9 subscales were found to be significantly different from the neutral point of 3. The results suggest that participants believed that their heart failure was a chronic, cyclic disease with serious consequences that they could control through treatment. In addition, participants believed that they understood their heart failure and did not have a negative affective response to their heart failure.