The Lived Experiences of Learning Cognitive Behavioral Therapy: a Qualitative Study of Psychiatry Residents.

OBJECTIVE: The purpose of this qualitative study was to investigate the lived experiences, beliefs, attitudes, and needs of psychiatry residents learning cognitive behavioral therapy (CBT). METHOD: Eight general psychiatry residents beginning their outpatient psychotherapy training in July 2020, answered open-ended questions about their experiences learning CBT in October 2020. The residents learned CBT through didactics, role-play, observation, video review, and individual and group supervision. Participants were asked to describe their experiences broadly, reflect on the simple and challenging aspects of learning, identify the most and least helpful learning modalities, and share thoughts or personal reflections activated through their journey. Written data were analyzed using Colaizzi's phenomenological methodology, including the extraction of significance statements and collapsing of meaning statements into key thematic clusters. Verification strategies were used to ensure the trustworthiness and credibility of data analysis. RESULTS: Participants found various learning modalities effective, most notably individual and group supervision. While rapport building and mood checks were least challenging, many found adhering to structure or implementation of advanced techniques to be the more arduous parts of learning. Patient progress tended to stimulate resident engagement, whereas incomplete action plans or lack of observable treatment gains led to some automatic negative thoughts. Many participants applied CBT techniques to themselves to address their own automatic thoughts, biases, or behavioral patterns. CONCLUSIONS: The results of this study offer valuable insight about learners' experiences of becoming a therapist that could help normalize residents' experiences and help educators guide residents through the learning process.

Expectations and reality: perceptions of support among African American breast cancer survivors.

Objective: The experience of an illness such as breast cancer is not a static event. Just as physiological needs change as a patient transitions through diagnosis, treatment, to long-term survivorship, so too will their needs for social support. We applied a transitions theory framework to explore how African American women with breast cancer conceptualized and experienced support along their breast cancer journey. Design: We recruited 16 African American women with breast cancer from a regional cancer center in South Carolina to complete qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. Results: Three core themes emerged: 'I guess she was supposed to': When support meets patient expectations; 'I wasn't expecting that and that just made me feel so good': When reality exceeds expectations; and 'Don't try to make an invalid out of me': When support given wasn't what was desired. Survivors shared how their family, friends and clergy met their needs for emotional (e.g. prayer, sharing affirmations about God) and instrumental support (e.g. cooking meals, house cleaning). They emphasized how receiving emotional support from their healthcare providers was a pleasant surprise. However, survivors also described unexpected disappointments when family members offered support that was un-needed or un-desired. Conclusions: Applying transitions theory, we found that social support is a process of bidirectional negotiation where African American women with breast cancer perceive support as helpful and acceptable depending on who offers support, what type of support is offered, and when it is offered. Members of their social support network (e.g. family, friends, providers) should periodically assess the survivor's evolving needs to ensure the social support harmonizes with the needs and expectations of the survivor.

African American Women's Recollected Experiences of Adherence to Breast Cancer Treatment.

PURPOSE/OBJECTIVES: To explore African American women's recollected experiences of breast cancer treatment.
. RESEARCH APPROACH: Qualitative description and narrative analysis.
. SETTING: South Carolina Oncology Associates, an outpatient oncology clinic serving rural and urban populations.
. PARTICIPANTS: 16 African American women with breast cancer previously enrolled in the control arm (n = 93) of a completed randomized, controlled trial. 
. METHODOLOGIC APPROACH: Feminist narrative analysis of in-depth individual interviews.
. FINDINGS: The authors identified three themes within the African American breast cancer survivors' recollected experiences of treatment adherence. INTERPRETATION: Although little evidence was presented of shared decision making with providers, patients were committed to completing the prescribed therapies. The narratives highlighted the value of in-depth examination of patients' perspectives, particularly among minority and underserved groups. With the exception of voicing personal choice of surgical treatment, the women trusted providers' recommendations with a resolve to "just do it." Although trust may enhance treatment adherence, it may also reflect power differentials based on gender, race, education, and culture.
. IMPLICATIONS FOR NURSING: Nurses should listen to patients describe their experience with cancer treatment and compare the themes from this study with their patients' story. This comparison will help nurses support patients through various aspect of diagnosis and treatment.

A collaborative care model for patients with Type-2 diabetes.

The research on diabetes has shown the need to move from a traditional medical model to a patient-team orientation. This has led to a number of collaborative programs targeting the patient and family's comprehensive needs. This paper details one collaborative care program for underserved patients with Type-2 diabetes set in rural, eastern North Carolina. Roles of the therapeutic team are incorporated along with a case example highlighting the bio-psychosocial-spiritual model in action. Sustainability, challenges, and strengths are included to facilitate a realistic appraisal of the program.

Enrichment, stress, and growth from parenting an individual with an autism spectrum disorder.

BACKGROUND: Past researchers have focused primarily on the associated negative impact of caring for a child with special needs. In this study, caregivers report the enrichment and stress of caring for a child with an autism spectrum disorder. METHOD: Eighty caregivers completed the Social Communication Questionnaire (SCQ), Effects of the Situation Questionnaire (ESQ), and Posttraumatic Growth Inventory (PTGI). Enrichment and stress scores were compared to symptom severity data and posttraumatic growth scores. RESULTS: Consistent with prior research, caregivers reported greater levels of stress than enrichment. On just over half of the stress/enrichment variables, parental ratings of stress and enrichment were negatively correlated. Scores of total stress and enrichment were not correlated to the severity of the individual's symptoms or caregivers' growth scores. CONCLUSIONS: These findings suggest that although stress is a major concern for caregivers, enrichment and growth may also occur in varying degrees.

Caring for an individual with autism disorder: a qualitative analysis.

BACKGROUND: Caregivers in this qualitative study reported the multidimensional implications of having a child with autism on their family's lives and overall functioning. METHOD: The Effects of the Situation Questionnaire (Yatchmenoff, Koren, Friesen, Gordon, & Kinney, 1998) was used to gather qualitative data from 80 caregivers. Colaizzi's (1978) phenomenological data analysis method was used to analyse the caregivers' written narratives. Biopsychosocial-spiritual, systemic, and ecological theoretical lenses were used to conceptualise the recorded experiences. RESULTS: Seven thematic content areas emerged from the caregivers' data. They include: psychological implications, familial implications, social implications, services, spiritual benefits, economic challenges, and focus on the future of having a child diagnosed with autism. CONCLUSIONS: The results of this study offer valuable insight into how helping professionals may attend to the biological, psychological, social, and spiritual dimensions of those caring for an individual with autism.