[Meaning-Centered Psychotherapy in Psycho-Oncological Care]. / Sinnzentrierte Psychotherapie in der psychoonkologischen Versorgung.

Being diagnosed with cancer is commonly associated with psychological distress. Especially patients with advanced disease report a range of distinct symptoms that are referred to as existential distress. The conceptualization of existential distress is mainly characterized by the loss of a sense of meaning and purpose in life resulting from the confrontation with a life-threatening disease. Existential distress has a significant impact on health care outcomes and quality of life. It has been found to be associated with suicidal ideation, even in the absence of mental disorders such as depression. Meaning-centered psychotherapy offers effective interventions with regard to reducing existential distress in cancer patients.

Effect of Group Logotherapy on Anxiety About Death and Existential Loneliness in Patients With Advanced Cancer: A Randomized Controlled Trial.

BACKGROUND: Although logotherapy has been shown to relieve other psychological symptoms of patients with cancer, no studies have specifically investigated the effect of logotherapy on anxiety about death and existential loneliness in these patients. OBJECTIVE: The aim of this study was to determine the effect of group logotherapy on anxiety about death and existential loneliness in patients with advanced cancer. METHODS: Sixty-three patients who were in the advanced stage of cancer were recruited from 2 hospital oncology services and were randomly assigned to either experimental (n = 31) or control group (n = 32). The intervention group received 10 weekly 2-hour group logotherapy. Templer's Death Anxiety Scale and ELQ were completed pre- and posttreatment. RESULTS: A 2 × 2 mixed analysis of variance was used to determine the effect of the treatment on each of the dependent variables. The analyses revealed that patients in the logotherapy group reported a significant decrease in anxiety about death and existential loneliness after (vs before) the treatment. No significant decreases were observed in the waitlist control group. CONCLUSIONS: These results have implications for treating death anxiety and feelings of existential loneliness among patients with advanced cancer. They suggest that group logotherapy is highly effective in reducing these existential concerns. Limitations and avenues for future research are discussed. IMPLICATIONS FOR PRACTICE: The study emphasizes that group logotherapy can be considered in oncology care programs by healthcare professionals and in educational curriculums and is suggested for use among caregivers and patients with advanced cancer.

Psychedelic-assisted psychotherapy to treat psychiatric and existential distress in life-threatening medical illnesses and palliative care.

Psychiatric and existential distress commonly occur in advanced cancer and other serious, life-threatening or end-of-life medical illnesses and are associated with poor medical and psychiatric outcomes. Currently available treatment modalities in this patient population, including medication and psychotherapy, are limited in effectiveness, especially regarding existential distress. The lack of effective psycho-spiritual interventions is a critical shortcoming in palliative care and represents a high unmet need in medicine. In this commentary, we review the rationale of researching and developing psychedelic-assisted psychotherapy as a novel pharmacologic-psychotherapeutic intervention to treat psychiatric and existential distress in life-threatening medical conditions and palliative care. This paper reviews efficacy data from first and second waves of psychedelic research, and future directions for research and implementation science. More rigorous research, especially funded by governments, is needed to assess effectiveness and mechanisms of action of psychedelic therapies to treat psychiatric and existential distress in life-threatening medical illnesses and palliative care. If psychedelic-assisted treatments were made available as approved and prescribable medications in people with serious medical illnesses, it could be a significant development that opens up a pathway for clinical dissemination and public health impact internationally.

Existential Insights in Cancer: Meaning in Life Adaptability.

Previous research demonstrated that the cancer diagnosis and treatment evoke existential concerns, especially ones related to meaning in life and meaning-making processes. The cancer experience is a vital challenge that often entails changes in what is personally important in life. Firstly, this paper collects evidence supporting that meaning adaptability, the way people adapt their meaning in life to the cancer experience, is a central element in the mental health of cancer patients. Various theories that could account for this meaning adaptability are introduced. Secondly, the paper provides a compilation of studies showing how people change what is significant in their lives within the course of cancer. Finally, the paper presents the available psychological therapies directed to facilitate meaning adaptability in this population. Meaning-centered interventions have been demonstrated to be effective in alleviating the suffering related to the cancer experience and promoting personal growth.

Existential Distress in Cancer Patients: A Concept Analysis.

BACKGROUND: Existential distress is a widely used concept used in describing cancer patients. However, this concept is vague and has failed to achieve a consensus. The lack of a recognized conceptual framework could hinder future research on existential distress. OBJECTIVE: The aim of this study was to clarify and analyze the concept of existential distress in cancer patients. METHODS: The Walker and Avant concept analysis approach was applied. RESULTS: For cancer patients, the concept of existential distress included 5 core attributes: (a) lack of meaning; (b) loss of autonomy; (c) loss of dignity; (d) hopelessness; and (e) death anxiety. Existential distress is a key factor causing poor quality of life, a poor emotional state, demoralization, and even suicide. It is often underpinned by uncontrolled physical pain, serious psychological morbidity, and a perceived sense of being a burden on others. CONCLUSION: The concept analysis provides a theoretical framework for healthcare providers to better understand existential distress in cancer patients, to improve patient well-being. IMPLICATIONS FOR PRACTICE: On the basis of the antecedents of this concept, cancer patients experiencing uncontrolled physical pain, severe psychological morbidity, and a perceived sense of being a burden on others are at a high risk of existential distress. These factors should be eliminated in a timely manner to prevent cancer patients from being caught in a state of existential distress. The 5 defining attributes and empirical referents of this concept could be used to develop tools to screen for existential distress in cancer patients and distinguish it from similar concepts.

Reflecting on meaning in an existential-reorientation group psychotherapy approach for cancer patients: A qualitative thematic analysis.

OBJECTIVE: The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients' main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other. METHOD: A short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework. RESULTS: Four superordinate themes were identified in the exercise meaning of the experience of cancer, namely "sense of stigma and loneliness (the foreigner)," "guilt (unjust guilt and anticipatory guilt)," "reconsidering one's own life and nostalgia," and "rebirth (a new life, life after life)." Three superordinate themes were found in the meaning of the group experience in the letters, namely "togetherness and gratitude," "legacy," and "acceptance." SIGNIFICANCE OF RESULTS: The study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.

Exploring the Use of Psilocybin Therapy for Existential Distress: A Qualitative Study of Palliative Care Provider Perceptions.

There is a growing body of research suggesting that palliative care patients coping with existential distress may benefit from psilocybin. However, there is a large gap regarding the perceptions of palliative care providers who may provide education, counseling services, recommendations, and/or prescriptions for psilocybin if it is decriminalized, commercialized, and/or federally rescheduled and legalized. The aim of this study was to explore the experiences and perceptions of interdisciplinary palliative care providers regarding existential distress and the use of psilocybin therapy. Five (n = 5) health care providers from a hospital-based palliative care team completed a semi-structured interview related to their experiences supporting patients with existential distress and their beliefs and attitudes related to psilocybin as a possible treatment modality. A qualitative descriptive approach was used to identify key themes which included: 1) multiple barriers to addressing existential distress at the cultural, institutional/organizational, relational, and individual levels, 2) the duality and power of presence, 3) suffering as an intrinsically subjective phenomenon, and 4) uncertainty about the risks and benefits of psilocybin. To inform an inclusive, safe, and holistic approach, more research is needed regarding the possible integration of psilocybin therapy within palliative care for the treatment of existential distress.

Gênero como modalidade existencial / Gender as existential modality / Género como modalidad existencial

As discussões de gênero são ainda fundamentais para as lutas (trans)feministas e possuem um campo aberto a novas reflexões que contribuam no tema. Essa questão é cara à fenomenologia desde Simone de Beauvoir até Judith Butler e outras fenomenólogas feministas contemporâneas. Considerando as contribuições já desveladas por essas autoras, este trabalho possui o objetivo de repensar a conceituação de gênero por meio do conceito de modalidade existencial encontrado em Merleau-Ponty e Heidegger em uma revisão teórica assistemática. O conceito de modalidade existencial implica em possibilidades, como fundamental na estrutura ontológica do ser. Possibilidade tem aqui características existenciais e de abertura que descrevem modos de ser, de se vincular, significar e tornar possível ser e sentido. O gênero como modalidade existencial desvela um espectro de potências que se realiza e se institui na existência corpórea e situada do ser. Este trabalho possibilita um diálogo com as reflexões já realizadas pelas autoras feministas e a abertura para o aprofundamento das discussões sobre gênero.

Gender discussions are still fundamental to (trans)feminist struggles and have an open field to new reflections that contribute to the topic. This issue is important to phenomenology from Simone de Beauvoir to Judith Butler and other contemporary feminist phenomenologists. Considering the contributions already unveiled by these authors, this paper aims to rethink the conceptualization of gender through the concept of existential modality found in Merleau-Ponty and Heidegger in a non-systematic theoretical review. The concept of existential modality implies possibilities as fundamental in the ontological structure of being. Here, possibility has existential and open characteristics that describe ways of being, of linking, meaning and make possible being and meaning. Gender as an existential modality reveals a spectrum of potencies that is realized and established in the corporeal and situated existence of being. This work allows a dialogue with the reflections already made by the feminist authors and the opening to deepen the discussions about gender.

Las discusiones de género siguen siendo fundamentales para las luchas (trans)feministas y tienen un campo abierto a nuevas reflexiones que contribuyen al tema. Este tema es apreciado por la fenomenología desde Simone de Beauvoir hasta Judith Butler y otras fenomenólogas feministas contemporáneas. Teniendo en cuenta las contribuciones ya presentadas por estas autoras, este artículo tiene como objetivo repensar la conceptualización del género a través del concepto de modalidad existencial que se encuentra en Merleau-Ponty y Heidegger en una revisión teórica no sistemática. El concepto de modalidad existencial implica posibilidades como fundamentales en la estructura ontológica del ser. La posibilidad aquí tiene características existenciales y abiertas que describen formas de ser, de vinculación, significado y hacer posible ser y sentido. El género como modalidad existencial revela un espectro de potencias que se realiza y establece en la existencia corporal y situada del ser. Este trabajo permite un diálogo con las reflexiones ya hechas por las autoras feministas y la apertura para profundizar las discusiones sobre género.

El sentido de vida, una condición existencial / The meaning of life, an existential condition

El ser humano siempre ha estado en la constante búsqueda de sentido y preguntándose por su existencia. El hombre moderno además de encontrase en esa búsqueda, también se halla permeado por la angustia constante, está sometido a la cosificación de sí mismo, la hipeconectividad, el consumismo, la incertidumbre y la inmediatez, lo cual lo conduce de manera casi inminente al aburrimiento y el tedio, es decir, a la frustración existencial, llevándolo a enfrentarse con sus pseudosatisfactores y dejándolo de cara ante el vacío de su propia existencia y el cuestionamiento: ¿para qué estoy en el mundo?

Human beings have been in a constant search for meaning and wondering about its existence. The modern man, in addition to finding himself in this search, is also permeated by constant anguish, is subjected to the objectification of himself, hyper-connectivity, consumerism, uncertainty and immediacy, which leads him almost imminently to boredom, which is existential frustration, leading him to face his pseudo-satisfiers and leaving him face to face with the emptiness of his own existence and the question: what am I in the world for?

Nursing and "being with" in a world with COVID-19: an existentialist look / Enfermería y "estar con" en un mundo con COVID-19: una mirada existencialista / Enfermagem e "estar com" em um mundo com COVID-19: um olhar existencialista

ABSTRACT Objective To reflect on nursing from an existentialist perspective, in which "being-with" has been shown to be the best type of care in a world with Covid-19. Method Reflective theoretical study on nursing in the context of a pandemic using an existentialist philosophical theoretical framework. Results Nursing is now perceived by society as a profession whose practices are beyond the clinical conditions that affect individuals who live with this pandemic, as taking care of others is not only performing technical actions, but means, fundamentally, taking sensitive ones, like "being-with" in a present and authentic way. Final considerations The pandemic has caused changes in the way human beings relate to the world, leading to reflections on values ​​due to the restrictions imposed by it. In this scenario, nurses becomes visible, being the protagonists in the different care spaces, since the focus of its practice is existential care, which is established through relationships in encounters between beings, thus making "being-with" possible.

RESUMEN Objetivo Reflexionar sobre la enfermería desde una perspectiva existencialista, en que "estar-con" fue demostrado como el mejor modo cuidado en un mundo con Covid-19. Método Estudio teórico reflexivo sobre la enfermería en el contexto de una pandemia bajo el marco teórico filosófico existencialista. Resultados La enfermería fue percibida por la sociedad como una profesión cuyas prácticas van más allá de las condiciones clínicas de los individuos que conviven con la pandemia, pues cuidar no es solo tomar acciones técnicas, sino también, y fundamentalmente, tomar acciones sensibles, como "estar-con" de una manera presente y auténtica. Consideraciones finales La pandemia provocó cambios en la forma en que seres humanos se relacionan con el mundo, ocasionando una reflexión sobre sus valores debido a las restricciones que impone. En este escenario, la enfermería se hace visible, siendo protagonista en los diferentes espacios de cuidado, pues el foco de su práctica es el cuidado existencial, que se establece por medio de relaciones en los encuentros entre seres, posibilitando así "estar-con".

RESUMO Objetivo Refletir a enfermagem sob um olhar existencialista, em que o "estar-com" tem se mostrado como o melhor cuidado no mundo com Covid-19. Método Estudo teórico reflexivo sobre a enfermagem no contexto de pandemia, sob referencial teórico filosófico existencialista. Resultados A enfermagem passa a ser percebida pela sociedade como profissão cujas práticas estão para além das condições clínicas que acometem os indivíduos que convivem com esta pandemia, pois cuidar do outro não é somente imprimir ações técnicas, mas fundamentalmente sensíveis, como "estar com" de forma presente e autêntica. Considerações finais A pandemia provocou mudanças na maneira do ser humano relacionar-se no mundo, ocasionando a reflexão sobre seus valores pelas restrições que impôs. Neste cenário, a enfermagem torna-se visível, sendo protagonista nos diferentes espaços de cuidado, pois o foco da sua prática é o cuidado existencial, que se estabelece através das relações em encontros entre seres, possibilitando, assim, o "estar com".

Daseinsanálise e a tonalidade afetiva do tédio: diálogos entre psicologia e filosofia / Daseinsanalysis and Boredom: dialogues between Psychology and Philosophy / Daseinsanálisis y la tonalidad afectiva del tédio: diálogos entre psicología y filosofía

O escopo do presente artigo é o de pensar a relação entre tonalidade afetiva do tédio e a daseinsanálise a partir, principalmente, de uma perspectiva fenomenológico-hermenêutica. Tal metodologia de questionamento surge de forma explícita com o filósofo alemão Martin Heidegger de modo que seu pensamento torna essencial a relação entre fenomenologia e hermenêutica. A partir de então, surge a possibilidade de um reposicionamento da compreensão em relação ao tédio: evita-se uma interpretação solipsista e entra em cena uma interpretação histórica de determinados transtornos existenciais que no mundo contemporâneo precisam de interpretações renovadas. Tendo isso em vista, a filosofia surge como elemento fundamental de diálogo nesse novo de compreensão do fenômeno do tédio, ainda pouco tematizado pelos principais autores da Daseinsanálise.

The aim of this article is to think, especially from the phenomenological-hermeneutic perspective, the relationship between the attunement of boredom and the daseinsanalysis. Such a thought arises explicitly with the German philosopher Martin Heidegger, making essential the relation between phenomenology and hermeneutics. From this, the possibility of a repositioning of understanding in relation to boredom arises: a solipsist interpretation is avoided and appears an historical interpretation of certain existential disorders that in the contemporary world need renewed interpretations. Philosophy emerges as a fundamental element of the dialogue in this new understanding of the phenomenon of boredom, unfortunately not yet thematized by the main authors of Daseinsanalysis.

El presente artículo tiene en vista pensar la relación entre tonalidad afectiva del tédio y la daseinsanálisis a partir, principalmente, de una perspectiva fenomenológico-hermenéutica. Tal metodología de cuestionamiento surge de forma explícita con el filósofo Martin Heidegger de modo que su pensamiento hace esencial la relación entre fenomenología y hermenéutica. A partir de esto surge la posibilidad de un reposicionamiento de la comprensión en relación al tedio: se evita una interpretación solipsista y entra en escena una interpretación histórica de ciertos trastornos existenciales que en el mundo contemporáneo necesitan de interpretaciones renovadas. En este sentido, la filosofía surge como elemento fundamental de diálogo en este nuevo entendimiento del fenómeno del aburrimiento, aún poco templado por los principales autores de la Daseinsanálisis.

Peaceful Warrior (2006), de Dan Millman: perspectivas existenciais na contemporaneidade / Peaceful Warrior (2006), by Dan Millman: contemporary existential perspectives / Peaceful Warrior (2006), de Dan Millman: perspectivas existenciales en la contemporaneidad

Este artigo tem como objetivo refletir acerca de valores e necessidades existenciais que atravessam o ser humano na atualidade de apressamentos, de consumismos exacerbados e da busca por prazeres efêmeros que vêm produzindo a sensação de vazio existencial. Tal vazio estabelece também a necessidade da busca de sentido de vida. Para este artigo, foi tomado como material de análise a narrativa do filme Peaceful Warrior (2006); optou-se por uma investigação qualitativa, na qual foi realizado um levantamento bibliográfico e se utilizou a Análise Categorial, a fim de definir as unidades de análise do filme, codificá-las e interpretá-las. O estudo aponta que a dedicação no desenvolvimento de um talento e no protagonismo das experiências subjetivas possibilitam transformações existenciais para o seguimento de um caminho vital com sentido no contexto contemporâneo.

This article aims to reflect on the values and existential needs that constitute the human being in the present times of hurries, exacerbated consumerism and the search for ephemeral pleasures that have been producing the sensation of existential emptiness. Such emptiness also establishes the need for the search for meaning of life. For this article, the narrative of the film Peaceful Warrior (2006) was taken as analysis material. This is a qualitative investigation, in which a bibliographic research was carried out and the Categorial Analysis was used. This process defined the film analysis units, which were coded and interpreted. The article concludes that the dedication to the development of a talent and the protagonism of the subjective experiences allow existential transformations for a vital path with sense in the contemporary context.

Este artículo tiene como objetivo reflexionar acerca de valores y necesidades existenciales que atravesan el ser humano en la actualidad de apresuramientos, de consumismos exacerbados y de la búsqueda de placeres efímeros que vienen produciendo la sensación de vacío existencial. Tal vacío establece también la necesidad de la búsqueda de sentido de vida. Para este artículo, fue tomado como material de análisis la narrativa de la película Peaceful Warrior (2006); se optó por una investigación cualitativa, en la que se realizó un levantamiento bibliográfico y se utilizó el Análisis Categorial para definir las unidades de análisis de la película, codificarlas e interpretarlas. El estudio apunta que la dedicación para el desarrollo de un talento, y el protagonismo de las experiencias subjetivas posibilita transformaciones existenciales para el seguimiento de un camino vital con sentido en el contexto contemporáneo.

Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial.

OBJECTIVE: Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness. METHOD: Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace. RESULTS: Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (<5 on POMS subscale) and depression (<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference -0.4 [95% CI, -1.6, 0.8], p = 0.49) or seven weeks (15.2 vs.15.4; between-group difference -0.2 [95% CI, -1.5, 1.0], p = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, -1.2, 1.7], p = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference -1.0 [95% CI, -2.7, 0.7], p = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales. DISCUSSION: In early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.

Expression of existential suffering in two patients with advanced cancer in an acute palliative care unit.

BACKGROUND: Recognizing and managing existential suffering remains challenging. We present two cases demonstrating how existential suffering manifests in patients and how to manage it to alleviate suffering. CASE DESCRIPTION: Case 1: A 69-year-old man with renal cell carcinoma receiving end-of-life care expressed fear of lying down "as he may not wake up." He also expressed concerns of not being a good Christian. Supportive psychotherapy and chaplain support were provided, with anxiolytic medications as needed. He was able to express his fear of dying and concern about his family, and Edmonton Symptom Assessment System scores improved. He died peacefully with family at bedside. Case 2: A 71-year-old woman presented with follicular lymphoma and colonic obstruction requiring nasogastric drain of fecaloid matter. Initially, she felt that focusing on comfort rather than cure symbolized giving up but eventually felt at peace. Physical symptoms were well-controlled but emotionally she became more distressed, repeatedly asking angrily, "Why is it taking so long to die?." She was supported by her family through Bible readings and prayers, but she was distressed about being a burden to them. An interdisciplinary approach involving expressive supportive counseling, spiritual care, and integrative medicine resulted in limited distress relief. Owing to increasing agitation, the patient and family agreed to titrate chlorpromazine to sedation. Her family was appreciative that she was restful until her death. CONCLUSION: Existential suffering manifests through multiple domains in each patient. A combination of pharmacologic and non-pharmacologic techniques may be needed to relieve end-of-life suffering.

Distress and the religious and spiritual coping of Brazilians living with cancer: A cross-sectional study.

PURPOSE: To analyze the relationship between the subjective experience of distress and the use of religious and/or spiritual coping by adult chemotherapy patients. METHOD: A cross-sectional study conducted in 2018, with 100 patients undergoing chemotherapy. The data were collected through three tools: a characterization form, the Inventory of Subjective Distress Experiences in Illness, and the Brief Religious/Spiritual Coping Scale. The analysis was based on descriptive and inferential statistics, using the Spearman correlation test (p < 0.05), ANOVA, the Kruskall-Wallis test, and negative binomial regression. RESULTS: A low level of overall, physical, existential, psychological and sociorelational distress was observed. The dimension of positive distress experiences, however, was above the intermediate level in the scale. With respect to coping, use of positive and negative facets was moderate and low, respectively. Very weak positive correlations were noted between negative coping and physical, existential, and overall distress. The regression analysis indicated a higher risk of distress with increasing age and greater negative religious coping. CONCLUSIONS: In this sample, higher means were found in the dimension of positive distress experiences; negative coping, although utilized less, had greater potential to exacerbate distress after adjustment for age, in contrast to that expected for positive coping, which did not manifest significant effects in alleviating it.

Psicoterapia focal: psicoterapia breve fenomenológica existencial / Focal Psychotherapy: existential phenomenologicalbrief psychotherapy / Psicoterapia Focal: psicoterapia breve fenomenológica existencial

O presente artigo pretende caracterizar a Psicoterapia Breve baseada na abordagem fenomenológica existencial. Primeiramente, será apresentada sucintamente a explicitação do filósofo Martin Heidegger do existir humano como Dasein (ser-aí) e ser-no-mundo para situar a psicoterapia fenomenológica existencial. Em seguida, será descrita essa proposição terapêutica, destacando que quando o existir humano é compreendido como Dasein (ser-aí) e ser-no-mundo, busca-se elucidar a experiência do paciente em sua relação consigo mesmo, com o outro e com tudo aquilo que se apresenta a ele. A experiência do paciente é também compreendida como situada em um contexto significativo que corresponde ao mundo do paciente. Posteriormente, começando com uma reflexão sobre o termo breve contida na proposta da psicoterapia breve, serão expostas algumas indicações dessa modalidade terapêutica, que denominamos de psicoterapia focal. A psicoterapia focal fenomenológica existencial priorizará a elucidação dos âmbitos do existir do paciente que revelam o sofrimento e as restrições em seu viver. O objetivo da psicoterapia visa favorecer que o paciente se liberte desses modos restritos de viver e possa ter mais liberdade para desenvolver as suas possibilidades. Para finalizar, exemplificaremos a terapia focal com um atendimento de um paciente que foi vítima de violência urbana e teceremos algumas considerações finais.

This article aims at characterizing Brief Psychotherapy based on the existen-tial phenomenological approach. Firstly, it will present a short explanation by the philosopher Martin Heidegger on the human existence as Dasein in being-in- the-world, in order to philosophically place existential phenomeno-logical therapy. Afterwards, this therapeutical proposition will be described highlighting that when human existence is understood as Dasein (being-there) and being in the world, we seek to elucidate patient's experience in his/her rela-tionship himself/herself with the other and with everything that is presented to him/her. Patient's experience is also understood as placed in a meaningful context, corresponding to the patient's world. Then, starting with a reflection about the term brief contained in the proposal of brief psychotherapy, we will present some indications of this therapeutical modality, which we call focal psychotherapy. The phenomenological existential psychotherapy prioritizes the clarification of the patient's tasks of existing that show suffering and restrictions in his/her life. The scope of this psychotherapy is the favoring the patient's clearance, enabling his/her development in what concerns restrictions in his/her life. The assignment of this psychotherapy is enabling the patient's release in order he/she can develop his/her possibilities. Finally, we will exemplify focal psychotherapy with the assistance of a patien, t victim of urban violence and some final considerations shall be made.

El presente artículo pretende caracterizar la psicoterapia breve con base en el enfoque fenomenológico existencial. Primeramente, se presentará sucinta-mente la explicitación del filósofo Martin Heidegger de la existencia humana como Dasein (estar-allí) y estar-en-el-mundo para situar la psicoterapia feno-menológica existencial. Enseguida, se describirá esta propuesta terapéutica, destacando que, cuando la existencia humana es comprendida como Dasein (estar-allí) y estar en el mundo, se busca dilucidar la experiencia del paciente en su relación consigo mismo, con el otro y con todo lo que se le presenta. La experiencia del paciente es también comprendida como situada en un contexto significativo que corresponde al mundo del paciente. Posteriormente, comen-zando con una reflexión sobre la palabra breve contenida en la propuesta de la psicoterapia breve, se expondrán algunas indicaciones de esta modalidad terapéutica que llamamos de psicoterapia focal. La psicoterapia focal feno-menológica existencial priorizará la elucidación de las áreas de existencia del paciente que revelan el sufrimiento y las restricciones en su vida. El objetivo de la psicoterapia es alentar al paciente a liberarse de estas formas restringidas de vida y tener más libertad para desarrollar sus posibilidades. Finalmente, ejemplificaremos la terapia focal con un atendimiento de un paciente que fue víctima de violencia urbana y traeremos algunas consideraciones finales.

Fear of cancer recurrence in haematological cancer patients: exploring socio-demographic, psychological, existential and disease-related factors.

PURPOSE: This study aims to explore the relation between the dimension of fear of cancer recurrence (FCR) in haematological cancer patients relapse-free for at least 2 years and socio-demographic, related to the disease, psychological and existential factors. METHODS: A sample of 75 haematological cancer patients agreed to participate in the study through a self-reported online questionnaire (51.9% males). A total of 70.1% had a low recurrence risk. The questionnaire included socio-demographic (gender, age, civil status, level of education and number of children), related to the disease (diagnosis, therapeutic line and years since diagnosis), psychological (anxiety and depression), existential (purpose in life; PIL) factors and Fear of Cancer Recurrence Concerns Inventory (FCRI). Simple and multiple linear regressions were conducted for the analyses, and we performed some preliminary analysis on the reliability of the FCRI. FINDINGS: A total of 53.3% of participants showed clinical levels of FCR on the severity dimension, which was higher than found in previous research in other cancer patients. The coping strategies, triggers, severity and psychological distress dimensions showed higher mean values. Women, patients with indolent non-Hodgkin lymphomas, years since diagnosis, anxiety and purpose in life are significantly related to one or more dimensions of FCRI. IMPLICATIONS: It is important that the clinicians have at their disposal multiple possibilities to help patients cope with haematological cancer. If future research will confirm the results of this study, the negative correlation between FCR and PIL can suggest indications for planning interventions based on a salutogenic approach.

Spirituality in cancer patients on phase 1 clinical trials.

OBJECTIVES: Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population. METHODS: Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up. RESULTS: Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients. CONCLUSIONS: Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.

À sombra de um diálogo: Heidegger e a poética de Augusto dos Anjos / In the shadow of a dialogue: Heidegger and the poetry of Augusto dos Anjos / A la sombra de um diálogo: Heidegger y la poética de Augusto dos Anjos

Na composição deste artigo busca-se promover um encontro entre o pensamento filosófico de Heidegger e a poética de Augusto dos Anjos. O pensamento de Heidegger, num momento denominado reviravolta, se afasta das terminologias fenomenologia e hermenêutica. A proposição do filósofo, doravante, passa a se voltar para a linguagem e a se denominar topologia do ser. Portanto, a obra de arte, com especial relevo na poesia, é manancial de onde brotam a desocultação e a revelação de mundo e terra, nos termos heideggerianos. Com arrimo nesse entendimento, fez importante um estudo em torno das contribuições de Heidegger à fenomenologia existencial, com relevo ao segundo momento de sua produção ou caminho. A partir de então, se afigurou necessário que se tangenciasse a singularidade de Augusto dos Anjos, expressa em sua história e sua poética, em diálogo com o pensamento filosófico heideggeriano. Augusto dos Anjos resgata o mundo em estado puro e a linguagem como possibilidade de sentido. Em direção convergente, Heidegger caminha rumo ao desvelamento do Ser, que se dá diante da angústia colada à existência e da possibilidade extrema do não-ser, em face de sua condição de ser-para-a-morte. O diálogo entre o filósofo e o poeta revelou-se instigante e profícuo.

This article seeks to promote a meeting between Heidegger's philosophical thinking and the poetics of Augusto dos Anjos. Heidegger's thinking, at a time called turning, departs from the terminology of phenomenology and hermeneutics. The proposition of the philosopher, henceforth, begins to turn to language and to be called the topology of being. Therefore, the work of art, with special emphasis on poetry, is the source from which the unveiling and the revelation of world and earth, in the Heideggerian terms, spring forth. Based on this understanding, a study was made of Heidegger's contributions to existential phenomenology, with emphasis on the second moment of his production or path. From then on, it appeared necessary to tangentiate the singularity of Augustus of the Angels, expressed in his history and his poetics, in dialogue with Heidegger's philosophical thought. Augustus of the Angels rescues the world in its pure state and language as a possibility of meaning. In a convergent direction, Heidegger walks toward the unveiling of the Being, which occurs in the face of the anguish of existence and the extreme possibility of non-being, in the face of its being-to-death condition. The dialogue between the philosopher and the poet was thought provoking and fruitful.

En la composición de este artículo, buscamos promover una reunión entre el pensamiento filosófico de Heidegger y la poesía de Augusto dos Anjos. El pensamiento de Heidegger, en un momento llamado "cambio de tendencia", se aparta de la fenomenología y de la hermenéutica. La proposición del filósofo, a partir de ahora, es volver a la lenguaje y a la denominación "topología del ser". Por lo tanto, la obra de arte, con especial énfasis en la poesía, es la fuente de la que brotan desenmascaramiento y la revelación del mundo y de la tierra, en términos de Heidegger. Con retenimiento en esta comprensión, se hizo importante un estudio en torno a las aportaciones de la fenomenología existencial de Heidegger, con énfasis en la segunda etapa de su producción o camino. Desde entonces, se ha comprobado que es necesario tangenciar la singularidad de Augusto dos Anjos, expresa en su historia y en su poética, en diálogo con el pensamiento filosófico de Heidegger. Augusto dos Anjos rescata el mundo en estado puro y el lenguaje como posibilidad de sentido. En dirección convergente, Heidegger camina hacia el desvelamiento del Ser, que se da ante la angustia pegada a la existencia y la posibilidad extrema del no ser, frente a su condición de ser para la muerte. El diálogo entre el filósofo y el poeta se mostró instigador y provechoso.

Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer.

BACKGROUND: A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60-80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses. METHODS: The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration. RESULTS: Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60-80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71-100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives. CONCLUSION: These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.