Where is an emotion? Using an emotional spatial cueing task to test for emotional localization following targeted visceroception.

The relationship between emotion and attention is vital for adaptation. Trained attention to bodily sensations can heighten emotional awareness, including during "visceroception" (sensing the viscera, principally the heart, lungs and gut), which has been linked to emotion intensity and regulation. However, it is not always clear when bodily attention is adaptive, and useful to maintain, or maladaptive and best inhibited. The current study, part of a wider exploratory project, investigates "localized emotion" in this context. Localized emotion is a novel construct, articulated within the project, and suggested to be manifested within a visceroceptive system: targeted visceroception could result in disinhibited attention to localized emotion. In particular, whilst evidence points to the importance of the gastrointestinal tract for emotion (e.g., gut biome, enteric nervous system), gut sensations are often barely detectable, consistent with an inhibition process. An emotional spatial cueing task was used to test for localized effects within several groups: one trained for 8 weeks to focus on their lower abdomen (gastroception), with another focused on their chest cavity (cardioception), plus a control group. The spatial cueing task involved rapid responding to the detection of bodily feelings following the presentation of an emotional picture. Participants then indicated on a body map where they had detected the feeling, followed by corresponding valence and arousal levels (i.e., core affect) on a self-assessment manikin. Data were analyzed using generalized estimating equations. There was some support for localization in the gastroception group relative to the chest-focused group and controls. Gastroception-related findings included: greater improvement in interoception (interoceptive sensibility), slowed reaction times, a cluster of lower abdominal detections on a body map, changes in core affect, and indications of improved emotion regulation. Attending to the gut may play a key role in improving one's ability to access emotional feeling, with associated implications for emotion regulation.

Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review.

INTRODUCTION: Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE: The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA: Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS: The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS: There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS: Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.

Learning from clinicians' positive inclination to suicidal patients: A grounded theory model.

Despite experts' contention that clinicians' positive inclination is essential to successful treatment of patients at risk for suicide (PRS), research in the area is lacking. This study used grounded theory to develop a model of clinicians' positive inclination based on interviews with 12 clinicians who "liked" working with PRS. The core process identified, a state of emotional synchrony through deep connection between clinicians and PRS, appeared to provide an intersubjective emotion regulation, associated with distress reduction in patients and deep satisfaction in clinicians. Findings suggest clinicians' deep sense of satisfaction and PRS' clinical improvement in treatment could be interdependent.

Anosognosia and schizophrenia - a reminder.

OBJECTIVE: To remind the clinical and legal practitioner that anosognosia is a recognised facet of schizophrenia with implications for capacity assessment and for relating effectively with people who experience it. CONCLUSIONS: The term anosognosia emphasises that, in schizophrenia, lack of capacity is the result of a neurological deficit. Under-appreciation of this may place that person at risk of a preventable harm.

The roles of phishing knowledge, cue utilization, and decision styles in phishing email detection.

This study investigated the roles of phishing knowledge, cue utilization, and decision styles in contributing to phishing email detection. Participants (N = 145) completed an online email sorting task, and measures of phishing knowledge, email decision styles, cue utilization, and email security awareness. Cue utilization was the only factor that uniquely predicted the capacity to discriminate phishing from genuine emails. Phishing knowledge was associated with greater phishing detection and a bias towards classifying all emails as phishing. A preference for intuitive decision making predicted lower detection of phishing emails, driven by a greater tendency to classify emails as genuine. These findings support the proposition that cue utilization is a distinct cognitive process that enables expert performance. The outcomes indicate that, in addition to increasing phishing knowledge and developing safe behavioral patterns, anti-phishing training needs to provide opportunities for trainees to develop meaningful cue associations.

A Grounded Theory Exploration of Addictions Treatment Within a Commercial Airline Setting.

INTRODUCTION: An Australasian Airline's Alcohol and Other Drug (AOD) Program demonstrates abstinence rates that exceed those of general AOD programs. The reasons for this are unclear. The purpose of this research was to develop a theory as to why this program is successful.METHODS: A qualitative examination following grounded theory methodology was undertaken. AOD program patients and healthcare professionals were interviewed until content saturation was reached. Data analysis followed grounded theory to identify the key concepts associated with the program's success.RESULTS: The core theory that emerged highlighted the pivotal roles of a strong employee-company relationship, shared values, and a safety-focused culture in explicating the program's success. This moves beyond the "carrot and stick" model of motivation, where belonging to this organization and safety consciousness serve as powerful drivers for abstinence. Challenges and barriers highlighted some unique challenges to the program in managing the coronavirus pandemic and the difference in approach to substance use in community spaces versus safety-critical employment.DISCUSSION: This research expands the understanding of this AOD program's success in a safety-critical industry, emphasizing the elements of a working relationship that are beyond positive or negative reinforcement. Future research should work to quantify and test the generalizability of these findings.Nairn J, Bell E, Myers J, Higgins M, Johnston B, Newton-Howes G. A grounded theory exploration of addictions treatment within a commercial airline setting. Aerosp Med Hum Perform. 2024; 95(6):313-320.

Eye movement desensitization and reprocessing (EMDR) therapy compared to usual treatment for posttraumatic stress disorder in adults with psychosis in forensic settings: Randomized controlled trial.

OBJECTIVE: Little direct evidence supports any particular treatment for posttraumatic stress disorder (PTSD) in people with schizophrenia, forensic histories, and/or multiple comorbidities. This trial assesses the efficacy and risks of eye movement desensitization and reprocessing (EMDR) for people with PTSD and psychotic disorders receiving forensic care, including inpatients and prisoners. METHOD: Single-blind randomized controlled trial comparing EMDR therapy to wait-list (routine care) in forensic-treated adults with psychotic disorders and PTSD. The primary outcome was clinician-rated PTSD symptoms. Secondary outcomes included participant-rated PTSD symptoms, psychotic symptoms, social functioning, disability level, self-esteem, depressive symptoms, posttraumatic cognitions, complex posttraumatic difficulties, and adverse events. Blinded investigators assessed outcomes at baseline, and after 10 weeks and 6 months. Analysis of the primary outcome was by a mixed linear model. Twenty-four participants were randomized, recruitment being hindered by COVID-19 restrictions. RESULTS: Clinician Administered PTSD Scale mean (SD) scores after 6 months were lower (better) in the EMDR group, 21.3 (13.3), compared with the control group, 31.5 (20.7). The point estimate [95% CI] difference, averaged over two measurement times, was 11.4 [1.3, 21.4], p = .028, favoring EMDR. Self-esteem increased in the EMDR group and depressive symptoms and disability reduced. There were no statistically significant differences in psychotic symptoms or adverse events, although point estimates favored EMDR. CONCLUSIONS: This is the first EMDR trial in mental health inpatient, forensic, or custodial settings, where PTSD is common. There were improvements in PTSD and other symptomatology consistent with EMDR being a safe and effective treatment for PTSD in these settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship Between Clinicians' Inclination Toward Patients at Risk for Suicide (PRS) and Self-reported Countertransference.

OBJECTIVES: We investigate the relationship between clinicians' inclination toward treating patients at risk for suicide (PRS), and self-reported countertransference (CT). We consider these observed group differences to explore two competing interpretations for observed CT patterns from a primary study; whether CT patterns are more consistent with defensive attitudes or an adaptative CT montage. METHOD: We used one-way ANOVA, Tuckey post-hoc, and t-test, to compare clinicians (n = 267) grouped by self-ratings of positive, neutral or non-positive inclination toward working with PRS, with regard to their level of endorsement of the Therapist Response Questionnaire (TRQ) with PRS. We hypothesized that positively inclined clinicians would demonstrate greater CT literacy skills than other clinicians, reflected in lower endorsement of negative/hindering CT and higher endorsement of positive/facilitating CT to PRS. RESULTS: Compared to non-positively inclined clinicians, positively inclined clinicians endorsed significantly lower levels of two potentially negative/hindering CT dimensions, factor 1: entrapped/rejecting and, factor 5: protective/overinvolvement, and higher levels of the only positive/facilitating CT dimension, factor 2: fulfilled/engaging. Neutral clinicians reported similar CT patterns to positively inclined clinicians. CONCLUSIONS: Hypothesis of greater CT literacy from positively inclined clinicians appears supported. Observed differences in CT endorsement by inclination group tend to support the CT montage interpretation of our original findings more than the defense mechanism interpretation proposed. Similarities in CT patterns between positively inclined and neutral clinicians suggest that positive inclination to PRS, as assessed in this study, may not be countertransferential per se.

Evaluating an emotion coaching programme for parents of young adolescents attending Child Adolescent Mental Health Services (CAMHS) in New Zealand: protocol for a multi-site feasibility trial including co-design with service users.

BACKGROUND: Early adolescence is a time of increased vulnerability for the development of common mental health conditions such as anxiety and depression (internalising outcomes). Current treatments such as cognitive-behavioural therapy and antidepressant medication are focused on the individual and have small effect sizes, particularly in real-world clinical settings such as the public Child Adolescent Mental Health Services (CAMHS). Parents are an important and under-utilised resource in treating these conditions in young adolescents. Teaching parents how to respond to their young person's emotions can improve emotion regulation and reduce internalising outcomes. One emotion-focused programme for parents of this age group is Tuning in to Teens (TINT). This is a structured, manualised skills group for parents only focused on teaching skills to coach young people through their emotional experiences. This study aims to investigate the impact of TINT in the clinical setting of publicly funded CAMHS in New Zealand. METHODS: The trial will evaluate the feasibility of a two-arm multi-site randomised control trial (RCT). Participants will be 10-14-year-olds referred to CAMHS in Wellington, New Zealand, with anxiety or depression, and their parents or guardians. Arm 1 will be parents attending and implementing TINT (in addition to the usual care received at CAMHS). Arm 2 will be usual care only. TINT groups will be facilitated by CAMHS clinicians who have been trained in the programme and will be delivered over 8 weekly sessions. Prior to the RCT, a co-design methodology will be used with service users to inform outcome measures used in the trial. A group of service users meeting the RCT criteria will be recruited to take part in workshops to help determine their priority outcomes. Measures based on the results of workshops will be included in the outcome measures. The primary feasibility outcomes will be the recruitment and retention of participants, acceptability of the intervention for service users and clinicians and acceptability of outcome measures. DISCUSSION: There is a need to improve outcomes for the treatment of adolescent anxiety and depression. TINT is a programme with the potential to enhance outcomes for those accessing mental health services by providing targeted support to parents of adolescents. This trial will inform whether a full RCT is feasible to evaluate TINT. Including service users in the design will increase its relevance of an evaluation in this setting. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ACTRN): ACTRN12622000483752. Registered on 28 March 2022.

A realist review of residential treatment for adults with substance use disorder.

ISSUES: Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment. APPROACH: We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded. KEY FINDINGS: We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory. IMPLICATIONS: Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment. CONCLUSION: We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.

Eye movement desensitisation and reprocessing (EMDR) therapy in prison and forensic services: a qualitative study of lived experience.

Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives.Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care.Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants.Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis ('giving the voices something to feed on'). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future.Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235.Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 374682.

This study canvases the lived experiences of forensic patients receiving EMDR for PTSD ­ people whose views are seldom captured. They described being profoundly impacted by trauma, developing debilitating and enduring PTSD symptoms which variably contribute to offending and psychosis.Participants did not have favourable first impressions when they first heard about EMDR, thinking it 'quackery'. However, they were surprised and delighted by results, with the majority describing marked symptom reduction and personal transformation. Having targeted some of the underlying drivers of maladaptive behaviour, people reported hope for a better future.EMDR was well suited to a forensic setting and was seen as an empowering therapy.

Adapting a two-stage water load test to measure gastric sensitivity over time.

Van Dyck et al. [8] developed a two-stage protocol to estimate interoceptive (gastric) sensitivity independently of stomach volume. They provided no foreknowledge of the second stage (reaching stomach fullness), following the initial stage (drinking until satiated), therefore preventing longitudinal research. The current study provided foreknowledge. Despite this, within-subject variation over time was found, with increases for satiation (p < 0.050) and% satiation (p < 0.000), and decreases regarding fullness (p < 0.000). Some participants expressed trepidation at baseline, hence foreknowledge may have encouraged avoidance of premature fullness. Future longitudinal studies should consider using one baseline to acclimatise, followed by a true baseline.

Correction: Survivorship of Patients After Long Intensive Care Stay With Exploration and Experience in a New Zealand Cohort (SPLIT ENZ): Protocol for a Mixed Methods Study.

[This corrects the article DOI: 10.2196/35936.].

Survivorship of Patients After Long Intensive Care Stay With Exploration and Experience in a New Zealand Cohort (SPLIT ENZ): Protocol for a Mixed Methods Study.

BACKGROUND: Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. OBJECTIVE: The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. METHODS: This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment-BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. RESULTS: This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. CONCLUSIONS: Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/35936.

Gate-tunable Veselago interference in a bipolar graphene microcavity.

The relativistic charge carriers in monolayer graphene can be manipulated in manners akin to conventional optics. Klein tunneling and Veselago lensing have been previously demonstrated in ballistic graphene pn-junction devices, but collimation and focusing efficiency remains relatively low, preventing realization of advanced quantum devices and controlled quantum interference. Here, we present a graphene microcavity defined by carefully-engineered local strain and electrostatic fields. Electrons are manipulated to form an interference path inside the cavity at zero magnetic field via consecutive Veselago refractions. The observation of unique Veselago interference peaks via transport measurement and their magnetic field dependence agrees with the theoretical expectation. We further utilize Veselago interference to demonstrate localization of uncollimated electrons and thus improvement in collimation efficiency. Our work sheds new light on relativistic single-particle physics and provide a new device concept toward next-generation quantum devices based on manipulation of ballistic electron trajectory.

Where is emotional feeling felt in the body? An integrative review.

Contemporary research on "embodied emotion" emphasizes the role of the body in emotional feeling. The evidence base on interoception, arguably the most prominent strand of embodied emotion research, places emphasis on the cardiac, respiratory and gastrointestinal systems. In turn, interoception has evidence-based links with improved emotion regulation. Despite the focus on separate bodily systems, it is unclear whether particular interoceptive locations play a greater role in emotional feeling and emotion regulation. Further, according to Gross' "process model", the sooner that regulation of an emotion occurs, the better; hence, it is additionally important to identify the first body areas to activate. These issues are investigated in a two-stage integrative review. The first stage was preliminary, giving an overview of the evidence base to highlight the distribution of measured body areas. This indicated that 86% of publications (n = 88) measured cardiac activity, 26% measured the respiratory system, and six percent the gastrointestinal system. Given the emphasis placed on all three systems in interoception theory and research on emotion, this suggests a dearth of comprehensive findings pertaining to feeling locations. The second stage investigated the core issues of where emotional feelings are felt in the body and time-related implications for regulation. This was based on ten texts, which together suggested that the head, throat and chest are the most consistently detected locations across and within numerous emotional contexts. Caution is required, however, since-among other reasons discussed-measurement was not time-restricted in these latter publications, and direct physiological measurement was found in only a minority of cases.

What are the long-term outcomes for New Zealand survivors of critical illness?

The COVID-19 pandemic has drawn considerable attention to the survival journey and recovery of patients post critical illness. A decade ago, the Society of Critical Care Medicine described the prolonged adverse health effects after a critical illness as the "post intensive care syndrome" (PICS). Evidence is emerging from Australia around the impact critical illness has on disability, mental health, cognitive function and health-related quality of life for patients this side of the world. For example, one study has shown that disability was highly prevalent in survivor's six-month post hospital discharge, with 50% having mild disability and 25% with moderate to severe disability. Currently it is unknown what the survival journey is like for patients in New Zealand; how we should best measure outcomes for our population; and how we should support Maori and Pasifika patients post critical illness. Research is needed in every aspect of PICS in New Zealand. In 2022, the much-anticipated Survivorship of Patients Post Long Intensive Care Stay, Exploration/Experience in a New Zealand Cohort (SPLIT ENZ) study will explore important aspects of recovery and long-term outcomes for New Zealand survivors of critical illness.

Where is an emotion? Using targeted visceroception as a method of improving emotion regulation in healthy participants to inform suicide prevention initiatives: a randomised controlled trial.

BACKGROUND: William James' 1884 paper "What is an emotion?" has generated much recent interest in affective science regarding somatic contributions to emotion. Studies of interoception ("sensing the physiological condition of the body") suggest that sensing specific parts of the body contributes to the production of emotion, namely when sensing the viscera (i.e. "visceroception" of the heart, gut or lungs). Improved visceroception has, for instance, been linked to increased emotional intensity, suggesting a role for interoception in emotion regulation that may pertain specifically to visceral bodily locations. Thus, in addition to asking James' question, "What is an emotion?", we ask, "Where is an emotion?". Further, there is an evidence base pointing to the connections between emotion regulation and suicide, and between interoception and suicide. This is a preliminary trial investigating whether targeted interoception/visceroception improves emotion regulation. Ultimately, the overall project aims to inform suicide prevention efforts. METHODS: The trial utilises a pre-test/post-test control group design, with two experimental groups undergoing visceroceptive interventions (focussing on areas pertaining to the gut or heart) and a control group. The interventions will run for 8 weeks. A spatial cueing task will measure reaction times to bodily changes relating to lower abdomen or chest focus. A stop/signal task will measure emotional inhibition, which is hypothesised to obscure awareness of active bodily locations. Visceroceptive ability will be tracked using a heartbeat estimation task, a water load test, and by self-report questionnaire. The sample will consist of healthcare professionals and healthcare students. Despite these being groups that represent a relatively high suicide risk among professional and student groups, all participants will be healthy, given the preliminary nature of this trial. DISCUSSION: To our knowledge, this will be the first project to address whether emotional feeling presents as a localised bodily phenomenon and whether trained awareness of emotional localisation can improve emotion regulation. It will also be the first to investigate relationships between interoception and emotional inhibition (i.e. whether a sustained interoceptive practice leads to the disinhibition of bodily emotional sensations, which can positively contribute to emotion regulation). These empirical findings on emotion regulation from a healthy sample will be used to inform a desk-based enquiry into the role of embodied emotion in suicide prevention, which may make a significant contribution to a growing evidence base on interoception and suicide. TRIAL REGISTRATION: ACTR N12619000324112 . Registered on 4 March 2019. Universal Trial Number (UTN): U1111-1221-0201.

Systematic Exploration of Countertransference Phenomena in the Treatment of Patients at Risk for Suicide.

Despite its critical role in clinical suicidology, empirical evidence on the nature of countertransference (CT) to patients at risk for suicide (PRS) is lacking. This study aimed to provide a systematic description of CT phenomena to PRS. Psychiatrists, psychologists, and psychotherapists completed the Therapist Response Questionnaire (TRQ) online, with reference to a PRS. Factor analysis (n = 267) yielded a 7-factor structure, including 1) entrapped/rejecting, 2) fulfilled/engaging, 3) aroused/reacting, 4) informal/boundary crossing, 5) protective/overinvolvement, 6) ambivalent/inconsistent, and 7) mistreated/controlling. On average, clinicians reported that CT dimensions tended to not apply to them, except for the positively connoted factor. Our findings suggest that patients at risk for suicide elicit specific dimensions of CT. We offer two alternative interpretations of clinicians' CT endorsement patterns.

A cohort study of the association between psychosocial factors and pain in patients with Spinal Cord Injury and Stroke.

PURPOSE: To explore associations between psychosocial factors and pain intensity and pain interference in a population with a new neurological injury on admission to rehabilitation, and after six months. MATERIALS AND METHODS: A longitudinal, prospective cohort study with participants with stroke or Spinal Cord Injury (SCI) completing questionnaires for pain intensity and interference, mental health, pain coping strategies and pain attitudes and beliefs within two weeks of admission to inpatient rehabilitation. After six months, participants completed measures of pain intensity and pain interference only. RESULTS: In all 32 participants completed the questionnaires at baseline and 19 after six months. Several associations between a person's mental health and certain beliefs were associated with pain outcomes. Additionally, poorer baseline mental health was associated with greater pain intensity and pain interference after six months, and a stronger belief in a medical cure for pain at baseline was associated with less pain intensity and pain interference after six months. CONCLUSIONS: Psychosocial factors are associated with pain early after stroke and SCI. Psychosocial factors are also associated with pain outcomes several months after stroke and SCI. This highlights the importance of psychosocial factors in both of these populations and their relationship with pain outcomes.