"Post-thrombotic panic syndrome": A thematic analysis of the experience of venous thromboembolism.

OBJECTIVES: Venous thromboembolism (VTE, including deep vein thrombosis [DVT] and pulmonary embolism [PE]) is a serious, potentially traumatic, life-threatening condition and a major cause of mortality and morbidity. The aim of this study was to explore the patients' experiences of VTE and its psychosocial impact. METHODS: Audio-recorded semistructured interviews with a purposive sample of 12 participants who had experienced a first-time DVT or PE within the previous 6 months. Interviews were transcribed and thematically analysed. RESULTS: Four key themes with 10 subthemes were identified. The major themes were as follows: VTE as life-changing and traumatic, living with uncertainty and fear of reoccurrence, feeling let down by health services, and positive changes and outcomes. The content of themes varied according to age at the time of VTE and participants' experiences of diagnosis and treatment. CONCLUSIONS: The data demonstrate the psychosocial impact of VTE as life-changing, encompassing a dynamic duality of trauma and growth. The findings highlight a potential role for health care professionals in identifying and supporting individuals at risk of post-traumatic stress, and targeted interventions to enhance psychological well-being and recovery and reduce distress. Statement of contribution What is already known on this subject? Venous thromboembolism (VTE) is often characterized by sudden onset and may carry a significant threat to life, particularly in the form of pulmonary embolism. Early studies suggest that health-related quality of life is negatively affected by VTE and there is likely to be a high prevalence of trauma. What does this study add? This study explores for the first time the experience of, and reactions to, VTE in the 6 months following its occurrence. It explores the role that psychological well-being can play in recovery after VTE. This study highlights that improvements are needed to support VTE patients to cope with the emotional impact of VTE. A dual process of trauma and post-traumatic growth after VTE is reported for the first time.

Living with an implantable cardioverter defibrillator: The patients' experience.

OBJECTIVES: To explore the lived experiences of implantable cardioverter defibrillator (ICD) recipients. BACKGROUND: Previous research suggests ICD recipients experience significant psychological distress with a focus on shock anxiety. In response, avoidant behaviors are often used which can lead to reduced quality of life, cardiac fitness and increased risk of arrhythmia. METHODS: A qualitative study using semi-structured interviews with a purposive sample of 18 recipients who had either received or not received an ICD shock was conducted. Data were analyzed using a thematic approach. RESULTS: Three themes with sub-themes were defined: (i) physical consequences; (ii) emotional consequences (feeling vulnerable and uncertain; anxiety and depression); and (iii) coping with the ICD (avoidance/restrictive behaviors; acceptance; concealment). CONCLUSION: ICD recipients might be helped by a psycho-social intervention that corrects false beliefs about exercise and offers some simple stress management techniques. Additional elements might include helping recipients to re-evaluate goals and find a valued sense of self which this study found aided ICD acceptance.

Comparing personal insight gains due to consideration of a recent dream and consideration of a recent event using the Ullman and Schredl dream group methods.

There have been reports and claims in the psychotherapeutic literature that the consideration of recent dreams can result in personal realizations and insight. There is theoretical support for these claims from work on rapid eye movement (REM) sleep having a function of the consolidation of emotional memories and the creative formation of connections between new and older memories. To investigate these claims, 11 participants (10 females, one male) reported and considered a recent home dream in a dream discussion group that following the "Appreciating dreams" method of Montague Ullman. The group ran 11 times, each participant attending and participating once. A further nine participants (seven females, two males) reported and considered a recent home dream in a group that followed the "Listening to the dreamer" method of Michael Schredl. The two studies each had a control condition where the participant also reported a recent event, the consideration of which followed the same technique as was followed for the dream report. Outcomes of the discussions were assessed by the participants on the Gains from Dream Interpretation (GDI) scale, and on its counterpart, the Gains from Event Interpretation scale. High ratings on the GDI experiential-insight subscale were reported for both methods, when applied to dreams, and for the Ullman method Exploration-Insight ratings for the dream condition were significantly higher than for the control event condition. In the Ullman method, self-assessment of personal insight due to consideration of dream content was also significantly higher than for the event consideration condition. The findings support the view that benefits can be obtained from the consideration of dream content, in terms of identifying the waking life sources of dream content, and because personal insight may also occur. To investigate the mechanisms for the findings, the studies should be repeated with REM and non-REM dream reports, hypothesizing greater insight from the former.

Dreaming and insight.

This paper addresses claims that dreams can be a source of personal insight. Whereas there has been anecdotal backing for such claims, there is now tangential support from findings of the facilitative effect of sleep on cognitive insight, and of REM sleep in particular on emotional memory consolidation. Furthermore, the presence in dreams of metaphorical representations of waking life indicates the possibility of novel insight as an emergent feature of such metaphorical mappings. In order to assess whether personal insight can occur as a result of the consideration of dream content, 11 dream group discussion sessions were conducted which followed the Ullman Dream Appreciation technique, one session for each of 11 participants (10 females, 1 male; mean age = 19.2 years). Self-ratings of deepened self-perception and personal gains from participation in the group sessions showed that the Ullman technique is an effective procedure for establishing connections between dream content and recent waking life experiences, although wake life sources were found for only 14% of dream report text. The mean Exploration-Insight score on the Gains from Dream Interpretation questionnaire was very high and comparable to outcomes from the well-established Hill (1996) therapist-led dream interpretation method. This score was associated between-subjects with pre-group positive Attitude Toward Dreams (ATD). The need to distinguish "aha" experiences as a result of discovering a waking life source for part of a dream, from "aha" experiences of personal insight as a result of considering dream content, is discussed. Difficulties are described in designing a control condition to which the dream report condition can be compared.

Advice to eat fish and mood: a randomised controlled trial in men with angina.

People with high intake of fish have lower reported rates of depression and a small trial in psychiatric patients suggested that fish oil supplements reduced episodes of depression and mania. As part of a factorial trial of interventions to reduce mortality in angina 452 men were randomised to advice to eat more fatty fish or no fish advice. Maxepa fish oil capsules were supplied to men who found the fish unpalatable. Fish intake and mood were assessed at baseline and six months. Most men (83%) had mood assessed using the Derogatis Stress Profile at baseline and follow-up. Self reported intake of fish was higher in the fish advice group at six months. There was, however, no difference in depression or anxiety in those allocated to receive fish advice. After controlling for baseline mood, the difference in depression score between those randomised to fish advice and those not was 1.29 (95% CI -0.29 to 2.88) and the difference in anxiety was 0.82 (95% CI -0.57 to 2.22) with positive differences indicating more depression or anxiety in those allocated to the fish arm. This trial provides no evidence that increased fatty fish intake in people without depressive symptoms has any substantial effect on mood.

Enhancement of antibody responses to influenza vaccination in the elderly following a cognitive-behavioural stress management intervention.

BACKGROUND: Previous research has demonstrated that the psychological morbidity experienced by informal caregivers is associated with increased vulnerability to infectious diseases, in particular influenza. A pragmatic trial was conducted to examine whether a stress management intervention (SMI) could reduce psychological morbidity and enhance the antibody response to influenza vaccination in the elderly, and whether changes in immune response of SMI participants were associated with hypothalamic-pituitary-adrenal (HPA) axis activity. METHODS: Forty-three elderly spousal carers of dementia patients and 27 non-carer controls were recruited. Sixteen carers were allocated to an 8-week SMI or a non-intervention condition (n = 27). The non-carers formed a no treatment, 'normal' comparison group. At the end of the SMI or its equivalent time period, all participants received an influenza vaccination. IgG antibody titres to the vaccine were measured 0, 2, 4 and 6 weeks post-vaccine. RESULTS: There was evidence of elevated distress in both carer groups compared with non-carer controls throughout the SMI period, but no between-group differences in salivary cortisol. Immune responses to the vaccine revealed that 50% of SMI carers, 7% of non-intervention carers and 29% of non-carer controls produced a four-fold increase in antibody titre. CONCLUSIONS: The immune response to influenza vaccination appears amenable to improvement through stress management, although the mechanisms underlying this effect remain unclear.