Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer.

OBJECTIVE: This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS: Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS: No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS: AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.

Barriers and facilitators to implementation of trauma support services at a large HIV treatment center in the Southern United States.

The high prevalence of trauma among people living with HIV underscore the need for tailored, integrated trauma management ("trauma-informed care" or TIC) to improve retention, adherence to care, and overall well-being. Although TIC has been identified as a priority area for HIV care, uptake has been limited. To investigate barriers and facilitators to integrating trauma support services within HIV primary care, surveys (n=94) and interviews (n=44) were administered to providers, staff, and patients at a large HIV treatment center. Results highlighted the availability of several trauma services, including psychotherapy and support groups, but also revealed the absence of provider training on how to respond to patient trauma needs. Identified gaps in TIC services included written safety and crisis prevention plans, patient education on traumatic stressors, and opportunities for creative expression. Providers and staff supported implementation of trauma support services and employee trainings, but expressed a number of concerns including resource and skill deficiencies. Patient-reported barriers to TIC services included lack of awareness of services and difficulties navigating the healthcare system. This assessment revealed support and methods for strengthening integration of trauma support services within HIV primary care, which future TIC implementation efforts should address.

The effectiveness of trauma-informed wilderness therapy with adolescents: A pilot study.

Objective: Wilderness therapy (WT) is a complementary/integrative approach for treating struggling adolescents by using outdoor adventure activities to foster personal and interpersonal growth/well-being. Empirical support for the effectiveness of traditional WT is growing, but evidence supporting trauma-informed WT (TIWT) is lacking. This pilot study addresses that gap. Method: Between 2009 and 2019, 816 adolescents (Ages 13-17, Mage = 15.36, SD = 1.25; 41.1% female) completed the Youth-Outcome Questionnaire-SR 2.0 at intake and discharge (M = 75.02 days, SD = 28.77). Three-hundred seventy-eight adolescents also completed the Family Assessment Device-General Functioning (FAD-GF), and 253 adolescents completed two, 2.5-min segments of heart-rate-variability biofeedback (one while resting and one while using a coping skill). One-hundred eighty-nine caregivers completed the Youth-Outcome Questionnaire 2.01, and 181 caregivers completed the FAD-GF. Between 25 and 99 adolescents and caregivers also completed psychological and family measures at 6 months and 1 year postdischarge. Results: Adolescents reported experiencing improvements in psychological and family functioning. They also exhibited improvement in psychophysiological functioning (heart-rhythm coherence). Caregivers reported improvements in family functioning and their child's psychological functioning. Caregivers observed more persisting benefits in their child's psychological functioning, whereas adolescents reported more persisting benefits in family functioning. Changes in psychological and family functioning were related. There were very few differential effects on the basis of demographic factors, trauma exposure, or past and current treatment factors. Conclusion: Results of this pilot study suggest TIWT is a promising complementary/integrative intervention for improving the psychological, family, and psychophysiological functioning of struggling adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Mindfulness and trauma symptoms predict child abuse potential in risk-exposed, men and women during pregnancy.

BACKGROUND: Nearly a third of adults report childhood trauma in their youth and approximately 700,000 cases of child maltreatment were reported in 2016. Both history of childhood trauma and current trauma symptoms in adults are linked to child maltreatment, although many trauma-exposed individuals are warm and nurturing parents. Identifying resiliency factors in adults with risk factors for harsh parenting may illuminate new pathways to sensitive parenting. Mindfulness is reported to improve trauma and mental health symptoms but the relationship between mindfulness, trauma, and child abuse potential is not yet understood. OBJECTIVE: This cross-sectional study investigated the relationship between mindfulness, childhood trauma experiences, trauma symptoms and child abuse potential. PARTICIPANTS AND SETTING: Our participants were 102 expectant parents recruiting from obstetric clinics and agencies Detroit, MI (58.8% African American, 27.5% Caucasian). METHOD: Bivariate correlations were examined using validated, self-report questionnaires. Significant variables were included in a hierarchical linear regression to identify predicting factors that contribute to child abuse potential scores. RESULTS: Significant correlations between child abuse potential with current trauma symptoms (r = .53, p < .01) and mindfulness (r = -.32, p < .01) were found, but no link with past childhood trauma experiences and child abuse potential were identified. The model significantly predicts child abuse potential (ΔR2 = .10, F(5, 96), = 12.48, p < .001). Trauma symptoms (B = .09, p < .001, 95% confidence interval [CI][-.40, -.07]) and mindfulness nonreactivity (B = -.24, p < .01, 95% CI[.05, .14]) predicted higher potential for child abuse scores. CONCLUSION: Findings suggest increased mindfulness, especially nonreactivity to one's own thoughts, may be an important factor to protect against child abuse potential. Interventions to increase parental mindfulness may reduce child abuse potential and improve child well-being, but further mechanistic research is needed to determine this.

Harnessing Electroceuticals to Treat Disorders Arising From Traumatic Stress: Theoretical Considerations Using A Psychosensory Model.

Traumatically encoded memories can last a lifetime. These memories, either by purposeful or inadvertent re-activation, cause the release of stress hormones and generate a persistent and inescapable allostatic load on the body, brain and mind. This leads to a maladaptive response, as the ability to return to pre-event homeostasis is no longer possible. The consequence of this response is that it increases risk for further traumatization and other disorders. Remarkably, recent research has shown that these memories become labile and subject to disruption upon recall. In this paper we outline conditions needed for an event to be encoded as a trauma and describe a method that abrogates the release stress hormones when cued by these memories of the event. Critical to this process is the AMPA receptor (so named for its specific agonist, AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, a compound that acts as glutamate, its natural substrate). It is hypothesized that traumatic encoding requires increasing the number and permanence of AMPA receptors on the lateral nucleus of the amygdala by a process called synaptic potentiation. Depotentiation, that is removal of these AMPA receptors, is required for de-encoding. We speculate that the generation of oscillatory intracellular calcium waves is necessary for this to occur. Electromagnetic fields, acting as electroceuticals, interact with voltage-gated calcium channels on depolarized post-synaptic membranes to produce these intracellular calcium oscillations of varying frequency. These oscillatory calcium waves are decoded by intracellular calmodulin which, depending on the frequency, either act to potentiate or depotentiate AMPA receptors. This article describes the theory and practical application of a psychosensory approach called Event Havening that generates an electromagnetic field to synaptically depotentiate these encoded AMPA receptors and eliminate the effects of traumatic encoding.

[Mental treatment of refugees in Germany : Model for a stepped approach]. / Psychische Versorgung von Flüchtlingen in Deutschland : Modell für ein gestuftes Vorgehen.

The recent influx of refugees and asylum seekers into Germany poses a challenge for the national healthcare system. In compliance with the present Asylum Seekers Benefits Act, the national healthcare system can be expected to have 1.5 million new members by early 2017. Providing adequate care particularly for people with mental illnesses or disorders will represent an immense challenge for all actors in the system. The circumstances of the flight combined with the foreign linguistic and socio-cultural background increase the severity of the cases and the difficulties of treatment. No procedures or guidelines for treatment have yet been established to ensure a standardized, cost-efficient and therapeutically effective treatment of patients with this background. This article describes the components of a stepped treatment procedure and proposes a stepped and collaborative care model (SCCM) that could be evaluated in nationwide studies. This approach is based on national and international treatment guidelines and aims to provide target-group specific, culturally sensitive methods of diagnosis and treatment. The various steps of the model build on each other, with the first steps relying on technological aids (e.g. online or smartphone options) and support from lay helpers and the more expensive specialist psychiatric and psychotherapeutic therapy only being initiated in cases of more severe mental disorders.

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial.

In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

Dispositional mindfulness in trauma recovery: Prospective relations and mediating mechanisms.

This study examined the protective properties and candidate mediating processes (cognitive fusion and cognitive suppression) linking dispositional mindfulness to distal risk factors (negative affect, anxiety sensitivity, rumination) and psychopathology symptom outcomes (depression and posttraumatic stress symptoms) following trauma exposure. To do so, a community-based sample of adults was longitudinally studied in the six-months following exposure--within 30-days (T1), 3-months (T2), and 6-months (T3)--to a shared disaster-related potentially traumatic event (PTE). Specifically, we found that cognitive fusion predicted, and mediated, the effect of mindfulness on outcomes related to distress post-trauma including negative affect, depression and posttraumatic stress symptoms. Complementary to these effects, we found that cognitive suppression predicted, and mediated, the effect of mindfulness on distal risk factors linked to negative self-referential processes including rumination and anxiety sensitivity. Findings are discussed with respect to their theoretical and clinical implications for the potential role and mechanisms of mindfulness in recovery following trauma.

Mitologias: perspectivas clínicas dos movimentos de integração e desintegração / Mythologies: clinical perspectives of integration and disintegration movements / Mitologías: perspectivas clínicas de los movimientos de integración y desintegración

Inerentes à vida, em todas as espécies, as dinâmicas de integração e desintegração assumem no humano formas inesperadas e surpreendentes. Desde os primeiros momentos da concepção, na vida intrauterina, durante todo o desenvolvimento e até a morte, essas dinâmicas forjam a existência de cada um, marcando o corpo e a subjetividade. Vivemos e nos desenvolvemos em meio a tais dinâmicas. Em nós convivem e interagem, permanentemente, processos de organização, que promovem a vida, e de desorganização, que tendem a conduzir à morte. Na multiplicação celular e na apoptose, na diferenciação das funções corporais e nos processos neoplásicos de indiferenciação, na complexificação do aparelho em funções psíquicas e na pulverização e dissolução do pensamento e do desejo, entre muitas outras. Dessa perspectiva, sugerida por Freud, na segunda forma de sua teoria das pulsões ("a nossa mitologia", segundo ele), vislumbramos as experiências de prazer e de sofrimento, as manifestações sintomáticas orgânicas, psíquicas, motoras e, mesmo, sociais, no âmbito coletivo. A clínica oferece não apenas um lugar privilegiado para a observação dos processos de integração e desintegração, mas também um recurso relacional para lidar e transformar muitos dos efeitos de suas manifestações. Também ali, no par terapêutico ou na solidão dos momentos de relação impossível, vida e morte manifestam-se por meio de diferentes matizes transferenciais e contratransferenciais, que buscaremos reconhecer e compreender neste trabalho.(AU)

the integration and disintegration dynamics are inherent to all forms of life. In the human being, they assume unexpected and surprising manifestations. From the first moments of conception, during the intrauterine life, throughout the development and even in the death process, these dynamics fake the existence of each one, shaping the body and the subjectivity. We live and we develop throughout those dynamics, in which interact in a permanent way organization processes, promoting life, and disorganization ones, which lead to death, for example in cell proliferation and apoptosis, in neoplastic processes of indifference, in the complexity of the psychic functions and the dissolution of thought and desire, among many others. From this perspective - suggested by Freud in his second theory of drives ("our mythology", as he said), we glimpse the experiences of pleasure and pain, the physical, psychological, motor and even social symptomatic manifestations. The clinic offers us not only a privileged place for the observation of integration and disintegration processes, but also a relational tool to handle and transform many of the effects of those manifestations. Between the therapeutic pair or in the loneliness moments of impossible relationship, life and death manifest themselves through different shades of transference and counter transfers, which we'll seek to recognize and understand in this work.(AU)

En todas las especies, las dinámicas de la integración y la desintegración son inherentes a la vida. En el ser humano, pueden asumir formas inesperadas y sorprendentes. Desde los primeros momentos de la concepción, durante la vida intrauterina, a través del desarrollo e incluso hasta la muerte, estas dinámicas forjan la existencia de cada uno, marcando el cuerpo y la subjetividad. Vivimos y nos desarrollamos en medio a esas dinámicas. En nosotros, conviven et inter ajen (interactúan) de forma permanente, los procesos de organización, que promueven la vida, y los de desorganización, que tienden a provocar la muerte: en la proliferación celular y en la apoptosis, en la diferenciación de las funciones corporales y en los procesos neoplásicos de des diferenciación, en la complejidad de las funciones psíquicas, y en la dispersión y disolución del pensamiento y del deseo, entre muchos otros. Desde esta perspectiva, propuesta por Freud, en su segunda teoría de las pulsiones ("nuestra mitología", dice él), vislumbramos las experiencias de placer y de dolor, las manifestaciones sintomáticas físicas, psicológicas, motoras e incluso sociales. La clínica nos ofrece no sólo un sitio privilegiado para la observación de los procesos de integración y desintegración, sino también un recurso para manejar esas relaciones y transformar muchos de los efectos de sus manifestaciones. También allí, en la pareja terapéutica o en los momentos de soledad de una relación imposible, la vida y la muerte se manifiestan a través de diferentes modulaciones de la transferencia y de la contra transferencia, que trataremos de reconocer y comprender en este trabajo.(AU)

Children enacting idioms of witchcraft and spirit possession as a response to trauma: therapeutically beneficial, and for whom?

This article examines children's enactment of spirit possession idioms and witchcraft in Africa including the meanings such idioms provide and the local healing resources they mobilize. Idioms of haunting spirits in Northern Uganda and witch-children elsewhere in Africa can be interpreted as manifestations of social crises and mass traumatic stress. On the other hand, such idioms also allow children to articulate, reflect upon, and communicate the complex feelings resulting from their precarious positions within families and communities under duress. With the help of Dow's transactional model of symbolic healing, this article explores obstacles to the effectivity of the rich variety of symbolic healing available for haunting spirits in Uganda and points to the generational gap between children and their families and communities. Elsewhere, witchcraft idioms may act as a healing resource at the group level, but at the expense of the accused child. The idioms of evil spirits and witchcraft speak of these children's navigation of the moral universe of their postconflict communities. Given that children's appraisal of their experiences through these notions may also exacerbate their anxiety, interdisciplinary research examining the microprocesses that lead to children being haunted or accused, including emotional and physiological levels effects, is urgently needed.

Mitologias: perspectivas clínicas dos movimentos de integração e desintegração / Mythologies: clinical perspectives of integration and disintegration movements / Mitologías: perspectivas clínicas de los movimientos de integración y desintegración

Inerentes à vida, em todas as espécies, as dinâmicas de integração e desintegração assumem no humano formas inesperadas e surpreendentes. Desde os primeiros momentos da concepção, na vida intrauterina, durante todo o desenvolvimento e até a morte, essas dinâmicas forjam a existência de cada um, marcando o corpo e a subjetividade. Vivemos e nos desenvolvemos em meio a tais dinâmicas. Em nós convivem e interagem, permanentemente, processos de organização, que promovem a vida, e de desorganização, que tendem a conduzir à morte. Na multiplicação celular e na apoptose, na diferenciação das funções corporais e nos processos neoplásicos de indiferenciação, na complexificação do aparelho em funções psíquicas e na pulverização e dissolução do pensamento e do desejo, entre muitas outras. Dessa perspectiva, sugerida por Freud, na segunda forma de sua teoria das pulsões ("a nossa mitologia", segundo ele), vislumbramos as experiências de prazer e de sofrimento, as manifestações sintomáticas orgânicas, psíquicas, motoras e, mesmo, sociais, no âmbito coletivo. A clínica oferece não apenas um lugar privilegiado para a observação dos processos de integração e desintegração, mas também um recurso relacional para lidar e transformar muitos dos efeitos de suas manifestações. Também ali, no par terapêutico ou na solidão dos momentos de relação impossível, vida e morte manifestam-se por meio de diferentes matizes transferenciais e contratransferenciais, que buscaremos reconhecer e compreender neste trabalho...

the integration and disintegration dynamics are inherent to all forms of life. In the human being, they assume unexpected and surprising manifestations. From the first moments of conception, during the intrauterine life, throughout the development and even in the death process, these dynamics fake the existence of each one, shaping the body and the subjectivity. We live and we develop throughout those dynamics, in which interact in a permanent way organization processes, promoting life, and disorganization ones, which lead to death, for example in cell proliferation and apoptosis, in neoplastic processes of indifference, in the complexity of the psychic functions and the dissolution of thought and desire, among many others. From this perspective - suggested by Freud in his second theory of drives ("our mythology", as he said), we glimpse the experiences of pleasure and pain, the physical, psychological, motor and even social symptomatic manifestations. The clinic offers us not only a privileged place for the observation of integration and disintegration processes, but also a relational tool to handle and transform many of the effects of those manifestations. Between the therapeutic pair or in the loneliness moments of impossible relationship, life and death manifest themselves through different shades of transference and counter transfers, which we'll seek to recognize and understand in this work...

En todas las especies, las dinámicas de la integración y la desintegración son inherentes a la vida. En el ser humano, pueden asumir formas inesperadas y sorprendentes. Desde los primeros momentos de la concepción, durante la vida intrauterina, a través del desarrollo e incluso hasta la muerte, estas dinámicas forjan la existencia de cada uno, marcando el cuerpo y la subjetividad. Vivimos y nos desarrollamos en medio a esas dinámicas. En nosotros, conviven et inter ajen (interactúan) de forma permanente, los procesos de organización, que promueven la vida, y los de desorganización, que tienden a provocar la muerte: en la proliferación celular y en la apoptosis, en la diferenciación de las funciones corporales y en los procesos neoplásicos de des diferenciación, en la complejidad de las funciones psíquicas, y en la dispersión y disolución del pensamiento y del deseo, entre muchos otros. Desde esta perspectiva, propuesta por Freud, en su segunda teoría de las pulsiones ("nuestra mitología", dice él), vislumbramos las experiencias de placer y de dolor, las manifestaciones sintomáticas físicas, psicológicas, motoras e incluso sociales. La clínica nos ofrece no sólo un sitio privilegiado para la observación de los procesos de integración y desintegración, sino también un recurso para manejar esas relaciones y transformar muchos de los efectos de sus manifestaciones. También allí, en la pareja terapéutica o en los momentos de soledad de una relación imposible, la vida y la muerte se manifiestan a través de diferentes modulaciones de la transferencia y de la contra transferencia, que trataremos de reconocer y comprender en este trabajo...

Llaki and ñakary: idioms of distress and suffering among the highland Quechua in the Peruvian Andes.

This article examines some of the long-term health outcomes of extreme adversities and the ways in which social inequalities and idioms of distress are historically and socially produced in the Peruvian context. We describe how the highland Quechua of northern Ayacucho construct and experience expressions of distress and suffering such as pinsamientuwan (worrying thoughts, worries), ñakary (suffering) and llaki (sorrow, sadness), in a context of persistent social inequalities, social exclusion and a recent history of political violence. It is concluded that the multiple expressions of distress and suffering are closely related to past and current events, shaped by beliefs, core values and cultural norms and, in this process, transformed, recreated and invested with new meanings and attributions.

Kiyang-yang, a West-African postwar idiom of distress.

In 1984, a healing cult for young barren women in southern Guinea Bissau developed into a movement, Kiyang-yang, that shook society to its foundations and had national repercussions. "Idiom of distress" is used here as a heuristic tool to understand how Kiyang-yang was able to link war and post-war-related traumatic stress and suffering on both individual and group levels. An individual experience born from a traumatic origin may be generalized into an idiom that diverse sectors of society could embrace for a range of related reasons. We argue that, for an idiom to be understood and appropriated by others, there has to be resonance at the level of symbolic language and shared experiences as well as at the level of the culturally mediated contingent emotions it communicates. We also argue that through its symbolic references to structural causes of suffering, an idiom of distress entails a danger for those in power. It can continue to exist only if its etiology is not exposed or the social suffering it articulates is not eliminated. We finally argue that idioms of distress are not to be understood as discrete diagnostic categories or as monodimensional expressions of "trauma" that can be addressed.

Trauma and humanitarian translation in Liberia: the tale of open mole.

The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia's recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.

Dissociative symptoms and reported trauma among patients with spirit possession and matched healthy controls in Uganda.

Spirit possession is a common, worldwide phenomenon with dissociative features. Studies in Europe and the United States have revealed associations among psychoform and somatoform dissociation and (reported) potential traumatic events. The aim of this study was to explore the relationships among spirit possession, dissociative symptoms and reported potentially traumatizing events in Uganda. One hundred nineteen persons with spirit possession, diagnosed by traditional healers, were compared to a matched control group of 71 nonpossessed persons. Assessments included demographic items and measures of dissociation and potentially traumatizing events. Compared to the nonpossessed group, the possessed group reported more severe psychoform dissociation and somatoform dissociation and more potentially traumatizing events. The associations between these events and both types of dissociation were significant. Yet, consistent with the cultural perception of dissociative symptoms, the participants subjectively did not associate dissociative symptoms with potentially traumatizing events. In conclusion, spirit possession deserves more interest as a possible idiom of distress and a culture-specific expression of dissociation related to potential traumatizing events.

Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses.

OBJECTIVE: Palliative care (PC) nurses experience several recurrent organizational, professional, and individual challenges. To address existential and emotional demands, the meaning-centered intervention was recently developed. The intervention applied didactic and process-oriented strategies, including guided reflections, experiential exercises, and education based on themes of Viktor Frankl's logotherapy. The objective of this study was to test its efficiency to improve job satisfaction and quality of life in PC nurses from three regional districts in Quebec Province, Canada. METHODS: A randomized waiting-list group design was conducted, intervention group (n=56) versus waiting-list group (n=53). Job satisfaction, perception of benefits of working in PC, and spiritual and emotional quality of life were measured at pre-, posttest, and 3-month follow-up. RESULTS: The PC nurses in the experimental group reported more perceived benefits of working in PC after the intervention and at follow-up. Spiritual and emotional quality of life remained, however, unaffected by the intervention. CONCLUSIONS: To explain null findings, theoretical and methodological challenges, related to existential interventions, such as choice of outcomes, and selection bias (participants recruited were healthy workers) are discussed. Future directions and strategies to deal with those issues are proposed.

O trauma psíquico e o paradoxo das narrativas impossíveis, mas necessárias / The psychical trauma and the paradox of the impossible but necessary narrations

Considerando-se, à luz das contribuições freudianas mais tardias, que o traumático, entendido como excesso pulsional, estaria situado além da capacidade de representação psíquica, exploramos neste artigo a estreita articulação entre trauma e "indizível". Para tal, são retomados alguns aspectos centrais da teorização psicanalítica sobre o trauma, aspectos relacionados com a sua dimensão "intransmissível". Segundo esta visada, o trauma constitui um vivido que ultrapassa a capacidade psíquica de apropriação e de recalcamento. Nosso objetivo é mostrar como a ideia de uma narrativa impossível, mas absolutamente necessária - eixo central do presente artigo - parece aplicar-se perfeitamente ao sofrimento indizível posto em cena a partir da experiência traumática, e que torna tão fundamental a paradoxal tarefa de narrá-la.(AU)

In this paper we examine the strict articulation between trauma and the "unsayable", taking into account that in the light of the latest Freudian contributions, the traumatic, understood as drive excess, would be situated beyond the capacity of psychical representation. For that, we analyze some central features of psychoanalytical theorizing on trauma, related to its "untransmissible" dimension. From that perspective, trauma constitutes an experience that exceeds the psychical capacity to appropriate and to repress. Our aim is to point out that the idea of an impossible, though absolutely necessary, narration - central axis of this paper - appears to fit the unsayable pain introduced by the traumatic experience, and makes essential the paradoxical task of narrating it.(AU)