The wellbeing paradox in Hungarian local sustainable agriculture: a health psychology approach.

BACKGROUND: The literature suggests that farmers' work involves a number of operational difficulties. Although alternative food networks address the majority of their problems, they can potentially generate new hardships. The aim of this study is to examine the situational and engagement-related work difficulties associated with the everyday world of Community Supported Agriculture (CSA) farmers. METHODS: This study used the health psychology approach, namely interpretive phenomenology, to understand the social determinants of farmers' working lives in CSA and to explore mental health challenges within the practices of local sustainable farming. To collect data, semi-structured, in-person interviews were conducted with CSA farmers in Hungary. RESULTS: Our study shows that new modes of consumer-producer connectivity create novel situations and issues which farmers are forced to address. Three personal experiential themes emerge from the data to describe CSA farmers' work difficulties: (1) Conflicted autonomy; (2) The pressure of boxes; (3) Social overload. The difficulties for CSA farmers seem to be rooted in the economic characteristics of alternative agriculture where farmers organize food production for the satisfaction of consumer needs. In addition, structural conditions require several different CSA farmer roles, which could even be conflicting. CONCLUSION: This study provides participants' perspectives on the health and wellbeing costs of sustainable farming. Newer producer-consumer connections require both time and experience and involve extra effort or skills, but farmers often lack these abilities. The results show how perceptions of work processes relate to the general framework of CSA, which necessitates a distinct strategy for farm management.

Voices of Temporary Sobriety - A Diary Study of an Alcohol-Free Month in Hungary.

Background: Temporary abstinence from alcohol as a challenge could support self-knowledge, self-care, and health consciousness in several ways. Objectives: The present study explored Dry November participants' personal experiences and coping strategies during a one-month abstinence period. The research is embedded in the Hungarian context of drinking habits, culture, society, and alcohol policy. Methods: This qualitative study comprised the thematic analysis of 23 participants' diaries, reported twice a week for 30 days (in November 2017), to identify and understand the common experiences of temporary sobriety. Results: Three main themes emerged from the analysis: challenge, community, and relationship toward alcohol and abstinence. Results showed that there are no categorical differences between successful and non-successful participants. Conclusions: The present research demonstrated that during the challenge, rather than simply saying 'no' to alcohol, participants utilized other refusal strategies to avoid social confrontation.

Assessing the experience of using synthetic cannabinoids by means of interpretative phenomenological analysis.

BACKGROUND: New psychoactive substances (NPS) have been increasingly consumed by people who use drugs in recent years, which pose a new challenge for treatment services. One of the largest groups of NPS is synthetic cannabinoids (SCs), which are intended as a replacement to cannabis. While there is an increasing body of research on the motivation and the effects associated with SC use, little is known about the subjective interpretation of SC use by the people who use drugs themselves. The aim of this study was to examine the experiences and personal interpretations of SC use of users who were heavily dependent on SC and are in treatment. METHODS: A qualitative research method was applied in order to explore unknown and personal aspects of SC use. Semi-structured interviews were conducted with six participants who had problematic SC use and entered treatment. The research was conducted in Hungary in 2015. We analyzed data using interpretative phenomenological analysis (IPA). RESULTS: Participants perceived SCs to be unpredictable: their initial positive experiences quickly turned negative. They also reported that SCs took over their lives both interpersonally and intrapersonally: the drug took their old friends away, and while initially it gave them new ones, in the end it not only made them asocial but the drug became their only friend, it hijacked their personalities and made them addicted. CONCLUSIONS: Participants experienced rapid development of effects and they had difficulties interpreting or integrating these experiences. The rapid alteration of effects and experiences may explain the severe psychopathological symptoms, which may be important information for harm reduction and treatment services. Since, these experiences are mostly unknown and unpredictable for people who use SCs, a forum where they could share their experiences could have a harm reducing role. For a harm reduction point of view of SCs, which are underrepresented in literature, it is important to emphasize the impossibility of knowing the quantity, purity, or even the number of different SC compounds in a particular SC product. Our study findings suggest that despite the adverse effects, including a rapid turn of experiences to negative, rapid development of addiction and withdrawal symptoms of SCs, participants continued using the drug because this drug was mostly available and cheap. Therefore, a harm reduction approach would be to make available and legal certain drugs that have less adverse effects and could cause less serious dependence and withdrawal symptoms, with controlled production and distribution (similarly to cannabis legalization in the Netherlands).

A needle in the haystack--the dire straits of needle exchange in Hungary.

BACKGROUND: The two largest needle exchange programs (NEPs) in Hungary were forced to close down in the second half of 2014 due to extreme political attacks and related lack of government funding. The closures occurred against a background of rapid expansion in Hungary of injectable new psychoactive substances, which are associated with very frequent injecting episodes and syringe sharing. The aim of our analysis was to predict how the overall Hungarian NEP syringe supply was affected by the closures. METHODS: We analyzed all registry data from all NEPs in Hungary for all years of standardized NEP data collection protocols currently in use (2008-2014) concerning 22 949 client enrollments, 9,211 new clients, 228,167 client contacts, 3,160,560 distributed syringes, and 2,077,676 collected syringes. RESULTS: We found that while the combined share of the two now closed NEPs decreased over time, even in their partial year 2014 they still distributed and collected about half of all syringes, and attended to over half of all clients and client contacts in Hungary. The number of distributed syringes per PWID (WHO minimum target = 100) was 81 in 2014 in Hungary, but 39 without the two now closed NEPs. CONCLUSIONS: There is a high probability that the combination of decreased NEP coverage and the increased injection risk of new psychoactive substances may lead in Hungary to a public health disaster similar to the HIV outbreaks in Romania and Greece. This can be avoided only by an immediate change in the attitude of the Hungarian government towards harm reduction.

[Assessing identity formation of synthetic cannabinoid products' users - an interpretative phenomenological analysis].

INTRODUCTION: The psychoactive substance addiction often leads to change in identity and the formation of the "user self". During recovery this "user self" or the "spoiled identity" (as Goffman described it) transforms into the identity of recovery. Due to the novel symptoms of synthetic cannabinoid products (SCPs), a new type of psychoactive substances and the lack of previous research the identity work of SCPs users is unpredictable. The aim of this study was to examine how the users of SCPs interpret their experiences delivered from SCPs consumption and how do they perceive the identity, for this we assessed the interpretative phenomenological analysis (IPA). METHOD: Based on the method of IPA a purposive sample was recruited, including 6 males (their age was between 20 and 27) who were self-identified SCPs users. They had been using the drug for 2-6 years, and before the analysis they were abstinent for at least one month. Semi-structured interviews were conducted and analyzed using IPA. RESULTS: During the analysis two master themes emerged; 1. The impact of SCPs use experience on self and identity formation, and 2. The transformed self and the user self. CONCLUSIONS: the experiences of SCPs users can be compared with some specificities of traumatic experience; therefore, the experience of SCPs use may be treated as a particular type of trauma. As a result, the resources of SC users to change their self and construct a new non-addict identity are limited, which may mean a significant obstacle in recovery. Hence, treatment should focus on identity work more emphatically.

[The experience of auditory hallucination and the role of self-help groups: an interpretative phenomenological analysis]. / A hanghallás élménye és az önsegito csoport szerepe: interpretatíve fenomenológiai analizisen alapuló kutatás.

INTRODUCTION: the aim of this study was to examine and to understand the experience of voice hearing, the meaning and participants' relationship with their voices. And also to explore what 'recovery' means in this context, and the role of self-help group. METHOD: six semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis (IPA). Emerging themes were identified and clustered into master themes, then interpreted. SUBJECTS: 6 (3 females, 3 males) voice hearers, recovering from psychosis. RESULTS: Analysis resulted in four master themes to represent the key points of life story interviews; the role of voices (first master theme), relationship with voices (second master theme); asymmetric and symmetric relational concept, position of voices (outside or inside). The third and fourth master theme refer to the role of self-help group, and the method applied by the group. CONCLUSION: applying self-help group in clinical context contributes to better outcomes in treatment of voice hearers.

[Fill it up...! Combined consumption of alcohol with energy drinks and its correlation with risk taking behaviour among young adults]. / Tölts rá...! Az alkohol és energiaital együttes fogyasztásának és a kockázatvállaló magatartási formák kapcsolatának felmérése fiatal felnottek körében.

INTRODUCTION: In Hungary and all around the world the incidence of consumption of energy drinks together with alcohol has increased among adolescents and young adults. AIM: The foremost aim of this survey was to find out whether alcohol mixed with energy drinks can enhance the appearance of other forms of risky behaviour among young adults. METHOD: In spring 2013 the authors carried out a quantitative sociological survey at three faculties of two major universities in Budapest, Hungary. RESULTS: The survey showed that 1) consumers, who mixed alcohol with energy drinks, were likely to drink more alcohol both at parties and on ordinary days, and they took part in binge drinking more frequently than those consuming only alcohol; 2) students drank significantly less alcohol when they mixed it with energy drink. CONCLUSIONS: The conflicts of the results showed that even at the starting point there was a clear distinction between the two groups, moreover, it is not yet clear what interactions the combined effect of caffeine and alcohol can trigger in the behaviour of the individual.

[Recovering helpers in the addiction treatment system in Hungary: an interpretative phenomenological analysis]. / Addiktológiai területen dolgozó tapasztalati szakértök: interpretative fenomenológiai analízisen alapuló kutatás.

INTRODUCTION: The work of recovering helpers who work in the addiction rehabilitation centres was studied. The aim was to investigate the process of addicts becoming recovering helpers, and to study what peer help means to them. METHODS: According to interpretative phenomenological analysis (IPA) design, subjects were selected, data were collected and analysed. SUBJECTS: 6 (5 males, 1 female), working as recovering helpers at least one year at addiction rehabilitation centres. Semi-structured life interviews were carried out and analysed according to IPA. RESULTS: Emerging themes from the interviews were identified and summarized, then interpreted as central themes: important periods and turning points of the life story interviews: the experience of psychoactive drugs use, the development of the addiction (which became " Turning Point No 1") then the "rock bottom" experience ("Turning Point No 2"). Then the experience of the helping process was examined: here four major themes were identified: the development of the recovering self and the helping self, the wounded helper and the skilled helper, the experience of the helping process. DISCUSSION: IPA was found to be a useful method for idiographic exploration of the development and the work of the recovering helpers. The work of the recovering helpers can be described as mentoring of the addict clients. Our experiences might be used for the training programs for recovering helpers as well as to adopt their professional role in addiction services.

[Emergence of novel psychoactive substances among clients of a needle exchange program in Budapest, Hungary]. / Új pszichoaktív anyagok megjelenése egy budapesti tucsereprogram kliensei körében.

In this paper the authors summarize experience of a drug service provider with the injecting use of novel psychoactive substances. Among clients of the needle exchange programme of Blue Point Drug Counselling and Outpatient Centre, the authors observed the spread of the novel substances since 2009. The extensive spread of the novel substances caused substantial change in injecting use patterns, thus in the usage of the needle exchange programme. The novel psychoactive substances appeared consecutively, so that this setting gave a unique opportunity to observe and track the emergence of these substances. The authors summarize the characteristics which are important for medical practice (risks, frequent use, severe psychopathological conditions) as well as special risks associated with these substances (substances with unknown composition and effect). They highlight the importance and role of the early warning system, monitoring the online sources of information and testing of samples containing novel psychoactive substances.

"I established a life; I can re-establish it again": Lived experiences of intimate partner violence in Mongolia.

Violence against women persists globally, transcending intersecting backgrounds, such as race, gender, socio-economic status, education, and ableness. The reality remains that women across diverse intersections continue to endure various forms of violence. According to a nationwide study, 30 % of women experience intimate partner violence during their lifetime in Mongolia. The present research adopts an intersectional lens to comprehensively address the survival experiences of Mongolian women who had lived through intimate partner violence. In-depth semi-structured interviews were conducted with 21 participants recruited through purposive sampling, most of whom had ended a relationship involving intimate partner violence. Thematic analysis was used to identify patterns and themes among survival experiences. Although women's experiences varied, intimate partner violence confronted them with the dilemma of maintaining or going against traditional values, including family unity when seeking protection (and safety) for themselves and their children. The women's survival experiences included a combination of building a sense of community and rebuilding a sense of self, while self-contentment was achieved when the women ceased to blame themselves. This study highlights a critical shift in mindset and behavior by investigating the survival experiences of women who defy social norms, prioritizing family unity over personal well-being. Recognition of survivors' efforts to cease self-blame and seek support signifies a crucial advancement in the survival process. The findings suggest a positive trend toward self-empowerment and a willingness to access the necessary resources and support systems. From a practical standpoint, these findings advocate for strengthening current interventions that empower survivors to challenge norms, cease self-blame, and actively seek assistance.

Online drug user-led harm reduction in Hungary: a review of "Daath".

Harm reduction has been increasingly finding its way into public drug policies and healthcare practices worldwide, with successful intervention measures justifiably focussing on the highest-risk groups, such as injecting drug users. However, there are also other types of drug users in need for harm reduction, even though they pose less, low, or no public health risk. Occasionally, drug users may autonomously organise themselves into groups to provide advocacy, harm reduction, and peer-help services, sometimes online. The http://www.daath.hu website has been operated since 2001 by the "Hungarian Psychedelic Community", an unorganised drug user group with a special interest in hallucinogenic and related substances. As of today, the website serves about 1200 visitors daily, and the online community comprises of more than 8000 registered members. The Daath community is driven by a strong commitment to the policy of harm reduction in the form of various peer-help activities that aim to expand harm reduction without promoting drug use. Our review comprehensively summarises Daath's user-led harm reduction services and activities from the last ten years, firstly outlining the history and growth phases of Daath, along with its self-set guidelines and policies. Online services (such as a discussion board, and an Ecstasy pill database) and offline activities (such as Ecstasy pill field testing, and a documentary film about psychedelics) are described. In order to extend its harm reduction services and activities in the future, Daath has several social, commercial, and legislative challenges to face. Starting with a need to realign its focus, outlooks for the upcoming operation of Daath are pondered. Future trends in harm reduction, such as separating harm-decreasing from benefit-increasing, are also discussed. We aim to share these innovative harm reduction measures and good practices in order to be critically assessed, and--if found useful--adapted and applied elsewhere.

[Relapse prevention in drug addicts]. / Relapszusprevenció drogfüggoknél: pszichoterápiás és farmakoterápiás lehetoségek.

The literature review deals with methods of relapse prevention. Relapse prevention is the key in the treatment of clients with drug addictions according to the transtheoretical model of change. If relapse prevention is more effective then not only the relapse would be prevented, but the client would leave the circulus vitiosus of relapses. Among psychotherapies cognitive behavioural methods are proven effective. Shorter forms of cognitive therapies are also available: for example, cognitive bias modification. Pharmacotherapy partly decreases craving of the clients or ceases the effects of psychoactive substances. Specific pharmacotherapeutic methods prevent relapses in a non-abstinent treatment design. Here the goal is not the abstinence in a short time, but the reduction of harms associated with drug use. In this way, a new target group of drug users can be involved in treatment.

Posttraumatic growth: Experiences of Mongolian and Hungarian survivors of intimate partner violence.

PURPOSE: The purpose of this study is to compare posttraumatic growth (PTG) of Mongolian and Hungarian survivors of intimate partner violence. METHODS: The study employed semi-structured interviews with fifteen women - ten Mongolian and five Hungarian survivors. Thematic analysis identified patterns and themes regarding survivors' PTG. RESULTS: PTG occurred in all participants, and identified themes were; positive changes, strengthened or new relationships and role models, personal strength, interest in advocacy for social change, and new found appreciation of life. Along with learning new skills and knowledge, a sense of security and caring for children were apparent as positive changes as well. Participants acknowledged interpersonal relationships through communities, including parents, colleagues and friends. Personal strengths, such as being trustworthy and optimistic, also contributed to the PTG with realized independence, increased self-confidence, assertiveness and being brave. Participants identified as individuals striving for social justice and being social change agents by involvement in local non-governmental organizations. Appreciation of life was enhanced or encouraged by supportive parents, community and believing in oneself. CONCLUSION: Similarities between Hungary and Mongolian survivors are more than the differences in posttraumatic growth for survivors of intimate partner violence. Posttraumatic growth includes acquiring new skills, aspiring for the future, interpersonal relationships, perseverance, and being social change agents. A sense of security, a sense of autonomy, independence and self-worth were significant common features found in this study.

Organizational environment of outpatient drug treatment services in Hungary: a pilot study.

OBJECTIVES: Organizations engaged in drug addiction treatment started their activities only recently in Hungary. This paper examines the organisational environment in drug outpatient treatment using the example of Blue Point Foundation (BPF), a non-governmental organization (NGO). The authors describe BPF's organizational structure and functioning related to its effectiveness. METHODS: BPF staff members anonymously completed a 59-item questionnaire about its organizational characteristics and functioning. The questionnaire covered demographic data, 50 items of the Quality Control questionnaire and a SWOT (Strengths, Weakness, Opportunities, Threats) analysis. RESULTS: Policy and strategy were considered BPF's best feature, while the management of funds received the lowest rating. The assessment of the staff and that of the organization as a whole was closer to the midpoint of the scale. DISCUSSION: High risk of staff burnout and unstable organizational environment are the most important threats on the NGOs working in addictology in Hungary.

[Changes in psychosocial symptoms of opiate users over six months with buprenorphine/naloxone substitution therapy]. / Buprenorphin/naloxon szubsztitúció alatt álló ópiátfüggök pszichoszociális tüneteinek változásai hathónapos terápia során.

AIMS: The main target of our research was to measure the changes in psychological symptoms (anxiety, depression, craving) of patients receiving buprenorphine-naloxone substitution treatment for six months, and the evaluation of the changes using the clients' dependency parameters (ASI). METHODS: The level of dependency was investigated using the Addicton Severity Index (ASI). The psychiatric symptoms related to Axis I and II disorders were examined using the Structured Clinical Interview for DSM-IV, SCID I and SCID II. The degree of craving was measured using the Heroin Craving Questionnaire, the assessment of the symptoms of depression using BDI and HAM-D, recorded by the medical attendant of the patient. To survey the extent of anxiety, we used STAI-S, and HAM-A. All patients receiving Suboxone therapy in Hungary between November 2007 and April 2008 were included in the study (n=80). During this time, Suboxone therapy was available in 6 locations. RESULTS: We found significant improvement in almost all observed fields of behavioural and symptomatic dimensions during the first month. The only exception was the dimension of subsistence/livelihood of ASI, the changes were only at the tendency level. During the next five months of therapy, there was no further sign of improvement or decline in the observed fields, the only exception was again the subsistence/livelihood dimension of the ASI. CONCLUSIONS: Our results indicate that buprenorphine/naloxone treatment is a promising possibility for patients in need of opiate-substitution treatment.

[The phenomenon of drug change in the interviews with injecting drug users]. / A drogvaltas jelensege injekcios droghasznalokkal keszult interjukban.

INTRODUCTION: Important part of the studies on drug use deals with drug use transitions because of their public health consequences. Narrating of drug use change states the active decision making in the centre of the process with adding mental states of the participants to the change process. The transitional narratives can be embedded in the social context of "risk environment". METHODS: In the micro-segregation of the Middle-Jozsefvaros (8th district, Budapest) the Blue Point Foundation runs a needle-exchange service in its "Contact Programme". Here the number of registered clients was 2066 in 2010. The study participants were recruited from the clients of this needle-exchange service (from December 2010 to February 2011). The criterion of entering the study sample was injecting mephedrone in the past 30 days. 17 participants were interviewed. The life story interviews had been coded thematically; it had been done until new codes did not carry new meanings. RESULTS: Study participants speak about rapid tolerance and more intensive use of mephedrone after changing their usual drug. This use is more risky because of more frequent injecting. The effect of mephedrone was described like 3,4- Methylenedioxymethamphetamine (MDMA) and cocaine. In the interviews the usual pattern was narrating the positive effects of mephedrone and after this text the narrating of the negative effects. The "risk narrative" and the "enjoyment narrative" were presented separately in the interviews. CONCLUSIONS: Not the expansion of the drug market, but the drug change was observed: earlier drugs to mephedrone or parallel use of mephedrone with earlier drugs (amphetamine and heroin). The purity and availability of heroin and the increase availability of mephedrone may take a role in this process. The absent of drug market expansion was explained by the closeness of the micro-segregation. Results raise attention of the public health consequences of drug change and the proper training of professionals for this change.

Folktales of Recovery - From Addiction to Becoming a Helper: Deep Structures of Life Stories Applying Propp's Theory: A Narrative Analysis.

Addiction research suggests that recovery narratives share common structural elements. For further investigation of this topic, the current study invoked Propp's folktale theory and method to identify narratemes within retrospectives to depict the stages of recovery. Semi-structured interviews were recorded about the experiences of six recovering helpers who had been sober for a minimum of five years and worked as a professional for at least one year. A deductive narrative analysis was carried out. From the 31 Proppian narratemes, 28 were identified and different recovery stories were threaded into a commonly shared narrative strand, where the hero's relationship and struggle with the villain (drug) are depicted in process. Applying Propp's narratemes to analyze recovery stories is a new development that seems applicable according to our results, as it is consistent with fairytale therapy within addiction treatment, which helps the lost wanderer to create structure in their life.

In the pitfall of expectations: An exploratory analysis of stressors in elite rhythmic gymnastics.

The present study explored the types of stressors faced by rhythmic gymnastics athletes, their parents, and coaches. Semi-structured interviews with 12 participants-four gymnasts, five coaches, and three parents-were analyzed using reflexive thematic analysis in a theory-driven framework. The categorizations of sport-related stressors for the parents, coaches, and gymnasts were based on existing theories. The results showed that both the gymnasts and the coaches predominantly noted mastery-avoidance goals in terms of performance, while the interviews with parents mostly indicated performance-avoidance goals. All three groups of participants consistently reported a detrimental atmosphere in rhythmic gymnastics. For instance, they emphasized the stress related to inadequate communication between the concerned parties. Moreover, all parties believed that having a lean body was linked to success in the competitive world of rhythmic gymnastics. The present study provides insight into some of the potential major stressors and the related subjective experiences affecting athletes socializing in the same sporting environment.

Identifying Types of Eco-Anxiety, Eco-Guilt, Eco-Grief, and Eco-Coping in a Climate-Sensitive Population: A Qualitative Study.

BACKGROUND: Climate change is one of the greatest challenges of the 21st century and it can affect mental health either directly through the experience of environmental traumas or indirectly through the experience of emotional distress and anxiety about the future. However, it is not clear what possible subtypes of the emerging "psychoterratic" syndromes such as eco-anxiety, eco-guilt, and eco-grief exist, how much distress they may cause, and to what extent they facilitate ecofriendly behavior. METHODS: We analyzed semi-structured interviews (N = 17) focusing on the thoughts, emotions, and behaviors related to climate change by using a combination of inductive and deductive qualitative methods. RESULTS AND CONCLUSIONS: The interviews revealed six eco-anxiety components, eight types of eco-guilt, and two types of eco-grief that help to understand the multifactorial nature of these phenomena. The six categories of coping strategies are in line with traditional coping models, and they are linked in various ways to pro-environmental behavior and the management of negative emotions. The results can help practitioners to gain a deeper understanding of emotions related to climate change and how to cope with them, and researchers to develop comprehensive measurement tools to assess these emotions.

The recovery of homicidal people diagnosed with schizophrenia and schizoaffective disorder-An interpretative phenomenological analysis.

Objective: Identity recovery in people diagnosed with schizophrenia who have committed homicide poses several difficulties. Premorbid mental illnesses, the experience of psychosis, and the absence of cohesive ego functions may result in the inability to integrate the homicidal act into self-identity. Problems with integration increase the risk of recidivism and further mental problems. The aim of the present research was to explore how homicidal people diagnosed with schizophrenia make sense of their actions, and how they identify with the homicide. Method: Six semi-structured interviews were conducted at a long-term psychiatric home with people who had committed homicide and who had been diagnosed with schizophrenia. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA), an idiographic method rooted in phenomenologist traditions that focuses on how participants experience and make sense of events in their lives, and how those events affect their identity and sense of self. Results: Three personal experiential themes were established as a result of the analysis: (1) homicide and responsibility; (2) homicide and self; and (3) control over threats to self and self-evaluation. (1) Homicide was often reported to have been committed in a non-conscious, delusional state that may have led to the loss of self-determination. (2) Our interviewees struggled to integrate their acts into their identities. They distanced themselves from the crime or held multiple, parallel interpretations of the act. (3) Recovering patients experienced the constant threat of entering into a delusional reality and losing control. The importance of control was central to their self-evaluation. The patients appeared to distance themselves from the homicidal act and to regard their delusional selves as a threat to their lives. Conclusion: Therapy aimed at bolstering self-control, supporting the integration of the fragmented self, and raising awareness of the connections between delusional reality and standard, intersubjective reality may be helpful in reducing the instability of the self. Therapy aimed at processing complex grief and loss of family is also needed.