Vitality training-A mindfulness- and acceptance-based intervention for chronic pain.

Chronic non-malign pain has a substantial impact on all parts of an individual's life. Mindfulness- and acceptance- based interventions are increasingly offered to help people manage their pain and strengthening their health promoting resources. In this paper, we present a mindfulness- and acceptance-based intervention, the Vitality Training Programme (VTP), to mitigating pain and accompanying symptoms and increasing pain coping abilities. Based on a clinical case presentation, we discuss how the VTP can help individuals to live a better life with pain. The VTP has been evaluated in two randomised controlled trials and two qualitative studies. Existing evidence is presented. Finally, based on a recently published theoretical model, we present some possible common explanatory mechanisms across various mindfulness- and acceptance-based interventions that might also apply to the VTP.

Processes of enhanced self-understanding during a counselling programme for parents of children with disabilities.

BACKGROUND: The stress and burden on parents of children with disabilities are well documented, and the parents' way of handling the situation is crucial to the health and well-being of all family members, including the child with special needs. We conducted a group-based counselling programme for parents, based mainly on Gestalt education and personal construct theories, aiming at increasing the parents' ability to handle the situation. AIMS: To explore the parents' experiences from processes of change after the counselling programme. METHOD DESIGN: This qualitative study is based on modified grounded theory. METHOD: The study conducted in Norway examines the experiences of 67 parents (of whom 29 fathers) of children with disabilities. Information was collected through focus group discussions after finishing their sessions of the counselling programme. FINDINGS: From the parents' experiences, the following categories were developed: feeling motivated to communicate, describing oneself in new words, being inspired to experience one's own emotions, being more present and in charge and making a difference by taking new steps. The core category in our analysis turned out to be Improved handling of the situation by enhanced self-understanding. The parents seemed to redevelop their self-understanding through new experiences of themselves. They emphasized the importance of a secure setting of peers with similar experiences and skilled counsellors to feel free to explore one's own emotions with connecting thoughts and bodily reactions. Discussion of existential issues as one's own values also contributed to enhanced self-understanding, which strengthened the parents to find new possibilities and priorities in handling the situation. CONCLUSIONS: The parents described subjective processes of awareness and self-reflection as important for being able to start a process towards enhanced self-understanding, which helped to detect one's own values and new ways of acting. These experiences may be relevant for the parents and for the conduction of future counselling.

Increased self-awareness in the process of returning to work.

BACKGROUND: A group of employees on sick leave, living in the Oslo area, Norway, was offered participation in a counselling programme, based on Gestalt theory, mindfulness and phenomenological understanding of the body. AIMS: To explore the participants' processes of change related to their increased ability to work. METHOD DESIGN: This qualitative study is based on modified grounded theory. METHOD: A total of 12 female employees, all who had increased work ability 1 year after the programme, participated in open focus-group interviews at the end of the programme. FINDINGS: The participants' experiences from processes of change are described through the following categories: becoming more aware of one's own thoughts, emotions and bodily reactions; taking oneself seriously and accepting oneself; being secure enough to face being challenged; realizing new possibilities and choices and trying out new ways of acting. The participants further described what had been helpful in these processes. Experience of a secure setting and open-minded listening seemed important for getting the courage to open up to all reactions. Then, they could explore new ways of thinking, communicating and behaving. Discussing existential issues such as their core values was important. This, together with being allowed to take their own emotions seriously and being challenged by the counsellors, had encouraged the processes of change. CONCLUSIONS: The women described how experiences of increased awareness contributed to reconstruction of their self-understanding and opened up for new possibilities. This seemed to have provided them with new ways of communicating and acting, which enhanced participation in work. The context of the learning programme, the existential issues and counselling challenges appeared as essential in these processes of change. The findings give insights into aspects that may be important when designing rehabilitation programmes.

What facilitates return to work? Patients' experiences 3 years after occupational rehabilitation.

OBJECTIVE: We have limited knowledge about the specific elements in an occupational rehabilitation programme that facilitate the process leading to return to work (RTW) as perceived by the patients. The aim of the study was to explore individual experiences regarding contributing factors to a successful RTW, 3 years after a resident occupational rehabilitation programme. METHODS: The study is based on interviews of 20 individuals who attended an occupational rehabilitation programme 3 years earlier. Ten informants had returned to work (RTW) and ten were receiving disability pension (DP). Data were analysed by systematic text condensation inspired by Giorgi's phenomenological analysis. RESULTS: The core categories describing a successful RTW process included positive encounters, increased self-understanding and support from the surroundings. While the informants on DP emphasized being seen, heard and taken seriously by the professionals, the RTW group highlighted being challenged to increase self-understanding that promoted new acting in every-day life. Being challenged on self-understanding implied increased awareness of own identity, values and resources. Support from the surroundings included support from peer participants, employer and social welfare system. CONCLUSION: Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others. An explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process.

[Could persons on sick leave learn to think differently about themselves and increase their participation in the workplace?]. / Kan sykmeldte endre selvforståelse slik at arbeidsevnen øker?

BACKGROUND: The aim of this study was to evaluate an empowerment programme for improved quality of life and ability to work. At two places of work, a total of 112 employees with frequent sick-leaves over the last six months were invited to participate; 19 women attended. After the intervention the participants reported better coping and quality of life, and they worked more hours per week than previously. In their opinion, the improvement was due to the intervention. This paper relates their experiences and gives an account of their work participation one year later. MATERIAL AND METHODS: Questionnaires by the start of and soon after the intervention, telephone interviews and focus group interviews. RESULTS: Only minor differences were found after one year compared to just after the intervention. Nearly all the participants expressed more self-esteem and worked more hours per week. They particularly emphasised their new work consciousness and the benefit from the counselling received. INTERPRETATION: The results in this small group indicate that after one year the participants had kept most of the self-reconstruction of life that seemed to be achieved during the intervention.

How do patients with rheumatic disease experience their relationship with their doctors? A qualitative study of experiences of stress and support in the doctor-patient relationship.

This study is evaluated what patients with rheumatic disease perceive as important in their medical encounters. We interviewed two groups of patients: one with a well-defined inflammatory condition (rheumatoid arthritis (RA) or ankylosing spondylitis) (n = 12) and one with non-inflammatory widespread chronic pain such as fibromyalgia (n = 14). Both groups focused on their relationship to their doctor. Two central themes emerged as of importance: 'to be seen' and 'to be believed'. However, these themes had different connotations for the two groups. For the patients with inflammatory conditions, 'to be seen' implied being seen as an individual and not as a mere diagnosis, and 'to be believed' as far as pain and suffering were concerned. For patients with non-inflammatory chronic pain 'to be seen' and 'to be believed' primarily implied being able to obtain a useful somatic diagnosis. Practical implications of these findings are discussed.

[Physician-patient relations in functional disorders]. / Lege-pasient-forholdet ved funksjonelle lidelser.

The doctor-patient relationship is often problematic in relation to "functional disorders". A strictly biomedical understanding fails in two ways: first, because it does not incorporate psychosocial factors; second, because it does not take into account the body as a subject and carrier of meaning. A more integrated model would include a general understanding of the aetiology and presentation of symptoms (bio-psychosocial) as well as of symptoms and body as carrier of meaning (phenomenology). This way the patient's subjective experience, gender, social and cultural situation become medically valid information on par with biological parameters. This article describes how a bio-psychosocial and phenomenological understanding of symptoms can change the communication between physician and patient. We present some approaches that the physician may use when meeting patients with "functional disorders".