Seeking help for perinatal depression and anxiety: a systematic review of systematic reviews from an interdependent perspective.

BACKGROUND: Seeking help for perinatal mood and anxiety disorders is crucial for women's mental health and babies' development, yet many women do not seek help for their condition and remain undiagnosed and untreated. This systematic review of systematic reviews aimed at summarizing and synthesizing findings from all systematic reviews on seeking help for PMAD in the context of interdependence theory, highlighting the interdependent relationship between women and healthcare providers and how it may impact women's seeking-help process. METHODS: Four electronic databases were searched, and 18 studies published up to 2023 met inclusion criteria for review. RESULTS: The capability, opportunity and motivation model of behavior was used as a framework for organizing and presenting the results. Results demonstrate that seeking help for PMAD is a function of the interdependent relationship between perinatal women's and healthcare providers' psychological and physical capabilities, social and physical opportunities, and their reflective and automatic motivation. CONCLUSIONS: Unmet needs in perinatal mental healthcare is an important public health problem. This systematic review of systematic reviews highlights key factors for policymakers, researchers, and practitioners to consider to optimize healthcare systems and interventions in a way that enhances perinatal women's treatment whenever necessary.

Parents' experience of a shared parent-child stay during the first week of hospitalization in a child psychiatry inpatient ward.

Hospitalization of children in an inpatient psychiatric ward is stressful for both the children and their parents, and separation from the parents during hospitalization is probably one major cause of this stress. We designated one room in a closed inpatient unit to enable a parent to stay with his/her child, including overnight, during the 1st week of hospitalization. We then examined the parents' experience of the shared parent-child stay. Thirty parents of 16 children aged 6-12 years admitted to our inpatient child psychiatry ward completed in-depth semi-structured interviews after that week's experience. The interviews covered the parents' experiences of the 1st week in the larger context of pre-hospitalization period, which also includes the decision to hospitalize the child. The contents of the interviews were analyzed by means of independent coders that identified the following major themes: (1) ambivalence and confusion of the parents as related to their decision to hospitalize their child in the time period just before admission; (2) gradual process of separation from the child during the joint stay at the ward; (3) building confidence and trust toward the staff. Themes 2 and 3 express benefits from the joint hospitalization that may have a strong positive impact on the child's and the parent's recovery. These themes warrant further evaluation of the proposed shared stay during hospitalization in future studies.

Awareness, Incidence and Psychological Wellbeing of Childhood Sexual Abuse as Reported by Ultra-Orthodox Mothers.

The harm caused by child sexual abuse (CSA) is well-documented, calling for more awareness and efforts at prevention. However, CSA in closed religious societies is still tightly under wraps, and therefore underreported and understudied. We chose to use the mother's point of view, in order get an estimate of the prevalence, the reporting rates and their psychological wellbeing. The current study aims at addressing this in the Jewish ultra-Orthodox community, an insular religious one, which may thus serve as a test case for understanding other closed, religious communities. Three hundred forty-seven ultra-Orthodox Israeli women completed self-report questionnaires and reported on their, or their children's exposure to CSA sexual abuse, about their emotional coping, and about considerations regarding disclosing the abuse. About 24% the participants reported that they were victims of sexual abuse. Only 24.3% of cases were reported to the police or official welfare services, with cultural reasons offered by the women to explain it. Lower psychological wellbeing was found among mothers who themselves or their children were victims of child sexual abuse, compared to controls. Interestingly, mothers who reported having undergone psychological treatment suffered a higher degree of distress than those who had not. These findings contribute to the understanding of the dynamics of sexual abuse exposure and disclosure in the ultraorthodox community, and in close societies and highlight the changes required to improve safeguarding of children.

The experience of divine struggle following child loss: The Case of Israeli bereaved Modern-Orthodox parents.

Child loss may undermine one's faith. Whereas much is known about religion's role following loss, less is known about the experience of divine struggle-namely, struggling with complex God-related emotions/beliefs-particularly among diverse sociocultural samples. Employing a narrative approach, we interviewed 20 bereaved Modern-Orthodox parents. Analysis revealed three types of divine struggle (explicit, implicit/silenced, none) differentiated by four categories: core emotional experience, response type, significance of faith in the coping process, and the impact of grief-induced divine struggle on parent-God relationship. Findings emphasize the need for culturally-sensitive inquiry of divine struggle, that divine struggle may be silenced, and therapists' awareness is critical.

Narrative Reconstruction as an Intervention for Posttraumatic Stress Disorder: A Pilot Delayed Intervention Quasi-Randomized Controlled Trial.

Although empirically supported treatments for posttraumatic stress disorder (PTSD) exist, many patients fail to complete therapy, are nonresponsive, or remain symptomatic following treatment. This paper presents the results of a delayed intervention quasi-randomized controlled study that evaluated the efficacy of narrative reconstruction as an integrative intervention for PTSD. During narrative reconstruction, the patient and therapist reconstruct an organized, coherent, and detailed written narrative of the patient's traumatic experience. Additionally, narrative reconstruction focuses on arriving at the subjective meaning of the traumatic experience for the patient as related to their personal history. Thus, the therapist asks the patient about associations between the traumatic event and other memories and life events. In the present study, 30 participants with PTSD were randomly assigned to an immediate (n = 17) or delayed (n = 13) 15-session narrative reconstruction intervention. Participants in the immediate narrative reconstruction group were evaluated using self-report measures and structured interviews at baseline, posttreatment, and 15-week follow-up. Participants in the delayed narrative reconstruction group were evaluated at baseline, postwaitlist/pretreatment, and posttreatment assessments. Data from the pretreatment evaluation showed no significant differences between groups. Mixed linear models showed significant intervention effects for posttraumatic symptom severity, d = 1.17, from pre- to posttreatment. Although preliminary, these promising findings suggest that narrative reconstruction may be an effective standalone therapy or an add-on to current effective treatment strategies.

Using computerized text analysis to examine associations between linguistic features and clients' distress during psychotherapy.

Raw linguistic data within psychotherapy sessions may provide important information about clients' progress and well-being. In the current study, computerized text analytic techniques were applied to examine whether linguistic features were associated with clients' experiences of distress within and between clients and whether changes in linguistic features were associated with changes in treatment outcome. Transcripts of 729 psychotherapy sessions from 58 clients treated by 52 therapists were analyzed. Prior to each session, clients reported their distress level. Linguistic features were extracted automatically by using natural language parser for first-person singular identification and using positive and negative emotion words lexicon. The association between linguistic features and levels of distress was examined using multilevel models. At the within-client level, fewer first-person singular words, fewer negative emotional words and more positive emotional words were associated with lower distress in the same session; and fewer negative emotion words were associated with lower next session distress (rather small f2 effect sizes = 0.011 < f2 < 0.022). At the between-client level, only first session use of positive emotion words was associated with first session distress (ηp2 effect size = 0.08). A drop in the use of first-person singular words was associated with improved outcome from pre- to posttreatment (small ηp2 effect size = 0.05). The findings provide preliminary support for the association between clients' linguistic features and their fluctuating experience of distress. They point to the potential value of computerized linguistic measures to track therapeutic outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Internalization and Opposition to Stigmatized Social Discourse among Incest Survivors.

Despite the high prevalence of incest, survivors are reluctant to disclose its existence for reasons such as shame, guilt and the presence of an accusatory and stigmatizing social discourse. The current mixed methods study examined the internal discourses of 13 incest survivors in Israel, reflected in self-reported internal dialogs which emerged during interviews. The qualitative analysis revealed a dialectical tension between two themes - one reflecting an internalization of the social discourse (manifested as quotes taken from social discourse and uttered by the survivors) and the other an agentic discourse (manifested in utterances either resisting the social discourse or showing an empowering advertence to one's own fulcrum). The quantitative analysis showed that for seven participants the internalized social discourse expressions were most frequent, for five the agentic expressions were most frequent, and that for one the discourses were at equilibrium. The ubiquitous sub-themes manifested in the internalized social discourse were: victimhood (feelings of vulnerability and helplessness), survivorship (meaningless existence, despair and hopelessness), negative self-esteem and self-pathology (perception of the self as having pathological psychological problems), and denial/repression of the abuse. The ubiquitous sub-themes manifested in the agentic discourse were: positive self-image and sense of potency, hope, optimism and positive perception of life, and uprising against the parents and institutions that did not give support. The discussion is based on Butler's concept of vulnerability, which suggests how to address the harms inflicted by incest without erasing aspects of the survivors' agency and growth.

Connecting Veterans and Their Community Through Narrative: Pilot Data on a Community Strengthening Intervention.

Military personnel transitioning to civilian life commonly report difficulty with establishing friendships, reconnecting with family, and a greater sense that they do not "fit in." Personal narrative interventions have the potential to increase the community's interest and understanding of Veterans' experience. This study examines the impact of a narrative intervention in which Veterans used film or verbal storytelling to describe their experience of being a Veteran to civilian audiences. A total 12 Veterans participated in at least one performance, and 88 community audience members attended one of six performances of the Veterans' narratives. Survey data indicate increase in positive attitudes towards Veterans, as well as a shift in the Veterans' perspective of civilians as receptive and supportive. These preliminary findings suggest that narrative interventions appear to have a positive impact on civilians' interest in Veterans and therefore, may be a valuable community reintegration intervention.

Patterns of Romantic Pathways among 23 Year Olds and their Adolescent Antecedents.

Observation of the romantic lives of the majority of young people shows that they might move between transitory and inconsistent states, being in and out of a relationship. The present study aims to better understand the meaning of these fluctuations. For this purpose, and employing a multi-method design, 144 Israeli adolescents (59.7% females) were followed from age 16 to 23. At age 23 in-depth interviews were conducted with the participants, focusing on their romantic histories. Analyses of interviews at age 23 yielded four distinctive romantic pathways differing in stability and the ability to progress toward intimacy: Sporadic and Casual Encounters, Sporadic Encounters in Response to a Stressful Romantic Experience, Steady Non-Intimate Involvements, and Progression toward Steady Intimate Involvements. The findings showed that more than half of participants belonged to the Progression toward Steady Intimate Involvements pathway, suggesting that romantic fluctuations served as means to progress toward intimate involvements. Progression toward steady intimate involvement was explained by greater secure attachment, greater capacity to face tension and to express one's views, and greater parental support measured seven years earlier. In contrast, lower earlier intra- and interpersonal assets during adolescence were more likely to associate with a variety of romantic experiences during emerging adulthood that are characterized by romantic instabilities and difficulty to progress toward intimacy. The findings are discussed within the framework of the Developmental Systems Theory.

Multiplicity and mutuality in the transition of patient and therapist's self-states: Comparison of good vs. poor outcome groups.

Objective: According to the Assimilation Model, the self is consisted of multiple internal voices which are sometimes conflicted, or even dissociated, from one another. Thus, a key therapeutic goal is to create awareness and dialogue between a patient's various internal voices, in order to facilitate positive change. A recent development of this theoretical line suggests that clinically addressing both the patients' and therapists' internal voices, and their mutual influences, contributes significantly to the treatment outcome. Current study aims to examine: (a) Patients' progression throughout treatment in their quality of movement of self-states, from lower levels of dissociation to higher ones of dialectics, and whether this pattern is associated with positive outcomes; (b) temporal congruence in patient-therapist quality of movement of self-states and its association with session outcome. Method: Nine good and nine poor-outcome cases of psychodynamic treatment were analyzed (N = 18) for both the patient and the therapist using the TPA, an expansion of the assimilation of problematic experiences scale (APES). Patients completed the Outcome Rating Scale (i.e., ORS), a session-by-session measure that assesses overall functioning, and symptomatic pre-and-post treatment measures (BDI). Results: A quadratic pattern of change was observed on the TPA of patients from the good-outcome cases: Patients showed more conflict in the beginning, avoidance between self-states in the middle phase, and dialectics towards the end. Additionally, the patient-therapist TPA temporal congruence was significantly related to session outcome of the good-outcome group. Conclusion: These findings emphasize the importance of combining an intra-psychic and inter-psychic set of lenses when inquiring therapeutic processes.

The Mediating Role of Integration of Loss in the Relationship Between Dissociation and Prolonged Grief Disorder.

OBJECTIVE: Findings from the field of trauma have shown that there is a negative relationship between dissociation and integration of loss into the self-narrative. At the same time, an increasing amount of literature on grief has stressed the importance of an integrated self-narrative in the grieving process. Accordingly, the current study examined the possible mediating role played by the extent to which individuals have integrated their loss into their self-narrative in the relationship between dissociation and symptoms of prolonged grief disorder (PGD). METHOD: The Prolonged Grief Disorder Scale (PGD-13), the Outcome Questionnaire, the Integration of Stressful Life Experiences Scale, the Dissociative Experiences Scale, and a sociodemographic questionnaire were administered to 66 individuals who had lost a loved one. RESULTS: The hypothesized mediation model of integration was confirmed. CONCLUSION: The effect of people's dissociative tendencies on their PGD symptoms seems to occur via the impairment of their ability to integrate the memory of their loss into their general autobiographical memory. Empirical and clinical implications are discussed.

The need for friendships and information: Dimensions of social support and posttraumatic growth among women with breast cancer.

OBJECTIVE: Employing a cross-sectional design, the current study examined the relationships between various agents and types of support and posttraumatic growth (PTG) among women with breast cancer. METHOD: Eighty married women who were coping with breast cancer completed social support and PTG questionnaires. RESULTS: All agents of social support (family, friends, belief-based), excluding spousal support, and all types of social support were found to be related to the various PTG dimensions and its total score. Regression analyses revealed that, among the agents of support, only support provided from friends and belief-based support uniquely contribute to prediction of total PTG score. While examining the contribution of various types of support, only cognitive support had a unique contribution to prediction of total PTG score. SIGNIFICANCE OF RESULTS: Various agents and types of support play different roles in the PTG process following breast cancer. Accordingly, friends as an agent of support and information as a type of support seem to be most important in enhancing PTG among women with breast cancer.

Parents of adolescents with psychiatric disorders: insight into the disorder, self-stigma and parental stress.

BACKGROUND: Parents of adolescents with mental disorders experience stress partially due to the way they perceive and experience their offspring's disorder. The current study assessed the mediator role of self-stigma in the relationship between insight into the disorder and parental stress of parents of adolescents with mental disorders. METHOD: A total of 37 parents of adolescents with psychiatric disorders were assessed for their level of insight, self-stigma and parental stress. RESULTS: The hypothesized mediation model was confirmed and is consistent with previous study on parents of adults with severe mental illness. DISCUSSION: The positive association between insight and parental stress is mediated by these parents' self-stigma, suggesting that insight increases the self-stigma, which in turn increases the parental stress. These results may have clinical implications with regard to the treatment of the family of adolescents with mental disorders.

Why do women with cardiac symptoms delay seeking medical help? Insights from a qualitative study among Jewish Israeli women.

BACKGROUND: The delay time from onset of symptoms of a myocardial infarction to seeking medical assistance can have life-threatening consequences. Women delay significantly more often than men do in calling for medical help, once symptoms of a myocardial infarction occur. OBJECTIVES: The current qualitative study's main aim was to explore psychosocial factors that contribute to Israeli women's delaying calls for medical assistance and, by contrast, the motivational factors that encourage them to do so. DESIGN: A qualitative study. METHOD: In total, 12 women were interviewed shortly after experiencing a myocardial infarction. Qualitative data were subjected to thematic analysis. RESULTS: Two major themes emerged describing barriers to seeking help: (1) the use of denial as a defense mechanism and (2) the need for control. The motivational factor which enhanced help-seeking was "fear of death." CONCLUSION: These findings may help in designing gender-sensitive interventions with the aim of minimizing the symptom onset to call time and thus preventing irreversible and life-threatening health damage.

Broadening the evidentiary basis for clinical practice guidelines: Recommendations from qualitative psychotherapy researchers.

To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research designs. This said, there has been growing interest in incorporating qualitative research in guideline development processes from both stakeholders and guideline development bodies. In this international collaboration, 19 qualitative psychotherapy researchers from 10 countries articulated the benefits of including qualitative findings within the guideline development process and generated recommendations for guideline developers. The underlying question of this report was "Why and how should qualitative research be used in efforts to develop guidance for psychotherapy practice?" The advantages of reviewing qualitative findings included the ability to identify treatment patterns at the level of in-session dynamics, cultural contexts, interpersonal relationships, and internal experiences, thereby creating guidance that is responsive to clients' needs in the moment-to-moment therapy process. Recommendations are offered at the systemic level (e.g., guideline formation processes, methods of education, research funding priorities). Also, methodological advice is offered for guideline developers when selecting to incorporate qualitative research in the implementation of an expanded guideline development process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negotiating maternal identity: mothers with eating disorders discuss their coping.

This qualitative study used a focus group methodology to examine how mothers with ED perceive the impact their eating disorder has on their children and their relationships with them, as well as how their illness is impacted by motherhood. Through 10 session group meetings with 13 mothers, several themes emerged: (a) concerns about not being a "good enough" mother; (b) the child's involvement in his/her mother's eating disorder; and (c) strategies mothers employed to manage these challenges. Participants' discussions illustrated how motherhood could positively affect one's illness by acting as a normalizing experience and inspiring motivation to recover. Being aware of the distinct challenges and possible benefits of ED motherhood can help guide treatment plans that consider one's illness and parenting role.

Good Health Practices and Well-Being among Adolescents with Type-1 Diabetes: A Cross-Sectional Study Examining the Role of Satisfaction and Frustration of Basic Psychological Needs.

Type 1 diabetes (T1D) is a chronic disease requiring medical adherence. However, among adolescents, non-adherence rates may reach up to 75%. Satisfaction or frustration with psychological needs is a crucial factor in the motivation and management of health-related behaviors. This study aimed to examine the differences in good health practices and psychological and physical well-being among adolescents with and without T1D and the mediating role of satisfaction and frustration of psychological needs on the association between good health practices and well-being in this population. A total of 94 adolescents (42 with T1D, 52 healthy controls, mean age 14.83 ± 1.82 years) completed questionnaires assessing good health practices, satisfaction or frustration of psychological needs, and well-being. Adolescents with T1D reported lower levels of physical well-being compared to healthy controls. Satisfaction or frustration of psychological needs had an effect on good health practices and psychological and physical well-being among healthy controls. Among adolescents with T1D, satisfaction or frustration of psychological needs was related to psychological well-being and partially related to physical well-being, but not to good health practices. The results demonstrate that the satisfaction or frustration of psychological needs has a unique effect on health behaviors and well-being among adolescents with T1D. This calls for further examination of the underlying mechanisms involved in health-related behaviors and well-being among adolescents with T1D.

Pilot outcomes of a filmmaking intervention designed to enhance treatment entry and social reintegration of veterans.

Military personnel transitioning to civilian life have reported significant challenges in reintegrating into civilian culture. Filmmaking has been used as a therapeutic intervention to enhance the community reintegration of veterans, but there are no published quantitative data documenting its impact. The present study provides outcome data on 40 veterans who participated in the I Was There (IWT) filmmaking workshop. This 3-day (20-hr) group intervention involved veterans working in small teams with a film coach, making short films designed to communicate some aspect of their experience during or after military service, and then creating a screening event to show their films to community members. The sample consisted of community-dwelling veterans who reported at least some mental health symptoms and who were not engaged in mental health treatment for those symptoms. Targeted outcomes included engagement in mental health care, symptoms of posttraumatic stress disorder (PTSD) and depression, and reported perception of community interest in their experience as veterans. Fifty-six percent of participants entered treatment within 4 months of participation. Significant decreases were noted in symptoms of PTSD at 1-month follow-up but not at the 4-month follow-up, while changes in depression were not statistically significant. Participation was related to increased perception of community interest in veterans' experience, and increased interest among community members who viewed the films. These data provide initial support for the conclusion that the IWT film workshop is a potentially effective tool for treatment engagement and for community reintegration among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

One uncertainty added on top of another: Challenges and resources of mothers of preterm infants during the COVID-19 pandemic.

Aims and objectives: To qualitatively explore COVID-19-related experiences of mothers of preterm infants in the Neonatal Intensive Care Unit (NICU), the main challenges they face, and the resources available for them. Background: The birth of a preterm infant is a stressful event under otherwise normal circumstances. The outbreak of COVID-19, the uncertainty about the virus and how it spreads, and the restrictions imposed, may have exacerbated the stress of caring for a preterm infant. Design: Retrospective interviews. Methods: In-depth interviews with 12 mothers of preterm infants who were hospitalized in the NICU at the time of study. The interview addressed challenges and resources related to coping with the pandemic. The interviews were transcribed and content analyzed, based on Lieblich et al's model for narrative analysis. This research was conducted in accordance with the COREQ checklist. Results: The overarching experience shared by all mothers was accumulative stress caused by a combination of factors related to the infant's health and COVID-19-related stressors. A central theme was the dissonance between the mothers' expectations from the birth and infant, and the reality they encountered. Other themes included fear of infecting the infant, loneliness, and stress caused by the restrictions that disrupted daily routines. Resources included a sense of shared fate regarding the pandemic, improvements in the infant's condition, religious faith, emotional support from the partner, and support from professional staff. Conclusion: Caring for a preterm infant during a pandemic is a challenging experience on many levels. The loss of significant support resources puts mothers of these infants at a higher risk for psychological distress. Relevance to clinical practice: Awareness of mothers' accumulative stress due to the COVID-19 pandemic may assist the staff in developing procedures that can alleviate parental stress, for example by enabling mothers to connect to each other, giving clear information to compensate for physical and social distancing and providing professional mental health support.

Using topic models to identify clients' functioning levels and alliance ruptures in psychotherapy.

Computerized natural language processing techniques can analyze psychotherapy sessions as texts, thus generating information about the therapy process and outcome and supporting the scaling-up of psychotherapy research. We used topic modeling to identify topics discussed in psychotherapy sessions and explored (a) which topics best identified clients' functioning and alliance ruptures and (b) whether changes in these topics were associated with changes in outcome. Transcripts of 873 sessions from 58 clients treated by 52 therapists were analyzed. Before each session, clients self-reported functioning and symptom level. After each session, therapists reported the extent of alliance rupture. Latent Dirichlet allocation was used to extract latent topics from psychotherapy textual data. Then a sparse multinomial logistic regression model was used to predict which topics best identified clients' functioning levels and the occurrence of alliance ruptures in psychotherapy sessions. Finally, we used multilevel growth models to explore the associations between changes in topics and changes in outcome. Session-based processing yielded a list of semantic topics. The model identified the labels above chance (65% to 75% accuracy). Change trajectories in topics were associated with change trajectories in outcome. The results suggest that topic models can exploit rich linguistic data within sessions to identify psychotherapy process and outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).