Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial
ABSTRACT: We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.
Long-term effects of the Entre-os-Rios tragedy on grief and traumatic stress symptoms
ABSTRACT: In 2001, in Entre-os-Rios, Portugal, a bridge fell on Douro River; all 59 passengers from 1 bus and 3 cars died and 36 bodies have never been recovered. The objective is to reveal the cumulative risk from multiple losses and unrecovered bodies, 10 years after, compared with grievers from road accidents. There are 2 groups of relatives of victims: from this tragedy (n = 20), with at least 1 unrecovered body; and from road traffic accidents (n = 20), with the same time after loss. The prevalence of prolonged grief was 95% and for traumatic stress was 70%. The associated factors of multiple losses and unrecovered bodies increase the long-term risk (relative risk = 1.6 to 2.8; R2 = .20 to .28) for prolonged and traumatic grief, providing evidence that the absence of body is an important long-term factor.
Emotion Regulation in Patients with Psoriasis: Correlates of Disability, Clinical Dimensions, and Psychopathology Symptoms
ABSTRACT: PURPOSE: There are known connections between emotions and psoriasis; however, we have not established a clear pathway for this association. This study aimed to explore correlates of difficulties in emotional regulation in patients with psoriasis and predict the influence of emotional regulation in psoriasis disability. METHOD: Two hundred and twenty eight participants completed the Difficulties in Emotion Regulation Scale, Self-administered Psoriasis Area and Severity Index, Psoriasis Disability Index, and Brief Symptom Inventory. Spearman's correlation and a hierarchical stepwise multiple regression were carried out to analyse associations. RESULTS: Results indicated that patients with the most recent diagnoses experienced greater difficulty in acting in accordance with goals (r = .16, p < .05) but lesser difficulty in engaging in goal-directed behaviour (r = -.15, p < .05). Those with greater satisfaction with treatment exhibited fewer difficulties in emotional regulation (r = -.23, p < .01). The patients who experienced greater difficulty in emotional regulation perceived greater psoriasis severity (r = .15, p < .05) and disability (r = .36, p < .05), reported more psychopathological symptoms (correlations between .46 and .56), and missed work/school more frequently (r = .24, p < .05). Impulse control proved to be the strongest predictor to psoriasis disability (β = .34). CONCLUSION: The results highlighted the relationship between emotional regulation difficulty, disease characteristics, and psychological variables in psoriasis disability emphasizing the importance of including a broader approach in clinical management of psoriatic patients.
Randomized Controlled Trial of a Cognitive Narrative Crisis Intervention for Bereavement in Primary Healthcare
ABSTRACT: Background and Aims: As there are known risks of retraumatization through bereavement crisis interventions, we tailored a new intervention lowering the degree of direct emotional activation. However, we need some evidence on the effects of depression and psychotraumatic symptoms between 1 and 6 months after a loss. Method: We conducted a randomized controlled trial with two groups: control group (n = 18) and experimental group (n = 11) in two assessments (1 and 6 months after loss); both included a semi-structured interview (Socio-Demographic Questionnaire, Beck Depression Inventory and the Impact of Events Scale-Revised–IES-R). The experimental group had a cognitive-narrative program with four sessions: recalling; cognitive and emotional subjectivization; metaphorization; and projecting sessions. Results: Participants in the experimental and control groups have lower levels of depression and traumatic stress 6 months after a loss. Statistically significant results in emotional numbing IES-R sub-scale are observed. Conclusions: A brief narrative-based cost-effective intervention has a positive effect on depression, controlling the traumatic stress and time after a loss.
Divergent and Convergent Validation of the Complicated Grief Prototype Narrative
ABSTRACT: Although there is a prototype narrative for complicated grief (CG), there are neither divergent nor convergent validity studies of its clinical value. We evaluated the CG prototype narrative using a sociodemographic questionnaire and the Clinical Interview for Complicated Grief Diagnosis. We first conducted a convergent validation analysis followed by a divergent validation analysis. Results showed that participants with CG identified significantly more with the complicated grief prototype narrative than participants without CG.
Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals
ABSTRACT: Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants’ stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women’s and 1245 health professionals’ questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women’s and health professionals’ preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.
Preferences for prenatal tests for Down syndrome: Comparing women and health professionals from nine countries
DOI: 10.1002/pd.4424 (proceeding)
Randomized Controlled Trial of a Cognitive Narrative Intervention for Complicated Grief in Widowhood
ABSTRACT: Objective: The implementation of bereavement interventions is frequently requested, and its effectiveness has been controversial. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief (CG) for controlling post-traumatic and depressive issues. Method: The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ), the Inventory of Complicated Grief (ICG), the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). There were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n = 82). The bereaved elders with the 40 highest ICG values (≥25) were randomly allocated into two groups: the intervention group (n = 20) and control group (n = 20); (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to participate in an intervention with four weekly 60-min sessions addressing recall, emotional and cognitive subjectivation, metaphorisation and projecting. (3) Two months later, the ICG, BDI and IES-R assessments were repeated. Results: Outcome measures showed a statistically significant reduction of CG, depressive and traumatic symptoms compared to the controls. Very high effect sizes for the ICG, BDI and IES-R reflect the effectiveness of the intervention along the longitudinal profile. Conclusions: These results reinforce the importance of brief interventions that combine a reduced number of sessions with lower costs, which is reflected in an increased adherence to the programme along with high effectiveness.
Predictive testing for two neurodegenerative disorders (FAP and HD): a psychological point of view
ABSTRACT: In this retrospective study, we have researched the psychological impact of pre-symptomatic testing (PST) for 2 autosomal dominant late-onset diseases: Huntington disease (HD and familial amyloidotic polyneuropathy (FAP) V30M TTR. The study included 53 subjects: 40 (75.5%) were the offspring at risk for FAP and 13 (24.5%) for HD. Of these, 38 (73.1%) received the carrier result and 12 (23.1%) the non-carrier result; 3 of them did not want to know the result. The indicators taken for emotional distress were the subscales and global indexes of psychopathological Behavior Symptoms Inventory (BSI), applied in the pre-test and post-test, one-year after notification of results. Values decreased significantly one year after the implementation of the PST, regardless of the studied disease or test result; this seems to corroborate previous studies showing that testing does not increase pre-symptomatic levels of emotional disturbance in individuals. However, the subjects studied showed, for all subscales and global indexes of the BSI, significantly higher values than those of control groups.
XII ESTSS Conference: "Trauma and its Clinical Pathways: PTSD and Beyond", Bologna, June 2013: Oral Presentations and Posters
The Moderating Effects of Previous Losses and Emotional Clarity on Bereavement Outcome
ABSTRACT: The connections between complicated grief and traumatic stress have previously been investigated; however, the learning effects resulting from previous losses and emotional clarity are still unclear. Understanding these effects may shed more light on the general hypotheses of emotional aging. We aimed to assess the moderating effects of emotional clarity and previous losses on bereavement outcomes. This study evaluated 190 participants with a sociodemographic questionnaire, the Inventory of Complicated Grief, the Impact of Event Scale–Revised, and the Difficulties in Emotion Regulation Scale. The results confirm that previous losses change the relationship between complicated grief and trauma and that emotional clarity changes the association between previous losses and complicated grief.
- José Rocha (2016) Síntese de resultados de quatro ensaios clínicos de intervenções curtas no luto. 3º Congresso da Ordem dos Psicólogos Portugueses
- Verónica Rodrigues e José Rocha (2016) Adaptação e validação de um instrumento de avaliação do Luto Funcional, 3º Congresso da Ordem dos Psicólogos Portugueses
- Ana Teixeira e José Rocha (2016) Validade Convergente das Escalas de Impacto de Eventos - Revista e da Escala de Impacto de Eventos 6. 3º Congresso da Ordem dos Psicólogos Portugueses
- Virgiana Sousa e José Rocha (2016) Ponto de corte e características psicométricas do Inventário de Luto Complicado. 3º Congresso da Ordem dos Psicólogos Portugueses
- Verónica Rodrigues, Inês Azevedo e José Rocha (2016) Avaliação do Stress Traumático Complexo.3º Congresso da Ordem dos Psicólogos Portugueses