Pain Management: A Flowsheet for Providers

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of pain medications and patients to treat pain adequately

Embodying the therapeutic alliance : an exploration of the working alliance in the personal trainer-client relationship

This quasi-experimental study examines, from the standpoint of the personal trainer, the extent to which the working alliance and its component parts of goal, task and bond as defined within Bordin\u27s (1975, 1979) theoretical framework, are experienced in the working relationship between personal trainer and client. Additionally, the study explores whether a personal trainer\u27s or a client\u27s ethnicity or gender, a trainer\u27s age or training history, the frequency of the personal training sessions, or the length of the training relationship impact the working alliance total or its subscale scores. An anonymous online survey was distributed by email to several hundred personal trainers. The survey included demographic information about the personal trainer, questions about the personal training client and length and frequency of the training relationship, and the Working Alliance Inventory - Short Revised Therapist-rated version (WAI-SRT-G). After data collection was complete, the sample consisted of 94 nationally-certified personal trainers, aged 21 years or older, who trained at least 50% of their clients in a gym setting. The major findings of the study were 1.) The mean total alliance and subscale scores reflected the presence of a strong working alliance. 2.) The bond subscales scores had the highest mean. 3.) When total alliance and subscale scores were compared by gender or ethnicity of personal trainer or client, no significant differences were found. 4.) Significant differences in total alliance and in certain subscales were found across the number of weekly training sessions and the personal trainers\u27 years of experienc

Hyponarrativity and Context-Specific Limitations of the DSM-5

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of these disorders in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment

Cannabis and schizophrenia

BACKGROUND Schizophrenia is a mental illness causing disordered beliefs, ideas and sensations. Many people with schizophrenia smoke cannabis, and it is unclear why a large proportion do so and if the effects are harmful or beneficial. It is also unclear what the best method is to allow people with schizophrenia to alter their cannabis intake. OBJECTIVES To assess the effects of specific psychological treatments for cannabis reduction in people with schizophrenia.To assess the effects of antipsychotics for cannabis reduction in people with schizophrenia.To assess the effects of cannabinoids (cannabis related chemical compounds derived from cannabis or manufactured) for symptom reduction in people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register, 12 August 2013, which is based on regular searches of BIOSIS, CINAHL, EMBASE, MEDLINE, PUBMED and PsycINFO.We searched all references of articles selected for inclusion for further relevant trials. We contacted the first author of included studies for unpublished trials or data. SELECTION CRITERIA We included all randomised controlled trials involving cannabinoids and schizophrenia/schizophrenia-like illnesses, which assessed:1) treatments to reduce cannabis use in people with schizophrenia;2) the effects of cannabinoids on people with schizophrenia. DATA COLLECTION AND ANALYSIS We independently inspected citations, selected papers and then re-inspected the studies if there were discrepancies, and extracted data. For dichotomous data we calculated risk ratios (RR) and for continuous data, we calculated mean differences (MD), both with 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed-effect model. We excluded data if loss to follow-up was greater than 50%. We assessed risk of bias for included studies and used GRADE to rate the quality of the evidence. MAIN RESULTS We identified eight randomised trials, involving 530 participants, which met our selection criteria.For the cannabis reduction studies no one treatment showed superiority for reduction in cannabis use. Overall, data were poorly reported for many outcomes of interest. Our main outcomes of interest were medium-term data for cannabis use, global state, mental state, global functioning, adverse events, leaving the study early and satisfaction with treatment. 1. Reduction in cannabis use: adjunct psychological therapies (specifically about cannabis and psychosis) versus treatment as usualResults from one small study showed people receiving adjunct psychological therapies specifically about cannabis and psychosis were no more likely to reduce their intake than those receiving treatment as usual (n = 54, 1 RCT, MD -0.10, 95% CI -2.44 to 2.24, moderate quality evidence). Results for other main outcomes at medium term were also equivocal. No difference in mental state measured on the PANSS positive were observed between groups (n = 62, 1 RCT, MD -0.30 95% CI -2.55 to 1.95, moderate quality evidence). Nor for the outcome of general functioning measured using the World Health Organization Quality of Life BREF (n = 49, 1 RCT, MD 0.90 95% CI -1.15 to 2.95, moderate quality evidence). No data were reported for the other main outcomes of interest 2. Reduction in cannabis use: adjunct psychological therapy (specifically about cannabis and psychosis) versus adjunct non-specific psychoeducation One study compared specific psychological therapy aimed at cannabis reduction with general psychological therapy. At three-month follow-up, the use of cannabis in the previous four weeks was similar between treatment groups (n = 47, 1 RCT, RR 1.04 95% CI 0.62 to 1.74, moderate quality evidence). Again, at a medium-term follow-up, the average mental state scores from the Brief Pscychiatric Rating Scale-Expanded were similar between groups (n = 47, 1 RCT, MD 3.60 95% CI - 5.61 to 12.81, moderate quality evidence). No data were reported for the other main outcomes of interest: global state, general functioning, adverse events, leaving the study early and satisfaction with treatment. 3. Reduction in cannabis use: antipsychotic versus antipsychotic In a small trial comparing effectiveness of olanzapine versus risperidone for cannabis reduction, there was no difference between groups at medium-term follow-up (n = 16, 1 RCT, RR 1.80 95% CI 0.52 to 6.22, moderate quality evidence). The number of participants leaving the study early at medium term was also similar (n = 28, 1 RCT, RR 0.50 95% CI 0.19 to 1.29, moderate quality evidence). Mental state data were reported, however they were reported within the short term and no difference was observed. No data were reported for global state, general functioning, and satisfaction with treatment.With regards to adverse effects data, no study reported medium-term data. Short-term data were presented but overall, no real differences between treatment groups were observed for adverse effects. 4. Cannabinoid as treatment: cannabidiol versus amisulprideAgain, no data were reported for any of the main outcomes of interest at medium term. There were short-term data reported for mental state using the BPRS and PANSS, no overall differences in mental state were observed between treatment groups. AUTHORS' CONCLUSIONS Results are limited and inconclusive due to the small number and size of randomised controlled trials available and quality of data reporting within these trials. More research is needed to a) explore the effects of adjunct psychological therapy that is specifically about cannabis and psychosis as currently there is no evidence for any novel intervention being better than standard treatment,for those that use cannabis and have schizophrenia b) decide the most effective drug treatment in treating those that use cannabis and have schizophrenia, and c) assess the effectiveness of cannabidiol in treating schizophrenia. Currently evidence is insufficient to show cannabidiol has an antipsychotic effect

The Body Recovers: Practitioner Perspective on Somatic Experiencing

Most individuals are exposed to a traumatic event in their lifetime, but not all go on to develop post-traumatic stress disorder (PTSD). PTSD is characterized by symptoms of intrusion and avoidance of stimuli related to the traumatic event, as well as dissociation. PTSD has been linked to a number of somatic syndromes including chronic fatigue syndrome (CFS), chronic lower back pain, hypertension, and hypothalamic-pituitary adrenal (HPA) axis dysfunction resulting in hormonal imbalance. Several evidence-based interventions for PTSD exist, including prolonged exposure therapy (PE), eye-movement desensitization and reprocessing (EMDR), and cognitive processing therapy (CPT), however many of these approaches address trauma using components of exposure or are not well-researched in addressing somatic symptoms related to trauma. Somatic Experiencing (SE) is an emerging intervention conceptually framed by the “bottom-up” processing theory. SE has been demonstrated to improve PTSD symptoms in early intervention studies across a variety of contexts and diverse populations, however research on SE is limited and the literature on SE is concentrated primarily in the theoretical realm. No prior studies have explored practitioner’s perspectives on how SE benefits trauma survivors and which clients are best suited for SE. This study explores this question through qualitative interviews with three practitioners in a Midwestern metro area. A common theme of practitioner-client fit emerged in the data, as well as four main subthemes: (1) conceptualization of trauma, (2) psychoeducation of the Somatic Experiencing approach, (3) clients who do not benefit from Somatic Experiencing, and (4) self-awareness. Implications are discussed as well as gaps and suggestions for future research

The Body Recovers: Practitioner Perspective on Somatic Experiencing

Most individuals are exposed to a traumatic event in their lifetime, but not all go on to develop post-traumatic stress disorder (PTSD). PTSD is characterized by symptoms of intrusion and avoidance of stimuli related to the traumatic event, as well as dissociation. PTSD has been linked to a number of somatic syndromes including chronic fatigue syndrome (CFS), chronic lower back pain, hypertension, and hypothalamic-pituitary adrenal (HPA) axis dysfunction resulting in hormonal imbalance. Several evidence-based interventions for PTSD exist, including prolonged exposure therapy (PE), eye-movement desensitization and reprocessing (EMDR), and cognitive processing therapy (CPT), however many of these approaches address trauma using components of exposure or are not well-researched in addressing somatic symptoms related to trauma. Somatic Experiencing (SE) is an emerging intervention conceptually framed by the “bottom-up” processing theory. SE has been demonstrated to improve PTSD symptoms in early intervention studies across a variety of contexts and diverse populations, however research on SE is limited and the literature on SE is concentrated primarily in the theoretical realm. No prior studies have explored practitioner’s perspectives on how SE benefits trauma survivors and which clients are best suited for SE. This study explores this question through qualitative interviews with three practitioners in a Midwestern metro area. A common theme of practitioner-client fit emerged in the data, as well as four main subthemes: (1) conceptualization of trauma, (2) psychoeducation of the Somatic Experiencing approach, (3) clients who do not benefit from Somatic Experiencing, and (4) self-awareness. Implications are discussed as well as gaps and suggestions for future research

Interdisciplinarity in vocational guidance: an action theory perspective

In addressing the issue of interdisciplinary research in vocational guidance, twelve propositions important for understanding the vocational guidance process as joint, goal-directed action are presented. They address the encounter between client and counsellor leading to relational ethics, the relevance of everyday action theory and methods for the analysis of goal-directed processes as joint actions, projects, and careers. Research on the school-to-work transition illustrates this conceptualisation and analysis. Links to other disciplines concerned with vocational guidance are identifie

Describe Your Pain: A Heuristic Exploration of the Role of Art in Communicating the Experience of Chronic Pain

The condition of chronic pain, like other chronic illness, is a phenomena that begs further investigation because of its significant physical and psychological impacts. Additionally, it is an affliction that is difficult to treat, understand and overcome. Traditionally, diagnosis and treatment of this condition has depended on retrospective recall of symptoms, which are often subjected to bias. Current research in medical art therapy has shown promising potential in the treatment of both the psychological, physiological and sociological impacts of chronic pain. However, there is limited arts-based research that steps outside of a medical model. In this research I have used my own experience to deepen the understanding of chronic pain by addressing the following question: How might a daily art practice describe the lived experience of a training art therapist experiencing chronic pain? This was explored using a heuristic, arts-informed methodology. Data was collected through a daily art exercise that responded to the prompt, “Describe your pain today” as well as reflective journaling. The discussion of these images utilizes Jungian theory in order to gain insight into the more intangible meanings produced by the imagery

The Psychological and Physical Rehabilitation of Amputees

Since physical therapy requires constant interaction with other people, it is a career that requires not only medical knowledge, but knowledge of the human psychology as well. A physical therapist may be well versed in recovery techniques, but how will he or she get the patient motivated if the patient is not motivated to begin with? Every person is different. Rehabilitation of amputees is a delicate process that requires significant work over an extended time period. Many factors are involved during the preoperative phase, as well as the postoperative phase. However, by being aware of the patient’s mental status and providing adequate patient education, the physical therapist and health care team can provide an extremely effective rehabilitation program. By understanding the patient and prescribing the proper exercise program, a physical therapist can help an amputee reach a high level of functionality