An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

<p>Abstract</p> <p>Background</p> <p>Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent.</p> <p>Methods</p> <p>Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan.</p> <p>Results</p> <p>We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle.</p> <p>Conclusion</p> <p>This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.</p

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

As maladaptive disgust responses are linked to mental health problems, and cancer patients may experience heightened disgust as a result of treatments they receive, we explored the associations between disgust-related side-effects and symptoms of depression and anxiety in people treated for cancer. One hundred and thirty two (83 women, Mage = 57.48 years) participants answered questions about their treatments, side-effects, disgust responding, and mental health. Experiencing bowel and/or bladder problems, sickness and/or nausea (referred to here as “core” disgust-related side-effects) was significantly related to greater symptoms of depression and borderline increased anxiety. Further, these links were explained by a moderated mediation model, whereby the effects of core disgust side-effects on depression and anxiety were mediated by (physical and behavioural) self-directed disgust, and disgust propensity moderated the effect of core disgust side-effects on self-disgust. These findings stress the importance of emotional responses, like disgust, in psychological adaptation to the side-effects of cancer treatments

A prospective investigation of rumination and executive control in predicting overgeneral autobiographical memory in adolescence

The CaR-FA-X model (Williams et al., 2007), or capture and rumination (CaR), functional avoidance (FA) and impaired executive control (X), is a model of overgeneral autobiographical memory. Two mechanisms of the model, rumination and executive control were examined in isolation and in interaction to investigate overgeneral autobiographical memory over time. Method: Across two time points, six months apart, a total of 149 adolescents (13-16 years) completed a minimal instruction autobiographical memory test, a measure of executive control with emotional and non-emotional stimuli, and measures of brooding rumination and reflective pondering. Results: It was found that executive control for emotional information was negatively associated with OGM, but only when reflective pondering levels were high. Conclusion: In the context of higher levels of reflective pondering, greater switch costs (i.e. lower executive control) when processing emotional information predict a decrease in OGM over time

Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial

Background: Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. Methods. The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α =.05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen's Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion. The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed. Trial registration. German Register of Clinical Studies (DRKS): DRKS00004749. © 2013 Heber et al.; licensee BioMed Central Ltd

An examination of the self-referent executive processing model of test anxiety: control, emotional regulation, self-handicapping, and examination performance

According to the self-referent executive processing (S-REF) model, test anxiety develops from interactions between three systems: executive self-regulation processes, self-beliefs, and maladaptive situational interactions. Studies have tended to examine one system at a time, often in conjunction with how test anxiety relates to achievement outcomes. The aim of this study was to enable a more thorough test of the S-REF model by examining one key construct from each of these systems simultaneously. These were control (a self-belief construct), emotional regulation through suppression and reappraisal (an executive process), and self-handicapping (a maladaptive situational interaction). Relations were examined from control, emotional regulation, and self-handicapping to cognitive test anxiety (worry), and subsequent examination performance on a high-stakes test. Data were collected from 273 participants in their final year of secondary education. A structural equation model showed that higher control was indirectly related to better examination performance through lower worry, higher reappraisal was indirectly related to worse examination performance through higher worry, and higher self-handicapping was related to worse examination performance through lower control and higher worry. These findings suggest that increasing control and reducing self-handicapping would be key foci for test anxiety interventions to incorporate. © 2018 The Author(s

Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up

The literature that addresses cost differences between randomized trials and full-scale repli- cations is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first- time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs.$12,398, p = .01), and lower costs per visit ($354 vs.$400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal awide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale