Avoidance in nonepileptic attack disorder:A systematic review and meta-analyses

Background Avoidance is the active process of trying to escape from or not experience situations, places, thoughts, or feelings. This can be done through behavioral or cognitive strategies, or more broadly, a combination of both, utilized in an attempt to disengage from private experiences referred to as experiential avoidance (EA). Avoidance is considered important in the development and maintenance of nonepileptic attack disorder (NEAD). This review aimed to understand avoidance in NEAD and evaluate its role as a contributory factor. Methods Fourteen articles were identified by searching Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE Complete, PsycINFO, and EMBASE and were combined in a narrative synthesis. Six of these articles were included in a meta-analysis comparing levels of EA for individuals with NEAD and healthy controls (HC), and four were included in a meta-analysis comparing EA in NEAD to epilepsy comparisons (EC). Conclusions Experiential avoidance appears to be a strategy that is used by a high proportion of the population with NEAD. The group with NEAD utilized significantly more avoidance compared with both the HC and EC. However, further research is needed to understand the extent and types of avoidance that are relevant

The experiences of being diagnosed with Parkinson’s Disease

Being diagnosed with a chronic illness such as Parkinson’s disease (PD) can have a considerable psychological impact on a person’s life. However, this has been little explored and therefore it is unclear what support may be most beneficial at this time. This study therefore explored personal experiences of being diagnosed with PD. Six participants were interviewed and data analysed using thematic analysis. Three over-arching themes emerged: 1) “Understanding it is an important thing” – The value of knowledge; 2) "You’ve got to get used to accepting the fact that you need help" - The social implications of being diagnosed with PD; and 3) "I think you need to talk to somebody" - The importance of supportive others. The process of diagnosis was complex and often challenging for participants, with respect to their own understanding and that of others. Recommendations for future practice within specialist PD services are made, to improve the support that is offered at this time

Understandings of psychological difficulties in people with the Huntington’s disease gene mutation and their expectations of psychological therapy

Objectives This study sought to investigate how people who had tested positive for the Huntington's disease (HD) gene mutation understood and experienced psychological distress and their expectations of psychological therapy. Design A qualitative methodology was adopted involving semi-structured interviews and interpretative phenomenological analysis (IPA). Method A total of nine participants (five women and four men) who had opted to engage in psychological therapy were recruited and interviewed prior to the start of this particular psychological therapeutic intervention. Interviews were transcribed verbatim and analysed using IPA whereby themes were analysed within and across transcripts and classified into superordinate themes. Results Three superordinate themes were developed: Attributing psychological distress to HD: ‘you're blaming everything on that now’; Changes in attributions of distress over time: ‘in the past you'd just get on with it’; and Approaching therapy with an open mind, commitment, and hope: ‘a light at the end of the tunnel’. Conclusion Understandings of psychological distress in HD included biological and psychological explanations, with both often being accepted simultaneously by the same individual but with biomedical accounts generally dominating. Individual experience seemed to reflect a dynamic process whereby people's understanding and experience of their distress changed over time. Psychological therapy was accepted as a positive alternative to medication, providing people with HD with hope that their psychological well-being could be enhanced

Correlates of stigma in adults with epilepsy:A systematic review of quantitative studies

Objectives The aim of this review was to identify quantitative correlates, predictors, and outcomes of stigma in adults with epilepsy living in Western countries. Methods To identify relevant literature, four academic databases (PsycINFO, CINAHL, PubMed, and Scopus) were systematically searched using key terms related to stigma and epilepsy. Results Thirty-three research papers reporting findings from 25 quantitative studies of correlates of stigma in epilepsy were identified. The findings suggest that stigma can be predicted by demographic, illness-related, and psychosocial factors, although associations were found to be highly culturally specific. Outcomes of stigma in people with epilepsy were replicated more consistently across cultures, and its impact was significant. Detrimental effects included both worse physical health, including less effective management of the condition, and reduced psychological well-being, including difficulties such as depression and anxiety. Implications Educational initiatives and therapeutic interventions that aim to address stigma in people with epilepsy are recommended; however, these need to be culturally informed to ensure that they are valid and effective

The experiences of parenting a child with an acquired brain injury:a metasynthesis of the qualitative literature

Objective. To systematically review and then synthesize the qualitative literature on the experience of parenting a child with an acquired brain injury (ABI). Design. Systematic literature review and meta-synthesis Methods. A systematic search of the literature was conducted in four databases. Papers which met the inclusion criterion were assessed for quality using the Critical Skills Appraisal Programme (CASP) tool and then synthesized according to Noblit and Hare’s (1988) guidelines for meta-ethnography. Results. Of the 4855 papers retrieved, 17 met the inclusion criteria. Synthesis resulted in three themes: (1) Disconnection: Cut off from internal emotions and isolated from others; (2) Seeking understanding and support to manage in an insecure world; and (3) New parent to a different child. Conclusions. Having a child with an ABI leads to many challenges for parents. These include feeling insecure, isolated from others and struggling to adapt to the different roles required to parent their different child. Clinical implications highlight the need for specialist support that is ongoing after discharge, including specialist knowledge and understanding of ABI and opportunities for peer support

Self-Compassion and Depression, Anxiety, and Resilience in Adults with Epilepsy

Background Research suggests that people with epilepsy (PWE) are more likely to experience depression and anxiety than the general population. Given the adversity associated with the condition, resilience may also be important. However, to date resilience has been largely overlooked in the epilepsy literature. Self-compassion has been widely associated with improved psychological wellbeing and, to a lesser extent, resilience. However, the relationship between self-compassion and depression, anxiety, and resilience in PWE has not been examined. Objectives Using a quantitative cross-sectional survey design, the aim of the present study was to examine the extent to which self-compassion predicted depression, anxiety, and resilience when controlling for demographic and illness-related variables. Methods Adults with epilepsy were invited to take part in a survey online or in epilepsy or neurology clinics. Two-hundred and seventy participants completed the survey and data were analyzed using hierarchical multiple regression models. Results In this sample of PWE, self-compassion significantly predicted lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. Conclusions The findings of the present study indicate that self-compassion could be an important factor in determining psychological outcomes for adults with epilepsy and its role is worthy of further exploration to help improve psychological outcomes for PWE

The use of the truth and deception in dementia care amongst general hospital staff

Objectives: Deceptive practice has been shown to be endemic in long-term care settings. However, little is known about the use of deception in dementia care within general hospitals and staff attitudes towards this practice. This study aimed to develop understanding of the experiences of general hospital staff and explore their decision-making processes when choosing whether to tell the truth or deceive a patient with dementia. Method: This qualitative study drew upon a constructivist grounded theory approach (Charmaz, 2006) to analyse data gathered from semi-structured interviews with a range of hospital staff. A model, grounded in participant experiences, was developed to describe their decision-making processes. Findings: Participants identified particular triggers that set in motion the need for a response. Various mediating factors influenced how staff chose to respond to these triggers. Overall, hospital staff were reluctant to either tell the truth or to lie to patients. Instead, ‘distracting’ or ‘passing the buck’ to another member of staff were preferred strategies. The issue of how truth and deception are defined was identified. Conclusion: The study adds to the growing research regarding the use of lies in dementia care by considering the decision-making processes for staff in general hospitals. Various factors influence how staff choose to respond to patients with dementia and whether deception is used. Similarities and differences with long-term dementia care settings are discussed. Clinical and research implications include: opening up the topic for further debate, implementing staff training about communication, and evaluating the impact of these processes

Non-heterosexual women's experiences of informal social support:a qualitative metasynthesis

This metasynthesis explores how non-heterosexual women experience informal social support. A systematic literature search was conducted to identify papers for inclusion, following which Noblit and Hare's (1988) meta-ethnographic approach was adopted to synthesise the findings of 16 papers. Four themes were derived: (i) disconnection from family life, (ii) the benefits of cross-sexual orientation friendships (iii) negotiating (internalised) homophobia and seeking a space for authenticity, and (iv) the intimacy of friendships between women. The impact of heterosexism on the women’s experiences of social support is discussed, implications for health and social care are explored and future research avenues are proposed