Therapeutic alliance: challenges and changes within a rapidly evolving context

Σκοπός του σύντομου αυτού Σχολίου είναι να περιγράψει ορισμένες σκέψεις και προβληματισμούς που προέκυψαν από την ανάγνωση των εξαιρετικών άρθρων που περιλαμβάνονται σε αυτό το Ειδικό Τεύχος. Θα εστιάσουμε σε τρία ειδικά σημεία: Στις διαφορές που φαίνονται να υπάρχουν, όχι τόσο ως προς το γενικό ορισμό της θεραπευτικής σχέσης, αλλά στον ακριβή προσδιορισμό των χαρακτηριστικών της σχέσης αυτής και των παραγόντων που τη διαμορφώνουν. Θα αναφερθούμε, επίσης, στην ανάγκη να κατανοήσουμε τη θεραπευτική σχέση λαμβάνοντας υπόψη τις πολύπλοκες αλληλεπιδράσεις μεταξύ διαφόρων βιολογικών, ψυχολογικών και κοινωνικών μεταβλητών. Τέλος, θα εστιάσουμε στην επίδραση που ασκούν στη θεραπευτική σχέση πρόσφατες σημαντικές εξελίξεις, όπως η μεγάλη πρόοδος στην ψηφιακή τεχνολογία και τις υπηρεσίες υγείας. Σε κάθε περίπτωση είναι σίγουρο ότι η αντίληψή μας για τη θεραπευτική σχέση θα συνεχίσει να εξελίσσεται και να μεταβάλλεται στο μέλλον.The aim of this short Commentary is to convey some thoughts and concerns that have arisen after reading the excellent articles included in this Special Issue. The focus will be on three particular points: (a) The differences that seem to exist, not so much regarding the general definition of therapeutic alliance, but rather with respect to the identification of the specific characteristics of this phenomemon and the factors that shape it. (b) The need to understand therapeutic alliance after taking into account the complex interactions that take place between several biological, psychological and social factors. Finally, (c) the impact of recent advancements, such as the great innovations in digital technology and health care, on therapeutic alliance. In any case, it is certain that our perception of therapeutic alliance will continue to evolve and change in the future

The stress process, self-efficacy expectations

Abstract In this study the effects of the stress process after a stressful encounter, that is an examination period, on university studentsÕ psychological health, as well as certain factors that play a significant role in this relationship are being examined. Two hundred and ninety-one (291) students at the University of Athens participated in our study. They completed a series of questionnaires concerning (a) psychological symptoms; (b) self-efficacy expectations; (c) threat, challenge and stakes; (d) coping strategies, and (e) a cognitive self-schema concerning personal examination abilities. The questionnaires were completed in three phases: three months and one week before an examination period, and one week after completion of this period. According to the findings, psychological symptoms are predicted by prior health, appraisal variables, and certain coping strategies. Self-efficacy expectations play a significant role in shaping threat, challenge, and stakes. These appraisal categories in turn exert influence upon psychological health, even after controlling for prior psychological health and coping strategies. Self-efficacy serves as the key variable in the appraisal process, as well as a mediator between inner cognitive structures and stress outcomes

The Common Sense Model of Self-Regulation and Acceptance and Commitment Therapy: integrating strategies to guide interventions for chronic illness

Most health behaviour intervention efforts are adapted from the typical psychological treatment experience and may not take into serious consideration theories specifically developed to describe the process of adaptation to illness. This paper presents a proposal for the combination of a theory about the experience of and adaptation to illness, that is, the Common Sense Model of Self-Regulation (CSM), and an efficient psychological theory and therapy, Acceptance and Commitment Therapy (ACT). Past combinations of CSM with cognitive or cognitive-behavioural interventions have focussed almost only on specific aspects of this model (mostly, illness representations and action plans) and left out other, equally important for a fruitful adaptation to illness, recommendations of the model (e.g., regarding the system coherence). Therefore, the development of the proposed combination is to try to match a broad array of the CSM aspects with the principles, intervention techniques and methods employed by ACT, in order to produce a 'double-pillared' intervention strategy that may prove especially effective for promoting patients' adaptation to a chronic condition and enhancing their well-being and health

The dyadic regulation approach of coping and illness representations in female cancer patients and their partners

PurposeAdjustment to any illness is a ‘dyadic' process whereby patients and their partners mutually determine each other's perceptions, behaviours, and well-being. The present study explored the association between dyadic coping strategies and illness representations in newly diagnosed female cancer patients and their partners.MethodsThe sample consisted of 92 female cancer patient-partner pairs from 3 oncology hospitals in Greece and Cyprus. The Actor Partner Interdependence Model was applied to test for dyadic regulation effects.ResultsThe findings revealed that patients' evaluations of dyadic coping were related to their own illness representations and, in some cases, to partners' illness representations of control. However, partner evaluations of dyadic coping were not associated with either patients' or their own illness representations. Relationship satisfaction did not moderate the relationship between dyadic coping and illness representations.ImplicationsThe study suggests that patients' perceptions of support provided by themselves and their partners play a significant role in shaping their illness representations. Future research could delve into the underlying reasons for the observed differences in the impact of dyadic coping on illness representations between patients and partners, considering factors such as gender roles and specific gender-related issues

In Search for Novel and More Effective Psychological Treatments for Chronic Pain: The “Algea” Research Project

The aim of this paper isto present the objectivesand current state of anongoing multilevelcollaborative researchproject for the study ofpain. “Algea”, the painand suffering deity inancient Greek mythology,was the name given tothis project, which aimsto investigate criticalfactors involved in theexperience of pain, andsuffering. Moreover, theproject will examine theeffects of a novelapproach to treatmentbased on Acceptance andCommitment Therapy.This is a collaborativeproject between theUniversity of Cyprus, theUniversity of Crete, andthe Cyprus Institute ofNeurology and Genetics.Algea is the first systematic effort to examine painrelated parameters and evaluate a noveltherapeutic approach aimed at alleviating thesuffering and interference in living experienced byindividuals with one or more chronic painconditions (e.g., rheumatoid arthritis). The specificobjectives of the “Algea” project include:a) understanding the contributing factors involvedin the experience of pain in individuals withchronic pain (CP) conditions, their dyadicinteractions with their partners, and differenceswith individuals suffering from other chronicillnesses not involving pain; b) designing aculturally sensitive intervention based on newempirical findings stemming from third-wave CBTsfor use in clinical settings (i.e., CP organizations,CP rehabilitation and outpatients units, etc.); c)evaluating via randomized clinical trials theacceptability and effectiveness of this interventionespecially in reducing suffering, interference ofpain and medical utilization in various chronic painconditions; d) training interested healthprofessionals in this new approach and widelydisseminating it into clinical settings; and e)translating the intervention into a digitally-basedintervention so as to be more accessible and reacha wider audience of CP sufferers

Determinants of Self-Rated Health in a Representative Sample of a Rural Population: A Cross-Sectional Study in Greece

Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as “very good”, “good” and “poor” respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed

Psychological and somatic symptoms among breast cancer patients in four European countries : A cross-lagged panel model

Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08-0.10), as well as vice-versa (beta 0.11-0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients-either from a somatic perspective or a psychological perspective-and adjust them to the specific experiences of the individual patient.Peer reviewe

Trajectories of Quality of Life among an International Sample of Women during the First Year after the Diagnosis of Early Breast Cancer: A Latent Growth Curve Analysis

The current study aimed to track the trajectory of quality of life (QoL) among subgroups of women with breast cancer in the first 12 months post-diagnosis. We also aimed to assess the number and portion of women classified into each distinct trajectory and the sociodemographic, clinical, and psychosocial factors associated with these trajectories. The international sample included 699 participants who were recruited soon after being diagnosed with breast cancer as part of the BOUNCE Project. QoL was assessed at baseline and after 3, 6, 9, and 12 months, and we used Latent Class Growth Analysis to identify trajectory subgroups. Sociodemographic, clinical, and psychosocial factors at baseline were used to predict latent class membership. Four distinct QoL trajectories were identified in the first 12 months after a breast cancer diagnosis: medium and stable (26% of participants); medium and improving (47%); high and improving (18%); and low and stable (9%). Thus, most women experienced improvements in QoL during the first year post-diagnosis. However, approximately one-third of women experienced consistently low-to-medium QoL. Cancer stage was the only variable which was related to the QoL trajectory in the multivariate analysis. Early interventions which specifically target women who are at risk of ongoing low QoL are needed