PSYKOTERAPI MED DEMOKRATISKE VERDIER I KULTURMØTET

Denne artikkelen er basert på en kandidatavhandling, hvor utgangspunktet var en forestilling om at psykoterapi med ikkevestlige klienter kan være utfordrende på grunn av terapeutens og klientens ulike kulturbakgrunner. Avhandlingens kvalitative intervjuer med erfarne terapeuter satte imidlertid fokus på betydningen av de non-spesifikke faktorer i den terapeutiske relasjon, og at disse er like viktige uavhengig av klientens kulturbakgrunn. Artikkelen presenterer en videre bearbeidelse av disse data, og beskriver to studenters voksende erkjennelse av at å være psykoteraput dypest sett kan sies å dreie seg om å være ’et profesjonelt medmenneske’. På denne måten omhandler ikke artikkelen ’demokrati’ i formal-politisk betydning, men snarere hvordan man som terapeut kan møte den ikke-vestlige klient med en demokratisk holdning; en form for ’sinnelagsdemokrati’

Trajectories of psychological distress during recovery from polysubstance use disorder

Introduction: Polysubstance use is a prevalent substance use pattern with adverse effects on psychological distress and diminished treatment outcomes. Although polysubstance use often dominates clinical practice, the trajectories of substance use and psychological distress in the initial phase of treatment have been subject to few empirical investigations. Material and Methods: 141 patients initiating inpatient or outpatient treatment for substance use disorder were followed for 12 months, using multiple assessments. We assessed psychological distress and substance use at baseline and at 3-, 6-, and 12-month follow-up visits. We implemented an SMS tracker of substance use during follow-up to reduce the impact of missing data. Results: Stable abstinence was associated with a lower baseline SCL-90-R score, as well as a more rapid symptomatic decline during the first 3 months of abstinence. Unstable abstinence was associated with higher GSI scores at baseline, but also with a significant drop in scores across the follow-up period. Relapse was associated with an initial drop in GSI scores, but a subsequent increase in GSI scores at later follow-ups. Conclusions: Most participants had a rapid reduction of psychological distress during the first 3 months of abstinence. Elevated levels of psychological distress may indicate an increased risk of drug use or relapse and should be monitored carefully. Our findings highlight the importance of early screening for psychological distress in SUD treatment, and advocate the use of tentative diagnostic procedures in the early phase of treatment of PSUD.publishedVersio

PSYKOTERAPI MED DEMOKRATISKE VERDIER I KULTURMØTET

Denne artikkelen er basert på en kandidatavhandling, hvor utgangspunktet var en forestilling om at psykoterapi med ikkevestlige klienter kan være utfordrende på grunn av terapeutens og klientens ulike kulturbakgrunner. Avhandlingens kvalitative intervjuer med erfarne terapeuter satte imidlertid fokus på betydningen av de non-spesifikke faktorer i den terapeutiske relasjon, og at disse er like viktige uavhengig av klientens kulturbakgrunn. Artikkelen presenterer en videre bearbeidelse av disse data, og beskriver to studenters voksende erkjennelse av at å være psykoteraput dypest sett kan sies å dreie seg om å være ’et profesjonelt medmenneske’. På denne måten omhandler ikke artikkelen ’demokrati’ i formal-politisk betydning, men snarere hvordan man som terapeut kan møte den ikke-vestlige klient med en demokratisk holdning; en form for ’sinnelagsdemokrati’

Trajectories of psychological distress during recovery from polysubstance use disorder

Introduction: Polysubstance use is a prevalent substance use pattern with adverse effects on psychological distress and diminished treatment outcomes. Although polysubstance use often dominates clinical practice, the trajectories of substance use and psychological distress in the initial phase of treatment have been subject to few empirical investigations. Material and Methods: 141 patients initiating inpatient or outpatient treatment for substance use disorder were followed for 12 months, using multiple assessments. We assessed psychological distress and substance use at baseline and at 3-, 6-, and 12-month follow-up visits. We implemented an SMS tracker of substance use during follow-up to reduce the impact of missing data. Results: Stable abstinence was associated with a lower baseline SCL-90-R score, as well as a more rapid symptomatic decline during the first 3 months of abstinence. Unstable abstinence was associated with higher GSI scores at baseline, but also with a significant drop in scores across the follow-up period. Relapse was associated with an initial drop in GSI scores, but a subsequent increase in GSI scores at later follow-ups. Conclusions: Most participants had a rapid reduction of psychological distress during the first 3 months of abstinence. Elevated levels of psychological distress may indicate an increased risk of drug use or relapse and should be monitored carefully. Our findings highlight the importance of early screening for psychological distress in SUD treatment, and advocate the use of tentative diagnostic procedures in the early phase of treatment of PSUD

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability

Background: The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers. This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. Methods: We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user’s own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. Results: Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. Conclusions: The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home

A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing

Background Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway

A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; Development and pilot testing

Background: Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods: The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results: Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion: To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway. Keywords: Rehabilitation, Musculoskeletal diseases, Quality indicators, Health care, Delphi techniqu