Strong Desires and Strategies of Self-control: A Semiotic Approach to Food Cravings

A semiotic analysis of qualitative interviews with obese individuals shows experiences of ‘food cravings’ (i.e. strong, temporary, desires to eat that are generally directed on specific types of food) to be instances of semiosis that intersect biological, psychological and cultural spheres. In its analysis, the article introduces a new distinction between non-symbolic and symbolic dominance in food craving. It also describes ways in which food cravers use different semiotic strategies to achieve self-control by manipulating the semiosis of food craving. It is suggested that the semiotic framework offers an approach that could be fruitful both in future interdisciplinary studies and intervention programmes relating to food craving

Goal setting and goal attainment in patients with major depressive disorder: a narrative review on shared decision making in clinical practice

Objective: Narrative review of the processes of goal setting and goal attainment scaling, as practical approaches to operationalizing and implementing the principles of shared decision making (SDM) in the routine care of people living with major depressive disorder (MDD). Methods: We searched electronic databases for clinical studies published in English using key terms related to MDD and goal setting or goal attainment scaling. Two clinical studies of goal setting in MDD are considered in detail to exemplify the practicalities of the goal setting approach. Results: While SDM is widely recommended for people living with mental health problems, there is general agreement that it has thus far been implemented variably. In other areas of medicine, the process of goal setting is an established way to engage the patient, facilitate motivation, and assist the recovery process. For people living with MDD, the concept of goal setting is in its infancy, and only few studies have evaluated its clinical utility. Two clinical studies of vortioxetine for MDD demonstrate the utility of goal attainment scaling as an appropriate outcome for assessing functional improvement in ways that matter to the patient. Conclusions: Goal setting is a pragmatic approach to turning the principles of SDM into realities of clinical practice and aligns with the principles of recovery that encompasses the notions of self-determination, self-management, personal growth, empowerment, and choice. Accumulating evidence supports the use of goal attainment scaling as an appropriate personalized outcome measure for use in clinical trials.</p