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 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 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

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management

Thinking positively about chronic illness: An exploration of optimism, illness perceptions and well-being in patients with Parkinson's disease

Objectives: Holding positive beliefs about illness and having an optimistic outlook has been associated with increased well-being across a range of health conditions. However research has indicated that being very optimistic may not actually be beneficial and holding a realistic attitude is more adaptive in some forms of chronic illness, e.g. Parkinson's disease (PD). The present study aimed to explore the nature of relationships between illness perceptions, optimism and well-being; specifically whether a linear or non-linear relationship best described the data. Additionally the proposed moderating effect of optimism on the relationship between illness perceptions and well-being was tested. Design: 109 participants with idiopathic PD completed questionnaire measures of illness perception, optimism, mood and health-related quality of life (HRQoL). Methods: Multiple regression analyses were used to explore relationships between illness perceptions, optimism, mood and HRQoL. The potential curvilinear effects of illness perceptions and optimism were modelled using squared variables and linear and quadratic curve estimation. Results: Holding positive illness perceptions predicted better well-being. Some evidence for a non-linear relationship between optimism and mood was found. Optimism had a significant moderating effect on the relationship between specific illness perceptions and outcome. Conclusions: Optimism appears to provide protection against some negative perceptions of illness and was associated with better mood and HRQoL. The findings indicate which specific illness perceptions may be beneficial targets for therapy. Therapeutic interventions should focus on enhancing positive perceptions of PD but potentially more importantly general optimistic attitude to maximise wellbeing

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