Oncology Clinicians' Defenses and Adherence to Communication Skills Training with Simulated Patients: an Exploratory Study

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms—defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient—on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N = 31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) = 5.26, p = 0.03, d = 0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning” to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respond adequately to his needs, and to foster the therapeutic alliance. Results of the above-mentioned study [13] showed two groups of clinicians: one with a higher defensive functioning and one with a lower defensive functioning prior to CST. After the training, a difference in defensive functioning between clinicians who participated in CST and clinicians of the control group was only showed for clinicians with a higher defensive functioning. Some clinicians may therefore be more responsive to CST than others. To further address this issue, the present study aimed to evaluate the relationship between the level of adherence to an "ideally conducted interview”, as defined by the teachers of the CST, and the level of the clinician' defensive functioning. We hypothesized that, after CST, clinicians with a higher defensive functioning show a greater adherence to the "ideally conducted interview” than clinicians with a lower defensive functionin

Mindfulness, authentic functioning, and work engagement : a growth modeling approach

Previous research has demonstrated that mindfulness helps reduce symptoms of work stress but research has yet to clarify whether and how mindfulness is linked to work engagement. Using self-determination theory we hypothesize that mindfulness is positively related to work engagement and that this relationship can be better understood through authentic functioning. We collected survey data on these variables in the context of six mindfulness trainings at three points in time: before the training, directly after the training, and four months after training. We examined the relationships between mindfulness, authentic functioning, and work engagement, both statically (cross-sectionally) and dynamically as they change over training. Results show that authentic functioning mediates the relationship between mindfulness and work engagement, partially for the static relationship and fully for the dynamic relationship. We discuss how these findings further clarify the role of mindfulness in the workplace and highlight the implications for the literature on authentic functioning and work engagement. © 2013 Elsevier Inc.publisher: Elsevier articletitle: Mindfulness, authentic functioning, and work engagement: A growth modeling approach journaltitle: Journal of Vocational Behavior articlelink: http://dx.doi.org/10.1016/j.jvb.2013.01.012 content_type: article copyright: Copyright © 2013 Elsevier Inc. All rights reserved.status: publishe

On psychological growth and vulnerability: basic psychological need satisfaction and need frustration as an unifying principle

Humans have a potential for growth, integration, and well-being, while also being vulnerable to defensiveness, aggression, and ill-being. Self-determination theory (R. M. Ryan & E. L. Deci, 2000, Self-determination theory and the facilitation of intrinsic motivation, social development and well-being, American Psychologist, Vol. 55, pp. 68–78) argues that satisfaction of the basic psychological needs for autonomy, competence, and relatedness both fosters immediate well-being and strengthens inner resources contributing to subsequent resilience, whereas need frustration evokes ill-being and increased vulnerabilities for defensiveness and psychopathology. We briefly review recent research indicating how contextual need support and the experience of need satisfaction promote well-being and different growth manifestations (e.g., intrinsic motivation, internalization), as well as a rapidly growing body of work relating need thwarting and need frustration to ill-being, pursuit of need substitutes, and various forms of maladaptive functioning. Finally, we discuss research on differences in autonomous self-regulation and mindfulness, which serve as factors of resilience

Effects of social disruption in elephants persist decades after culling.

BACKGROUND Multi-level fission-fusion societies, characteristic of a number of large brained mammal species including some primates, cetaceans and elephants, are among the most complex and cognitively demanding animal social systems. Many free-ranging populations of these highly social mammals already face severe human disturbance, which is set to accelerate with projected anthropogenic environmental change. Despite this, our understanding of how such disruption affects core aspects of social functioning is still very limited. RESULTS We now use novel playback experiments to assess decision-making abilities integral to operating successfully within complex societies, and provide the first systematic evidence that fundamental social skills may be significantly impaired by anthropogenic disruption. African elephants (Loxodonta africana) that had experienced separation from family members and translocation during culling operations decades previously performed poorly on systematic tests of their social knowledge, failing to distinguish between callers on the basis of social familiarity. Moreover, elephants from the disrupted population showed no evidence of discriminating between callers when age-related cues simulated individuals on an increasing scale of social dominance, in sharp contrast to the undisturbed population where this core social ability was well developed. CONCLUSIONS Key decision-making abilities that are fundamental to living in complex societies could be significantly altered in the long-term through exposure to severely disruptive events (e.g. culling and translocation). There is an assumption that wildlife responds to increasing pressure from human societies only in terms of demography, however our study demonstrates that the effects may be considerably more pervasive. These findings highlight the potential long-term negative consequences of acute social disruption in cognitively advanced species that live in close-knit kin-based societies, and alter our perspective on the health and functioning of populations that have been subjected to anthropogenic disturbance

Mortality Salience and Metabolism: Glucose Drinks Reduce Worldview Defense Caused by Mortality Salience

The current work tested the hypothesis that a glucose drink would reduce worldview defense following mortality salience. Participants consumed either a glucose drink or placebo, wrote about either death or dental pain, and then completed a measure of worldview defense (viewing positively someone with pro-US views and viewing negatively someone with anti-US views). Mortality salience increased world- view defense among participants who consumed a placebo but not among participants who consumed a glucose drink. Glucose might reduce defensiveness after mortality salience by increasing the effectiveness of the self-controlled suppression of death-related thought, by providing resources to cope with mortality salience and reducing its threatening nature, or by distancing the individual from actual physical death

Behavioural inhibition and valuation of gain/loss are neurally distinct from approach/withdrawal

Gain or omission/termination of loss produces approach; while loss or omission/termination of gain produces withdrawal. Control of approach/withdrawal motivation is distinct from valuation of gain/loss and does not entail learning – making “reward” and “punishment” ambiguous. Approach-withdrawal goal conflict engages a neurally distinct Behavioural Inhibition System, which controls “anxiety” (conflict/passive avoidance) but not “fear” (withdrawal/active avoidance)

From the emotional integration to the cognitive construction: the developmental approach of Turtle Project in children with autism spectrum disorder

Background: Children with autism spectrum disorder show a deficit in neurobiological processes. This deficit hinders the development of intentional behavior and appropriate problem-solving, leading the child to implement repetitive and stereotyped behaviors and to have difficulties in reciprocal interactions, empathy and in the development of a theory of mind. The objective of this research is to verify the effectiveness of a relationship-based approach on the positive evolution of autistic symptoms. Method: A sample of 80 children with autism spectrum disorder was monitored during the first four years of therapy, through a clinical diagnostic assessment at the time of intake and then in two follow-up. Results: The results showed that through the Autism Diagnostic Observation Schedule it is possible to assess the socio-relational key elements on which the therapy is based. There was evidence, in fact, of significant improvements after two and four years of therapy, both for children with severe autistic symptoms and for those in autistic spectrum. Conclusions: Socio-relational aspects represent the primary element on which work in therapy with autistic children and can be considered as indicators of a positive evolution and prognosis that will produce improvements even in the cognitive are

Stress and Quality of Life Among Parents of Children with Congenital Heart Disease Referred for Psychological Services

Objective The study examined parent stress and health‐related quality of life (HRQOL) among families of children with congenital heart disease (CHD) referred for psychological services. Methods Parents of 54 children (85% boys) aged 3 to 13 (Mage = 7.48, SD = 2.38) completed measures to assess parenting stress (Parenting Stress Index – Short Form; Pediatric Inventory for Parents) and the PedsQL Family Impact Module. Medical information was retrieved from medical record review. Results Half of parents of children with single ventricle anatomy had clinically significant levels of parenting stress. Parents of children with single ventricle anatomy reported more frequent illness‐related stress and more difficulty dealing with illness‐related stress than parents of children with two ventricle anatomy. Younger gestational age at birth and referral for attention or behavior problems were associated with greater likelihood of parent at‐risk psychosocial functioning. Conclusions Among children referred for psychological services, many parents report significant stress and significant negative impact of the child\u27s medical condition on the family. Results underscore the need to consider assessing parent psychosocial functioning and providing additional support for parents of children with CHD