A study of defensive-coping behavior in medical students with different levels of sociability

В статье анализируются результате особенностей защитно-совладающего поведения у студентов медицинского вуза с различным уровнем общительности. В исследовании особое внимание уделено уровню общительности, поскольку данный компонент включен в профессионально важное качество личности врача и от данного компонента зависит эффективность лечебного взаимодействия. В исследовании приняли участие студенты 5 курса лечебного факультета в количестве 55 человек. Методиками обследования послужили: 1) оценка уровня общительности (В.Ф. Ряховский); 2) методика измерения психологической защиты (Е.Р. Пилюгина, Р.Ф. Сулейманов). Доминирующими копинг стратегиями в поведении студенты-медики используют: «подавление», «проекция» и «юмор». У студентов медицинского вуза первой и второй группы преобладают адаптивные типы защитно-совладающего поведения. Эмпирически доказано различие в сформированности копинг стратегий по уровню общительности, используемых студентами медицинских специальностей. Нами были обнаружены различия в уровнях психологических защит между данными группами, а именно по шкалам «диссоциация», «изоляция» Полученные результаты исследования могут применяться психологами образовательных учреждений при составлении программ психологического сопровождения с целью коррекции совладающего поведения. The article analyzes the result of the peculiarities of defensive-coping behavior among medical students with different levels of sociability. In the study, special attention is paid to the level of sociability, since this component is included in the professionally important quality of the doctor's personality and the effectiveness of the therapeutic interaction depends on this component. The study involved 55 students of the 5th year of the Faculty of General Medicine. The survey methods were: 1) assessment of the level of sociability (V.F. Ryakhovsky); 2) a technique for measuring psychological defense (E.R. Pilyugina, R.F. Suleymanov). The dominant coping strategies in behavior are used by medical students: "suppression", "projection" and "humor". Among students of a medical university of the first and second groups, adaptive types of defensive-coping behavior prevail. The difference in the formation of coping strategies by the level of sociability used by students of medical specialties has been empirically proven. We found differences in the levels of psychological defenses between these groups, namely on the scales of "dissociation", "isolation". The obtained results of the study can be used by psychologists of educational institutions when drawing up programs of psychological support in order to correct coping behavior.

PSYCHOTHERAPY METHOD OF THERAPY BY MEANS OF CREATIVE SELF-EXPRESSION BY M.YE.BURNO (TCSEB) IN TREATMENT AND REHABILITATION OF PSYCHIATRIC DISEASE PROFILE PATIENTS

Приводимые в статье данные об организационной структуре, методиках (направлениях) и основополагающих принципах психотерапевтического метода Терапии творческим самовыражением М.Е.Бурно (ТТСБ), как части Клинической классической психотерапии, Терапии духовной культурой, позволяют получить более точные представления о ТТСБ и овладеть навыками использования данного метода в лечении и реабилитации пациентов с психиатрическим профилем заболевания. Рассказывается о показаниях и противопоказаниях к использованию метода ТТСБ. О непосредственных алгоритмах и психотерапевтических методиках осуществления помощи. Затрагивается вопрос значимости личной — творческой роли специалиста в ТТСБ, осуществляющего Психосоциальную терапию и реабилитацию. Рассматривается феномен особого психотерапевтического эмоционального интимного контакта с шизофреническими, шизотипическими пациентами, являющегося существенным компонентом продуктивного терапевтического взаимодействия с данной группой обратившихся за помощью. Рассказывается об особой терапевтической среде психотерапевтического метода ТТСБ в Психосоциальной терапии и реабилитации. The data presented in the article on the organizational structure, methodologies and fundamental principles of psychotherapy method of Therapy by means of creative self-expression by M.Ye.Burno (TCSEB), as a part of Clinical classical psychotherapy, Therapy by intellectual culture, allows us to get more accurate understanding of TCSEB and master the skills of using this method in treatment and rehabilitation of psychiatric disease profile patients. The indications and contraindications for using the TCSEB method are explained. The direct algorithms and psychotherapy methodologies of helping mentally ill patients are mentioned here. We also talk about special personal and creative role of a TCSEB specialist who performs Psychosocial therapy and rehabilitation. We emphasise the importance of psychotherapeutic deep emotional contact, working with schizophrenic and schizotypal patients as an essential component of productive therapeutic interaction with this group of patients. The special therapeutic environment of the psychotherapeutic method of TCSEB in Psychosocial therapy and rehabilitation is described.

Therapeutic Interaction of Apatinib and Chidamide in T-cell Acute Lymphoblastic Leukemia through Interference with Mitochondria Associated Biogenesis and Intrinsic Apoptosis

T-cell acute lymphoblastic leukemia (T-ALL) shows poor clinical outcome and has limited therapeutic options, indicating that new treatment approaches for this disease are urgently required. Our previous study demonstrated that apatinib, an orally selective VEGFR-2 antagonist, is highly effective in T-ALL. Additionally, chidamide, a histone deacetylase inhibitor, has proven to be cytotoxic against T-ALL in preclinical and clinical settings. However, whether the therapeutic interaction of apatinib and chidamide in T-ALL remains unknown. In this study, apatinib and chidamide acted additively to decrease cell viability and induce apoptosis in T-ALL in vitro. Notably, compared with apatinib or chidamide alone, the combinational regimen was more efficient in abrogating the leukemia burden in the spleen and bone marrow of T-ALL patient-derived xenograft (PDX) models. Mechanistically, the additive antileukemia effect of apatinib and chidamide was associated with suppression of mitochondrial respiration and downregulation of the abundance levels of several rate-limiting enzymes that are involved in the citric acid cycle and oxidative phosphorylation (OXPHOS). In addition, apatinib enhanced the antileukemia effect of chidamide on T-ALL via activation of the mitochondria-mediated apoptosis pathway and impediment of mitochondrial biogenesis. Taken together, the study provides a potential role for apatinib in combination with chidamide in the management of T-ALL and warrants further clinical evaluations of this combination in patients with T-ALL.

Exploring the care needs of Iranian patients with cancer: a qualitative content analysis

Background‏ Cancer is currently one of the most critical health problems worldwide. Different studies have shown that disease can reduce people’s ability to take care of themselves and this makes them face many needs. Therefore, this study aimed to investigate unmet needs faced by patients with cancer‏. Methods This study employed a conventional, qualitative content analysis method. Data saturation was achieved after interviewing 13 participants in 15 interview sessions. With the in-depth semi-structured approach, the participants were asked to narrate their experiences of self-care needs in the process of disease. The collected data were analyzed using Graneheim and Lundman’s method through the following steps: Construction of the units of analysis, construction of codes of meaning, condensation, extracting codes, and categorization (subcategories, categories, and the core category) ‏. Results‏ Data analysis revealed two main categories. The first category was “Deficiency in disease management” with three subcategories: “the need to get rid of annoying physical symptoms”,“ the need for a caregiver to help with the daily routine”, and “feeling frustrated and giving up treatment”. The second main category covered “the need for sympathetic and knowledgeable caregivers” with the following five subcategories:” the need for sympathy and interaction with the nurse”, “the need to hear the truth about the illness “, “the need for appropriate therapeutic interaction from physicians”, “Inadequate qualification of medical secretaries about the patient”, and” need for advice from psychologists for psychological adaptation‏”. Conclusion‏ The most critical need reported by the patients was the need for compassionate and informed caregivers. So nursing management and care with kindness, competence, and conscience is the fundamental right of patients with cancer. Identifying patients’ needs and problems can be used as a background for increasing the knowledge and experience of nurses and providing care for patients with cancer‏.

THERapy–Related InterACTion (THER-I-ACT) in Rehabilitation—Instrument Development and Inter-Rater Reliability

Objective: To develop an instrument for the observation of therapeutic communication interactions during rehabilitation sessions and test its inter-rater reliability.Methods: The new instrument THER-I-ACT (THERapy–related Inter-ACTion) has been designed to assess both the frequency and timing of therapeutic interactions in the thematic fields information provision, feedback, other motivational interaction, and bonding. For this inter-rater reliability study, a sample of stroke survivors received arm rehabilitation as either arm ability training, arm basis training, or mirror therapy, or neglect training as individually indicated. Therapy sessions were video-recorded (one for each participant) and therapeutic interactions rated by two independent raters using THER-I-ACT.Results: With regard to the instrument's comprehensiveness to document therapeutic interactions with pre-defined categories the data from 29 sessions suggested almost complete coverage. Inter-rater reliability was very high both for individual categories of therapeutic interaction (frequency and time used for interaction) (intraclass correlation coefficient, ICC 0.91–1.00) and summary scores for the thematic fields of interaction (again for frequency and time used for interaction) (ICC 0.98–1.00).The inter-rater reliability for rating engagement and being focussed for both the therapist and patient was substantial (ICC 0.71 and 0.86).Conclusions: The observational study documented that by use of the newly designed THER-I-ACT various types of therapy-related communication interactions performed by therapists can be assessed with a very high inter-rater reliability. In addition, the thematic fields and categories of therapeutic interaction as defined by the instrument comprehensively covered the type of interaction that occurred in the therapeutic sessions observed.

Self-amplification of Oxidative Stress With Tumour Microenvironment-activatable Iron-doped Nanoplatform for Targeting Hepatocellular Carcinoma Synergistic Cascade Therapy and Diagnosis

Background: Hepatocellular carcinoma (HCC) is insensitivity to chemotherapy drugs and conventional chemotherapy has long been regarded as ineffective against HCC. Ferroptosis is a form of programmed cell death with a definite Fenton reaction mechanism that converts endogenous hydrogen peroxide (H2O2) into highly toxic hydroxyl radicals (·OH), expected to inhibit HCC in cooperation with chemotherapy.Methods: The organic/inorganic nanoplatform were characterized by various methods to analyze the morphology, element composition and tumour microenvironment response-ability. Determine the tumour-targeting efficiency and imaging capabilities of nanoplatform through magnetic resonance imaging (MRI) in vivo and in vitro. Confocal microscopy, flow cytometry and western blotting were used to study the therapeutic efficacy and mechanism of complementary ferroptosis/apoptosis treatment of nanoplatform. Results: This nanoplatform consists of a silica shell doped with iron and disulfide bonds, and the etched core loaded DOX that generate H2O2 in situ to enhance the ferroptosis effect. The ultrasensitive nanoplatform relied on transferrin for precise delivery and could be activated by the tumour microenvironment (TME) in which the glutathione (GSH)-responsive biodegradability could synergize with the therapeutic interaction between DOX and iron and induce tumour cells death through complementary ferroptosis and apoptosis mechanisms. Simultaneously, the nanoplatform had a superparamagnetic framework that can be used for treatment guidance and monitoring under the guidance of T2-weighted MRI.Conclusion: The rationally designed nanoplatform is expected to realize the integration of diagnosis, treatment and monitoring, and provides a new strategy for anti-tumour effects.

Η θεραπευτική σχέση στη γνωσιακή συμπεριφοριστική θεραπεία

The article describes the distinctive features of the therapeutic relationship in cognitive behavioral therapy (CBT) and the ways of dealing with problems in the therapeutic interaction. The development of the way that the therapeutic relationship is understood within the context of cogntive behavioral therapy is presented, from the initial view that the therapeutic relationship is a necessary but not sufficient condition in order to achieve therapeutic change, to the modern view that the therapeutic change is produced by the therapeutic techniques, as well as the therapeutic relationship. The role of the therapist and the features of the therapeutic alliance in CBT are described, central among which is collaborative empiricism and Socratic questioning. The difficulties in the therapeutic relationship and the ways that can be addressed are discussed in the context of the related concepts of resistance, of ruptures in the therapeutic alliance and of transference and countertransference. The rationale regarding boundaries to the therapeutic relationship is discussed. In conclusion, in CBT the emphasis on the therapeutic relationship is not so central as in other therapeutic models and the relationship is integrated with techniques, although there is ongoing effort to enhance and expand the understanding of the therapeutic interaction. Nonetheless the quality of the relationship is not inferior to that of other treatment models and the therapeutic change in CBT is attributed equally to the implementation of techniques and relationship factors.

Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N)

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.

Psychosocial Assessment in the Emergency Department

Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the “person” and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the “risk” and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.

Distributing Agency and Experience in Therapeutic Interaction: Person References in Therapists' Responses to Complaints

The primary means for psychotherapy interaction is language. Since talk-in-interaction is accomplished and rendered interpretable by the systematic use of linguistic resources, this study focuses on one of the central issues in psychotherapy, namely agency, and the ways in which linguistic resources, person references in particular, are used for constructing different types of agency in psychotherapy interaction. The study investigates therapists' responses to turns where the client complains about a third party. It focuses on the way therapists' responses distribute experience and agency between the therapist and the client by comparing responses formulated with the zero-person (a formulation that lacks a grammatical subject, that is, a reference to the agent) to responses formulated with a second person singular pronoun that refers to the client. The study thus approaches agency as situated, dynamic and interactional: an agent is a social unit whose elements (flexibility and accountability) are distributed in the therapist-client interaction. The data consist of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis, and the method of analysis is conversation analysis and interactional linguistics. The main findings are that therapists use the zero-person for two types of responses: affiliating and empathetic responses that distribute the emotional experience between the client and the therapist, and responses that invite clients to interpret their own experiences, thereby distributing control and responsibility to the clients. In contrast, the second person references are used for re-constructing the client's past history. The conclusion is that therapists use the zero-person for both immediate emotional work and interpretative co-work on the client's experiences. The study suggests that therapists' use of the zero-person does not necessarily attribute “weak agency” to the client but instead might strengthen the clients' agency in the sense of control and responsibility in the long term.