Emotional Relief Research Articles

Development of an app for lung cancer survivors (iEXHALE) to increase exercise activity and improve symptoms of fatigue, breathlessness and depression.

Exercise-based self-management interventions are recommended for lung cancer survivors and can provide physical, psychosocial and emotional relief. Mobile health technologies can encourage self-management; however, currently, no cancer-related app addresses exercise-specific needs of lung cancer survivors. This paper details the design, development and testing of an exercise app for lung cancer survivors (iEXHALE), which aims to increase exercise activity and improve symptoms. The research had two stages: (1) focus groups with healthcare professionals, patients and family members (n=21) and (2) app development and usability study with lung cancer survivors (n=6). The Capability, Opportunity, Motivation-Behaviour model was used as a theoretical framework; data were thematically analysed. Focus group findings identified many helpful exercises for managing lung cancer survivors' symptoms. These findings, alongside relevant literature, informed iEXHALE's content and design. The usability study found that lung cancer survivors valued iEXHALE's self-management capabilities but identified potential modifications including improved self-monitoring diaries and navigation. iEXHALE's development has been theoretically and empirically informed, showing value as a self-management tool. Next, we will test its effectiveness, acceptability and cost-effectiveness.

TAKING A BREAK: DAILY RESPITE EFFECTS OF ADULT DAY SERVICE AS ACTUAL TIME AWAY FROM CAREGIVING

Adult day service (ADS) can provide emotional and physical relief for caregivers of persons with dementia (PWD). Studies have examined differences between caregivers of service users and non-users; less known, however, is how actual hours away from caregiving responsibilities through using ADS impact caregivers’ daily outcomes. Using daily diary data from 173 family caregivers whose relatives are using ADS (day N = 1,359), this study investigated within-person differences in respite hours across 8 consecutive days and how daily respite hours are associated with daily well-being (i.e., mood and health symptoms). On average, caregivers reported 7.12 respite hours on ADS days and 1.74 respite hours on non-ADS days. Multilevel models revealed that having more respite hours is associated with better positive mood, but not with negative mood and health symptoms – after controlling for ADS use. Further, when caregivers perceived more break time from caregiving responsibilities, they showed better positive mood.

Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study

ObjectivesTo explore the impact of a Mindfulness-Based Stress Reduction (MBSR) intervention for people with metastatic cancer integrated in Early Palliative Care (EPC). Design: Mixed-method study. Settings/LocationEPC Service integrated with Oncology Unit, Carpi General Hospital, Italy from January to October 2017. The MBSR intervention took place inside the hospital. SubjectsStudy participation was offered to 25 consecutive people referred to the EPC service. Inclusion criteria: people with metastatic cancer between 18 and 75 years old; informed consent. Exclusion criteria: Performance Status <60% according to Karnofsky scale; active psychiatric disorder. 20 patients were included in the study. InterventionThe adapted program consists of 8 meetings for 2.5 h once a week, a 4.5 h session between the 6th and 7th weeks and 0.5 h home practice daily. The following mindfulness practices were included during the training: formal sitting meditation, body scan, light yoga, walking meditation, and Aikido exercises. Participants were provided with materials for home practice. A qualified MBSR instructor conducted the program. Sessions were attended by a clinical psychologist and a physician trained in meditation, together with the palliative nurse as facilitators. Outcome MeasuresFeasibility and acceptability were assessed on 16 participants. In addition, pre-post measures of cancer pain and mood state were collected. Semi-structured, in-depth interviews were conducted on a subset of 8 participants at the end of the study and analysed using the Interpretative-Phenomenological approach. ResultsMBSR attendance to meetings and adherence to home practice were 75%. MBSR intervention helped participants to develop an accepting attitude in respect to metastatic cancer disease helping them to face anxiety and cancer pain. MBSR improves self-regulation of mood state engendering feelings of compassion MBSR program supports participants in questioning and reconnecting with their values and spiritual beliefs. ConclusionsA Mindfulness intervention integrated into EPC setting is feasible, well accepted and could help metastatic cancer patients to control cancer pain together with an opportunity of emotional and spiritual relief.

Use of patients\u2019 unsolicited correspondence to a family doctor to describe and understand valued components of a doctor-patient relationship: A Hermeneutics approach

BackgroundCommunication and behavior within doctor - patient encounters have been examined using varied techniques; however the nature of unsolicited writings from patients to their family doctors has rarely been reported. This paper therefore aimed to explore the content of, and motivation for, such correspondence.MethodsOne hundred and seven writings to one family physician about care provided during a four decade period were considered. Univariate analyses were used to identify features of patients or family members who wrote personalized notes to the doctor, when, and in what fashion. A hermeneutic approach helped look at the content of the notes, the specific words or sentiments used to describe encounters or care received, and possible motivations for writing. Iterative review of words or phrases generated themes which summarized appreciated physician or relational attributes, as well as motivations for writing.ResultsNotes were mostly handwritten, predominantly by women, and frequently coinciding with holidays and life span events. Appreciated doctor characteristics and behaviors were (1) quality care; and physician (2) competence; (3) physical presence; (4) positive personal traits; (5) provision of emotional support; and (6) spiritual impact. Motivations for writing were grouped as desire to (1) express appreciation for an established relationship; (2) acknowledge value / benefit experienced from continuity of care; (3) seek catharsis, emotional relief or closure; (4) reflect on termination of care; (5) validate care that incorporates both Hippocratic tradition and Asklepian healing; and (6) share personal reflection, experience, or impact.ConclusionsUnsolicited writings provide personalized links from patients to physicians, expressing thoughts perhaps difficult to share face to face. They offer potential as teaching tools about the content of doctor-patient relationships; for example, the writers studied expressed appreciation for quality continuity care that was competent, considerate, and supportive of emotional and spiritual needs.

Technology can sting when reality bites: Adolescents’ frequent online coping is ineffective with momentary stress

The fact that youth widely engage with the online space in order to improve their emotional health has been lost amongst the debate surrounding adolescents' technology use and associated well-being. Two studies focused on adolescents’ use of technology to cope with stressors in daily life. Focus groups (Study 1; n = 16) indicated that youth readily identify using technology to cope and perceive it as helpful for emotional relief. Experience sampling participants (Study 2; n = 156) completed a baseline assessment of online coping and mental health and one week of reports, five times daily, on their technology use, stress, and emotions. Multilevel regression results indicated that across their daily lives, youth who widely endorsed using online strategies to cope responded more negatively to stressors and displayed difficulties in recovering from worry and jealousy. Results held even controlling for use of technology, typical number of stressors, and mental health. Findings highlight the potential shortcomings and comorbid vulnerabilities for youth who frequently turn to the online environment to seek support, information, or distraction.

Negative affect is associated with increased stress-eating for women with high perceived life stress

Perceived life stress (PLS) and cognitive restraint are associated with increased comfort food intake under stress and lead to weight gain and obesity, but the mechanisms by which they do so remain unclear. Stress and negative affect (NA) are associated with increased reward-driven comfort food intake as a means to ‘feel better’, particularly for individuals with higher PLS and cognitive restraint. Thus, we propose that PLS and cognitive restraint increase stress-eating by strengthening the relationship between stress-induced NA and comfort food intake. Upon comfort eating, individuals with higher PLS show greater reductions in the negative consequences of stress (e.g. NA). The rewarding effects of this ‘emotional relief’ may promote future stress-induced comfort eating, but this has yet to be examined. Thus, we investigate the pathways by which PLS or cognitive restraint increase snack intake under stress by proposing that 1) stress-induced NA is a stronger predictor of increased snack intake for women with greater PLS and cognitive restraint, and 2) greater PLS will be associated with greater reductions in NA upon snacking under stress (i.e. emotional relief). Forty-three healthy women were given snacks (chips, golden oreos, and M&Ms) to eat after a Trier Social Stress Test or rest period on separate days in counterbalanced order. Following linear regression analyses, we determined that stress-induced NA predicted more snack intake for women with higher PLS, and that higher PLS was associated with heightened emotional relief upon snacking under stress. Future studies are needed to directly assess whether greater emotional relief following stress-eating reinforces the learned association between stress-induced NA and intake, and ultimately explains greater stress-eating and obesity in women with higher PLS. This work may lead clinicians to focus on NA in the treatment of obesity-and stress-related illnesses for women with higher PLS.

The regulation of negative and positive affect in response to daily stressors.

Experimental investigations of emotion regulation have shown that reappraisal (changing interpretations to change emotions) and distraction (directing attention to change emotions) are effective for regulating the experience of both negative and positive affect, while suppression (changing the outward expression of emotion) has been consistently shown to be ineffective. It is unknown, however, whether this pattern of effects generalizes to the context of daily stressors-a common part of daily life in which effective emotion regulation should be particularly beneficial. In addition, little is known about how frequently different strategies are deployed in response to daily stressors. The present investigation used daily diary methodology in two separate samples of adults (N = 174) to examine the use of these three emotion regulation strategies and their relationships with both negative and positive affect in response to daily stressors. Results revealed that reappraisal was negatively associated with negative affect and positively associated with positive affect, although the effect sizes for positive affect were larger than those for negative affect, suggesting that reappraisal may be particularly important for increasing positive affect in response to daily stressors. Distraction was consistently positively associated with negative affect, while suppression was not consistently associated with either negative or positive affect, suggesting that these two strategies may not be associated with emotional relief in the face of stressors. In terms of frequency of use, suppression was endorsed at higher rates than reappraisal and distraction, suggesting that individuals' use of emotion regulation strategies may not align with their effectiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nothing Else Matters! Trade-Offs Between Perceived Benefits and Barriers of AAL Technology Usage.

Ambient assisted living (AAL) technologies present one approach to counter the challenges of demographic change in terms of an aging population, rising care needs, and lacking care personnel by supporting (older) people in need of care and enabling a longer and more independent staying at own home. Although the number of studies focusing on AAL users' acceptance and perception has increased in the last years, trade-off decisions—the weighing of perceived benefits and barriers of technology usage—have not been studied so far. Nevertheless, this is of high relevance: A realistic evaluation of adoption behaviors in different stakeholders (patients, care personnel) requires an understanding of exactly the weighing process of benefits against the barriers in line with the decision of the final willingness to use AAL technology. The current study applied a conjoint analysis approach and investigates people's decision behavior to use an AAL system for a family member in need of care. Study participants (n = 140) had to decide between realistic care scenarios consisting of different options of two benefits (increase in safety, relief of caring burden of relatives) and two barriers (access to personal data and data handling) of technology usage. Results revealed data access and privacy to be most relevant for the decision to use AAL technology at home. However, care experience essentially influenced the decision patterns. For the care experienced group, data access should be limited to most trusted persons and close relatives, rather than to medical professionals. The most important reasons to use AAL are the emotional relief and the felt safety for the person in care. For care novices, in contrast, data access should be in the exclusive responsibility of medical professionals. The reasons that militate in favor of using AAL technology are the increase in process efficiency and medical safety. The results are useful to develop user-tailored technology concepts and derive user-specific communication guidelines within and across clinical and home care contexts.

Examining emotion relief motives as a facilitator of the transition from suicidal thought to first suicide attempt among active duty soldiers.

Cross-sectional and retrospective studies indicate that a primary motive for suicidal behavior among United States soldiers is the desire to alleviate or reduce emotional distress. This is also the aim of psychological services designed to prevent suicidal behavior. The prospective association of emotion relief (and other) motives with future suicidal behavior has yet to be examined, however. In a high-risk sample of 97 active duty soldiers presenting for an emergency behavioral health appointment, suicide motives were examined and compared between those with and without a history of suicide attempts. Results indicated that soldiers with a history of suicide attempts reported significantly more emotion relief (i.e., reducing or avoiding negative emotional states) and feeling generation (i.e., creating positive emotional states) motives. Feeling generation motives were positively correlated with severity of suicide ideation, hopelessness, depression, and posttraumatic stress, especially among those with a prior suicide attempt. Among soldiers with no previous suicide attempts, emotion relief motives were associated with significantly increased risk for suicide attempt during the 6-month follow-up assessment. Among soldiers with a prior attempt, emotion relief motives were not associated with later suicide attempts. Results provide preliminary evidence suggesting the desire to reduce or avoid negative emotional states may facilitate the emergence of a first suicide attempt among treatment-seeking Soldiers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder

Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI.

What do parents expect from a genetic diagnosis of their child with intellectual disability?

Caring for a child with intellectual disability (ID) has been associated with increased social and psychological burdens. Diagnostic and prognostic uncertainty may enhance emotional stress in families. The present authors assessed the motivations, expectations, mental health, physical health and the quality of life of 194 parents whose children with intellectual disability were undergoing a genetic diagnostic workup. Most parents considered a diagnosis highly relevant for their own emotional relief, their child's therapies and education, or family planning. Parental mental health was significantly lower compared with the normative sample, but physical health was not different. The severity of the child's intellectual disability correlated negatively with their parents' mental and physical health, quality of life, and positively with parental anxiety. Healthcare providers should be aware of the disadvantages facing families with intellectually disabled children. Receiving practical, social and psychological support as well as genetic testing might be particularly relevant for families with severely disabled children.

Value-in-acquisition: an institutional view

PurposeBy combining consumer culture theory and service dominant logic, this study proposes that value might be understood as value-in-acquisition, such that value outcomes result from the acquisition process in which broader social forces shape the exchange process.Design/methodology/approachThis study addresses low-income consumers, for whom societal arrangements strongly determine service interactions. Qualitative interviews reveal service value processes and outcomes for low-income consumers during acquisition processes.FindingsFor low-income consumers, inclusion, status, resource access and emotional relief represent key value outcomes. Important value processes shape those value outcomes, reflecting broader societal arrangements at macro, meso and micro levels. Marketing constitutes an institutional arrangement that establishes an empowered “consumer” role. Value processes are hindered if consumers sense that their agency in this role is diminished, because marketing interactions give precedence to other social roles.Research limitations/implicationsMarketing should be studied as an institutional arrangement that shapes value creation processes during acquisition. Micro-level value processes have important implications for service quality and service value. Value outcomes thus might be designed in the acquisition process, not just for the offering.Practical implicationsThe acquisition process for any good or service should be designed with its own value proposition, separate to the core product or service. Careful design of value processes during acquisition could mitigate conflict between social roles and those of consumption.Originality/valueThere is value in the acquisition process, independent of the value embedded in the goods and services.

Prosthetic rehabiliation of anotia: a sense of emotional relief

Microtia is the abnormal development of the external ear that results in a malformed auricle. The deformity that results can range from mild distortion of the anatomic landmarks to the complete absence of the ear which is anotia. An otolaryngologist can expect to be called on to evaluate this defect several times in the average career. Although not every otolaryngologist will perform the complex surgical reconstruction of these malformations, one should be familiar with the aetiology, anatomy, medical management, and nonsurgical options available. The loss of an ear has a considerable psychological impact on an individual. Maxillofacial prostheses replace the lost body parts by using the silicone materials in order to alleviate these problems, prosthesis may be fabricated. This clinical report portrays a method to fabricate silicone auricular prosthesis for a patient who had congenital anotia. These prostheses support the patients physically as well as psychologically enhancing their confidence and social acceptance.

Does written informed consent adequately inform surgical patients? A cross sectional study

BackgroundInformed consent (IC) is an essential step in helping patients be aware of consequences of their treatment decisions. With surgery, it is vitally important for patients to understand the risks and benefits of the procedure and decide accordingly. We explored whether a written IC form was provided to patients; whether they read and signed it; whether they communicated orally with the physician; whether these communications influenced patient decisions.MethodsAdult postsurgical patients in nine general hospitals of Italy’s Campania Region were interviewed via a structured questionnaire between the second and seventh day after the surgery at the end of the first surgical follow up visit. Physicians who were independent from the surgical team administered the questionnaire.ResultsThe written IC form was given to 84.5% of those interviewed. All recipients of the form signed it, either personally or through a delegate; however, 13.9% did not know/remember having done so; 51.8% said that they read it thoroughly. Of those who reported to have read it, 90.9% judged it to be clear. Of those receiving the written consent form, 52.0% had gotten it the day before the surgery at the earliest 41.1% received it some hours or immediately before the procedure. The written IC form was explained to 65.6% of the patients, and 93.9% of them received further oral information that deemed understandable. Most attention was given to the diagnosis and the type of surgical procedure, which was communicated respectively to 92.8 and 88.2% of the patients. Almost one in two patients believed that the information provided some emotional relief, while 23.2% experienced increased anxiety. Younger patients (age ≤ 60) and patients with higher levels of education were more likely to read the written IC form.ConclusionsThe written IC form is not sufficient in assuring patients and making them fully aware of choices they made for their health; pre-operative information that was delivered orally better served the patients’ needs. To improve the quality of communication we suggest enhancing physicians’ communication skills and for them to use structured conversation to ensure that individuals are completely informed before undergoing their procedures.

Examining social support and its relation to worry in Malaysia

This study examined the role of social support in managing worry among a sample of Malaysian adults. An online questionnaire was completed by 136 participants (age M = 34, SD = 7.65; 71% female, 29% male). Each wrote open-ended, essay-type descriptions of their experiences with social support in relation to worry, as well as completing measures of pathological worry (Penn State Worry Questionnaire), normal worry (Worry Domains Questionnaire), and perceived social support (Multidimensional Scale of Perceived Social Support). Results indicated that young adults experienced a higher degree of normal worry compared to older adults, but pathological worry was not significantly different between the two groups. No significant differences in worry were found in relation to gender, ethnicity or marital status. Perceived social support was negatively related to levels of both normal and pathological worry. Qualitative analyses pointed towards four important roles for social support: providing a sense of belonging and security, providing emotional relief or catharsis, helping to reappraise situations, and facilitating problem-solving and decision-making. The role of social support as a secure base that facilitates emotion management and helps to ground thinking is discussed.

Emotional Labor among Taiwanese Nurses

Background: Nursing staff is important health manpower in hospital. In order to provide a good quality of care to patients, nurses are indispensable. However, emotional labor may cause physical and psychological pressure on nurses and then affect the patient care. The study aims to investigate the correlations among the nurses’ status of emotional labor in order to suggest practical methods for their management, prevention, and reduction. Methods: This study was cross-sectional research design. A convenience sampling was used in a medical center located in Southern Taiwan. In this study, questionnaires such as demographic information, Emotional Labor Scale were distributed to 919 nurses. Results: The results showed nurses had high emotional labor (M=88, SD= 10.5). Age (r?.09, p?.01), and year of nursing experience (r?.10, p?.01), educational level (F?2.59, p=.05), work unit (F?6.48, p?.01?), and work shift (F?3.48, p?.01) was found to have positive and significant correlation with emotional labor. Discussion and Conclusions: The study results suggested that in order to improve the quality of medical service, nursing administrators should pay more attention to how to manage emotional relief and adaptation working stress, and improve health such as regularly exercise and so on.

남녀대학생의 식행동과 스트레스 영향요인

Purpose : This study was performed to investigate the dietary behaviors and stress-related factors among male and female college students. Methods : A total of 405 college students (male-195, female-210) were recruited, of whom a questionnaire-based survey was conducted. The study investigated the general characteristics, health-related factors, dietary behaviors, and stress-related factors of the respondents. Results : The body mass index was significantly higher in males. The rates of underweight and overweight were significantly different between male and female respondents. The scores for workout frequency, health concerns and health condition were significantly higher in males, while the score for watching TV & playing computer games was significantly higher in females. The scores for meal regularity, frequency of breakfast consumption, and smoking were significantly higher in males. Eating problems showed a significant difference between males and females. The biggest source of stress was social factors, followed by college study and individual factors and the most experienced stress-induced symptom was anxiety, followed by headache and stomachache. The most popular way to overcome stress was taking a rest, followed by drinking & smoking and outdoor activity. The most preferred food under stressful conditions were alcohol or beverages, followed by hot & spicy food and sweet food, which showed a significant difference between males and females. Conclusions : These results indicate that stress affects dietary behaviors, drinking, smoking, and health status. Stress not only changes dietary behaviors, but is also related to health status. Therefore, it is necessary to develop appropriate programs for emotional stability and stress relief targeting college students which provide continuous nutrition education focused on desirable dietary behaviors and nutritional aspects.

Secrecy versus disclosure of mental illness among adolescents: I. The perspective of adolescents with mental illness

Background: Many adolescents with mental illness (MI) struggle with the decision whether to disclose their condition. They may decide to keep their MI secret, whether due to fear of public stigma or due to self-stigma and shame. Secrecy may protect against discrimination, but has often negative long-term consequences such as social isolation.Aim: To explore personal views of adolescents with MI on secrecy and disclosure of their MI.Method: Six focus groups consisting of 39 adolescents with MI were recorded, transcribed, and analyzed by qualitative content analysis to identify major themes deductively and inductively.Results: Participants described MI as a stigmatized condition and stressed both the benefits and risks of secrecy. Disadvantages included fear of stigma and loss of friendships, benefits included emotional support and relief. Adolescents underlined the importance of individual disclosure decisions (DDs). The majority preferred selective disclosure. Additionally, the role of other adolescents with and without MI was emphasized.Conclusions: DDs are individual and depend on social factors since stigma and fear of discrimination remain significant concerns for adolescents with MI. Implications for future interventions to support adolescents with MI are discussed.

Self-injurious behaviors among adolescents: A qualitative study of characteristics, meanings, and contexts.

Self-injurious behaviors, such as cutting, are quickly spread and transmitted among adolescents, although it is not clear how. Our objective was to describe and analyze the social interactions occurring in relation to these behaviors. Descriptive, qualitative, and cross-sectional design. Population: adolescents with self-injuries detected at the Department of Adolescence between June 2015 and May 2016. Sampling was purposive and randomized until reaching information redundancy. Data were collected from audio-recorded, semi-structured interviews. Descriptive categories were developed based on personal relationships regarding self-injuries. Thirty-six adolescents were included (33 girls). Age: 15.2 ± 1.9 years. Self-injuries occurred in contexts of conflict with the adult world due to tensions in the household and a neglect of the problems affecting adolescents. Skin cutting was done alone, hidden from the family but shared with peers. Among adolescents, cuts functioned as symbols for their suffering and generated strong ties of identification, belonging, and empathy. Wounds became a recognized and shared asset, around which they grouped their discourse, affection, and other representations of the moment they were living. Self-injuries provide a transient emotional relief; they are usually in opposition to the adult world, and strong ties of belonging and identification are developed among peers in relation to such injuries. This configuration favors concealment of such behavior from the family and its circulation among adolescents.

Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy

BackgroundNeural Therapy (NT) is a common complementary treatment approach using injections with short-acting local anesthetics to treat pain and chronic diseases. However, little is known about the underlying mechanisms and the domains of treatment response. This study therefore analyzed patient experiences following NT injections with procaine.MethodsMaximum variation sampling was used to collect data from semi-structured interviews conducted with 22 hospital inpatients aged 59.6 ± 14.9 years (81.8% female). Each had multiple (9.4 ± 6.9) diagnoses. They were undergoing two weeks of integrative treatment, which included individualized NT. The interview data were analyzed in MAXQDA using qualitative content analysis.ResultsWith injection, patients first described local anesthetic effects including temporary blocking of pain and increased local warmth. Second, patients reported on vegetative reactions frequently leading to turmoil within the body like initial aggravation of existing symptoms or the appearance of new, concealed or phantom symptoms. This often required the need for rest to deal with the treatment stimulus. As a third step, many patients could gain physical and emotional release and relief in symptoms, mood and functioning. Emotional release was often accompanied by weeping and initially overwhelmed affected patients with dissociated memories. However, in cases where patients were able to experience those memories with a new distance, a fourth step of integration was achievable. It included reframing processes as well as a gain in pain perception and body-awareness. As a possible fifth step, patients experienced improved mood, increased pain acceptance and empowerment. Adverse events of NT included pain from the injections, vegetative complaints and emotional turmoil that lasted for minutes or hours, with a maximum of two days.ConclusionsPatients treated with procaine injections reported different psychophysiological outcomes contributing to the understanding of the mechanisms underlying NT. Further efficacy studies should separate specific NT from non-specific/placebo effects.Trial registrationDRKS00004567.