Long-term Coping Research Articles

Pregnancy termination for fetal abnormality: are health professionals\u2019 perceptions of women\u2019s coping congruent with women\u2019s accounts?

BackgroundPregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts.MethodsFifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences.ResultsHealth professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women.ConclusionsHealth professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.

Serum Response Factor (SRF) Ablation Interferes with Acute Stress-Associated Immediate and Long-Term Coping Mechanisms.

Stress experience modulates behavior, metabolism, and energy expenditure of organisms. One molecular hallmark of an acute stress response is a rapid induction of immediate early genes (IEGs) such as c-Fos and Egr family members. IEG transcription in neurons is mediated by the neuronal activity-driven gene regulator serum response factor (SRF). We show a first role of SRF in immediate and long-lasting acute restraint stress (AS) responses. For this, we employed a standardized mouse phenotyping protocol at the German Mouse Clinic (GMC) including behavioral, metabolic, and cardiologic tests as well as gene expression profiling to analyze the consequences of forebrain-specific SRF deletion in mice exposed to AS. Adult mice with an SRF deletion in glutamatergic neurons (Srf; CaMKIIa-CreERT2 ) showed hyperactivity, decreased anxiety, and impaired working memory. In response to restraint AS, instant stress reactivity including locomotor behavior and corticosterone induction was impaired in Srf mutant mice. Interestingly, even several weeks after previous AS exposure, SRF-deficient mice showed long-lasting AS-associated changes including altered locomotion, metabolism, energy expenditure, and cardiovascular changes. This suggests a requirement of SRF for mediating long-term stress coping mechanisms in wild-type mice. SRF ablation decreased AS-mediated IEG induction and activity of the actin severing protein cofilin. In summary, our data suggest an SRF function in immediate AS reactions and long-term post-stress-associated coping mechanisms.

Maternal negative affect during infancy is linked to disrupted patterns of diurnal cortisol and alpha asymmetry across contexts during childhood

Maternal negative affect in the early environment is believed to sensitize long-term coping capacities in children. Yet, little work has identified physiological systems associated with coping responses, which may serve as mechanisms for links between early maternal negativity and child outcomes. Using a longitudinal twin sample (N=89), we found that high levels of maternal negative affect during infancy were associated with dysregulation of diurnal cortisol and electroencephalograph (EEG) asymmetry, two physiological systems that may support active approach-oriented coping when children are 7years old. Flattened slopes of diurnal cortisol were also associated with greater numbers of concurrent overanxious behaviors in children. A mediation analysis supported the role of dysregulated diurnal cortisol as a mediator of the link between maternal negative affect in the early environment and childhood risk for anxiety problems.

Person-centred care of women with urinary incontinence

Urinary incontinence can affect adults as they age and develop long-term conditions and difficulty coping with an ageing urinary system. This overview explores how ageing, long-term conditions and functional abilities combine to affect the ability of women to retain urinary continence. It emphasizes the importance of ensuring that the individual's needs are met, and that sensitive, compassionate care, that maintains dignity and privacy, is delivered.

The experiences of family members in the year following the diagnosis of a child or adolescent with cancer: a qualitative systematic review.

BACKGROUND Research shows that it is stressful for family members when a child or an adolescent within the family unit is diagnosed with cancer and this stress continues over the course of the year after the diagnosis. Qualitative studies have been conducted aimed at exploring parental, siblings’ and other family members’ experiences when facing health-illness transition-related stress during the first year after the child is diagnosed with cancer. This study integrates the research findings of relevant existing qualitative studies on this topic in order to provide empirical evidence-based suggestions for clinical care. OBJECTIVES This study intent is to obtain an understanding of the family members’ experiences over the course of the following year after learning that a child or adolescent within their family unit has been diagnosed with cancer. INCLUSION CRITERIA Types of participants: The participants of interest are family members of a child or adolescent with cancer who verbally describe the whole experience and/or report on the impact of the diagnosis and disease on their lives. In this systematic review, there were no restrictions on the type, severity and prognosis of cancer. Studies investigating the experiences of the family of a child or adolescent with cancer that were reported verbally and the opinions of others external to the family (e.g. nurses) were excluded from the review. Phenomena of interest: The phenomena of interest were the self-reported experiences over the course of the following year of family members of a child or adolescent with cancer and the impact on the whole family of the child or adolescent receiving a cancer diagnosis. The settings included acute care, home and community settings with any cultural context. Research on other phenomena, such as experiences related to social support intervention for the family, the long-term coping experience of the family, the bereavement experiences of children with cancer, the experiences of a child or adolescent with cancer and experiences more than one year after the diagnosis was excluded from the review. Types of studies: This review considered studies that used qualitative methods to examine the experiences of families of a child or adolescent with newly diagnosed cancer; these included but were not limited to designs such as qualitative research, phenomenology, hermeneutic phenomenology, grounded theory, ethnography, action research, focus groups and narrative research. The search was limited to studies published in English or Chinese because the reviewers were fluent in both of these languages. SEARCH STRATEGY The search strategy sought to find both published and unpublished studies. CINAHL, PUBMED, ProQuest Dissertations and Theses and Chinese electronic periodical services were used to search for articles. METHODOLOGICAL QUALITY Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise the methodological quality of the articles. Any disagreements that arose between the reviewers were resolved through discussion, or via a third reviewer. DATA COLLECTION Qualitative data were extracted from papers for inclusion in the review using the standardized data extraction tool from TRUNCATED AT 500 WORDS

Exposure to daily trauma: The experiences and coping mechanism of Emergency Medical Personnel. A cross-sectional study

To investigate the experience and coping mechanisms used by Emergency Medical Services (EMS) personnel following exposure to daily or routine traumatic events. A total of 189 respondents from three EMS in the Cape Town Metropole completed a questionnaire, containing close-ended quantitative questions. This was followed up by a semi-structured interview in order to get greater insight from in-depth qualitative data. The significant results of this study indicate that EMS personnel find dealing with seriously injured children most traumatic. They experience avoidance symptoms after exposure to a traumatic incident and apply emotion-focused coping to help them deal with their emotions. Very little or no training has been received to prepare them for the emotional effects of traumatic incidents or how to deal with the bereaved family, and there was consensus amongst the participants that their company debriefings and support structures are inadequate. EMS personnel are exposed to critical incidents on a daily basis. Commonly used emotion-focused coping mechanisms are not effective in long-term coping. A key recommendation emanating from this finding is that integrated intervention programmes are needed to assist EMS personnel working in this sustained high-stress environment. The findings can assist health care educators in the design of co-curricular activities intended to help in the development of resilience and the psychological wellbeing of EMS personnel. Policy makers and EMS managers may find the results useful as they evaluate the effectiveness of their current debriefing and support structures. Les accidents et décès liés à des traumatismes représentent une partie importante du quotidien du personnel des services des urgences médicales. Selon les études menées, le personnel de ces services fait l’expérience de nombreuses réactions après avoir été exposé à un événement traumatique. Cette étude avait pour objectif d’enquêter sur l’expérience et les stratégies d’adaptation utilisées par le personnel des services des urgences médicales suite à une exposition à des événements traumatisants quotidiens ou habituels. Au total, 189 personnes issues de trois services d’urgences médicales de la ville du Cap ont répondu à un questionnaire composé de questions quantitatives fermées. Un entretien semi-structuré a ensuite été réalisé afin de tirer davantage d’informations de ces données qualitatives détaillées. Les résultats significatifs de cette étude indiquent que le personnel des services des urgences considère que la prise en charge d’enfants victimes de blessures graves est l’événement le plus traumatisant. Ils se retrouvent confrontés à des symptômes d’évitement après avoir été exposés à un accident traumatique et ont recours à des stratégies d’adaptation axées sur les émotions les aidant à gérer leurs émotions. Une formation très limitée, voire aucune formation n’a été reçue pour les préparer aux effets émotionnels associés aux accidents traumatiques ou à la façon de faire face à des familles endeuillées; les participants à l’étude s’accordaient sur le fait que les structures de débriefing et de soutien proposées par leur entreprise étaient inadéquates. Le personnel des services des urgences médicales est quotidiennement exposé à des incidents critiques. Les stratégies d’adaptation axées sur l’émotion ne sont pas efficaces pour l’adaptation sur le long terme. L’une des principales recommandations découlant de cette conclusion est que des programmes d’intervention intégrée sont nécessaires pour aider le personnel des urgences médicales à travailler dans un tel environnement hautement stressant. Les conclusions peuvent aider ceux qui délivrent des formations au personnel des services des urgences médicales à élaborer des activités destinées à favoriser le développement de la résilience ainsi que du bien-être psychologique de ce personnel. Les décideurs et directeurs de ces services peuvent trouver les résultats utiles lors de leur évaluation de l’efficacité de leurs structures de débriefing et de soutien actuelles.

Risk perceptions of dust and its impacts among communities living in a mining area of the Witwatersrand, South Africa

Mining is a major economic activity in many developing countries. In South Africa, gold mining has played a significant role in the development and sustenance of the country's economy, with both positive and negative consequences. In gold mining areas, tailings dams and mine dumps are significant sources of ambient dust, known to be a nuisance, and health risk, to communities living near them and who must find appropriate coping mechanisms to protect themselves. A qualitative study based on five focus groups with sixty-two participants of different ages and sex was carried out in the Witwatersrand mining district of South Africa. All focus groups agreed that they had noticed dust in the air where they live, stating that the dust came largely from mine dumps but also from other sources. They agreed that the dust causes, among others, health problems, and both short-term and long-term coping mechanisms for protecting themselves against excess dust were mentioned yet considered inadequate, i.e. closing windows and doors, watering their yards, paving their yards and planting trees. Little support from government, mines and other organisations was identified as an important perceived barrier to resolving the dust problem. Means for communication of communities' perceptions of the impacts, risks and possible mitigation / adaption measures associated with dust need to be created and supported in a formal risk management plan.

Urban adaptation planning and climate-related disasters: An integrated assessment of public infrastructure serving as temporary shelter during river floods in Colombia

Emergency reports prove that extreme weather events are overcoming disaster management systems in vulnerable cities. While a number of studies focus on comprehensive and long-term coping strategies to deal with disasters, only few have addressed the challenge of temporary shelter in acute crisis intervention. Experiences in developing countries have shown that local governments have improvised emergency accommodation in sport halls, schools, and similar infrastructure identified as Collective Centres. The aim of this paper is hence to develop and apply an integrated assessment of public infrastructure serving as temporary shelter in case of extreme weather events. We chose the case study of Chía in Colombia in 2011, where erratic rainfalls and river floods led to property loss and damages and the designation of collective centres. We propose a Collective-Centre Suitability Index to evaluate the appropriateness of public infrastructure to serve as transitional shelter through a ranking-based assessment of (i) compliance of humanitarian shelter standards; (ii) the analysis of geographical risks; and (iii) the accessibility of selected infrastructure. Results for the case study suggested compliance of minimum transitional shelter standards on most of assessed locations and infrastructure. Scenarios of flood-risk recurrence intervals indicated higher exposure from the urbanized area along the Frío River. Suitability of Collective Centres near the Frío River was comparably higher than the evaluated shelter near the Bogotá River. The proposed assessment offers a flexible screening tool for transitional shelter and local adaptation planning considering urban changing settings.

Influence of Family Environment on Long‐Term Psychosocial Functioning of Adolescents With Juvenile Fibromyalgia

Little is known about the impact of family environment on the long-term adjustment of patients with juvenile-onset fibromyalgia (JFM). Our objective was to evaluate whether family environment in early adolescence predicted later physical functioning and depressive symptoms of adolescents with JFM as they transitioned to early adulthood in the context of a controlled long-term followup study. Participants consisted of 39 youth (mean age 18.7 years) with JFM and 38 healthy matched controls who completed web-based surveys about their health status (Short Form 36 health survey) and depressive symptoms (Beck Depression Inventory II) ~4 years after a home-based, in-person assessment of child and family functioning. During the initial assessment, parents of the participants (94% mothers) completed the Family Environment Scale and adolescents (mean age 14.8 years) completed self-report questionnaires about pain (visual analog scale) and depressive symptoms (Children's Depression Inventory). The results indicated that family environment during early adolescence significantly predicted greater depressive symptoms in early adulthood for both the JFM group and the healthy controls. In particular, a controlling family environment (use of rules to control the family and allowing little independence) during early adolescence was the driving factor in predicting poorer long-term emotional functioning for patients with JFM. Family environment did not significantly predict longer-term physical impairment for either group. Adolescents with JFM from controlling family environments are at an increased risk for poorer emotional functioning in early adulthood. Behavioral and family interventions should foster independent coping among adolescents with JFM and greater parenting flexibility to enhance successful long-term coping.

Consistency Over Flattery

Negative social feedback is often a source of distress. However, self-verification theory provides the counterintuitive explanation that negative feedback leads to less distress when it is consistent with chronic self-views. Drawing from this work, the present study examined the impact of receiving self-verifying feedback on outcomes largely neglected in prior research: implicit responses (i.e., physiological reactivity, facial expressions) that are difficult to consciously regulate and downstream behavioral outcomes. In two experiments, participants received either positive or negative feedback from interviewers during a speech task. Regardless of self-views, positive compared to negative feedback elicited lower self-reported negative affect. Implicit responses to negative feedback, however, depended on chronic self-views with more negative self-views associated with lower blood pressure reactivity, lower facial negativity, and enhanced creativity. These findings point at the role self-verification may play in long-term coping and stress regulation.

Midwives’ Experiences of Work-Related Shoulder Musculoskeletal Problems

INTRODUCTION: Little is known about musculoskeletal disorders in midwives as distinct from nurses. The study objective was to gain an understanding of midwives’ experiences with work-related shoulder problems.METHODS: We carried out semistructured interviews with 11 qualified Australian midwives with a history of shoulder problems, recruited through purposive sampling. Interviews were recorded, transcribed verbatim, and manually coded. An inductive approach was used to generate themes.RESULTS: Five major themes emerged in the analysis: attribution, universality of the experience, short-term coping, long-term coping, and support. Most participants held the view that musculoskeletal problems were normal occurrences and to be expected. Participants felt vulnerable and described the ways they protect themselves from further injury. Those who had left midwifery practice had generally done so for reasons other than the shoulder problem. Family members and coworkers were the main sources of support, whereas most supervisors were perceived as neutral at best.CONCLUSIONS: Coping strategies that enhance well-being may be most effective. The workplace culture must encourage injury reporting to monitor safety issues and decrease costs at all levels. The study findings suggest several areas for future research in midwives to provide an evidence base for prevention/intervention strategies.

Children and adolescents' self‐reported coping strategies during the Southeast Asian Tsunami

The objective of this study was to investigate how Norwegian children on holiday in Southeast Asia coped when the tsunami hit December 26, 2004. The goal is to understand more about children and adolescents' immediate coping strategies when faced with a life-threatening situation. Acquiring more knowledge on coping strategies at different points in the recovery process can be useful for gaining insight to the relationship between coping and psychological adjustment. Semi-structured interviews of 56 children aged 6-18 years (36 girls and 20 boys) were conducted in their homes approximately 10 months after the tsunami. The interviews were analysed using qualitative methods. Two primary coping strategies were described and labelled as self-soothing thoughts and behavioural strategies. Self-soothing thoughts were divided into five categories: positive thinking; avoidant thinking; rational thoughts; and thoughts on parental competencies and parental protection. Behavioural strategies were divided into six categories: attachment seeking behaviour; distraction behaviour; helping others; seeking information and comfort; and talking. The children's coping responses point to the developmental aspects of coping and how children are dependent upon adults for guidance and protection. In addition, very few youth reported using problem-focused coping strategies that are normally thought of as helpful in the aftermath of trauma, whereas strategies often thought of as not so helpful such as distraction and avoidance, was more predominant. It may be that helpful immediate coping strategies are different from long-term coping strategies, and that coping strategies differ according to the degree of perceived control of the situation.

Exploring the Roles of Emotions, Motivations, Self-Efficacy, and Secondary Control Following Critical Unexpected Life Events

We examined individuals’ retrospective accounts and personal analyses regarding how their emotional, motivational, and epistemological beliefs coalesced to affect their long-term coping and resilience following a critical life event. Analyses from interviewed subjects who had encountered significant life-changing events revealed three major themes that influenced their decisions, abilities for self-regulation, and life course paths: (1) types of unexpected events, (2) types and intensity of emotional responses to the critical event, and (3) beliefs about primary control (i.e., personal agency and self-efficacy) and mediated control (i.e., external sources of influence). Regarding the extent to which participants experienced resiliency and current satisfaction with their lives, a dominant theme was their ability to see their critical life events as part of a larger tapestry—involving issues of personal and externally mediated controls—that provided a framework for their positive redirections, perceptions of self-efficacy, and abilities for coping and self-regulation.

Beyond the HPA Axis: Progesterone-Derived Neuroactive Steroids in Human Stress and Emotion

Stress and social isolation are well-known risk factors for psychopathology. However, more research is needed as to the physiological mechanisms by which social support buffers the impacts of stress. Research in animal models suggests important roles for progesterone (P) and its product, the neuroactive steroid allopregnanolone (ALLO), in stress and psychopathology. These hormones are produced in brain and periphery during stress in rodents, and down-regulate anxiety behavior and hypothalamic-pituitary–adrenal axis activity. Human clinical populations, including depressed patients, have alterations in ALLO levels, but it is unclear whether these basal hormone level differences have clinical import. To begin to address this question, this review examines the role of P and ALLO in stress physiology, and the impact of these hormones on mood, in healthy humans. Evidence largely supports that P and ALLO increase during stress in humans. However, P/ALLO administration appears to cause only mild effects on mood and subjective anxiety, while exerting effects consistent with gamma-aminobutyric acid receptor modulation. Additionally, P is linked to motivation for affiliation/social contact; P (and ALLO) release may be especially responsive to social rejection. These observations lead to the novel hypothesis that stress-related P/ALLO production functions not only to down-regulate stress and anxiety, but also to promote social contact as a long-term coping strategy. Malfunctioning of the P/ALLO system could therefore underlie depression partly by decreasing propensity to affiliate with others.

Gaps in Knowledge in Caring for HIV Survivors Long-term

MORE THAN 1.1 MILLION INDIVIDUALS IN THE United States live with human immunodeficiency virus (HIV) infection. Since the mid1990s, much of the clinical, behavioral, and psychosocial research has rightly focused on how to most effectively use combination antiretroviral therapy, improve adherence to medications, and address the shortterm complexities of caring for this population. Success on these fronts has led to improvements in survival and quality of life. Life expectancies for patients newly diagnosed with HIV infection increased from 10.5 to 22.5 years from 1996 to 2005. The reality of patients living with HIV infection for decades will require physicians and the health care system to confront 4 critical issues. First, HIV-infected patients will likely require continuous, life-long therapy. Recent guidelines recommend starting therapy earlier, with a modeling analysis suggesting treatment should be started as soon as possible after diagnosis. Adherence both to medications and to medical care appointments is the sine qua non of long-term survival with HIV infection. Once optimal adherence is achieved, it can only decline, and, in general, adherence in a population diminishes with time. Yet surprisingly little is known about medication adherence and retention in care beyond a 1-year or 2-year horizon. For instance, what are the long-term patterns of adherence and retention in care, and what factors determine a patient’s adherence? How can adherence to appointments and medications over a long period be maximized? Also, what approaches will best reengage patients in care after lapses? The long-term roles of expensive modalities such as directly observed therapy, electronic pill boxes, outreach, and multifaceted interventions need to be defined. Failure to understand how to maximize adherence and retention in care will forfeit many of the gains made in the last decade and a half. Second, aging patients with HIV are more likely to develop the metabolic syndrome consisting of diabetes, hyperlipidemia, and obesity. These patients are at increased risk of cardiovascular disease, liver disease, renal disease, non−AIDS-defining malignancies, altered bone metabolism, pulmonary disease, depression, and neurocognitive impairment. There is little evidence on how to best screen for and manage these long-term metabolic, oncologic, and cardiovascular risks and complications. Little is known about how these physical and mental complications affect patients’ quality of life, long-term medication adherence, and psychosocial well-being. What coping mechanisms do patients with HIV evoke daily over a long period and how can this information be used to help patients living with HIV? What roles do spirituality, stigma, and social relationships play as patients manage their chronic infection and its complications over the years? Do long-term coping and social support mechanisms differ by race/ethnicity, gender identity, sexuality, and socioeconomic status? The emotional, psychological, and physical toll family and friends experience while caring for patients with HIV infection over the long-term is also currently poorly understood. What interventions would maximize and maintain patients’ overall health and quality of life? Third, improved survival has brought about challenges in sexual and reproductive health. How do patients maintain safer sexual relationships over decades and how should this be promoted? In addition, individuals living with HIV infection with such improved prognoses are now more interested in having children. What methods of attaining parenthood achieve a balance of effectiveness, safety, and cost? How should levels of HIV transmission risk be conveyed to potential parents, so they can make an informed decision? Fourth, how best to complete the transformation of programs that provide and fund HIV health care both in the United States and in the developing world must be studied. These programs were initially designed to treat patients with HIV infection for the short term to keep them alive and out of the hospital. These programs have evolved into a complex, multilayered set of services that are minimally integrated but manage to provide excellent care to many patients. However, these programs are not well equipped to provide integrated, comprehensive care to HIV patients over their projected lifespan. A systematic review article found that there still is not a clear under-

Holocaust Survivor Typology and Forgiveness

This article examines the long-term coping patterns of aging Holocaust survivors and their relationship to attitudes toward forgiving in later stages of life. Survivors who reported increased ability to cope positively with past events in their lives were predicted to be more likely to be forgiving than those who reported difficulty in long-term coping. Three research instruments were used to examine this: the typology of survivors; the Life History Questionnaire, based on Erikson's eight stages of development; and the Enright Forgiveness Inventory. No significant differences were found between the three groups (clusters) of survivors and their attitudes towards forgiveness. It is suggested that by the time these survivors reached old age, issues relating to prior traumatic experiences had possibly been worked out.

Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction?

In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers’ failure to treat tobacco use on patients’ alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients’ tobacco use and provide available evidence-based treatments.

On the role of goal dysregulation in the treatment of bipolar disorder.

Nusslock, Abramson, Harmon-Jones, Alloy, and Coan (this issue) propose that current psychosocial treatments for bipolar disorder be supplemented with interventions focused on altering goal dysregulation pathways. While innovations to existing treatment manuals are always welcome, there are several reasons why this suggestion may require further consideration. We highlight issues pertaining to the status of cognitive-behavioral therapy for bipolar disorder, the distinction between education and psychoeducation, the nature of familial expressed emotion, differences between clinical and analog samples, and the larger question of how to assess mechanisms in psychosocial treatment studies. We also raise the question of whether an optimistic goal orientation can be a protective factor in patients' long-term coping with bipolar disorder.

The role of religion in HIV-positive women's disclosure experiences and coping strategies in Kinshasa, Democratic Republic of Congo

Literature from the U.S. has documented the importance of spirituality on the psychological health of people living with HIV/AIDS; however there is little published data on the ways in which people living with HIV/AIDS in Africa turn to religion for support. We conducted 40 in-depth interviews with HIV-positive women who were pregnant or had recently given birth in Kinshasa, Democratic Republic of Congo to inform the development of a comprehensive family-centered HIV treatment and care program. Women described how they relied upon their faith and turned to church leaders when they were diagnosed with HIV and prepared to share their diagnosis with others. The women used prayer to overcome the initial shock, sadness and anger of learning their HIV diagnosis. They turned to their church leaders to help them prepare for disclosing their diagnosis to others, including their partners. Church leaders were also important targets for disclosure by some women. Women's faith played an important role in their long-term coping strategies. Conceptualizing their infection as a path chosen by God, and believing that God has the power to cure their infection comforted women and provided them with hope. In settings like the Democratic Republic of the Congo, where there is a strong foundation of faith, we need to recognize how individuals draw upon their different health belief systems in order to develop and implement coherent and effective prevention, treatment and care strategies.

Rheumatic Disease and Complementary-Alternative Treatments

Complementary-alternative medicine (CAM) has been widely used by rheumatic patients for many years, but doctors are often unaware of the actual use. This study aimed at patients' experience and perceptions of CAM as a way for long-term coping with illness. Fifteen in-depth interviews were conducted with patients sampled by contact with voluntary patient-driven rheumatic disease societies, outside of any treatment settings. Strategically, the sampling included a variety of rheumatic diseases and CAM-treatments, but strived otherwise to be typical of CAM-users. Interviews were taped and fully transcribed; coding and analysis of themes were assisted by computer software. Rheumatic disease patients expressed use of CAM as methods of regulation of discomforts, the feeling of the body, and self-empowerment, not for unrealistic healing of their rheumatic disease. They experienced a variety of effects, most often expressed in terms of mind-body interrelated experiences, such as "lightness of the body" rather than relief in specific symptoms. They expressed the feeling of "have been helped" when leaving a CAM-session and appreciated to have more than 1 way to understand their disease and symptoms. They were usually not naive, but were critical consumers. The patients typically believed in the alternative viewpoints of "natural is best" and in "energy meridians," but they were otherwise not believers in any alternative, "new age"-type worldview. These findings suggest that clinical practice may be enriched by listening to or asking rheumatic disease patients' CAM-experiences in a nonpatronizing way.