Subsequent Distress Research Articles

The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment.

Distress tolerance, or the perceived ability to tolerate negative emotional states, is often associated with posttraumatic stress disorder (PTSD) such that higher distress tolerance is generally associated with less severe PTSD symptom levels. As distress tolerance is often considered a risk and maintenance factor in distress disorders, examining the association between changes in distress tolerance and changes in PTSD symptoms may have clinical relevance. The present study examined the associations between PTSD symptom severity and distress tolerance across three assessment points over 12 weeks among 212 patients receiving outpatient psychotherapy services. Using random-intercept cross-lagged panel modeling (RI-CLPM), concurrent and prospective associations between PTSD and distress tolerance were examined. PTSD symptoms at Time 1 and Time 2 significantly predicted distress tolerance at Time 2, β = -.296, and Time 3, β = -.395, respectively. Distress tolerance did not predict subsequent PTSD symptom severity. Exploratory analyses examined distress tolerance and four PTSD symptom clusters over time. Patterns of results differed across clusters, though it was consistent that only PTSD symptom clusters predicted subsequent distress tolerance and not vice versa. The results support the interrelationship of changes in psychopathology and emotional distress tolerance and indicate that distress tolerance may be an important factor in symptom remission during PTSD treatment.

Prepandemic Resilience to Trauma and COVID-19 Infection in Older Women.

Prior work suggests that psychological resilience to trauma may protect not only mental but also physical health. This study examined the relationship of prepandemic psychological resilience to lifetime trauma with self-reported COVID-19 infection and symptoms during the early years of the COVID-19 pandemic. Data are from 18,670 longitudinal cohort participants in the Nurses' Health Study II. Based on prior evidence that trauma and subsequent distress can increase infection risk and severity, and that psychological assets may offset this risk, we hypothesized higher versus lower psychological resilience to prior trauma would be associated with lower risk for COVID-19 infection. Prepandemic resilience was assessed via self-report between 2017 and 2019 based on self-reported lifetime trauma exposure and psychological health. COVID-19 infection and symptoms were self-reported on seven questionnaires administered between May 2020 and October 2021, from which we derived a composite outcome measure of probable COVID-19 infection, defined as having 3+ COVID-19 symptoms (out of 9) and/or a positive COVID-19 test result at any single assessment. Multivariable regression revealed significant associations between higher prepandemic resilience scores and lower risk for probable COVID-19 infection, adjusting for sociodemographic and COVID-19-related risk factors (risk ratio [RR] = 0.90 [95% confidence interval {CI}, 0.87-0.93]). Considering subcomponents of the composite COVID-19 infection measure separately, prepandemic resilience was significantly associated with lower risk of reported symptoms (RR = 0.83 [95% CI, 0.79-0.88]), but not with a positive test result alone (RR = 0.96 [95% CI, 0.91-1.01]). Identifying protective factors for infection risk may help inform psychosocial interventions to improve health outcomes.

Potentially morally injurious events as a mediator of the association of gratitude and mindfulness with distress.

Potentially morally injurious events (PMIEs) are events that contradict one's own personal ethics and may promote a deep sense of violation, leading to psychological distress. Individuals with greater trait gratitude and mindfulness may be less likely to perceive events as being morally injurious and may, in turn, be less likely to experience subsequent distress. The current study seeks to examine (a) PMIE rates in a multioccupational first responder sample and (b) the indirect effect of trait gratitude and mindfulness on psychological distress via fewer perceived PMIEs. 293 first responders from agencies/departments within southeastern Texas (in-person) and nationwide (online) completed a survey assessing PMIEs, PTSD symptoms (PCL-C), anxiety (GAD-7), depression (PHQ-8), gratitude (GRAT-S), and mindfulness (MAAS). PMIEs were common (61% witnessed a transgression; 21% committed a transgression; 40% felt betrayed by others). Gratitude was indirectly associated with fewer PTSD [-.09, 95% CI (-.13, -.05)], anxiety [-.03, 95% CI (-.04, -.01)], and depression [-.03, 95% CI (-.05, -.01)] symptoms via lower PMIEs. Similarly, mindfulness was indirectly associated with fewer PTSD [-.92, 95% CI (-1.55, -.38)], anxiety [-.20, 95% CI (-.42, .02)], and depression [-.26, 95% CI (-.48, -.06)] symptoms via lower PMIEs. PMIEs were common in this first responder sample and associated with increased distress. Trait gratitude and mindfulness may protect first responders from perceiving events as morally injurious, which may lead to improved mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

“I’m so dumb and worthless right now”: factors associated with heightened momentary self-criticism in daily life

ABSTRACT Self-criticism is a trait associated with increased psychopathology, but self-criticism is also a personality state reflecting an action that people do in moments of time. In the current study, we explored factors associated with heightened self-criticism in daily life. Participants (N = 197) received five random prompts per day for one week on their mobile phones, where they reported their current affect (negative and positive affect), willpower self-efficacy, distress intolerance, degree of support and criticism from others, current context (location, activity, hunger, tiredness) and momentary self-criticism. We first demonstrated that self-criticism varies over time and across contexts, and is associated with heightened trait self-criticism. Then, using multilevel modelling, we explored the contextual factors associated with greater self-criticism. We found that self-criticism was higher when people were at home, and more tired. We also found higher self-criticism to be associated with greater negative and lower positive affect, greater distress intolerance, lower willpower and greater perceived criticism from others. In addition, self-criticism predicted subsequent distress intolerance, willpower and positive affect in lagged analyses. This study provides evidence that both environmental and psychological factors are associated with the dynamics of self-critical thoughts.

Immune and metabolic challenges induce changes in pain sensation and related pathways in the hypothalamus.

The hypothalamic molecular processes participate in the regulation of the neuro-immune-endocrine system, including hormone, metabolite, chemokine circulation, and corresponding physiological and behavioral responses. RNA-sequencing profiles were analyzed to understand the effect of juvenile immune and metabolic distress 100 days after virally elicited maternal immune activation during gestation in pigs. Over 1,300 genes exhibited significant additive or interacting effects of gestational immune activation, juvenile distress, and sex. One-third of these genes presented multiple effects, emphasizing the complex interplay of these factors. Key functional categories enriched among affected genes included sensory perception of pain, steroidogenesis, prolactin, neuropeptide, and inflammatory signaling. These categories underscore the intricate relationship between gestational immune activation during gestation, distress, and the response of hypothalamic pathways to insults. These effects were sex-dependent for many genes, such as Prdm12, Oprd1, Isg20, Prl, Oxt, and Vip. The prevalence of differentially expressed genes annotated to proinflammatory and cell cycle processes suggests potential implications for synaptic plasticity and neuronal survival. The gene profiles affected by immune activation, distress, and sex pointed to the action of transcription factors SHOX2, STAT1, and REST. These findings underscore the importance of considering sex and postnatal challenges when studying causes of neurodevelopmental disorders and highlight the complexity of the "two-hit" hypothesis in understanding their etiology. Our study furthers the understanding of the intricate molecular responses in the hypothalamus to gestational immune activation and subsequent distress, shedding light on the sex-specific effects and the potential long-lasting consequences on pain perception, neuroendocrine regulation, and inflammatory processes.NEW & NOTEWORTHY The interaction of infection during gestation and insults later in life influences the molecular mechanisms in the hypothalamus that participate in pain sensation. The response of the hypothalamic transcriptome varies between sexes and can also affect synapses and immune signals. The findings from this study assist in the identification of agonists or antagonists that can guide pretranslational studies to ameliorate the effects of gestational insults interacting with postnatal challenges on physiological or behavioral disorders.

ELIFEwithIBD: study protocol for a randomized controlled trial of an online acceptance and commitment therapy and compassion-based intervention in inflammatory bowel disease.

Inflammatory bowel disease (IBD) entails physical, psychological, and social burden and holds a significant impact on quality of life. Experiential avoidance, cognitive fusion, shame, and self-criticism have been identified as possible therapeutic targets for improving mental health in people with IBD. Traditional face-to-face psychological therapy continues to provide obstacles for patients seeking assistance. Online psychological therapies centered on acceptance, mindfulness, and compassion have been shown to improve psychological distress in other populations. This paper presents the study protocol of a two-arm Randomized Controlled Trial (RCT) of an ACT and compassion-based, online intervention - eLIFEwithIBD - on the improvement of psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, and self-compassion. The eLIFEwithIBD intervention is an adaptation of the LIFEwithIBD programme (delivered through an in-person group format) and entails an ACT, mindfulness, and compassion-based intervention designed to be delivered as an e-health tool for people with IBD. This protocol outlines the structure and contents of the eLIFEwithIBD intervention. Participants were recruited by an advertisement on the social media platforms of Portuguese Associations for IBD in January 2022. A psychologist conducted a brief interview with 80 patients who were interested in participating. Fifty-five participants were selected and randomly assigned to one of two conditions [experimental group (eLIFEwithIBD + medical TAU; n = 37) or control group (medical TAU; n = 18)]. Outcome measurement took place at baseline, post-intervention, and 4-month follow-up. All analyses are planned as intent-to-treat (ITT). The eLIFEwithIBD intervention is expected to empower people with IBD by fostering psychological strategies that promote illness adjustment and well-being and prevent subsequent distress. The eLIFEwithIBD aims to gain a novel and better understanding of the role of online contextual behavioral interventions on improving the quality of life and mental health of people with IBD. https://classic.clinicaltrials.gov/ct2/show/NCT05405855, NCT05405855.

Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma

Background and objectivesCognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals. MethodsOne-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period. ResultsAs anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency. LimitationsThe observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality. ConclusionsThe findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.

Stability Analysis of a Real Life Tilted RCC Over Head Reservoir (Tank) considering Soil-Structure and Fluid-Structure Interaction

Tilt and settlement of RCC structures with foundations over alluvial soil of greater Kolkata and surrounding Ganges Flood Basin is a frequent problem with respect to the stability of these structures. The tilt and subsequent distress have a significant effect on the overall stability of the Over Head Reservoirs (Tanks); which also depend on the nature of the supporting soil, Fluid Structure Interaction (FSI). Various NDTs can be performed to assess the condition of the concrete members, but this piecewise assessments may not adequately address the overall stability of the OHRs subjected to various loadings including lateral seismic forces, particularly for a tilted one. Thus, numerical analysis of the tilted OHR is significantly important to assess its overall stability considering its global behaviour. The present numerical study aims to evaluate the effect of the tilt on the overall stability of a real life existing RCC OHR supported on frame staging. The increase in design reinforcement demand and lateral displacement at crown top level are compared to assess the effect of tilt from the Limit State of Collapse and Limit State of Serviceability points of view. The global effect of the tilt is studied based on the changes of its fundamental period of vibrations of the OHR. Subsequently, Pushover analysis is also performed to evaluate the effect of the tilt on the various parameters e.g. base shear capacity, inelastic displacement at crown top level, global ductility. The vulnerability index based on the pushover analysis results are also compared to ascertain the effect of the tilt. Soil-Structure Interaction and Fluid-Structure Interaction have been duly considered in the Finite Element models on SAP2000 platform to study the effect of tilt on the OHR stability. It is found that the tilt plays a great role on the overall stability and safety of the frame staging OHR, which further get aggravated due to softer supporting soil and considering Fluid-Structure Interactions. The proposed stability analysis of this case study seems to have a great potential for its practical application in safety evaluation and retrofit of existing OHRs subjected to tilt.

Role of Preemptive Nebulized Lignocaine in Endotracheal Tube Tolerance during General Anesthetic induction and emergence

Background: General anesthesia is an essential component of anesthesia and endotracheal intubation is a basic step to secure the airway in patients undergoing any surgical procedure. Airway manipulation causes mucosal inflammation resulting in coughing, straining, bucking and subsequent distress to the patient. Aim: To find out whether preemptive use of nebulized lignocaine has some role in endotracheal tube tolerance during General anesthetic induction and emergence. Study design: Randomized control trial Methodology: The randomized controlled study was done on 68 patients scheduled for general surgical procedures.Patients were allocated intoGroup A and Group Bby closed envelope method with 34 patients in each group. In Group A lignocaine 2% (1.5-2mg/kg) with normalsaline 0.9% to prepare total of 5 ml solution, was used to nebulize the patients with face mask connected with O2 at 7L/min and in Group B5ml normal saline 0.9% was used to nebulize the patients for 15minutes. The endotracheal tube tolerance was noted at both intubation and extubation. Results: Endotracheal tube tolerancein Group A was markedly significant than in Group B both during intubation and extubation. In Group A, 32/34(94.12%) patients reflected tolerance to endotracheal tube both during intubation and extubation while in Group B only 06/34(17.65%) reflected tolerance to endotracheal tube both during intubation and extubation. Conclusion: Preemptive nebulized lignocaine suppresses the airway reflexes and significantly improves the endotracheal tube tolerance. Keywords: Endotracheal intubation, extubation, nebulization, lignocaine.

Stress hormones are associated with inflammatory cytokines and attenuation of T-cell function in the ascites from patients with high grade serous ovarian cancer

Mounting evidence suggests that chronic stress and subsequent distress can promote ovarian cancer progression. These altered psychological states have been linked to sustained release of stress hormones, activation of the β-adrenergic receptors in ovarian cancer cells, and induction of pro-tumoral signaling pathways. In addition, data suggest that chronic stress promotes an inflammatory landscape highlighted by increased infiltration of tumor-associated macrophages into the ovarian tumor microenvironment (TME). In ovarian cancer, ascites is a unique TME comprised of tumor, and immune cells, which secrete pro-tumoral cytokines and chemokines that modulate tumor-associated immunity. However, our knowledge about how stress hormones impact the ascites TME remains limited. We hypothesized that the ascites harbors measurable levels of stress hormones, and accumulation of these in the ascites generates a pro-tumorigenic, inflammatory, and immunosuppressive TME. We evaluated ascites samples from 49 patients with high grade serous ovarian cancer (HGSOC) and quantified cortisol and stress hormones metabolites, metanephrine (MN), and normetanephrine (NMN) in all samples. We also measured 38 individual cytokines in the ascites, including several pro-inflammatory cytokines, such as IL-6, which were positively correlated to MN or NMN levels of those samples. Conversely, we found cortisol levels were negatively correlated to several pro-inflammatory cytokines. As T-cells are integral to the TME and our analyses identified cytokines in the ascites known to modulate T-cell function, we characterized ascites-derived T-cells and assessed the impact of stress hormones on the T-cell phenotype. Our data show an altered CD4+/CD8+ T-cell ratio and a heterogeneous expression of exhaustion markers in T-cells from the ascites, while ascites-derived CD8+ T-cells exposed to epinephrine had decreased co-expression CD38 and Granzyme B. To extend these findings to animal models, we subjected ovarian cancer-bearing mice to daily restraint stress, which resulted in increased tumor growth in two models. Congruent with our human analyses, we detected corticosterone, MN, and NMN in the ascites from tumor-bearing mice, and these stress hormones correlated with several inflammatory cytokines. Moreover, daily restraint stress leads to increased CD4+PD-1+/CD8+PD-1+ T-cell ratio in the ovarian tumor microenvironment. Overall, these data highlight a role of stress hormones in the ascites TME as a driver of tumor-associated inflammation, T-cell suppression, and disease progression.

Internet addiction is associated with psychological distress in highly schizotypal students.

There is some limited evidence of an association between technology addictions and emergence of pre-psychotic symptoms, high psychoticism, psychotic like experiences and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk. We aimed to compare smartphone, Internet and Facebook addictions between low and high schizotypal individuals; and to explore the association between these addictions and distress in the high schizotypy group. From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. The Schizotypal Personality Questionnaire, the Bergen Facebook Addiction Scale, the Internet Addiction Test, the Smartphone Addiction Scale-Short Version and the Depression, Anxiety and Stress Scales. Students of the high schizotypy group displayed significantly greater scores on smartphone (p< .001), Internet (p< .001) and Facebook (p= .001) addictions scales, as compared to those of the low schizotypy group. After controlling for potential confounders, Internet addiction predicted psychological distress in the high schizotypy group (R2 = 0.380, F(13,55) = 2.597, p< .001) and explained an additional 19.7% of variation in Depression, Anxiety and Stress Scales total scores in the final model. Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. It is recommended to raise awareness about Internet addiction risks, particularly among vulnerable young adults; and to find ways to turn Internet into a protective rather than stressor factor, by utilizing it as a resource in the care pathway.

The impact of verbal and physical abuse on distress, mental health, and intentions to quit in sports officials

Sports officials (e.g., referees, umpires, judges) can experience distress from a multitude of sources, including episodes of verbal and physical abuse from spectators, coaches, and athletes. Little is known about the impact of this abuse on mental health (MH) outcomes and intentions to quit, however. As such, the primary aims of this study were to survey the prevalence and frequency of abuse in sports officials and to examine relationships between abuse, distress, and subsequent MH and intentions to quit outcomes. Survey data were collected from 438 Gaelic Games match officials. Of these, 94.29% and 23.06% had experienced verbal and physical abuse respectively during their career. Verbal abuse was mostly experienced a couple of times a season (reported by 43.83% of officials) or every couple of games (31.48%), whereas physical abuse was predominantly experienced once or twice in a career (85.15%). Structural equation modelling was used to assess three alternative models that proposed the relationship between experiences of abuse, and MH and intentions to quit outcomes to be either 1) direct, 2) indirect, fully mediated by distress, or 3) both direct and indirect, partially mediated by distress. For verbal abuse, only the direct and indirect effects model achieved acceptable fit and significantly explained variance in mental wellbeing (9.4%), anxiety (15.2%), depression (15.6%), and intentions to quit (19.1%). For physical abuse, though higher distress was associated with poorer MH and greater intentions to quit, none of the models fully explained the relationships between all variables. These findings demonstrate, for the first time, relationships between abuse, subsequent distress, and MH outcomes. We highlight the urgent need to develop evidence-based psychological interventions to tackle abuse, manage conflict, and support the MH needs of sports officials.

The recurrence of financial distress: A survival analysis

Companies often suffer periods of financial distress before filing for bankruptcy. Unlike one-off bankruptcies, financial distress can occur repeatedly within the same individual firm. This paper is focused on the recurrence of financial distress and studies the Chinese stock market, where Special Treatment – an official indicator of financial distress – can be repeatedly applied to a listed company. We employ a stratified hazard model to predict the probability of subsequent distress with variables, including duration dependency, event-based factors, institutional variables, financial ratios, market-based variables and macroeconomic conditions. Our empirical results show that accounting and market-based variables have limited power in predicting the recurrence of distress, whereas the duration of recovery, restructuring events and their interaction terms with the accounting and macroeconomic factors affect the recurrent risk significantly. Tested on out-of-time samples, our proposed hazard models show a robust performance in the prediction of recurrent risk over time.

ICRE Top Research Abstracts

ICRE Top Research Abstracts

The Death of a Child and Parents' Psychological Distress in Mid to Later Life: Racial/Ethnic Differences in Exposure and Vulnerability.

This study considered whether experiencing the death of a child is associated with subsequent psychological distress in older populations, as well as variation in both exposure and vulnerability to the death of a child among Black, Hispanic, and White older parents. We used multilevel models to link the death of a child with subsequent distress for 9,763 non-Hispanic White, 2,496 non-Hispanic Black, 1,014 foreign-born Hispanic, and 712 U.S.-born Hispanic parents from the Health and Retirement Study, 2006-2016. The death of a child is associated with increased psychological distress in mid to later life for Black, White, and Hispanic parents, with greater vulnerability for foreign-born Hispanic parents. Notably, Black and U.S.-born Hispanic parents are disadvantaged because of the additive effects of their greater exposure to bereavement and their higher distress levels regardless of bereavement status. These effects persist net of additional stressors associated with race/ethnicity. The death of a child is a traumatic life course event associated with lasting psychological distress for aging parents. Black and U.S.-born Hispanic parents are disadvantaged in that they are more likely than White parents to experience the death of a child, and foreign-born Hispanic parents may be disadvantaged by greater vulnerability to distress following child death.

Dynamic thromboembolic left ventricular outflow tract obstruction after aggressive procoagulant treatment in hemorrhagic shock: a case report

BackgroundIn cases of hypertrophic obstructive cardiomyopathy (HOCM), the systolic anterior motion of the mitral valve apparatus results in an obstruction of the left ventricular outflow tract (LVOT), which is known as the SAM [systolic anterior motion] phenomenon. Hypothetically, a pathological obstruction of the LVOT of a different etiology would result in a comparable hemodynamic instability, which would be refractory to inotrope therapy, and may be detectable through echocardiography.Case presentationWe observed a severely impaired left ventricular function due to a combination of a thrombotic LVOT obstruction and distinctive mitral regurgitation in a 56-year-old Caucasian, female patient after massive transfusion with aggressive procoagulant therapy. Initially, the patient had to be resuscitated due to cardiac arrest after a long-distance flight. The resuscitation attempts in combination with lysis therapy due to suspected pulmonary artery embolism were initially successful but resulted in traumatic liver injury, hemorrhagic shock and subsequent acute respiratory distress syndrome (ARDS). Oxygenation was stabilized with veno-venous extracorporeal membrane oxygenation (ECMO), but the hemodynamic situation deteriorated further. Transesophageal echocardiography (TEE) showed a massive, dynamic LVOT obstruction. Two thrombi were attached to the anterior leaflet of the mitral valve, resulting in a predominantly systolic obstruction. Unfortunately, the patient died of multiple-organ failure despite another round of lysis therapy and escalation of the ECMO circuit to a veno-venoarterial cannulation for hemodynamic support.ConclusionMassive transfusion with aggressive procoagulant therapy resulted in mitral valve leaflet thrombosis with dynamic, predominantly systolic LVOT obstruction, comparable to the SAM phenomenon. The pathology was only detectable with a TEE investigation.

Methicillin-Resistant Staphylococcus aureus -Associated Diarrhea in a Critically Ill Burn Patient

Described in surgical patients after antibiotic use in the 1950s and 1960s, Staphylococcus aureus ( S. aureus ) enterocolitis is a rare form of nosocomial diarrhea. However, S. aureus is not routinely tested like Clostridium difficile ( C. difficile ). We report a case of methicillin-resistant S. aureus (MRSA) enterocolitis found on stool culture in a 22-week pregnant female with a previously negative nasal MRSA culture, and a total burn surface area greater than 60%. She also developed necrotizing MRSA pneumonia and bacteremia. After starting broad-spectrum antibiotic for the necrotizing pneumonia with subsequent acute respiratory distress syndrome, the patient exhibited large voluminous diarrhea that tested positive for MRSA and negative for C. difficile in the stool culture. Similar to other reports of high-volume diarrhea, the diarrhea resolved quickly with enteral vancomycin. S. aureus should be considered along with C. difficile during the workup of nosocomial diarrhea, especially with exposure to broad-spectrum antibiotics in the critically ill patient. J Med Cases. 2021;12(7):257-261 doi: https://doi.org/10.14740/jmc3690

Pain and gain of auditory intrusions with video game content: Game transfer phenomena in clinical cases

IntroductionStudies about Game Transfer Phenomena (GTP) have demonstrated lingering effects of playing video games manifesting as sensory, cognitive, and motoric intrusions (e.g., seeing images or hearing voices from the game after playing), transient changes in perception and self-agency. GTP are common among non-clinical players, though those with mental disorders are more susceptible. Gamers tend to appraise GTP as pleasant. Distress has been reported when GTP are experienced frequently and with specific content.ObjectivesTo show the interplay between GTP and patients’ symptomatology and the benefits of using the GTP framework in clinical contexts.MethodsGTP were assessed via clinical interviews and with a validated GTP scale (three cases, males, 10-16 years old, playing time 6-10 h/day).ResultsThe cases were characterised by i) incorporation of videogame content into hallucinations and delusions, ii) identification with a videogame character and subsequent distress provoked by hearing the character’s voice and iii) self-induced GTP as self-soothing behaviour when reducing playing time. Main GTP manifestations were in the auditory modality as sounds or voices. The primary clinical diagnoses were gaming disorder, depressive disorder, and psychosis.ConclusionsOn one hand, GTP can be pleasurable and a way to cope with withdrawal symptoms from gaming disorder, though it can lead to compulsive behaviours and dissociation. On the other hand, GTP can be interpreted negatively and fulfil delusions that provoke distress and compromise mental stability. The cases reveal that the GTP framework can be an effective psycho-pedagogic method and support differential diagnosis.DisclosureNo significant relationships.

Acceptability of immediate postpartum and post-abortion long-acting reversible contraception provision to adolescents: A systematic review.

Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC. In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy.

Trauma: phenomenological causality and implication

The relationship between traumatic experiences and subsequent distress is not well understood, and little research focuses on the lived experience of psychological trauma. I draw on Louis Sass’s phenomenological taxonomy to address this lacuna. I present his differentiation between relations of phenomenological causality and implication and demonstrate that his taxonomy can be applied to experiences of trauma. Relations of phenomenological causality and implication can be identified in the genesis and constitution of post-traumatic distress. My adaptation of Sass’s taxonomy will furthermore offer an extension and development of his account, applying it to the study of post-traumatic experiences and elaborating it in the process. I shall demonstrate that whether experiences occur synchronically or diachronically is not essential to their categorization in terms of phenomenological implication and causality, respectively. I will show that an alteration in perception or behavior post trauma might temporally succeed the traumatizing event while, at the same time, being implied in the experience of the event. Thereby, I demonstrate how phenomenology may contribute to a detailed understanding of experiences of trauma. Scrutiny of traumatic experiences furthermore promises to contribute to the philosophical discourse on causality, implication, and temporal experience.