Part II: Psychological Factors In Delayed And Failed Recovery and Unnecessary Disability

2019 ◽  
Vol 24 (4) ◽  
pp. 3-14
Author(s):  
Garson Caruso ◽  
Les Kertay
Keyword(s):  
Psychological Factors ◽  
Cost Utility ◽  
Stepped Care ◽  
Evidence Based ◽  
Mind And Body ◽  
Compensation Claims ◽  
Management Approaches ◽  
Health Cognitions ◽  
Difficult Cases ◽  
Specific Evaluation

Abstract Part two of this two-part article on psychological factors in delayed and failed recovery and resultant unnecessary work disability (DFRUD) considers both conceptual and practical interventions, including specific evaluation and treatment methods. The authors propose five categories of intervention for DERUD: 1) advance and operationalize our knowledge base; 2) make conceptual and practical shifts in our approaches; 3) place greater emphasis on prevention; 4) improve recognition of potentially difficult cases, and 5) apply specific management approaches and tools. Further, the authors propose conceptual and practical changes that should be made: Eliminate the dualistic separation of mind and body and the scientific reductionism that follows; change the focus from disability to capability; reduce improper workers’ compensation claims; improve the administrative and medical management of valid claims; enhance collegiality and communication among all stakeholders; and adopt a cost-utility vs absolute cost approach. The overarching goals of managing DFRUD include optimizing administrative and clinical treatment of the worker; protecting all stakeholders from excess; and overcoming barriers to intervention. To these ends, three activities can optimize the process: Intervene early; avoid iatrogenicity (ie, shorten claim durations and reduce costs); and stratify risk and employ stepped care. Barriers to meaningful intervention in DFRUD include questions of jurisdiction and responsibility for management (eg, does management of DFRUD fall to insurers or clinicians); who will pay; what are the maladaptive health cognitions and/or psychiatric comorbidities; and how can clinician behavior be altered to implement evidence-based practice?

Disorders of Impulse Control and Self-Harm

2010 ◽  
pp. 504-530 ◽  
Author(s):  
Matthew K. Nock ◽  
Christine B. Cha ◽  
Halina J. Dour
Keyword(s):  
Environmental Factors ◽  
Psychological Factors ◽  
Impulse Control ◽  
Clinical Presentation ◽  
Evidence Based ◽  
Comprehensive Review ◽  
Assessment And Treatment ◽  
Self Harm ◽  
Clinical Problems ◽  
Control Spectrum

Disorders of impulse-control and self-harm are dangerous clinical problems that often present significant challenges for scientists and clinicians. In this chapter, we provide a comprehensive review of each disorder on the impulse-control spectrum. We begin by describing the clinical presentation and epidemiology of each disorder. Next, we discuss what is currently known about the etiology of these disorders, summarizing recent research on genetic/neurobiological factors, environmental factors, and psychological factors that appear to influence these disorders. The assessment and treatment of disorders of impulse-control and self-harm is complicated by the relatively low base-rate of these disorders, as well as by their dangerous and sensitive nature. Nevertheless, several evidence-based approaches to assessment and treatment have been developed and also are reviewed here. We conclude with recommendations for future scientific and clinical efforts aimed at better understanding, predicting, and preventing disorders of impulse-control and self-harm.

Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

2021 ◽  
Vol 35 (3) ◽  
pp. 221-231
Author(s):  
Alessandro S. De Nadai ◽  
Joseph L. Etherton
Keyword(s):  
Stepped Care ◽  
Insurance Companies ◽  
Evidence Based ◽  
Efficiency Ratio ◽  
Low Intensity ◽  
Clinical Efficiency ◽  
Referral Decisions ◽  
New Perspective ◽  
Evidence Based Care ◽  
Widespread Dissemination

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

Access to Evidence-Based Services for Individuals With Borderline Personality Disorder

2019 ◽  
pp. 155-176
Author(s):  
Peter King ◽  
Jennifer M. Martin
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sexual Assault ◽  
Treatment Outcomes ◽  
Psychological Factors ◽  
Borderline Personality ◽  
Evidence Based ◽  
International Literature ◽  
High Prevalence ◽  
Key Features

This chapter outlines the key features of the diagnosis of borderline personality disorder. This is a diagnosis that has attracted significant levels of stigma and has generally been viewed as difficult to treat. This has resulted in often inadequate service responses for people experiencing high levels of distress. Increased understanding is facilitated by exploring precipitating factors leading to this diagnosis, including invalidating and often traumatizing environments. Available evidence from Australian and international literature is considered, with main treatments identified to inform improved treatment outcomes. The need for attention to biological, psychological factors is highlighted and in particular acknowledgment of the high prevalence of trauma, particularly childhood sexual assault, amongst the mostly women who are given this diagnosis.

Psychogenic Pain: A Useful Concept?

2021 ◽  
pp. 189-210
Author(s):  
Daniel M. Doleys ◽  
Nicholas D. Doleys
Keyword(s):  
Psychological Factors ◽  
Modern Technology ◽  
Research Data ◽  
Physical Factors ◽  
Supporting Evidence ◽  
Mental Processes ◽  
Philosophical Approach ◽  
Psychological States ◽  
Psychogenic Pain ◽  
Mind And Body

The term “psychogenic” pain was use liberally during the 20th century. It has been applied in a number of different ways. First, to describe pain originating from psychological/psychiatric (ie, mental) processes. Second, as a way of declaring that, although there may be physical abnormalities, the degree of pain experienced is dictated by psychological states. Finally, to imply that psychological factors co-mingle with physical factors in the experience of pain, especially chronic pain. By its very nature, “psychogenic” implies of separation of mind and body. Most often it has been used as a diagnosis of exclusion—we cannot find the real (ie, medical/physical) cause, so it must be psychological, all but impugning the validity of the patient’s report. In the midst of modern technology and research, and the prevailing philosophical approach to pain (chronic), the term “psychogenic” has exhausted its research, clinical, and practical utility. This chapter provides supporting evidence for this conclusion and research data highlighting the complex and dynamic nature of pain (chronic).

Exploring undergraduates’ money-management life: insight from an emerging economy

2019 ◽  
Vol 20 (3) ◽  
pp. 167-189 ◽  
Author(s):  
Vilani Sachitra ◽  
Dinushi Wijesinghe ◽  
Wajira Gunasena
Keyword(s):  
Financial Literacy ◽  
Psychological Factors ◽  
Management Strategies ◽  
The Body ◽  
Future Research ◽  
Money Management ◽  
Content Type ◽  
Financial Decisions ◽  
Management Behaviour ◽  
Management Approaches

Purpose Undergraduates are expected to be future leaders responsible for business and nations. Given that sound financial decision-making is critical to their success in their careers and lives, it is important to understand the money-management behaviour of undergraduates. In the context of developing countries, the body of knowledge on money-management behaviour is dominated by functional financial literature and there is little research on factors beyond this. This study aims to fill this gap by exploring economic, social and psychological factors that influence money-management behaviour of undergraduates in a developing nation (Sri Lanka) and how undergraduates respond to these influences. Design/methodology/approach The study used a qualitative exploratory approach. Data collection was carried out using focus group discussions and individual interviews amongst undergraduates in a leading Sri Lankan state university. Findings The results indicate that undergraduates adopted both careful and risky money-management approaches. The subthemes, specifically identified under economic, social and psychological factors, revealed how undergraduates responded to each of these factors and the influence of contextual and cultural differences in their money-management behaviour. Research limitations/implications Findings of the study revealed the importance of promoting innovative educational strategies to change the dependability mindset of undergraduates and to promote stress-management strategies that will assist them to enhance their personalities and creativity in making financial decisions. Theoretical and practical implications and future research directions are provided. Originality/value The literature scores in developing context are limited to exploring the existing pattern and the levels of the functional financial literacy. This study has deepened the authors’ understanding of how the developing context affects undergraduates’ response to the factors relating to their money-management behaviour. The findings from this study will be useful to government, financial institutions, educational institutions, parents and those who have a keen interest in encouraging healthy money-management behaviour in undergraduates.

Disorders of Impulse Control and Self-Harm

2014 ◽  
pp. 510-536
Author(s):  
Matthew K. Nock ◽  
Christine B. Cha ◽  
Halina J. Dour
Keyword(s):  
Environmental Factors ◽  
Psychological Factors ◽  
Impulse Control ◽  
Clinical Presentation ◽  
Evidence Based ◽  
Comprehensive Review ◽  
Assessment And Treatment ◽  
Self Harm ◽  
Clinical Problems ◽  
Control Spectrum

Disorders of impulse-control and self-harm are dangerous clinical problems that often present significant challenges for scientists and clinicians. In this chapter, we provide a comprehensive review of each disorder on the impulse-control spectrum. We begin by describing the clinical presentation and epidemiology of each disorder. Next, we discuss what is currently known about the etiology of these disorders, summarizing recent research on genetic/neurobiological factors, environmental factors, and psychological factors that appear to influence these disorders. The assessment and treatment of disorders of impulse-control and self-harm is complicated by the relatively low base-rate of these disorders, as well as by their dangerous and sensitive nature. Nevertheless, several evidence-based approaches to assessment and treatment have been developed and also are reviewed here. We conclude with recommendations for future scientific and clinical efforts aimed at better understanding, predicting, and preventing disorders of impulse-control and self-harm.

scholarly journals What Is the Potential for Applying Cost-Utility Analysis to Facilitate Evidence-Based Decision Making in Schools?

2019 ◽  
Vol 48 (5) ◽  
pp. 287-295 ◽  
Author(s):  
Fiona Hollands ◽  
Yilin Pan ◽  
Maya Escueta
Keyword(s):  
Decision Making ◽  
Program Effectiveness ◽  
Multicriteria Decision Making ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Decision Makers ◽  
Evidence Based ◽  
Utility Analysis ◽  
Local Conditions ◽  
Education Decision

Education decision makers routinely make choices among programs and strategies to implement. Policy demands increasingly require that such decisions are based on evidence regarding program effectiveness at improving student outcomes. However, research evidence is but one of the considerations that practitioners must juggle, along with local conditions, capacity, resource availability, and stakeholder values. We investigated the feasibility of applying a multicriteria decision-making framework based on cost-utility analysis to facilitate evidence-based decisions by educators. Working with a total of 183 aspiring school leaders in class settings, we determined to what extent they could implement the initial steps of the framework. We subsequently invited three educators to apply the full framework to substantive decisions in their schools and report the results.

scholarly journals Medically Unexplained Pain Is Not Caused by Psychopathology

2000 ◽  
Vol 5 (4) ◽  
pp. 251-257 ◽  
Author(s):  
Lucia Gagliese ◽  
Joel Katz
Keyword(s):  
Psychological Factors ◽  
Research Management ◽  
Psychological Disorder ◽  
Unexplained Pain ◽  
Gate Control Theory ◽  
Mind And Body ◽  
Gate Control ◽  
Medically Unexplained ◽  
Theory Research

This paper highlights Professor Ronald Melzack's theoretical contributions to the understanding of psychological factors in pain. His work continues to have profound influences on pain theory, research, management and public policy. His ideas have been pivotal to the acceptance of the role of the brain and psychological factors in the experience of pain. This article briefly outlines the prevailing theories of the psychology of pain before the gate-control theory. Melzack's contributions argue against the simplistic linear thinking inherent in specificity theory, which leads to the attribution of pain to either 'organic' or 'psychogenic' causes. Nevertheless, Cartesian dualism continues to thrive. The authors illustrate the nature and extent to which dualistic thinking pervades the field, show that a dualistic conceptualization of pain introduces an element of distrust to the relationship between patient and health professional, and conclude that the available data fail to reach today's standards for an evidence-based approach to pain. The authors believe that medically unexplained pain is not a symptom of a psychological disorder and that it is time to abandon the thinking that separates mind and body. The challenge remains for proponents to provide the empirical evidence to prove that psychopathology causes pain and, in so doing, to specify the mechanisms by which it is generated.

scholarly journals Stepped-Care Approaches to Posttraumatic Stress Disorder: Sharpening Tools for the Clinician’s Toolbox

2017 ◽  
Vol 13 (2) ◽  
pp. 142 ◽  
Author(s):  
Jeffrey A. Cigrang ◽  
Alan L. Peterson
Keyword(s):  
Stress Disorder ◽  
Research Literature ◽  
Stepped Care ◽  
Current Status ◽  
Traumatic Experiences ◽  
Evidence Based ◽  
Care Model ◽  
Evidence Based Treatment ◽  
Potential Value ◽  
Care Models

<p> Austern (2017) presents three composite Veteran case studies using Written Exposure Therapy (WET; Sloan, Lee, Litwack, Sawyer, &amp; Marx, 2013) as a first-level intervention in a larger stepped-care model for PTSD.  The relatively minimalist WET intervention may be appealing to Veterans with PTSD who have opted not to seek out more time and therapist-intensive treatments.  In addition, writing has been used effectively in other protocols as a method of achieving exposure to memories of traumatic experiences.  Austern’s three cases demonstrate a range of success in using WET to engage Veterans in evidence-based treatment and reduce suffering associated with PTSD.  We comment on the current status of the research literature on stepped-care models for PTSD, the potential value of incorporating Motivational Interviewing principles and specific homework tasks into these efforts, and the promise that abbreviated interventions and stepped-care approaches may hold for helping clinicians manage their clinical caseloads and avoid burnout.</p><p> </p>

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