Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy

Background In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. Methods Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. Conclusions Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

Introducing The Dizziness Wheel – A New Approach for Optometrists to Evaluate Dizziness/Imbalance in mTBI/Concussion Patients

More than 3.8 million Americans sustain a concussion or mild traumatic brain injury each year. Over 70 percent (2.66 million) of these patients suffer consequential vision dysfunctions. Research has shown that optometric vision therapy can provide significant improvement in post-concussion vision problems. However, assessing and managing post-concussion visual dysfunctions can be challenging for the optometrist. This difficulty is primarily due to the complex and diffuse damage the brain incurs from concussion, resulting in a unique clinical profile for each individual patient. When vision-based dizziness or imbalance complaints are included in the post-concussion patient’s presentation, the evaluation and management process becomes more complicated. This challenge is exacerbated by the plethora of comorbid, non-vision-based causes for dizziness/imbalance (D/I) that might also be present. According to the Center of Disease Control and Prevention, more than one-third of adults aged 65 years and older suffer falls each year, many of which are secondary to D/I. At least half of the U.S. population is affected by a balance or vestibular disorder sometime during their lives. The purpose of this article is to introduce The Dizziness Wheel. It is a graphic tool, developed and utilized by this author, to help assess and triage a concussed patient’s D/I. It also aids the identification of links amongst multisystem disruptions. This is especially helpful because D/I almost always represent a complex combination of overlapping symptoms. The Dizziness Wheel is not intended to be used as a formal diagnostic tool. Rather it is a differentiation graphic for use throughout the patient’s therapeutic experience. This author has found it to be helpful during initial exams, follow-ups, and in-office therapy. The Dizziness Wheel also can serve as a helpful guide for referral to other types of healthcare providers. Many D/I patients present to the neuro-rehabilitation optometrist without having been comprehensively assessed and treated for non-visual causes of D/I. The Dizziness Wheel can help the optometrist ensure the patient’s safety and access to effective integrated management of dizziness and imbalance.

COVID Feel Good – A Self-Help Virtual Therapeutic Experience for Overcoming the Psychological Distress of the COVID-19 Pandemic: Results from a European Multicentric Trial

The primary aim of the present study was to investigate the efficacy of a self-help virtual therapeutic experience (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown across different countries. For this purpose, we focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. Primary outcome measures were depression, anxiety and stress symptoms, perceived stress levels and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. To assess the efficacy of the intervention in a multicentric context, we evaluated the strength of evidence supporting the COVID Feel Good computing a single summary estimate of the effect across the different countries. Using separate linear mixed-effect models, the most consistent result across the different countries was an improvement of the perceived stress level after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effect meta-analysis, we found that COVID Feel Good intervention was associated a decrease in the perceived general distress [mean standardized effect size for general distress in the treatment groups compared to the control conditions was 0.52 (p = 0.007, 95% CI: 0.14, 0.89] and with an increase the perceived social connection [mean standardized effect size for social connection using COVID Feel Good compared to the control conditions was -0.50 (p = < 0.001, 95% CI: -0.76, -0.25)]. Globally findings suggest the efficacy of the proposed protocol and contribute the growing literature supporting the use of digital psychological interventions to reduce the psychological stress among general population during the COVID-19 crisis.

Digging Down or Scratching the Surface: How Patients Use Metaphors to Describe their Experiences of Psychotherapy

Background: In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression.Methods: Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results: Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent.Conclusions: Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration: Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic

Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants’ responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating “positive valency”. “Positive valency” responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, “negative valency” responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.

The complexity of the therapeutic experience within the therapeutic community based on an ex-patient’s account

Purpose The purpose of this paper is to explore the effectiveness of the therapeutic community and to look at the potential changes that some patients may experience following treatment at the therapeutic communities (TC). Design/methodology/approach A thematic analysis was conducted on an e-mail sent by an ex-patient of the TC. The text was reviewed multiple times and codes were generated. Based on the data found, three themes were identified. The e-mail was sent to the patient’s primary therapist, who was asked to provide an account of the e-mail. The therapist was sent six questions created by the authors of the paper; the responses were used to compare the two perspectives. Findings The main findings entailed the changes the patient went through after her treatment at the TC. The patient’s account described her inability to process the adversities she had been through at the time and therefore her inability to communicate them. However, the impact the service had on the patient, according to the e-mail was evident years later. The lack of a support network during treatment at the TC and evidence of one following treatment seemed to be the key factor in the patient’s improvement. Originality/value The authors confirm that the research presented in this paper is their original work. The authors hereby acknowledge that all material included in this piece of work, that has been published or written by another person has been referenced accordingly.

Trigeminal rhizotomies in the treatment of trigemium neuralgia

Background: Rhizotomy is a procedure that seeks to interrupt, the pain function of sensitive nerves. Trigeminal Neuralgia (TN) is a disease that can benefit from a trigeminal rhizotomy. Currently, percutaneous trigeminal radiofrequency rhizotomy and balloon microcompression techniques are widely used. Objective: To expose therapeutic experience of TN by trigeminal rhizotomy therapy. Methods: Retrospective study of TN patients undergoing trigeminal rhizotomy in a reference service in endovascular neurosurgery in Blumenau, Santa Catarina, from 2009 to 2019. The variables analyzed were gender, age, symptoms, comorbidities and procedural characteristics. Results: 39 patients were analyzed, 24 were women (61.5%) aged between 33 and 84 years and a mean of 62.8 years old. Regarding the symptoms presented, the most prevalent was headache (69.2%), followed by paresthesia (10.2%), tinnitus (7.7%) and dizziness (5.1%). For comorbidities, 25.6% had systemic arterial hypertension and 15.4% had dyslipidemia. The trigeminal branches most involved in rhizotomies were V2-V3 (56.4%), followed by V2 (28.2%), V1 (7.7%), V1-V2 (5.1%) and V3 (2.5%). The left side was more affected (56.4%). The percutaneous approach was performed in all patients, in 92.3% the balloon technique was performed and in 7.7% radiofrequency was used. In 79,5% of the cases, it was possible to accomplish the treatment with only one session. Conclusion: The approach of TN through rhizotomy proved to be a technique with low morbidity, reaffirming the good results of therapy. The monitoring of cases is essential to allow a better assessment of the long-term effectivenes of the treatment.