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Geng C, Zhang M, Zhang L, Yin H, Wang S. Effects of Narrative Exposure Therapy for Treating Depressive and Anxious Disorders: A Systematic Review and Meta-Analysis. Psychiatry Investig 2024; 21:329-339. [PMID: 38695040 PMCID: PMC11065527 DOI: 10.30773/pi.2023.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 12/28/2023] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE Narrative exposure therapy (NET) has been used in various contexts for the treatment of the effects of trauma, with promising results in clinical trials. However, its effects on anxiety and depression are still unclear. The present study is a systematic review and meta-analysis of the effects of NET on depression and anxiety. METHODS The Embase, Cumulative Index of Nursing and Allied Health Literature, PubMed, Web of Science core collection, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and Wangfang databases were searched from the earliest records to March 2023. Two researchers independently screened the literature, extracted data, evaluated the risk of bias, and cross-checked the data. Meta-analysis was performed using the program RevMan 5.3. RESULTS Eleven randomized controlled trials with a total of 754 participants were included in the study. The results showed that NET reduced both the depression (standard mean difference [SMD]=-0.51, 95% confidence interval [CI] -0.73--0.29, p<0.00001) and anxiety (SMD=-0.65, 95% CI -1.13--0.18, p=0.007) scores of the patients. Furthermore, NET was found to alleviate negative emotions associated with guilt (mean difference [MD]=-3.60, 95% CI -5.52--1.68, p=0.0005) and negative change (MD=-5.80, 95% CI -9.76--1.83, p=0.004). CONCLUSION This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients' negative feelings and aid their overall recovery.
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Affiliation(s)
- Chen Geng
- Department of Intensive Care Unit, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Miao Zhang
- Department of Intensive Care Unit, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Lily Zhang
- Department of Intensive Care Unit, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Hai Yin
- Department of Intensive Care Unit, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Suyun Wang
- Department of Nursing, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Zhou M, Li X, Huang C, Xie J, Liu L, Wang Y, Xiao G, Zhang T, Qin C. Needs for supporting women undergoing termination of pregnancy for fetal anomaly: A phenomenological study based on the cognitive-emotional-behavioral framework. Midwifery 2023; 123:103726. [PMID: 37192569 DOI: 10.1016/j.midw.2023.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine and describe the needs of women undergoing termination of pregnancy for fetal anomaly (TOPFA) in China. STUDY DESIGN Qualitative study with semi-structured interviews. Consolidated Criteria for Reporting Qualitative Studies checklist was used for reporting. SETTING Three general hospitals and one special hospital in Changsha, Hunan, China. PARTICIPANTS 12 women who had undergone TOPFA and 12 healthcare providers who had experienced in caring for these women. METHODS This study was based on the cognitive-emotional-behavioral framework (CEBF) of women who had to undergo TOPFA. Twenty-four participants (12 women and 12 healthcare providers) were recruited from two hospitals in China. Semi-structured face-to-face interviews were conducted based on interview guides. ATLAS.ti software was used to encode and analyze data. Qualitative content analysis was also applied. FINDINGS Four themes emerged: information, emotional, professional psychological, and social supports. Each theme was subdivided into four phases for a detailed description of the temporal order (denial, confirmation, decision-making, and recovery phases) within the framework. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our study analyzes the four needs of women who underwent TOPFA and the specifics of each need at different phases based on the CEBF. The importance of offering professional psychological support, detailed information, timely emotional support, and comprehensive social support for these women is illustrated. This study contributes to the understanding of women's needs, hence providing a theoretical basis for the construction of supportive programs.
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Affiliation(s)
- Mengjia Zhou
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Xi Li
- School of Medicine, Jishou University, Jishou, China
| | - Chi Huang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Jiaying Xie
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Li Liu
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Ying Wang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Gui Xiao
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Tingting Zhang
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China; XiangYa School of Nursing, Central South University, Changsha, China
| | - Chunxiang Qin
- Department of Health Management, The Third XiangYa Hospital, Central South University, Changsha, China.
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Moreira A, Moreira AC, Rocha JC. Randomized Controlled Trial: Cognitive-Narrative Therapy for IPV Victims. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2998-NP3014. [PMID: 32755265 DOI: 10.1177/0886260520943719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective is to test the efficacy of cognitive-narrative therapy in the treatment of depression, post-traumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD) and borderline symptoms on a sample of women who suffered from intimate partner violence (IPV). Trial design is a longitudinal randomized controlled trial with a sample of 19 battered women allocated in two groups, a control group and treatment group, assessed twice at baseline before intervention, and at follow-up. The outcome measures were the Patient Health Questionnaire, International Trauma Questionnaire, PTSD and CPTSD Diagnostic Interview Schedule for International Classification of Diseases (ICD)-11, Conjugal Violence Exposure Scale (CVES), Life Events Checklist and Intervention Program Satisfaction Assessment Instrument. The treatment group received a four-session cognitive-narrative manualized intervention. There were no statistically significant differences between groups at baseline and follow-up, however, positive effect sizes ranging between 0.04 and 0.43 were found in depression, PTSD, and borderline, as well in some CPTSD dimensions when analyzing baseline-follow-up deltas between groups. There was also a negative effect size of -0.28 in the CPTSD total. This intervention is effective in the treatment of depression, PTSD and borderline and is an important tool in the treatment of these disorders.
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Affiliation(s)
- André Moreira
- Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
| | | | - José Carlos Rocha
- Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Gandra, Portugal
- Centro de Psicologia do Trauma e do Luto, Vila Nova de Gaia, Portugal
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González-Ramos Z, Zuriguel-Pérez E, Albacar-Riobóo N, Casadó-Marín L. The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review. Midwifery 2021; 103:103095. [PMID: 34320417 DOI: 10.1016/j.midw.2021.103095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In most countries of the world the only basis for considering a termination of pregnancy is for medical reasons. Depending on the circumstances and determinants of each case, the emotional responses to this event vary greatly. The aim of this study is to map the emotional responses of women when their pregnancy is terminated for medical reasons. METHODS A scoping review was carried out. This covered all types of qualitative and quantitative studies published in English or Spanish since 2014 which included first-person accounts of women's emotional responses when they had a termination. A bibliographic search was made of four databases (CINAHL, Cochrane Library, PsycINFO and Pubmed) along with an additional manual search and backward and forward citation chaining of the studies included. The data were reported in narrative form and the results grouped according to the descriptive characteristics of the study and the emotions involved. FINDINGS The review process resulted in the inclusion of thirty-four studies. nineteen of these followed a qualitative approach and fifteen used quantitative methodology, with six of them being intervention studies. The emotions found ranged from anxiety and depression to guilt and thankfulness, so various authors stressed the need to improve training for health professionals to provide information, advice and support to the women during the entire process of the termination of pregnancy for medical reasons. CONCLUSIONS The available studies cannot be compared given the variety of designs. The predominant emotions underlying the termination for medical reasons were stress, anxiety and depression. Future research should be carried out using samples of participants covering all causes of termination for medical reasons in a particular context so that an intervention can be designed to help lessen the impact of the process on women's mental health.
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Affiliation(s)
- Zuleika González-Ramos
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain; Hospital Vall d'Hebron. Passeig de la Vall d'Hebron, 119-129, Postal Code 08035 Barcelona, Spain
| | - Núria Albacar-Riobóo
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
| | - Lina Casadó-Marín
- Department of Nursing, University Rovira i Virgili. Avinguda Catalunya, 35, Postal Code 43002, Tarragona, Spain
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Sexton A, James PA. Metaphors and why these are important in all aspects of genetic counseling. J Genet Couns 2021; 31:34-40. [PMID: 34233383 DOI: 10.1002/jgc4.1463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/11/2022]
Abstract
Metaphors appear simple but are fundamental schemata allowing expression and processing of complex emotions and information. They are so embedded in language and thinking that we are often unaware of their impact, despite the crucial role of metaphors in communication, learning and creating meaning from experiences. A deeper understanding of how to recognize and work with client-generated and counselor-generated metaphors has great potential as an addition to the genetic counseling 'tool-box'. Here, we draw on studies from related health and psychotherapy fields to discuss how working purposefully with metaphors may offer a powerful way to enhance communication within a reciprocally engaged client-counselor relationship. Metaphors present ways to explain complex genetic concepts in a personally meaningful form, to gain a deeper understanding of client's experiences and emotions, to assist processing of experiences, emotions, and concepts, and to assist client and counselor to access and reflect on subconscious emotions, self-concept, and motivations. In addition, working with metaphors has been shown to facilitate coping and action. This paper sets the scene for why and how genetic counselors can utilize client-generated and counselor-generated metaphors purposefully in all areas of practice, including enhancing the therapeutic interaction with clients, as well as in supervision, training, cultural competence, and shaping of societal attitudes toward genetics.
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Affiliation(s)
- Adrienne Sexton
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Paul A James
- Genomic Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Psychosocial interventions on psychological outcomes of parents with perinatal loss: A systematic review and meta-analysis. Int J Nurs Stud 2021; 117:103871. [PMID: 33548593 DOI: 10.1016/j.ijnurstu.2021.103871] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perinatal loss can occur due to miscarriages and ectopic pregnancies, among other circumstances. Psychological health of parents can deteriorate due to perinatal loss. Parent's negative psychological outcomes include depression, anxiety, and grief. OBJECTIVE To evaluate the effectiveness of psychosocial interventions in reducing depression, anxiety, and grief among parents after perinatal loss. DESIGN A systematic review and meta-analysis of randomized controlled trials DATA SOURCES: English language articles published from database inception to 19 November 2019 were systematically retrieved from eight electronic databases (CINAHL, Cochrane, EMBASE, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science). REVIEW METHODS The Cochrane Risk of Bias tool was used to conduct quality appraisal of each individual article and data was analyzed using Review Manager 5.3. A meta-analysis of randomized controlled trials was conducted using a random-effect model. RESULTS Among this review's 17 included studies, 15 studies' results were included in the meta-analyses. The remaining two studies were summarized narratively. Meta-analyses revealed that psychosocial interventions significantly reduced depression (95% CI: -0.64 to -0.29, Z = 5.17, p = <0.00001), anxiety (95% CI: -0.50 to -0.18, Z = 4.21, p < 0.0001) and grief (95% CI: -0.71 to -0.32, Z = 5.12, p < 0.0001). CONCLUSION Psychosocial interventions are effective in improving depression, anxiety, and grief amongst parents with perinatal loss. Psychosocial care can be provided by medical healthcare professionals and expanded with technology-assisted implementation. STUDY REGISTRATION NUMBER CRD42019145526.
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A systematic review of instruments measuring grief after perinatal loss and factors associated with grief reactions. Palliat Support Care 2020; 19:246-256. [PMID: 32867873 DOI: 10.1017/s1478951520000826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Expectant parents who live through perinatal loss experience intense grief, which is not always acknowledged or accepted. A screening tool to detect bereaved parents' grief reactions can guide professionals, including perinatal palliative care teams, to provide follow-up for those in need. This review's goal is to identify and synthesize the international published literature on existent instruments specifically measuring the grieving process after any perinatal loss and to identify factors that could moderate grief reactions. METHOD Systematic review (PROSPERO # CRD42018092555) with critical synthesis. PUBMED, Cochrane, and PsycINFO databases were searched in English language articles using the keywords "perinatal" AND ("grief" OR "bereavement" OR mourning) AND ("scale" OR "questionnaire" OR "measure" OR "assessment") up to May 2018. Eligibility criteria included every study using a measure to assess perinatal grief after all kinds of perinatal losses, including validations and translations to other languages and interventions designed to alleviate grief symptoms. RESULTS A total of 67 papers met inclusion criteria. Seven instruments measuring perinatal grief published between 1984 and 2002 are described. The Perinatal Grief Scale (PGS) was used in 53 of the selected studies. Of those, 39 analyzed factors associated with grief reactions. Six articles used PGS scores to evaluate pre- and post-bereavement interventions. Studies in English language only might have limited the number of articles. SIGNIFICANCE OF RESULTS The PGS is the most used standardized measures to assess grief after perinatal loss. All parents living through any kind of perinatal loss should be screened.
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