The role of sense of coherence and emotion regulation difficulties in the relationship between early maladaptive schemas and grief

The protective role of sense of coherence in resident physicians facing secondary trauma due to patient death in intensive care-A qualitative inquiry

The salutogenic paradigm is increasingly used in research and practice but remains to be investigated in secondary trauma of health professionals. This qualitative study explored the main anchor of salutogenics, the sense-of-coherence, as a coping mechanism among resident physicians facing secondary trauma due to continuous exposure to patient suffering and deaths. Participants were sixteen resident physicians from intensive care units at emergency departments of two Israeli public tertiary hospitals. Data analysis employed reflexive thematic analysis. Findings suggest that while all residents described having comprehensibility, manageability and meaningfulness differed among residents. Some residents thrived, coped well with secondary trauma, centered on patient emotional needs, and drew meaningfulness from the challenges. Other residents suffered while providing care, reported poor well-being, were too overwhelmed to center patients, and doubted their career choices. Salutogenic-based interventions to cultivate the resilience of resident physicians experiencing secondary trauma are proposed.

Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis

BACKGROUND

Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia.

METHOD

PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain.

RESULTS

A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]).

CONCLUSIONS

The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.

Investigating the mediating influence of distress tolerance on the relationship between existential thinking, sense of coherence, and the severity of mourning among families who lost a loved one to COVID-19: A cross-sectional study

Background and Aims

The objective of the current study was to examine how distress tolerance functions as a mediator in the relationship between existential thinking, sense of coherence, and the severity of mourning experienced by families who have lost a loved one to COVID-19.

Methods

The present study employed a descriptive correlational research design, targeting family members of those who passed away due to COVID-19 in the city of Mianeh in 2022. A sample of 160 individuals was selected for statistical analysis. The research instruments used in this study consisted of Flensberg's sense of coherence questionnaire (2006), Simmons and Gaher's emotional distress tolerance questionnaire (2005), Sugbart and Scott's grief experience questionnaire (1989), and Branton Scherer's existential thinking questionnaire (2006). The collected data were analyzed using path analysis, as well as SPSS and Amos software.

Results

The findings of the study revealed a significant correlation coefficient between existential thinking (r = 0.465), sense of coherence (r = 0.401), and distress tolerance (r = 0.521) with the severity of mourning experienced by families who lost a loved one to COVID-19. Moreover, the results indicated a positive and significant relationship (p > 0.01) between distress tolerance and sense of coherence (r = 0.126), as well as between distress tolerance and existential thinking (r = 0.059) among the bereaved families. However, the bootstrap test results suggested that distress tolerance did not mediate the relationship between sense of coherence and the severity of mourning in the families of COVID-19 victims.

Conclusion

Consistent with prior research, the current study's findings indicated that both existential thinking and sense of coherence had a direct impact on the severity of mourning experienced by families who lost a loved one to COVID-19. Additionally, the results revealed that the influence of existential thinking on the severity of mourning was mediated indirectly by increasing distress tolerance.