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Gordon RM, Dahan JF, Wolfson JB, Fults E, Lee YSC, Smith-Wexler L, Liberta TA, McGiffin JN. Existential–Humanistic and Relational Psychotherapy During COVID-19 With Patients With Preexisting Medical Conditions. Journal of Humanistic Psychology 2020. [DOI: 10.1177/0022167820973890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unexpected traumatic events, including life-threatening medical conditions, brain injuries, and pandemics, can be catalysts for patients and clinicians to consider existential issues, including meaning in life. The existential–humanistic and relational perspectives on therapeutic interventions emphasize creating meaning, taking responsibility for one’s own life and self-narratives, choosing and actualizing ways of being in the world that are consistent with values, and expanding the capacity for agency, commitment, and action. Myriad factors have made the COVID-19 pandemic upsetting and potentially traumatic for individuals, including the novel experience of self and other as possibly infectious and dangerous, a sense that anyone is vulnerable, and protracted uncertainty about the duration of the crisis and its consequences. The vignettes included in this article explore risk and reliance factors relevant to patients with preexisting medical conditions during COVID-19 and highlight the benefits of exploring values, priorities, and assumptions, asking open-ended questions about meaning in life and posttraumatic growth, learning for each emotion, and interpretation of dreams. The existential–humanistic and relational approaches offer unique insights into how practitioners might help their patients to reflect on the unanticipated changes and anxieties ignited by COVID-19, while reinforcing the potential to live with greater purpose and intention.
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Affiliation(s)
| | | | | | - Erin Fults
- Hackensack Meridian Health Inc., Edison, NJ, USA
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Swencionis C, Smith-Wexler L, Lent MR, Cimino C, Segal-Isaacson CJ, Ginsberg M, Caban-Pocai A, Wassertheil-Smoller S, Theodore JL, Wylie-Rosett J. Triggers of Lapse and Relapse of Diet and Exercise in Behavioral Weight Loss. Obesity (Silver Spring) 2019; 27:888-893. [PMID: 31033215 PMCID: PMC6533136 DOI: 10.1002/oby.22437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/15/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to (1) develop instruments to evaluate situations that lead to lapse and relapse in diet and exercise and (2) prospectively investigate when and which psychosocial situations predict failure to lose weight in a clinical trial of intentional weight loss. METHODS Participants were 469 individuals with overweight or obesity participating in a behavioral weight loss program (age: mean = 53.6 years, SD = 11.4; BMI: mean = 35.7 kg/m2 , SD = 6.5). RESULTS The Cronbach alphas for the Diet Lapse and Relapse Triggers Scale and the Exercise Lapse and Relapse Triggers Scale were 0.93 and 0.91, respectively. Subscale alphas ranged from 0.60 to 0.96. Lapse and relapse were assessed at 3 and 9 months for associations with weight loss at 12 months. At 9 months, diet triggers were negative emotional states (beta = 0.11, P = 0.02) and urges (beta = 0.14, P = 0.01). Predicted social situations showed the opposite (beta = -0.09, P = 0.02). Exercise subscales were all nonsignificant. CONCLUSIONS Findings suggest the ongoing importance of addressing negative emotional states and the contributing influence of urges. The novel finding that participants whose difficulties arise in social situations may do better over time requires further study.
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Affiliation(s)
- Charles Swencionis
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, New York, USA
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
| | | | - Michelle R Lent
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher Cimino
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - C J Segal-Isaacson
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
| | - Mindy Ginsberg
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
| | - Arlene Caban-Pocai
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
| | - John L Theodore
- Department of Psychology, Iona College, New Rochelle, New York, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology/Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
- Department of Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, New York, USA
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Kim S, Zemon V, Rath JF, Picone M, Gromisch ES, Glubo H, Smith-Wexler L, Foley FW. Screening Instruments for the Early Detection of Cognitive Impairment in Patients with Multiple Sclerosis. Int J MS Care 2017; 19:1-10. [PMID: 28243180 DOI: 10.7224/1537-2073.2015-001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cognitive impairments are common in individuals with MS and adversely affect functioning. Early detection of cognitive impairment, therefore, would enable earlier, and possibly more effective, treatment. We sought to compare self-reports with a short neuropsychological test as possible screening tools for cognitive impairment. METHODS One hundred patients with MS were tested with the Minimal Assessment of Cognitive Function in Multiple Sclerosis; z scores were used to derive the Cognitive Index (CI). Receiver operator characteristic curve analyses were performed, with criteria for impairment set at -1.5 and -2.0 SD below the mean. Scores from two self-reports (the Multiple Sclerosis Neuropsychological Screening Questionnaire-Patient Version and the Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A]) and a neuropsychological test (the Symbol Digit Modalities Test [SDMT]) were entered as test variables. Exploratory regression analyses were conducted with 1) CI and self-reports and 2) CI and the Problem-Solving Inventory (PSI). RESULTS Classification accuracy was high or moderately high for SDMT when the criterion was -2.0 or -1.5 SD, respectively, but low for the self-reports. Hierarchical linear regression showed that the SDMT alone was the best predictor of cognitive impairment; adding the self-reports did not improve the model. Exploratory analyses indicated that certain self-reports (BRIEF-A, PSI) provided some explanatory power in separate models. CONCLUSIONS The SDMT is a more accurate screening tool for cognitive impairment; however, self-reports provide additional information and may complement objective testing. Results suggest that screening for cognitive impairment may require a multidimensional approach.
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Smith-Wexler L, Childs A, Rath JF. Disordered Eating, Weight, and Physical Activity Concerns in Rehabilitation Outpatients with Acquired Brain Injury. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Childs A, Long C, Smith M, Ellois V, Smith-Wexler L, Rath JF, Bushnik T. Body Mass Index Following Traumatic Brain Injury: Demographic and Psychosocial Variables at Injury and One-Year Follow-up. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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