The functions of the dreams of the deceased: A qualitative study of women bereaved by partner's suicide

Suicide bereavement is a challenging experience that affects relationships, feelings, and physical and mental health. The research on dreams during suicide bereavement might deepen the understanding of how the loved one's suicide affects the person and what functions the dreams can have during the bereavement process. Therefore, the goal of the current study was to explore the functions of the dreams of the deceased during suicide bereavement in a sample of 9 women bereaved by their partner's suicide. The data was gathered by conducting semi-structured interviews and analyzed using reflexive thematic analysis. Three themes were generated: dreams function as helping during the process of suicide bereavement; dreams reflect the traumatic aspects of suicide bereavement; dreams function as a space to maintain or sever an ongoing relationship with the deceased. The findings reveal that dreams can function in different ways and can be a valid part of suicide bereavement.

Gender Self-Confidence as a Protective Factor for Suicide Risk: Analysis of the Sample of Lithuanian Men

Background

Along with other suicide risk factors, masculinity has been analyzed as an important subject for suicidal behavior in men. This study examines masculinity as a gender self-confidence which is the intensity of an individual's belief that he meets his standards for masculinity. We use Hoffman and her colleague's concept, which provides two theoretical constructs as elements of gender self-confidence: gender self-definition and gender self-acceptance. Gender self-definition relates to how salient masculinity is in one's identity; gender self-acceptance relates to how positively one views his masculinity.

Methods

The quantitative research approach was applied in the study. The survey with a nonprobability quota sampling design was implemented to collect the data. The sample consisted of 562 Lithuanian men from various age groups and regions. The age of participants varied from 18 to 92 years (M = 42.99, SD = 17.18); 40.9% of men were from cities, 28.1% from towns, and 30.8% from rural locations. We used the Hoffman Gender Scale to measure gender self-definition and gender self-acceptance. Suicide risk was estimated with the Suicide Behavior Questionnaire—Revised. Patient Health Questionnaire-2 was used to measure depression symptoms as a controlled variable. Statistical analysis of regression and moderation was used to test the hypothesis.

Results

Higher gender self-definition and higher gender self-acceptance were associated with lower suicide risk. The moderation analysis showed that in men with relatively low gender self-definition, the effect of gender self-acceptance on suicidality was larger than in men with high or moderate gender self-definition.

Discussion

We conclude that a stronger gender self-confidence is an important protective factor in male suicide risk. Both, a smaller part of masculinity in one's identity and a negative view of one's masculinity have a cumulative effect on increased suicide risk. The findings have been discussed in accordance with the theories that explain suicidal behavior through the lenses of self-concept.

The Analysis of the Phenomenon of Reflexivity in Psychotherapy Supervision: A Systematic Literature Review

Reflexivity is a concept that is increasingly gaining prevalence in the literature of professional practice and it has been defined in a variety of ways; however, the differences in definition largerly depend on the context. Therefore, reflexivity development is the main goal of supervision; it is a powerful instrument that can impede the psychotherapist’s connection with his client, but there is no answer on what specifically enhances or decreases reflexivity during the supervision process. In the scientific articles analyzing supervision, there is no clear definition of the phenomenon of reflexivity and there is also a lack of empirical studies of reflexivity in supervision. The aim of this paper is to present our own definition and theoretical model of reflexivity in the psychotherapy supervision process as well as distinguish reflexivity between adjacent concepts like “reflection,” “self-reflection,” and “self-reflexivity.” We carried out a systematic review of literature within three databases and created a theoretical model of reflexivity in psychotherapy supervision. We also discuss the guidelines and methods for further empirical investigations of this phenomenon in psychotherapy supervision.

Effectiveness of Applied Suicide Intervention Skills Training (ASIST) in Lithuania

This study evaluated the effectiveness of the Lithuanian translation of the Applied Suicide Interventions Skills Training (ASIST). In total 248 participants (45.7%) completed pre- and post-assessment and 146 (26.9%) had data at 3-month follow-up. Suicide Intervention Response Inventory (SIRI-2) was used to evaluate suicide intervention skills. The results indicated no change in the overall SIRI-2 score following training or at a 3-month follow-up. A more detailed analysis of the response pattern indicated that both following training and at 3-months follow up participants were better at identifying helpful responses but tended to overestimate their helpfulness.

How relatives look back at suicide risk after their close one's death by suicide

The aim of the current study is to analyze how relatives understand in retrospect the suicide risk of their next of kin who died by suicide. We interviewed 103 adult relatives who lost their significant others to suicide, using qualitative content analysis to explore the data. Participants expressed difficulties understanding suicide risk by identifying personal traits incompatible with suicide, reasons to doubt the risk, life oriented actions, the situation seemed better than it was, or that the loved one denied suicide risk; only a few recognized suicide risk. Prevalent myths about suicide and denial are possible explanations for these findings.

Factors of Seeking Professional Psychological Help by the Bereaved by Suicide

Background

Studies show that people bereaved by suicide often feel a strong need for professional help. It is hypothesized that aspects related to suicide bereavement, such as stigmatization, shame or guilt, hinder help-seeking process of the bereaved. However, little is known about help-seeking behaviors of people who has lost someone due to suicide.

Aims

This study was conducted to attain a better understanding of the contributing factors, including the specific features of grief following suicide, to help-seeking behaviors of the bereaved by suicide.

Methods

The sample consisted of 82 adults bereaved by suicide (64 female; average age 37.79, SD = 14.33). Instruments assessing stigmatization, shame, guilt levels, well-being, tendency to disclose emotional distress and attitudes toward seeking professional psychological help were used. The participants were also asked an open-ended question what professional help-seeking barriers they had encountered. Comparisons between the groups, logistic regression analysis and thematic analysis of the qualitative data were performed.

Results

The findings revealed that bereaved participants who sought professional psychological help reported experiencing stigmatization and feeling guilty after the loss significantly more often. Also the results showed that attitudes toward mental health specialists had the highest prognostic value in predicting help-seeking behaviors of the bereaved. The participants themselves identified the gaps in the health care system as main barriers to seeking help.

Conclusion

The results challenge previously spread notion that stigmatization, guilt and shame after suicide can act only as help-seeking barriers.

Changes in prospective helpline volunteers' suicide intervention skills throughout the initial training

The objective of this study was to evaluate the changes in prospective helpline volunteers' suicide intervention skills throughout the training in Lithuania. In total, 90 participants of the Youth Line volunteer initial training course completed the Suicide Intervention Response Inventory (SIRI-2) before any training, before and after the suicide intervention module, and after all training. There was a steady and significant increase in the trainees' suicide intervention competencies during the training. Younger and less skilled trainees benefited more from the training. These results indicate that helpline volunteers can be trained in suicide intervention skills in a relatively short time.

'It will get even better': preliminary findings from a trauma-focused psychotherapy effectiveness study reveal false positive patients' long-term outcome expectations after the treatment

BACKGROUND

There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment.

AIMS

The aim of this study was to evaluate patients' long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study.

METHODS

Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale-Revised (IES-R), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients' expectations of their distress at previous post-treatment assessment.

RESULTS

Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up.

CONCLUSION

It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.

Too strong? Barriers from getting support before a suicide attempt in Lithuania

The study aimed to understand the tendencies of help seeking before a suicide attempt in Lithuania. An analysis of interviews with 21 Lithuanian adults demonstrated strong avoidance of seeking help. The main reasons for avoidance included a lack of trust in other people, thinking that one must solve problems independently without sharing them, avoiding troubling others, and a belief that showing genuine emotions is a sign of weakness. These findings may contribute to suicide prevention by more deeply understanding the barriers to help seeking among high suicide risk groups, particularly in countries with a traumatic historical experience.

Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial

BACKGROUND

Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11.

METHODS/DESIGN

This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed.

DISCUSSION

Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder.

TRIAL REGISTRATION

The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.

The subjective impact of the traumatic experience of clean-up workers of Chernobyl power plant accident 27 years after the disaster

A long-term psychological trauma is considered to be a possible consequence of being informed of radioactive contamination. In the case of the Chernobyl disaster, various circumstances possibly have led to even more serious psychological damage. For example, the socio-political context of the accident could be linked to extremely restricted information given out to the public. This disaster particularly affected clean-up workers, some of whom were brought from Lithuania, part of the Soviet Union at the time. This study thus is aimed to reveal the perceived impact of the traumatic experience of clean-up workers 27 years after the Chernobyl Disaster. Semi-structured 32 interviews with clean-up workers (age varying from 47 to 77 years), who are currently living in Lithuania, were conducted. A thematic analysis of the responses reveals that the clean-up workers are still feeling influenced by what they have experienced in Chernobyl. First of all, they link various health problems, which they are suffering from, to their presence in Chernobyl and express anxiety about the possible future illnesses, as they believe their bodies are irreversibly damaged by radiation. Secondly, the clean-up workers express a lot of anger towards the government for insufficiently supporting them financially and not showing enough gratitude for the work that they have done. Also, they experience a feeling of injustice as they believe that the government considers their experience in Chernobyl to be voluntary and not significantly influencing their present physical and psychological condition. Finally, post-traumatic stress symptoms were also found to be manifested. As the most distressing of those symptoms the clean-up workers name general irritability and anxiousness, although symptoms of intrusion and avoidance can also be detected as well as helplessness and a feeling of constantly living under threat. All these findings raise the awarness of how important it is that the government and society would validate the clean-up workers’ experiences – at least symbolically recognizing the long-term impact of being in Chernobyl as well as its involuntary nature. This recognition should also lead to the necessary physical and psychological help in consideration of the clean-up workers’ traumatic experiences and the psychological component of their physical illnesses.

County Council Politicians’ Attitudes Toward Suicide and Suicide Prevention

The purpose of the present study was to compare county council politicians’ attitudes toward suicide and suicide prevention in five European countries. A questionnaire was distributed and here the responses to the open-ended questions are analyzed qualitatively. Considerable differences were found in what the politicians in the five countries believed to be the most important causes of suicide and how suicide can be prevented. There were also differences in to what degree the politicians revealed a judgmental attitude toward suicide, which seemed to be related to the magnitude of the problem in the respective countries. A certain implicit inconsistency in the logic directing the politicians’ responses was found when their views on causes to suicide and suicide prevention strategies were compared. The responses indicate a need for increased consciousness and knowledge about suicide and suicide prevention among politicians in all the five countries. This is important since they are responsible for initiating and funding suicide preventive efforts.

The Lithuanian Version of the Attitudes Towards Suicide Questionnaire (ATTS)

Several psychological models explaining formation of attitudes towards suicide and their influence on suicidal behaviour have been developed recently. Reliable an valid instruments measuring attitudes towards suicide are needed to test these models. There are several well known questionnaires in this field: Suicide Opinion Questionnaire (SOQ; Domino et al., 1982), Suicide Attitude Questionnaire (SUIATT; Diekstra & Kerkhof, 1988). Both these questionnaires have methodological or practical disadvantages that were taken into account when developing a new instrument – Attitudes Towards Suicide Questionnaire (ATTS; Salander Renberg & Jacobsson, 1998).Objective: Lithuanian version of ATTS was created in 2001 and was used in a number of studines since then. Availability of large data pool (N = 1259) collected with Lithuanian version of ATTS has created a good opportunity for examining reliability and validity issues of the instrument, which is the aim of this study.Method: The data for the present study was taken from studies conducted in the framework of European multicenter research project SUPPORT. Sample consisted of 16 target groups that were studied with the Lithuanian version of ATTS: army conscripts (N = 368), army sergeants (N = 106), army officers (N = 44), medicine students (N = 103), students of priest seminaries (N = 68), catholic religion students (N = 63), psychology students (N = 137), members and mayors of Municipality Councils (N = 55), students of journalism (N = 43), journalists (N = 43), volunteers of psychological help-line (N = 43), suicide attempters (N = 40), personnel of emergency hospital (N = 39), homosexual and bisexual men (N = 30), alcohol dependant patients (N = 38), alcohol dependant patients undergoing Minnesota rehabilitation program (N = 39). A test-retest survey was performed in a sample of medicine students (N = 30) in order to evaluate temporal stability of ATTS Lithuanian version.Results: Confirmatory factor analysis (implemented through SEM) hasn’t confirmed the original ATTS factor model obtained by developers in Sweden. However, an exploratory factor analysis produced 5 factor model (explaining 53.5% of total variance), which is very similar at face value to other proposed ATTS factor models. Internal consistency of this model is satisfactory (Cronbach alpha – 0.68). Differences between attitudes of suicidal and non-suicidal individuals are regarded as support for criterion validity of the instrument. ICC coefficients from test-retest study are satisfactory (ranging from 0.62 to 0.87) for three ATTS factors. The remaining have demonstrated low testretest reliability (ICC coefficients are 0.48 and 0.59).Conclusions: psychometric properties of Lithuanian ATTS version were found to be satisfactory, although structural validity indicators were somewhat controversial and two factors have demonstrated low test-retest coefficients. Lithuanian ATTS version can be used for scientific research of attitudes towards suicide.

Level of Hopelessness, Attitudes towards Suicide and Suicide Risk

Objectives: There is a substantial level of evidence that affirmative attitudes towards suicide are connected to suicidality (suicide ideation, suicide attempts and completed suicide). Hopelessness is proved to be one of the best available predictors of the suicide risk. A hypothesis that attitudes can serve as mediating variable between hopelessness and suicidality was proposed in recent studies (Gibb et al., 2006). The main aim of this study is to test the hypothesis that interaction between attitudes towards suicide and hopelessness will be a better predictor of suicidality than hopelessness.Methods: Different aspects of attitudes towards suicide and suicidality were measured with Questionnaire on Attitudes Towards Suicide (ATTS). Hopelessness level was assessed with Beck Hopelessness Scale (BHS). The study was conducted in the sample of Lithuanian army conscripts (N = 368) aged between 18 and 26 (mean age was 20.46; SD = 1.29).Results: Suicidality index significantly correlated both with hopelessness (r = .45, p < .01) and various aspects of attitudes towards suicide. The strongest correlation was between acceptance of suicide and suicidality index (r = .36, p < .01), but we have also found significant correlations between five other aspects of attitudes and suicidality. Significant correlations between hopelessness and various aspects of attitudes towards suicide were found. Variables using hierarchical stepwise model were entered into multiple regression model. Hopelessness accounted for 21.1% of suicidality variance. Attitudes towards suicide, added into regression model on second step, increased prediction of suicidality to 34.2%.Conclusions: Results of this study show that different aspects of attitudes towards suicide correlate with the suicide risk. Correlation between hopelessness and suicidality was confirmed as well. Finally, the results indicate that attitudes towards suicide are significant predictors of suicide risk. Interaction of attitudes towards suicide and hopelessness predicts suicide risk better than hopelessness. Results of present study have confirmed, that attitudes towards suicide are significant mediators between hopelessness and suicidality.