• Diego Vitali – The role of acceptance and meaning-in-life in psychological therapies of chronic pain: lessons from the perspective of patients
  • Esther Ingham – Systematic review of studies exploring what ‘being-in-the-world’ entails as an individual with a Spinal Cord Injury: 1st person narrative accounts.
  • Laura Dewitte – What and how can we learn about meaning from Alzheimer patients? Questioning cognitive assumptions and reductionist approaches
  • Vos & Hutchinson –  Meaning in cardiovascular disease: a systematic literature review and a pilot study of meaning-centered therapy.

Diego Vitali

Title: The role of acceptance and meaning-in-life in psychological therapies of chronic pain: lessons from the perspective of patients.

Affiliation: University of Roehampton

Abstract

Objectives: 1. Explore the role of acceptance from the perspective of patients who received acceptance and commitment therapy (ACT) in the NHS. 2. Explore the relevance of the psychological construct “meaning in life” and its implications for these cohort of patients.

Design: Semi-structured interviews after completion of a course of therapy

Method: participants were 8 chronic pain patients who had recently received ACT in a NHS multidisciplinary pain clinic. They were invited for a 1 hour individual interview. Interviews were transcribed verbatim and analysed thematically.

Results: Thematic analysis revealed interesting nuances around the role of acceptance in ACT and about 4 thematic components of acceptance that emerged in the perspective of the interviewed patients. Analyses also showed how the relationship with the other patients was affecting (positively and negatively) the crucial components of the presented ACT intervention. Meaning in life was found a relevant construct to these patients and nuances of this finding are presented.

Conclusions: Acceptance and empathy emerge as important components in determining patients’ decision and action. Experiencing and finding “meaning” in life seem to enrich the psychological construct of “values” that is so central in ACT therapies. In particular the role of meaning should be further explored as a drive or catalyst to motivate patients’ action and creativity in coping with their pain.

 

Esther Ingham

Title: Systematic review of studies exploring what ‘being-in-the-world’ entails as an individual with a Spinal Cord Injury: 1st person narrative accounts.

Affiliation: University of Manchester

Abstract

To further enable the potential for counselling psychologists to understand the personal experience of spinal cord injury, a qualitative systematic review was conducted based solely on first-person narrative accounts of lived experiences. A multi-case cross-case analysis of six peer-review papers and one book identified the ever-fluctuating nature of SCI as affected by commonalities of experience; the existential, the phenomenological and the ecological. Six sub-themes were recognised within these, and a wide variety of individual responses/reactions were acknowledged as illustrative of the many potential psychological complexities such an acquired injury may bring. The author’s personal experience of SCI was felt to resonate with these findings. The themes/issues discussed can be considered as likely to have some impact on all individuals with SCI, albeit to varying degrees. Consequently, it is hoped that the study might aid counselling psychologists’ awareness/understanding of living with SCI, in order to better facilitate holistic wellbeing through the therapeutic relationship.

 

Laura Dewitte

Title: What and how can we learn about meaning from Alzheimer patients? Questioning cognitive assumptions and reductionist approaches

Affiliation: KU Leuven

implications for practice: This work can contribute to the implementation of existential and meaning related practices in care for people with dementia.

implications for research: This work can help refine the concept of Meaning in Life by examining the cognitive assumptions underlying current conceptualizations.

Abstract:

The majority of theoretical and empirical approaches to the concept of meaning in life (MiL) generally attach great importance to a cognitive component. However, experiences from dementia care practice suggest that a strong cognitive point of departure might be too reductive. Patients, caregivers, and family point to MiL as a theme with lasting, if not increasing importance in this population, despite diminishing cognitive capacities. Accordingly, dementia patients might contribute to our insight into the underlying components of MiL and invite us to enrich both our conceptualization and methodological approaches to the study of MiL.

We set up a longitudinal mixed-method project focused on elderly Alzheimer disease (AD) patients in residential care settings. A quantitative study examines the underlying cognitive processes supposedly indispensable for meaning, while a qualitative phenomenological study focuses on the lived experience of AD patients and provides a deeper, more holistic understanding of how this population experiences MiL. On a fundamental level, the project aims to rethink the current MiL framework, by questioning strong cognitive assumptions and inviting a more pluralistic approach to the concept. Furthermore, it enhances the emancipation of AD patients in research and provides a counterbalance to the predominance of biomedical approaches to the disease. On an applied level, the project can inform policy about the relevance and importance of implementing existential themes within support and care practices for people with dementia. Preliminary findings will be discussed.

 

Joel Vos and Zsuzsanna Hutchinson

 

Title: Meaning in cardiovascular disease: a systematic literature review and a pilot study of meaning-centered therapy

Abstract:

Background. Psychological stress and personality traits contribute to Cardio Vascular Disease (CVD). CVD events such as a myocardial infarction significantly increase stress. Therefore, stress reduction is important to prevent future CVD events. However, there are no consistent positive findings for psychological treatments in CVD. A conceptual model was developed and a feasibility study conducted about a new psychological treatment. Based on abundant medical psychology research, this treatment aimed to help how patients live a meaningful life despite CVD.

Method. A systematic literature review was conducted on the role of meaning in CVD, leading to a meaning-centered conceptual model and treatment manual. A pilot study trial examined its feasibility, acceptance and preliminary effectiveness. Effects were evaluated with anxiety and depression questionnaires (PH9, GAD7), qualitative writing and a case study.

Findings. Hundred-thirty-six articles showed that the patient’s central clinical concern was their question how to live a meaningful and satisfying life despite CVD. Meaning-centered concerns contribute to a lack of motivation to make lifestyle changes, continued stress, lower quality-of-life, worse physical well-being and CVD risk. Trials in other physically ill populations show that meaning-centered improve the patients’ meaning-centered skills (i.e. meaning despite change, value, meaning-centered coping, self-worth, commitment, self-regulation and existential acceptance). Improved meaning-centered coping-skills lead to positive lifestyle changes, lower stress and higher quality-of-life, which lead to better physical functioning and reduced recurrence risk. The treatment manual detailed 10 sessions, combining didactics, reflective and mindfulness-experiential exercises. The pilot study in 18 CVD-patients showed large improvements in depression (pre-M=15.6, SD=4.8; post-M=6.8, SD=5.4; Cohen’s d=1.7, p<.0001) and anxiety (pre-M=13.2, SD=5.1; post-M=5.5, SD=5.2; Cohen’s d=1.5, p<.001). Approximately two-third recovered from clinical depression or anxiety, and average changes were reliable and clinically significant, and larger than waiting-lists and psychological interventions in meta-analyses of 24 previous trials (Whalley et al, 2014). Qualitative evaluations confirmed the outcomes and conceptual model.

Discussion. An evidence-based conceptual framework was developed for meaning-centered treatment for CVD patients. Preliminary evidence suggests its feasibility and effectiveness. Randomized controlled trials should confirm these findings.