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Self-image and selected clinical variables in the context of childhood abuse in subjects with alcohol dependence

Abstract

Objective: The objective of the study was to determine the differences in selected clinical variables and self-image in people with alcohol dependence differing in severity of physical, emotional and sexual abuse experienced before age 18.

Method: The study included 90 people with alcohol dependence. The following research tools were used: Early Trauma Inventory (ETI), Adjective Check List (ACL), MAST, SAAD, and a questionnaire designed by the authors. In order to identify groups with varying indices of physical, emotional and sexual childhood abuse, a cluster analysis method was used.

Results: Two groups of subjects with alcohol dependence were identified: Group 1 with high indices of physical, emotional and sexual childhood abuse and Group 2 with low indices. In terms of self-image the subjects in Group 1 compared to subjects in Group 2 were characterized by a lower self-esteem, self-acceptance, resistance to stress, less intense needs for achievement, endurance, order, nurturing others, interaction with opposite-sex partners, subordinations but more intense need for change. The age of alcohol use initiation and the onset of regular alcohol drinking was statistically significantly lower in Group 1. The severity of alcohol dependence was significantly lower in Group 2. The subjects in Group 1 significantly more frequently confirmed the history of a hereditary predisposition to alcohol dependence, suicidal ideation, suicide attempts and self-harm.

Discussion: The obtained results closely correspond to the data available in the literature.

Conclusions: An assessment of exposure to various forms of childhood abuse appears to be an indispensable element of collecting medical history of people with alcohol dependence.

Open access
Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)

Abstract

Objectives

Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.

Methods

This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.

Trial registration: ISRCTN 11913964

Open access
Editorial
Open access
Figure, Ground and the Notion of Equilibria in the Work of Gilbert Simondon and Gestalt theory

Summary

Based on Clausius’ phrasing of a “transformational content” and the resulting 2nd law of thermodynamics, I demonstrated that Gilbert Simondon’s On the Mode of Existence of Technical Objects is historically situated at the threshold of understanding open systems thermodynamics and the related concepts of balance. Furthermore, I showed that Gestalt theory, as represented by Wolfgang Köhler, at least reproduced, if not partially anticipated or even prepared this development of 20th century thinking. Finally, I gave some short examples of how Simondon applied the figure/ground distinction to human perception, memory, and a general theory of becoming and I introduced his proposal to analyse “the grounds” just as thoroughly as the laws of figuration.

Open access
Frondizi and Mandelbaum on the Phenomenology and Ontology of Value

Summary

In this article the ethical systems of Risieri Frondizi and Maurice Mandelbaum, both decisively influenced by Wolfgang Köhler, are investigated for the first time. Each writer took different things from Köhler, Frondizi the idea of value as a Gestalt quality and Mandelbaum the idea of value as a felt demand. Their positions are highly complementary and Frondizi’s axiological approach enlightens the ontology of value whereas Mandelbaum’s phenomenological approach clarifies the nature of “requiredness” (Köhler) or “fittingness.”

Open access
Manifest Dream/Association Comparison: A Criterion to Monitor the Psychotherapeutic Field (2nd part) Field Transformations: A Clinical Case

Summary

The present work focuses on the transformations of the psychotherapeutic field through the relationship dynamics that occur within it.

The first part of this article starts with a brief outline of the Gestalt psychological understanding of the field concept, also in its application to the psychotherapeutic situation, followed by a brief review of the introduction of the field concept into the psychoanalytic theory formation.

After this, the first author first presents the theoretical concept underlying a new approach he has developed for observing the relationship dynamics in psychotherapy. Mirroring a formation both psychoanalytic and gestaltic of the main author, this new approach is based on the combination of psychoanalytic and Gestalt psychological concepts. According to the clinical experience and insights of the author, the phenomenological and relational approach of Gestalt theory fits well with the psychoanalytic approach; on this basis, a criterion for recording the progress of therapy can be developed. This criterion is the phenomenology of the development of the qualities of the relationships of the client, as they become visible in his dream narrations and the subsequent associations in the analysis room, and continue to develop during the session and the further course of therapy. The relationship dynamics in the dream narration is thus compared with those that develop in the course of the subsequent associations.

This is demonstrated and further elaborated in the second part of this paper on the basis of a clinical case. The clinical example shows how the relationship dynamics develop in this sense in the individual therapy sessions and over a longer course of therapy. The associated transformations of the therapeutic field give a good indication of the progress of therapy. The main author gained such insights into the transformations of the therapeutic field and the progression of therapy, which are visible in the course of therapy, from the careful application of the criterion “manifest dream/associations comparison of relational dynamics”. In the specific case, there was also a high degree of correspondence between the results of the application of this phenomenological criterion and the empirical evidence of the symptom questionnaire, a self-report measure requested by the patient himself during the course of the therapy.

Open access
Perceptual Simplicity: The True Role of Prägnanz and Occam

Summary

In recent years, the concept of simplicity in perception has acquired a leading role, above all thanks to scholars linked to Bayesian modeling and to theories like structural information theory derived from information theory. Unfortunately, two misleading ideas made their way into the discussion: that in perception, simplicity is equivalent to Prägnanz and that Occam’s razor plays a role in the simplicity of percepts. Here it is shown that in Gestalt theory, simplicity is only one of the factors of Prägnanz and that the use of Occam’s razor is improper, because it applies only to the theories that generate, in this case, a percept, and not to the product of the theory.

Open access