Explore the vast range of titles available.

Background: Previous research reveals an association between traumatic stress and an increased risk for numerous diseases, including cancer. At the molecular level, stress may increase carcinogenesis via increased DNA damage and impaired DNA repair mechanisms. We assessed DNA breakage in peripheral blood mononuclear cells from individuals with post-traumatic stress disorder (PTSD) and measured the cellular capacity to repair single-strand breaks after exposure to ionizing X-radiation. We also investigated the effect of psychotherapy on both DNA breakage and DNA repair. Methods: In a first study we investigated DNA breakage and repair in 34 individuals with PTSD and 31 controls. Controls were subdivided into 11 trauma-exposed subjects and 20 individuals without trauma exposure. In a second study, we analysed the effect of psychotherapy (Narrative Exposure Therapy) on DNA breakage and repair. Thirty-eight individuals with PTSD were randomly assigned to either a treatment or a waitlist control condition. Follow-up was performed 4 months and 1 year after therapy. Results: In study 1 we found higher levels of basal DNA breakage in individuals with PTSD and trauma-exposed subjects than in controls, indicating that traumatic stress is associated with DNA breakage. However, single-strand break repair was unimpaired in individuals with PTSD. In study 2, we found that psychotherapy reversed not only PTSD symptoms, but also DNA strand break accumulation. Conclusion: Our results show - for the first time in vivo - an association between traumatic stress and DNA breakage; they also demonstrate changes at the molecular level, i.e., the integrity of DNA, after psychotherapeutic interventions.

Theological/spiritual reflection in psychotherapeutic practice has increased in recent years. Approaches for reflection and integration vary depending on the practitioner’s spiritual and theoretical beliefs. The integrative approach utilized in this paper is derived from a phenomenological perspective of the author, who was schooled in pastoral theology and later family therapy. Considering the pastoral theologian Seward Hiltner’s perspectival approach, this integrative approach creates a conversational method, integrating the client’s concerns with specific narrative therapy interventions or practices and the theological/spiritual concepts of immanence–transcendence. Finally, this case study’s methodology offers constructive questions that clinical practitioners can apply to specific psychotherapy approaches as well as theological concepts.

Purpose Discourse analysis is commonly used to assess language ability and to evaluate language change following intervention in aphasia. The purpose of this study was to identify differences in language produced during different discourse tasks in a large aphasia group and an age- and education-matched control group. Method Four structured discourse tasks across 3 discourse types (expositional, narrative, and procedural) were evaluated in a group of adults with aphasia (n = 90) and an age-matched control group (n = 84) drawn from AphasiaBank. CLAN software was used to extract primary linguistic variables (mean length of utterance, propositional density, type-token ratio, words per minute, open-closed class word ratio, noun-verb ratio, and tokens), which served as proxies for various language abilities. Using a series of repeated-measures analyses of covariance, with significantly correlated demographic and descriptive variables as covariates, main effects of discourse type were evaluated. Results Despite an impoverished output from the aphasia group (i.e., the control group produced significantly more overall output), there was a main effect of discourse type on most primary linguistic variables in both groups, suggesting that, in adults with and without language impairments, each discourse type taxed components of the spoken language system to varying extents. Post hoc tests fleshed out these results, demonstrating that, for example, narrative discourse produced speech highest in propositional density. Conclusion Each discourse type taxes the language system in different ways, verifying the importance of using several discourse tasks and selecting the most sensitive discourse tasks when evaluating specific language abilities and outcomes.

Background Traumatic events like critical illness and intensive care are threats to life and bodily integrity and pose a risk factor for posttraumatic stress disorder (PTSD). PTSD affects the quality of life and morbidity and may increase health-care costs. Limited access to specialist care results in PTSD patients being treated in primary care settings. Narrative exposure therapy (NET) is based on the principles of cognitive behavioral therapy and has shown positive effects when delivered by health-care professionals other than psychologists. The primary aims of the PICTURE trial (from “PTSD after ICU survival”) are to investigate the effectiveness and applicability of NET adapted for primary care with case management in adults diagnosed with PTSD after intensive care. Methods/design This is an investigator-initiated, multi-center, primary care-based, randomized controlled two-arm parallel group, observer-blinded superiority trial conducted throughout Germany. In total, 340 adult patients with a total score of at least 20 points on the posttraumatic diagnostic scale (PDS-5) 3 months after receiving intensive care treatment will be equally randomized to two groups: NET combined with case management and improved treatment as usual (iTAU). All primary care physicians (PCPs) involved will be instructed in the diagnosis and treatment of PTSD according to current German guidelines. PCPs in the iTAU group will deliver usual care during three consultations. In the experimental group, PCPs will additionally be trained to deliver an adapted version of NET (three sessions) supported by phone-based case management by a medical assistant. At 6 and 12 months after randomization, structured blinded telephone interviews will assess patient-reported outcomes. The primary composite endpoint is the absolute change from baseline at month 6 in PTSD symptom severity measured by the PDS-5 total score, which also incorporates the death of any study patients. Secondary outcomes cover the domains depression, anxiety, disability, health-related quality-of-life, and cost-effectiveness. The principal analysis is by intention to treat. Discussion If the superiority of the experimental intervention over usual care can be demonstrated, the combination of brief NET and case management could be a treatment option to relieve PTSD-related symptoms and to improve primary care after intensive care. Trial registration ClinicalTrials.gov, NCT03315390 . Registered on 10 October 2017. German Clinical Trials Register, DRKS00012589 . Registered on 17 October 2017.

This study investigated the potential effectiveness, feasibility, acceptability, and putative mechanisms of change of Narrative Exposure Therapy (NET) delivered via videoconferencing with young people who witnessed domestic violence. A naturalistic, mixed-method, AB, interventional single case design was used. Five female adolescents aged 13–17 years were recruited from a Child and Adolescent Mental Health Service in the United Kingdom and attended 4–10 video-sessions of the child-friendly NET protocol. Participants completed questionnaires assessing posttraumatic stress symptoms (PTSS), general psychological distress, and trauma memory quality, wore a heart rate (HR) monitor assessing habituation, and were offered a Change Interview. At post-intervention, three participants showed reliable improvement in PTSS, but only one showed clinically significant change. One participant also demonstrated reliable improvement in general psychological distress. Effect size estimates ranged from moderate to very large and indicated change in the desired direction for all but one participant; estimated effects for general psychological distress were more modest. Three participants showed reductions in trauma memory quality, indicating increased integration. Within-session habituation was observed for all participants with available HR data; between-session habituation was also recorded for two of them. The lifeline was mentioned as a helpful aspect of NET, the video delivery was considered both a barrier and a facilitator to engagement, and positive or mixed changes were reported by two participants. Future research with more control and larger samples is needed to answer questions on generality of findings and impact of online delivery; future studies may also include longer follow-up periods and investigate other outcomes.Trial registration number NCT04866511 (ClinicalTrials.gov).

Case study and narrative inquiry as merged methodological frameworks can make a vital contribution that seeks to understand processes that may explain current realities within professions and broader society. This article offers an explanation of how a critical perspective on case study and narrative inquiry as an embedded methodology unearthed the interplay between structure and agency within storied lives. This case narrative emerged out of a doctoral thesis in occupational therapy, a single instrumental case describing a process of professional role transition within school-level specialized education in the Western Cape, South Africa. This case served as an exemplar in demonstrating how case study recognized the multiple layers to the context within which the process of professional role transition unfolded. The embedded narrative inquiry served to clarify emerging professional identities for occupational therapists within school-level specialized education in postapartheid South Africa.

Although humility has long been valued as a virtue in the Christian tradition, congregational conflict can be driven by the narcissistic needs of ministry leaders and church members alike. Congregations are places where competing narratives intersect and sometimes collide, and parties to a conflict may each have their own unique and conflicting accounts of the situation. Because of disparities of power, however, pastors and ministry leaders bear a specific responsibility for ensuring that their behavior is not driven by narcissistic needs for self-enhancement. Against this background, the importance of narrative humility is proposed, a concept which originated in narrative medicine to address the intrinsic hierarchy between doctor and patient that can lead to the patient’s dehumanization. Parallel ideas from the practice of narrative therapy are also explored. The application of the concept to the congregational context is illustrated through a case study, and several questions for self-reflection are offered to support the cultivation of narrative humility.

Hormones are complex biosocial objects that provoke myriad cultural narratives through their association with social activities and identities, and these narratives have the power to shape people’s lived realities and bodies. While hormones were historically conceptualised as ‘master molecules’ capable of controlling various life processes, their explanatory potential has now been overshadowed by technoscientific developments like omics- and gene-based biotechnologies that have reframed how human bodies and behaviours are understood. Considering these shifts, this paper asks what roles hormones perform and what stories they are arousing today. Through a patchwork of four hormone stories about contraception, gender hacking, birth, and autism-specific horse therapy, we show how hormones remain vital protagonists in the constitution of bodies, affects, environments, places, politics, and selves in the contemporary period. Building on new materialist approaches, we adopt and extend the notion of ‘emplotment’ to encapsulate how hormones act as key characters in our plots. They are working to complicate dominant understandings of what bodies are and can be in new ways as they mediate different plots of bodily experience, in ways showing the ongoing powerful salience of hormones and their ascendancy in the present.

This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia. Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density. Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia. Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.