Many existing questionnaires fail to capture non-religious aspects of spirituality. This review investigates whether existing questionnaires assess secular expressions of spirituality relevant to resilience and coping. A literature search (March 1, 2024) in Web of Science, APA PsycInfo, Embase, and Medline identified 6,577 articles. Twenty-nine questionnaires were screened and qualitatively analyzed, focusing on connection, spiritual coping, and transcendence. Three instruments, the Spiritual Attitude and Involvement List (SAIL), the Spirituality Scale, and the Spiritual Orientation Inventory (SOI), almost adequately addressed non-religious transcendence. Items (twelve on transcendence, four on coping) conceptualized transcendence abstractly, emphasizing receptivity and trust in coping. Few questionnaires deeply assess secular spirituality, but several suitable items were found, enabling development of a survey applicable to both religious and non-religious individuals.
Background: Mental images of threat are common in panic disorder and may contribute to its onset and maintenance, making them potential relevant targets for treatment. They can be related to distressing memories or catastrophic future simulations (i.e., “ flashforwards ”). This study explored the similarities and differences between these two types of threat representations in terms of the credibility of encapsulated beliefs, emotional intensity, distress, controllability, aversiveness, sensory complexity, and episodic and semantic details. Methods: Forty-six patients diagnosed with panic disorder were asked about distressing memories and flashforwards related to their disorder using structured audio-recorded interviews and questionnaires before the treatment. The narratives were coded for episodic and semantic details. Results Results showed that both distressing memories and flashforwards were common and highly similar in image characteristics, but overall memories were self-rated as being more sensory-complex. Flashforwards were rated as more aversive, but threat representations did not differ in terms of credibility of encapsulated beliefs, emotional intensity, distress, and controllability. Compared to flashforwards, memories contained more episodic details, but threat representations did not differ in the number of semantic details or in relative scores. Conclusions Distressing memories and flashforwards in panic disorder are highly similar but differ in complexity and perceived aversiveness. The theoretical and clinical implications of distinguishing between these two types of threat representation are discussed.
Background In the province of Utrecht, the Netherlands, people experiencing a mental health crisis encountering the police had to wait, temporarily detained in a police cell, for evaluation by the emergency mental health services. To avoid temporarily detaining persons in a police cell in these situations, collaboration between the emergency mental health services and the police was redesigned. Today over 79% of the patients referred by the police are not seen in a police cell anymore. A process evaluation is conducted to explore facilitators and barriers influencing the implementation of this collaboration redesign which is perceived as a ‘complex intervention’. Methods A process evaluation with a mixed methods design was conducted with both data sets facilitating a ‘between methods’ approach. Aggregated data of 2,684 medical files is included. Data from three focus groups are used, consisting of respondents of all stakeholders at different levels of involvement: the police, emergency mental health services and specialized mental health transport service. Results Clear agreements in the collaboration redesign acted as a facilitator to decrease the use of the police cell as ‘a place of safety’, strengthened and confirmed in bilateral meetings. Low-threshold contacts within and between organizations, dedicated project leaders, active early adaptors and exchange programs between organizations supported the implementation. Enforcement took place by digitalizing the triage procedure and administrative process, training of employees of the emergency mental health services and ascertaining a safe working place. A new independent participant in the collaboration for transport, enhanced the patient experience and collaboration. Working in a compact geographical area is seen as an advantage. A perceived barrier was high staff turnover. Another barrier was that experienced mental health care staff members had difficulty with changing their narrative approach into a methodical triage approach. Conclusions Redesigning the collaboration between emergency mental health services and police led to a decrease in the use of the police cell for people experiencing a mental health crisis encountering the police. Unforeseen results are a more shared perspective of all stakeholders and a sense of collectiveness regarding a safe and humane access to emergency mental health care. Trial registration Not applicable
BACKGROUND:Childhood trauma is associated with increased risk of depression and epigenetic alterations in stress-related pathways. Preclinical studies suggest that methyl donors may facilitate DNA methylation changes. This first-in-human trial of epigenetic treatment investigated methyl donor S-adenosylmethionine (SAMe) as add-on to trauma-focused therapy for depression. METHODS:In this randomized, double-blind, placebo-controlled trial with 6-month follow-up, 31 adults with trauma-related depression were enrolled. Participants received 1200 mg SAMe or placebo alongside 12-weeks trauma-focused therapy. Depression symptoms were assessed using the Hamilton Rating Scale of Depression (HAM-D). Plasma SAMe levels and genome-wide DNA methylation were measured pre- and post-treatment, including epigenome-wide association analyses, differentially methylated region analyses, and epigenetic clock measures. RESULTS:Twenty-eight participants completed the study. Depression symptoms decreased significantly during treatment and remained improved at follow-up, reflecting the effect of psychotherapy, without clinical benefit of SAMe. SAMe supplementation did not alter plasma SAMe levels. However, SAMe treatment was associated with differential methylation across 66 regions. Epigenetic clock analyses showed no consistent treatment-related changes. CONCLUSIONS:This first-in-human epigenetic intervention study in psychiatry demonstrates the feasibility of combining trauma-focused psychotherapy with targeted epigenetic analyses. While SAMe showed no additive clinical effects, the results provide important leads for future trials. CLINICAL TRIAL IDENTIFIER (EUDRACT):2017-002097-38.
