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Frontiers in Psychology 2023Philosophers maintain that touch confers a sense of reality or grounding to perceptual experience. In touching oneself, one is simultaneously both subject and object of...
Philosophers maintain that touch confers a sense of reality or grounding to perceptual experience. In touching oneself, one is simultaneously both subject and object of touch, a template for experiencing oneself as subject and object of intentions, feelings, and motivations, or intersubjectivity. Here, I explore a form of self-touch carefully documented by Winnicott in observing how the infant engages the transitional object. I compare the processes of self-loss in transitional states, including absorption in art, empathic immersion, drug-induced ego dissolution, and depersonalization. I use examples drawn from Rodin, Dante, and the Beatles; research correlating neurophysiological findings with aspects of self-representation; predictive processing-based models; Hohwy's concepts of minimal and narrative self; Clark's notion of the extended mind; and phenomenological perspectives on touch, to postulate a role for self-touch in the pre-reflective sense of mine-ness, or grounding, in transitional states.
PubMed: 37533722
DOI: 10.3389/fpsyg.2023.1097402 -
Brain Sciences Aug 2023Pesticides are chemicals used in agricultural fields for the prevention or destruction of pests. Inappropriate use of these substances, as well as handling them without... (Review)
Review
Pesticides are chemicals used in agricultural fields for the prevention or destruction of pests. Inappropriate use of these substances, as well as handling them without using personal protective equipment, may result in serious health problems such as neurodegenerative diseases and mental disorders. Previous studies have demonstrated the adverse effects of pesticides on brain function. However, some researchers have associated pesticide poisoning with the development of disorders such as dissociative amnesia, multiple personality disorders, and depersonalization disorder. The objective of this work was to perform a bibliographic review of the relationship between pesticide poisoning and the development of dissociative disorders. Previous studies suggest that the duration of pesticide exposure is a major determinant in the development of dissociative diseases and disorders. The information obtained in this review suggests that there is no specific relationship between dissociative disorders and pesticide poisoning. However, these results point to associating the most representative symptoms of dissociative disorder (such as amnesia and memory loss) with pesticide exposure. Based on the bibliographic search, possible mechanisms of action were suggested in an attempt to explain a possible association between exposure to pesticides and the appearance of dissociative disorders.
PubMed: 37626550
DOI: 10.3390/brainsci13081194 -
Heliyon Dec 2023This study aims to determine the prevalence and degree of Burnout during the COVID 19 pandemic in practicing Pakistani dentists.
OBJECTIVE
This study aims to determine the prevalence and degree of Burnout during the COVID 19 pandemic in practicing Pakistani dentists.
INTRODUCTION
The COVID-19 pandemic has significantly impacted dental practices worldwide, leading to increased stress and burnout among dental practitioners. Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can have detrimental effects on the quality of care and patient safety. Previous studies have shown high rates of burnout among healthcare workers, including dentists. The pandemic has added new challenges, such as financial losses and increased costs due to safety protocols. Recognizing and managing burnout is crucial to mitigate its severe consequences. By understanding the prevalence of burnout in this unique context, strategies can be developed to support dental practitioners and improve their well-being.
METHODS
A cross-sectional study was conducted using a 22-items based validated Maslach Burnout Inventory. The study was conducted between July and September 2021. Practicing dentists across Pakistan were approached via social media platforms. The questions were answered on a 7-point Likert scale. The sums of the scores were used as the evaluation criteria. Data analysis was done using SPSS version 24. Shapiro Wilk test was used to check normality of data. Mann Whitney U and Kruskal Wallis tests were utilized to analyze the differences in the prevalence of burnout amongst the different demographic groups. A P-value of <0.05 was considered as statistically significant.
RESULTS
Total of 282 dentists responded with 116 (41.1 %) male and 166 (58.9 %) female. Majority of the respondents were postgraduate residents (24.8 %), 47.9 % of the practitioners had 0-3 years of work experience, 48.6 % of the respondents were practicing in the Federal region, and 62.8 % of the subjects were between the age of 25-34. Emotional exhaustion was the major dimension of burnout identified in our study with 47.5 % of the population reporting high levels, while only 23 % of the population showed high levels of depersonalization and 29.4 % showed low sense of personal accomplishment.
CONCLUSION
This study indicates a considerable percentage of burnout in the chosen sample. The mean scores of Emotional Exhaustion, Depersonalization and Diminished sense of personal accomplishment were all found to be in the moderate range, and that appropriate measures should be taken to manage it.
PubMed: 38076061
DOI: 10.1016/j.heliyon.2023.e23061 -
Frontiers in Psychology 2023Resilience is the ability to bounce back from setbacks and adapt to new circumstances. Resilient teachers can handle these issues. In this case, it's proposed to... (Review)
Review
Resilience is the ability to bounce back from setbacks and adapt to new circumstances. Resilient teachers can handle these issues. In this case, it's proposed to interpret the recent decade's resilience research on teachers. Provide a conceptual framework for teacher resilience factors. The Scopus database was used to collect articles. The titles and abstracts of articles were read one by one. As a result, 22 articles were included in the data analysis. The country where the data were collected, the aims of the study, the education level which the participants working, the sample size, the scale used, and the variables included in the study are marked in the full text. Most studies were effect determination, correlation, or exploratory. Initially, age and gender inequalities among instructors were examined. Postgraduate instructors are more resilient than undergraduates. Psychological factors, workplace variables, and teacher competency and attributes are used to study teacher resilience. Teachers' resilience negatively impacts depression, stress, anxiety, well-being, and mood. Quality of life and well-being are positively connected. Job crafting, work engagement, and working environment are favorably connected, whereas job burnout and turnover intention are adversely correlated. Resilience was positively connected with emotion regulation, empathy, others' emotion evaluation, teacher competence, teacher self-efficacy, and self-esteem in teachers. Anger, anxiety, mindfulness, pleasure, social support, fear, and training affect teachers' resilience. Teachers' resilience affects stress, depersonalization, personal accomplishment, emotional exhaustion, children's resilience, job engagement, happiness, well-being, self-care, and success.
PubMed: 37546476
DOI: 10.3389/fpsyg.2023.1179984 -
Brain Sciences Jul 2023Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in...
Fear extinction is the basis of exposure therapies for posttraumatic stress disorder (PTSD), but half of patients do not improve. Predicting fear extinction in individuals with PTSD may inform personalized exposure therapy development. The participants were 125 trauma-exposed adults (96 female) with a range of PTSD symptoms. Electromyography, electrocardiogram, and skin conductance were recorded at baseline, during dark-enhanced startle, and during fear conditioning and extinction. Using a cross-validated, hold-out sample prediction approach, three penalized regressions and conventional ordinary least squares were trained to predict fear-potentiated startle during extinction using 50 predictor variables (5 clinical, 24 self-reported, and 21 physiological). The predictors, selected by penalized regression algorithms, were included in multivariable regression analyses, while univariate regressions assessed individual predictors. All the penalized regressions outperformed OLS in prediction accuracy and generalizability, as indexed by the lower mean squared error in the training and holdout subsamples. During early extinction, the consistent predictors across all the modeling approaches included dark-enhanced startle, the depersonalization and derealization subscale of the dissociative experiences scale, and the PTSD hyperarousal symptom score. These findings offer novel insights into the modeling approaches and patient characteristics that may reliably predict fear extinction in PTSD. Penalized regression shows promise for identifying symptom-related variables to enhance the predictive modeling accuracy in clinical research.
PubMed: 37626488
DOI: 10.3390/brainsci13081131 -
Journal of Trauma & Dissociation : the... 2024Depersonalization-derealization disorder (DPD) is characterized by persistent or recurrent experiences of detachment from oneself and surroundings, as well as a sense of... (Review)
Review
Depersonalization-derealization disorder (DPD) is characterized by persistent or recurrent experiences of detachment from oneself and surroundings, as well as a sense of unreality. Considering the inadequacy of current research on treatment, we performed a systematic review of the available pharmacotherapies, neuromodulations, and psychotherapies for DPD. The systematic review protocol was based on PRISMA 2020 guidelines and pre-registered. The PubMed, Web of Science, PsycINFO, Embase, the Cochrane Library, Scopus, and ScienceDirect databases were searched from inception to June 2021. All treatments for DPD and all study types, including controlled and observational studies as well as case reports, were assessed. Of the identified 17,540 studies, 41 studies (four randomized controlled trials, one non-randomized controlled trial, 10 case series, and 26 case reports) involving 300 participants met the eligibility criteria. We identified 30 methods that have been applied independently or in combination to treat DPD since 1955. The quality of these studies was considered. The relationship between individual differences, such as symptoms, comorbidities, history, and duration since onset, and treatment effects was explored. The results suggest that a series of treatments, such as pharmacotherapies, neuromodulation, and psychotherapies, could be considered in combination. However, the quality and quantity of studies were generally low considering the high prevalence of DPD. The review concludes with suggestions for future research and an urgent call for more high-quality research.
Topics: Humans; Comorbidity; Depersonalization; Psychotherapy
PubMed: 37431255
DOI: 10.1080/15299732.2023.2231920 -
Nature Communications Oct 2023Ketamine commonly and rapidly induces dissociative and other altered states of consciousness (ASCs) in humans. However, the neural mechanisms that contribute to these... (Randomized Controlled Trial)
Randomized Controlled Trial
Ketamine commonly and rapidly induces dissociative and other altered states of consciousness (ASCs) in humans. However, the neural mechanisms that contribute to these experiences remain unknown. We used functional neuroimaging to engage key regions of the brain's affective circuits during acute ketamine-induced ASCs within a randomized, multi-modal, placebo-controlled design examining placebo, 0.05 mg/kg ketamine, and 0.5 mg/kg ketamine in nonclinical adult participants (NCT03475277). Licensed clinicians monitored infusions for safety. Linear mixed effects models, analysis of variance, t-tests, and mediation models were used for statistical analyses. Our design enabled us to test our pre-specified primary and secondary endpoints, which were met: effects of ketamine across dose conditions on (1) emotional task-evoked brain activity, and (2) sub-components of dissociation and other ASCs. With this design, we also could disentangle which ketamine-induced affective brain states are dependent upon specific aspects of ASCs. Differently valenced ketamine-induced ASCs mediated opposing effects on right anterior insula activity. Participants experiencing relatively higher depersonalization induced by 0.5 mg/kg of ketamine showed relief from negative brain states (reduced task-evoked right anterior insula activity, 0.39 SD). In contrast, participants experiencing dissociative amnesia showed an exacerbation of insula activity (0.32 SD). These results in nonclinical participants may shed light on the mechanisms by which specific dissociative states predict response to ketamine in depressed individuals.
Topics: Adult; Humans; Brain; Consciousness; Emotions; Ketamine
PubMed: 37857620
DOI: 10.1038/s41467-023-42141-5 -
JAMA Network Open Oct 2023Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking.
OBJECTIVE
To assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees.
DESIGN, SETTING, AND PARTICIPANTS
A randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported).
INTERVENTION
A 4-month, web-based, group coaching program.
MAIN OUTCOMES AND MEASURES
The primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes.
RESULTS
Among the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings.
CONCLUSIONS AND RELEVANCE
The findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05222685.
Topics: Female; Humans; Male; Adult; Mentoring; Physicians, Women; Gender Identity; Anxiety Disorders
PubMed: 37792378
DOI: 10.1001/jamanetworkopen.2023.35541 -
World Journal of Clinical Cases Apr 2024In the evolving landscape of cardiac rehabilitation (CR), adopting digital technologies, including synchronous/real-time digital interventions and smart applications,...
In the evolving landscape of cardiac rehabilitation (CR), adopting digital technologies, including synchronous/real-time digital interventions and smart applications, has emerged as a transformative approach. These technologies offer real-time health data access, continuous vital sign monitoring, and personalized educational enhanced patient self-management and engagement. Despite their potential benefits, challenges and limitations exist, necessitating careful consideration. Synchronous/real-time digital CR involves remote, two-way audiovisual communication, addressing issues of accessibility and promoting home-based interventions. Smart applications extend beyond traditional healthcare, providing real-time health data and fostering patient empowerment. Wearable devices and mobile apps enable continuous monitoring, tracking of rehabilitation outcomes, and facilitate lifestyle modifications crucial for cardiac health maintenance. As digital CR progresses, ensuring patient access, equitable implementation, and addressing the digital divide becomes paramount. Artificial intelligence holds promise in the early detection of cardiac events and tailoring patient-specific CR programs. However, challenges such as digital literacy, data privacy, and security must be addressed to ensure inclusive implementation. Moreover, the shift toward digital CR raises concerns about cost, safety, and potential depersonalization of therapeutic relationships. A transformative shift towards technologically enabled CR necessitates further research, focusing not only on technological advancements but also on customization to meet diverse patient needs. Overcoming challenges related to cost, safety, data security, and potential depersonalization is crucial for the widespread adoption of digital CR. Future studies should explore integrating moral values into digital therapeutic relationships and ensure that digital CR is accessible, equitable, and seamlessly integrated into routine cardiac care. Theoretical frameworks that accommodate the dynamic quality of real-time monitoring and feedback feature of digital CR interventions should be considered to guide intervention development.
PubMed: 38680265
DOI: 10.12998/wjcc.v12.i12.2009 -
Revista Brasileira de Enfermagem 2023To investigate Burnout Syndrome and empathy self-reported by the nursing staff and empathy perceived by the patient.
OBJECTIVE
To investigate Burnout Syndrome and empathy self-reported by the nursing staff and empathy perceived by the patient.
METHOD
Cross-sectional study in a public emergency unit in São Paulo (from October/2020 to March/2021). The nursing staff answered the Maslach Burnout Inventory and the Consultation and Relational Empathy Measure-Nurses (Brazilian version), whereas adult patients answered the Consultation and Relational Empathy Measure (Brazilian version). Descriptive and inferential analysis, with a 5% significance level.
RESULTS
A total of 92 professionals and 271 patients participated. Most professionals reported impact of COVID-19 (80; 86.96%) and, among them, increased Burnout Syndrome (93; 75%), but with low emotional exhaustion (71; 74%), low depersonalization (59; 78%) and high level of professional accomplishment (72; 83%). Most reported impact and increased empathy, and the results reported by professionals and patients (mean and standard deviation) were: 39.89 (6.44) and 38.25 (9.45), respectively.
CONCLUSION
The professionals reported a low level of Burnout Syndrome and a high level of empathy in pandemic.
Topics: Adult; Humans; Empathy; Cross-Sectional Studies; COVID-19; Brazil; Burnout, Professional; Emergency Service, Hospital; Surveys and Questionnaires
PubMed: 38055466
DOI: 10.1590/0034-7167-2021-0869