bluuebunny/crossref_metadata_2025_split huggingface dataset:
Session 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter discusses practicing Acceptance and Commitment Therapy (ACT) and provides a review of treatment. It covers the session work regarding embracing urges and other inner experiences while also thinking about the values and motivation to commit to changing the behavior. Some difficulties in practicing ACT involve being overwhelmed by the exercise, undoing the work to change, and losing motivation. The chapter lists habit reversal training and trigger reduction strategies as some of the important concepts and skills in the treatment review. It highlights the significance of maintaining the gains made during treatment, such as engaging with the chosen competing response.
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter discusses the second session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. The therapist should review the client’s completed self-monitoring form, praise the client for doing the homework, and point out the importance of continued monitoring. The self-monitoring data can be plotted on the Daily Graph of Progress to examine fluctuations in pulling. The chapter explains the purpose of awareness training, which is to help the client recognize and react to episodes of pulling or subtle signs that pulling is about to start. The therapist elicits a detailed description of a client’s entire pulling episode, including actions the client takes before the actual act of pulling, the act itself, and any post-pulling behavior. Patients are taught competing responses to block pulling and trigger reduction strategies to reduce the likelihood pulling will occur.
Session 10: Review and Relapse Prevention
Authors: Woods Douglas W. , Twohig Michael P. 
Published: January 2023

Abstract
This chapter talks about the tenth and final session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. The therapist should urge the client to continue using the skills learned in therapy. Common pitfalls and methods for addressing them are covered. The first pitfall involves becoming less reliable in using habit reversal training and trigger reduction strategies. The second pitfall involves more time fighting with urges, increased pulling, and less time pursuing the meaningful parts of life. Clients may once again react to pulling-related thoughts, urges, or emotions as if they were real events with physical characteristics. In the final session the therapist should review with the client the progress made in therapy and should congratulate the client on their progress.
Case 1
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 23-year-old woman in her first pregnancy presented at 32 weeks of gestation with a 1-day history of progressively worsening, constant, lower thoracic and upper lumbar back pain. There was no history of trauma or heavy lifting, and no symptoms of urinary retention, faecal incontinence, or neurological symptoms in the lower limbs. Her pregnancy had been uncomplicated prior to this. At booking her BMI was normal and her BP was 95/70 mmHg. She had a past medical history of hypermobility. Her family history included hypertension in her father, and her sister had a history of spontaneous bowel perforation. She was a non-smoker.
Case 8
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 45-year-old woman presented to the Emergency Department with a 3-day history of severe headache. She described some visual changes and nausea. Her past medical history was notable for infertility, for which she had undergone numerous investigations and three unsuccessful IVF cycles. She had a history of gastro-oesophageal reflux for which she took omeprazole daily. She had a family history of hypertension in both her parents and her older sister. She worked as an accountant. She had smoked 20 cigarettes a day for many years but stopped 1 year prior to this presentation. She drank 15–20 units of alcohol a week.
Case 11
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 44-year-old woman attended for pre-conception counselling following a review in the local fertility service. She had been trying to conceive with her current partner for four years. She had had two first trimester miscarriages during this time. Past medical history was notable for polycystic ovarian syndrome, with 6–8 spontaneous periods each year. She takes metformin 500 mg twice daily as well as pregnancy multivitamins. She is a non-smoker and drinks approximately 15 units of alcohol per week. The fertility service asked for advice about her thyroid function.
Case 18
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 35-year-old woman with type 1 diabetes mellitus was pregnant for the first time. Her glycaemic control prior to conception was very good (pre-conception HbA1c 42 mmol/mol) and she had no history of retinopathy or nephropathy. She had an insulin pump and used continuous glucose monitoring. At booking her BP was 105/65 mmHg and BMI was 21 kg/m2. She also had a history of vitiligo. She was taking folic acid 5 mg daily, vitamin D 1000 units daily, and aspirin 150 mg daily. Her family history was notable for rheumatoid arthritis and hypothyroidism in her mother. She did not smoke or drink alcohol.
Case 30
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 22-year-old woman was pregnant for the first time. At 36 weeks of gestation she presented with a 3-day history of worsening left-sided lower back pain. She had no gastrointestinal or urinary symptoms, and no symptoms in her legs, for example paraesthesia, numbness or swelling. Her pregnancy had been uncomplicated prior to this presentation; her booking blood pressure was normal (100/60 mmHg) and her BMI was 24 kg/m2. She had no significant past medical history or family history. She took pregnancy multivitamins and no other medications. On examination her observations were normal. Tenderness in her left flank was identified on palpation.
Case 34
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 38-year-old woman was brought to the Emergency Department at 28 weeks of gestation. She was unwell, complaining of acute severe epigastric pain and vomiting for the preceding 8 hours. She complained of mild constipation throughout pregnancy, but last opened her bowels 2 days previously. She had no fever and no other symptoms. The pregnancy was uneventful aside from nausea and vomiting in the first trimester. This was her second pregnancy, her first being 10 years previously. She was diagnosed with gestational diabetes in that pregnancy. Two years prior to this pregnancy she underwent a Roux-en-Y gastric bypass. Her BMI at the start of pregnancy was 26 kg/m2, having been 39 kg/m2 prior to surgery.
Case 48
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry 
Published: January 2023

Abstract
A 43-year-old woman with type 2 diabetes mellitus was seen in the antenatal clinic at 9 weeks of gestation in her first pregnancy. This pregnancy was unplanned, and she had never discussed pregnancy or pre-pregnancy counselling with healthcare professionals. In addition to diabetes, she had a history of hypertension and polycystic ovarian syndrome. Her current medications include metformin, liraglutide, and ramipril. She has no features of diabetic neuropathy or nephropathy and no history of cardiovascular disease. She attends her first trimester retinal screening which shows proliferative diabetic retinopathy and mild macular oedema.
Test Accuracy As Positive and Negative Predictive Values
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter explains how to generate positive and negative predictive values from the rows of a 2×2 table and that unlike sensitivity and specificity, they answer patient-relevant questions such as the probability of disease with a given result. It goes on to describe an important drawback of predictive values, namely that they vary with disease prevalence. It emphasizes that positive and negative predictive values are only meaningful when quoted alongside disease prevalence and are only directly applicable to individual patients when the probability of disease approximates the prevalence in the study from which the values are calculated.
Diagnostic and Prognostic Research
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter describes methods of drawing together multiple strands of information about patients, often in the form of multivariable prediction models (MPMs). It references two landmark papers that explain the process of developing MPMs and then uses the Framingham Heart Study as an example. It gives examples of web-based tools and nomograms for calculating predicted outcomes and then explains discrimination and calibration as valuable statistics for evaluating MPM as well as the importance of internal and external validation. Finally, the chapter gives a brief introduction to machine learning approaches to developing MPMs.
Conclusions
Authors: Boyles Tom 
Published: January 2023

Abstract
This chapter provides a four-point plan to be considered before requesting any test, which begins with formulating a patient-relevant question, determining if the test can answer the question, considering costs, and then pausing to think. It continues with common pitfalls of testing such as mindlessly ticking boxes on request forms and asking for multiple pieces of information when one will suffice. It continues with a summary of the second half of the book and brings in examples from the media, who often portray tests as ‘game changers’ before adequate evaluation. The chapter finishes by returning to the professor from Chapter 1 and explaining in terms of likelihood ratios, probabilities, and thresholds how she was able to solve a seemingly difficult case with a simple urinary pregnancy test.
Anxiety in Palliative Care
Authors: Chin Martin S. , Roth Andrew J. , Matsoukas Konstantina 
Published: January 2023

Abstract
This chapter discusses the prevalence, assessment, and management of anxiety in patients receiving palliative care. Anxiety commonly increases as patients become aware of both the relative ineffectiveness of medical treatments in halting the progress of their disease and, consequently, of approaching death. The aim of this chapter is to build awareness of anxiety as an important factor in this patient population and to emphasize the importance of the systematic workup and management of anxiety in the terminal phase of illness. Guidance for recognizing the symptoms of anxiety at the end of life is provided, and available psychological, pharmacological, and multimodal treatment options are explored.
Family and Couple Issues in Palliative Care
Authors: Kissane David W. , Zaider Talia I. 
Published: January 2023

AbstractFor dying patients, their partners and families are integral to their overall care and support needs. Distress and grief reverberate among all involved, necessitating couple- and family centered care as the norm. Psychiatry and psycho-oncology contribute much to our understanding of how to deliver couple-focused and family centered care at the end of life. Through promoting open disclosure and mutual support, couples and families can comfort one another, celebrate their shared lives, express gratitude, and prepare to say goodbye. Key skills in running family meetings include the development of shared agendas, use of circular questions, and integrated summaries that bring consensus and understanding to those involved. Enhanced coping, adaptation to illness, and prevention of mental illness and complicated grief are salient outcomes. Intervention studies show such clear benefits that palliative care does well to include couple- and family centered care within its routine practice.
Treatment of Suffering in Patients with Advanced Cancer
Authors: Cherny Nathan I. , Reyners Anna K. L. 
Published: January 2023

AbstractThe relief of suffering is a cardinal goal of medicine and cancer care. The ability to formulate a response to the challenge of suffering requires a clinically relevant understanding of the nature of the problem and familiarity with the factors that cause it. Suffering can be defined as an aversive experience characterized by the perception of personal distress that is generated by adverse factors that undermine quality of life. The defining characteristics of suffering include the presence of perceptual capacity (sentience), that the factors undermining quality of life are appraised as distressing, and that the experience is aversive. The encounter with advanced cancer is a potential cause of great distress to patients, their families, and the professional caregivers attending them. Emphasizing this triangular relationship, this chapter describes the many factors that contribute to the experience of suffering in the context of advanced cancer and an approach to care planning that addresses all aspects of the care trilogy: patient, family, and healthcare providers
Interprofessional Spiritual Care in Palliative Care
Authors: Puchalski Christina , Ferrell Betty R. , Battista Vanessa , Waldman Elisha , Bauer Richard W. 
Published: January 2023

AbstractPalliative care, often referred to as “whole-person care,” addresses pain and suffering across the physical, emotional, psychosocial, and spiritual continuum. An increasing amount of evidence supports that individuals from pediatrics through adulthood living with serious, chronic illness and their families have significant spiritual needs. Palliative care is delivered by an interdisciplinary team and involves the use of comprehensive assessments and treatments for spiritual, physical, and psychosocial symptoms. This care, based on a generalist-specialist model, includes trained and certified chaplains. Guidelines and evidence support the inclusion of spiritual care models in clinical palliative care. Spiritual care is more than religious care and is based on spirituality broadly defined to include spiritual, existential, and religious care. Spiritual care is respectful care for all people. Spiritual health is a domain of whole-person care with spiritual distress as a clinical symptom that must be assessed and treated routinely in the care of seriously and chronically ill patients no matter their age. It is the responsibility of all clinicians to address the spiritual needs of their patients and work collaboratively with spiritual care professionals. Spiritual care professionals are essential members of the team, providing spiritual care for both the patient and family and the interprofessional team. Spiritual care may include moments of reflection, pause, ritual, and renewal to support the team in their shared values and vision of providing optimal palliative care.
Psychodynamic Therapy in the Terminally Ill
Authors: Emanuel Linda , Brody Stephanie 
Published: January 2023

Abstract
This chapter describes how psychodynamic approaches contribute to understanding and fostering quality of dying. Non-existence is uniquely difficult for the psyche to understand and it terrifies. People live with a fantasy of indefinite life, yet reality puts checks on that. Such opposing perceptions, which people may be unaware of, can result in unmanageable anxiety and other suffering. Getting to know one’s deeper mind regarding mortality and finding a reasonably integrated way to understand opposing perceptions allows some acceptance and a more realistic vitality. The process, in both children and adults, entails oscillating between these divergent experiences in the holding attention of the therapist. In this fostering relationship, the therapist helps to uncover often unconscious and person-specific experiences of terror and hope, non-existence and vitality. Through constructive grief, the person can discover how to integrate realistic ways to think and feel about dying that bring resilience. These new ways can become part of how they work, love, and play whether for a short time or longer. Altogether, they provide openness to realistic continuity through in family, friends, and community. Dynamic approaches also help clarify why blocks on this growth process often come from attachment or trauma issues or from a culture of death denial. Dynamic approaches are uniquely suited to finding and redressing such blocks. A resulting realistic conception of the future allows less turbulent contemplation of death, increased capacity to meaningfully relate, less indecision, attainable goals to hope for, and readiness for tasks such as legacy making.
Supportive-Expressive Group Therapy and the Terminally Ill
Authors: Spiegel David , Kogon Manuela 
Published: January 2023

Abstract
Supportive-expressive group therapy (SEGT) was developed in the 1970s to help women with metastatic breast cancer find opportunities for growth as well as symptom relief by giving as well as receiving support to one another, expressing emotion, facing existential concerns openly, reordering life priorities, communicating clearly with family as well as healthcare professionals, and learning self-hypnosis to manage stress and pain. Key elements of the psychotherapeutic method are personalizing the discussion using the group’s here-and-now interaction, encouraging the expression and exploration of emotion, supporting constructive group interaction among all members, and facilitating active coping. This psychotherapeutic approach has been carefully studied and found effective in reducing distress, anxiety, depression, and pain in a number of randomized clinical trials, and it has been utilized in cancer treatment programs around the world. In addition, some but not all studies have shown that those randomized to SEGT experience longer survival as well. Essentials of the treatment technique and evidence regarding psychological and physiological outcome are reviewed. Opportunities for expanding the reach of this and other therapeutic approaches utilizing internet-based intervention are discussed.
Psilocybin-Assisted Psychotherapy in Palliative Care
Authors: Ross Stephen , Bossis Anthony P. 
Published: January 2023

AbstractFollowing a decades-long hiatus and building on an innovative research model first developed from the 1960s to 1970s utilizing psychedelic therapeutics to alleviate the marked psychic distress in end-of-life cancer patients, major academic centers are resuming contemporary clinical research into the safety and efficacy of psilocybin and other serotonergic psychedelics delivered in conjunction with psychotherapeutic platforms to treat psychiatric and existential distress associated with terminal medical illnesses. While there have been significant advances in the treatment of medical and pain symptomatology in palliative care, there remains a paucity of efficacious psychopharmacologic and psychotherapeutic interventions to alleviate the psychiatric and existential anguish—notably depression, anxiety, and demoralization—often present at the end of life. Relevant to end-of-life therapeutics, the World Health Organization and the Institute of Medicine have identified treating spiritual and existential distress as essential to improving the emotional well-being and quality of life in patients with advanced or terminal illnesses. This chapter covers topics related to psilocybin-assisted psychotherapy in palliative care: history, anthropology, ethnobotany, neuropharmacology, safety, efficacy data from first and second waves of psychedelic research, putative mechanisms of action, and future directions. Psilocybin-assisted psychotherapy offers a potential paradigm shift to improve the existential, psychosocial, and spiritual well-being of patients in palliative care settings.
The emergence of a right to pain relief
Authors: Sullivan Mark D. , Ballantyne Jane C. 
Published: January 2023

Abstract
This chapter describes the gradual establishment of a right to pain relief. After the Second World War, and because of the horrors that war, Western nations formed the United Nations, which saw the protection of human rights as part of its role. The United Nations wrote a Declaration of Human Rights in 1948. Although it did not initially establish a right to pain relief per se, later amendments established a right to pain relief at the end of life. Other bodies, including the U.S. Supreme Court, similarly established a right to pain relief at the end of life. Although these august bodies have never followed with statements of a right to the relief of all pain, the largest and most influential international pain society, the International Association for the Study of Pain, in 2011 wrote its own declaration, the Declaration of Montreal, which states that access to pain management is a “fundamental human right.”
Communication about Advanced Progressive Disease , Prognosis, and Advance Care Plans
Authors: Michael Natasha , Shah Rajvi 
Published: January 2023

Abstract
eHealthcare professionals face many challenges in imparting information and balancing hope and truth-telling at the time of disease progression or recurrence, and transition to the end-of-life for cancer patients. The way information is communicated verbally, and through the actions and approaches of cancer professionals, leaves a lasting impact on those afflicted by advanced cancer. It enables coping, assists with adjustment, allows for early family communication and coherence, and supports meaningful and purposeful living until the end. This chapter covers the importance of cancer communication and strategies to aid practitioners in discussing recurrence, progression, prognostication, and transition to palliative care. It highlights the importance of family communication, future care planning, and specific challenges when considering cultural, ethical and legal issues.
Delirium and Cognitive Impairment
Authors: Alici Yesne , Boettger Soenke , Breitbart William S. 
Published: January 2023

AbstractCognitive syndromes are prevalent in palliative care settings. Delirium is the most common and often serious neuropsychiatric disorder found in palliative care settings. Delirium is characterized by abrupt onset, fluctuating disturbance in awareness, attention, cognition, and perception. Delirium is associated with increased morbidity and mortality, causing distress in patients, family members, and staff. Delirium is often underrecognized or misdiagnosed and inappropriately treated or untreated. Clinicians who care for patients with advanced cancer and at the end-of-life must be able to diagnose delirium accurately, undertake appropriate assessment of etiologies, and understand the benefits and risks of pharmacologic and nonpharmacologic interventions currently available. Dementia and other neurocognitive disorders can also be encountered in palliative care settings, have multifactorial etiologies ranging from cancer-treatments to brain metastases, and include neurodegenerative illnesses comorbidly, especially in the oldest old patient population. This chapter presents an overview of the assessment and management of delirium in cancer patients in palliative care settings. Other cognitive syndromes will be briefly described with a focus on the assessment and differential diagnosis. Professional issues, including communication challenges, ethical dilemmas, legal requirements, and service development agendas will be considered.