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Concept: Denial

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REALISE Asia-an online questionnaire-based study of Asian asthma patients-identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal-control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal-control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal-control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.

Concepts: Asthma, Sociology, Control, Tailor, Denial

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Denial in sexual offenders represents the first barrier to successful treatment a clinician is likely to face. Most sex offender treatment programs devote significant time to overcoming denial, with most programs having a focus on disclosure and “accepting responsibility.” This is the first study that has aimed to make sense of sexual offenders' denial through a rigorous qualitative analysis. The main objective was to explore the experiences and lived worlds of sexual offenders in denial. A qualitative phenomenological methodology combining interpretative phenomenological analysis and repertory grids was implemented. Ten incarcerated sexual offenders in categorical denial participated in the research. The analysis revealed the narrative, relational, and self-reconstructive properties of denial and discusses the role and function denial may be playing for sexual offenders. The results highlight that denial can be viewed as a form of “sense making” and that clinically relevant treatment targets can be elicited without disclosure. It is concluded that viewing denial as a barrier to treatment impedes constructive work with offenders, and implications for treatment are discussed.

Concepts: Scientific method, Focus group, Qualitative research, Sex offender, Interpretative phenomenological analysis, Self-deception, Psychological manipulation, Denial

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The authors review the literature on two dramatic psychosomatic disorders of reproduction and offer a potential classification of pregnancy denial.

Concepts: Pregnancy, Reproduction, Avicenna, Fertility, Psychosomatic medicine, Denial, Holocaust denial, Denial of pregnancy

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The present study examined the mnemonic consequences of true/false denials and affirmatives on how a listener appraises their personal past. To this end, participants (listeners) rated the extent to which they were confident certain events occurred during their childhood. They rated these events both before and after a confederate (speaker) denied or affirmed the occurrence of four different childhood events each, for a total of eight “rehearsed” events. For each set (denials and affirmatives) of events, half were true and half were false. In turn, this created four types of events (two each): true denials, true affirmatives, false denials, and false affirmatives. Additionally, half of the participants were told that the speaker was provided independent information about the veracity of the event’s occurrence (“expert” condition). Overall, listeners were less confident in the occurrence of false denial events, but more so when they believed the speaker to be more knowledgeable of the listeners memories, more confident in false affirmative events and, counter intuitively, more confident in the occurrence of true denial events. These results underscore the importance of a nuanced approach to the mnemonic consequences of true and false denials and affirmations in the course of social interactions.

Concepts: Present, Epistemology, Lie, Sigmund Freud, Policy debate, Psychological manipulation, Denial, Holocaust denial

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This study investigated the importance of the combination of the hostility and defensiveness variables as psychosocial factors that predict the risk of cardiovascular dysfunction. We examined the impact of a stressful situation on blood pressure responses, using a continuous psychophysiological assessment approach.

Concepts: Blood, Anger, Hostility, Denial

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Despite women’s increased representation in the overall workforce, construction remains a male-dominated industry. Prior studies have noted that the hazardous workplace environment combined with a culture that can be discriminatory and openly hostile can threaten women workers' health and safety. However, little information exists about the current physical and psychosocial hazards at work affecting tradeswomen.

Concepts: Risk, Gender, The Current, Hazard, Occupational safety and health, Denial

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To explore general practitioners (GPs') experiences from consultations when a patient’s request is denied, and outcomes of such incidents.

Concepts: Physician, General practitioner, Doctor, Denial

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Attacks on peoples' dignity help to produce and maintain stigmatization and interpersonal hostility. As part of an effort to develop innovative measures of possible pathways between structural interventions or socially-disruptive Big Events and HIV outbreaks, we developed items to measure dignity denial. These measures were administered to 300 people who inject drugs (PWID), 260 high-risk heterosexuals who do not inject drugs, and 191 men who have sex with men who do not inject drugs (MSM). All of the PWID and many of the high risk heterosexuals and MSM were referred to our study in 2012-2015 by a large New York city study that used respondent-driven sampling; the others were recruited by chain-referral. Members of all three key populations experienced attacks on their dignity fairly often and also reported frequently seeing others' dignity being attacked. Relatives are major sources of dignity attacks. MSM were significantly more likely to report having their dignity attacked by police officers than were the other groups. 40 % or more of each key population reported that dignity attacks are followed “sometimes” or more often both by using more drugs and also by using more alcohol. Dignity attacks and their health effects require more research and creative interventions, some of which might take untraditional forms like social movements.

Concepts: Sexual intercourse, Population, Attack, New York City, Attack!, Exploratory research, Social movement, Denial

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The present study was designed to analyze association between problematic internet use and use of ego defense mechanisms in medical students. This cross-sectional study was undertaken at CMH Lahore Medical College (CMH LMC) in Lahore, Pakistan from 1st March, 2015 to 30th May, 2015. 522 medical and dental students were included in the study. The questionnaire consisted of three sections: a) demographic characteristics of respondent b) the Defense Style Questionnaire-40 (DSQ-40) and c) the Internet Addiction Test (IAT). All data were analyzed in SPSS v20. Chi square, Independent sample t test and One Way ANOVA were run to analyze association of different variables with scores on IAT. Multiple regression analysis was used to delineate ego defenses as predictors of problematic internet use. A total of 32 (6.1%) students reported severe problems with internet usage. Males had higher scores on IAT i.e had more problematic use of internet. Scores on internet addiction test (IAT) were negatively associated with sublimation and positively associated with projection, denial, autistic fantasy, passive aggression and displacement. There was a high prevalence of problematic use of internet among medical and dental students. It had significant associations with several defense mechanisms.

Concepts: Regression analysis, Psychiatry, Internet, Psychological projection, Defence mechanism, Id, ego, and super-ego, Regression, Denial