Despite an extensive body of research showing the negative consequences of weight stigma, healthcare providers (HCPs) continue to marginalize fat 1 patients through negative attitudes, stereotypical beliefs, and discriminatory actions (Daníelsdóttir et al., 2010;Phelan et al., 2015). Weight stigma is present through all stages of medical training, where derogatory comments about fat patients abound (see Flint, 2015). It is therefore imperative to combat weight stigma early in medical education. Reviews of weight stigma reduction research have shown that existing interventions are ineffective, or, at best, only minimally effective (Alberga et al., 2016;Lee et al., 2014).There is a clear need for new approaches in this field. Fat studies is an interdisciplinary field of scholarship that may offer new insights for intervening in weight stigma, guided by three tenets: first, the oppression of fat people exists on a structural level; second, fat bodies are part of the natural diversity of body sizes; and third, any knowledge produced about fat people should include fat people
Cognitive distortions associated with depression may amplify the sense of strain and pressure derived from everyday stressors. The Perceived Stress Scale (PSS), designed to assess the degree to which situations are perceived as stressful, was administered before and after open treatment with fluoxetine 20 mg/day for eight weeks to 60 consecutive outpatients with major depression (15 men and 45 women; mean age: 36.9 f 10.6 years) and to 22 normal controls (1 1 men and 11 women; mean age: 34.6 f 10.1 years). Pretreatment, the mean PSS score among the depressed patients was 38.8 f 6.4, which was significantly higher ( z score: 6.33; p < 0.0001) than that (22.4 * 7.0) of the group of normal controls. After treatment with fluoxetine, the mean PSS score was 25.1 f 8.9, not different from controls but significantly different from baseline (paired t-test = 10.8; p < 0.OOOl). The correlation between PSS and Hamilton Rating Scale for Depression (HAM-D-I 7) scores was significant both before (r = 0.33; p < 0.02) and after (r = 0.62; p < 0.0001) treatment with fluoxetine. An even greater correlation was found between differences in pre-and posttreatment PSS scores and differences in pre-and posttreatment HAM-D-17 scores (r = 0.65; p < 0.0001).
Could sympathetic hyperarousal limit treatment success in complicated grief? The present study investigated persons with complicated grief, a chronic condition with distinct symptoms including persistent intense yearning and longing for the person who died, avoidance of reminders that the person is gone, deep relentless sadness, self-blame, bitterness, or anger in connection with the death, and an inability to gain satisfaction or joy through engaging in meaningful activities or relationships with significant others. Length of bereavement did not correlate with complicated grief scores. Catecholamines (i.e., epinephrine, norepinephrine, dopamine) in plasma were assessed pre- and post-psychotherapeutic treatment. Participants with the highest levels of epinephrine at pre-treatment had the highest levels of complicated grief symptoms at post-treatment, accounting for baseline levels of symptoms. This predictive relationship was not seen for depressive symptoms. The present study supports the hypothesis that catecholamine levels are affected by bereavement, and in turn, can affect the ability of those with complicated grief to benefit from psychotherapy.
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