Moments of change: Clients' immediate experiences when sharing emotions in psychotherapy.

OBJECTIVE: In-session processing of emotions is important in facilitating psychotherapeutic change. This study explores how clients in active treatment experience inner changes when sharing emotions in psychotherapy sessions. The aim was to retrieve in-depth knowledge about clients' moment-by-moment experiences of change in a naturalistic psychotherapy context. METHOD: Two psychotherapy sessions (session 3 or 4 and session 7 or 8) were videotaped and immediately followed by semi-structured interviews with clients (n = 11) in the format of Interpersonal Process Recall (IPR). Interviews were analysed using thematic analysis. RESULTS: Four themes resulted from analysis: (1) reaching a new clarity about inner struggles; (2) a shift in how I approach and experience my feelings; (3) grieving losses and gaining a more positive understanding of myself; (4) feeling relief and liberation when allowing difficult emotions. CONCLUSION: The resulting themes took into account the importance of the felt quality of change experiences within sessions, which appears to be important in making micro-processes of change salient. Across themes, we found accounts of shifts in awareness and self-compassion, which we discuss as micro-outcomes that clients can ideally be guided to dwell with.

Perfection is a sad and lonely place: A study of existential vulnerability in the life stories of persons struggling with perfectionism.

Under what life conditions do individuals turn to perfectionistic striving and ideals as a solution? The present paper examines how people with perfectionism narrate their relationship to our shared existential vulnerability; that we are vulnerable as human beings, and that the ways we relate to this vulnerability have consequences for psychological health. In the present qualitative study, we explored the life narratives told by nine students with perfectionism, drawing on semi-structured life-story interviews. We conducted an explorative-reflexive thematic analysis and identified five themes: 1) Outside-Feeling Alienated, 2) Relating to Chaos, 3) Trying to Control the Painful and Uncontrollable, 4) Islands of Just Being and Positive Contact, and 5) Heading Toward a Balance Between Doing and Being. Their perfectionism can be seen as a way of handling existential vulnerability at a point in their lives where relational resources needed to stay firm in a vulnerable state are lacking. Perfectionistic themes influence their personal identity in the domain of narrative constructions, values, belongingness, and embodiment. Accomplishments were dominant themes in the plots of their narrative self-constructions and values. They felt their "self-made" identities kept others at a distance. However, we also found strivings for a more fulfilling life with broader self-definitions.

Engaging with difficult topics and emotional experiences in psychotherapy: A study of helpful therapist acts.

OBJECTIVE: The purpose of this study was to explore moments during psychotherapy sessions in which clients experience that they have an opportunity to approach and engage with difficult topics and emotional experiences, with the aim of describing therapists' acts that support clients' in-session engagement. METHODS: Two treatment sessions of 11 participants were videotaped and immediately followed by an in-depth semi-structured interview, using the interpersonal process recall (IPR) interview method. A follow-up interview was conducted 3 months after the final IPR interview. Participants' accounts were analyzed using thematic analyses. RESULTS: Five themes of engagement-supportive acts resulted from our analyses: 1. inviting the client by showing acceptance; 2. recognizing the clients' hints and try-out signs; 3. providing information on the process and evaluating clients' expectations; 4. actively helping the clients to notice and stay with difficult experience and 5. showing sensitivity to the client's needs for micropauses. We discuss these themes as acts of recognition. CONCLUSION: Clients found it was engagement-supportive when therapists implicitly and explicitly recognized the challenges of being in psychotherapy. This recognition could be achieved through the engagement-supportive acts described in the five themes. Therapists should continually make space for and seek a balance between different engagement-supportive acts.

Does it get easier over time? Psychologists' experiences of working with suicidal patients.

Does working with suicidal patients become easier with time? A representative national survey of 375 psychologists (72% women, Mean age 44 years) showed that years of experience (r = -.13, p = .01) and frequency of contact with suicidal patients (r = -.15, p = .004) correlated only weakly with perceived difficulty. Thematic analysis of respondents' descriptions of difficult suicide-related situations on an open survey-question yielded four themes: Unreachable patients, choosing between therapy and security, therapist's boundaries and empathy with death-wishes. We conclude that improved confidence in coping with suicidality may require specific training rather than simply years of work.

Like Taking a Magnifying Glass Into Everyday Life: Vulnerable Parents' Experiences With Video Guidance in an Infant Mental Health Clinic.

Background: Parents are a central focus in clinical infant mental health interventions because of the key importance of the caregiver-infant relationship, especially when dyads are burdened by psychosocial and parental mental health problems. However, knowledge is scarce about the lived experience of vulnerable parents who undergo video-based guidance. Aim: The study explores how parents in an infant-psychiatric outpatient clinic who struggled to mentalize and remain emotionally connected to their infant experienced helpful and challenging elements in video guidance. Method: We analyzed the interviews of a strategic sample of 12 parents after undergoing Marte Meo video guidance, using a team-based, reflexive thematic analysis (TA). Results: We identified four main themes: (a) Handling initial feelings of fear and loss of control; (b) Filming as a disturbing or agentic experience; (c) Feeling validated or devalued in the therapeutic relationship; and (d) Bringing insights from video guidance into everyday life. Therapeutic and existential factors became apparent in the main themes of adjustment to the guidance, experiences with filming, the therapeutic relationship and integration of new experiences. Conclusion: The parents' sense of agency, dignity, and shame may be important for their ability to integrate new ideas about themselves. Implications: Video guidance for vulnerable parents in specialized clinical treatment should address relational challenges, parental mental health, and issues of recognition.

Learning to mentalize: Exploring vulnerable parents' experiences of change during video guidance in an infant mental health clinic.

BACKGROUND: Interventions that promote infant mental health face challenges when applied for parents who struggle with psychosocial and psychological burdens. Video-based guidance using the Marte Meo method is used in specialized clinical settings with high-risk families to improve parent-child interaction, parental sensitivity and mentalizing. However, knowledge about the lifeworlds of these parents and their experiences of the therapeutic process during video guidance is limited. AIM: This qualitative study explores how parents in an infant mental health outpatient clinic who had difficulties mentalizing and maintaining an emotional connection with their infants experienced the change process during Marte Meo video guidance. METHODS: We identified a strategic sample of parents with difficulties mentalizing and maintaining an emotional connection with their infants through the Parent Development Interview. Twelve parents received video guidance and were afterwards interviewed in-depth. The research interviews were qualitatively analysed via a team-based reflexive thematic analysis. RESULT: We identified four themes: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected; and d) still feeling challenged by personal mental health issues. CONCLUSION: Parents described positive changes in their interactions, in mentalizing their infants, the relationship and themselves as parents, in their experiences of self-efficacy and on a representational level. They also described increased confidence and improved coping despite ongoing personal mental health challenges. The findings suggest that video guidance using the Marte Meo method can be a critical intervention for vulnerable parents but should be coordinated with parents' primary treatments when complex parental mental health issues are involved.

Parenthood-Lost and Found: Exploring Parents' Experiences of Receiving a Program in Emotion Focused Skills Training.

BACKGROUND: Parents play a crucial role in the development, maintenance, and deterioration of child difficulties. Emotion focused skills training (EFST) targets parents' capacity to provide their child with emotion-oriented skills in order to promote good child mental health. Few qualitative studies have specifically investigated parents' experiences of receiving such programs. OBJECTIVE: This study aimed to explore how parents experience working with their own and their child's emotions undergoing a short-term program in EFST; in particular, changes in their experience of being a parent and in everyday life are reported. METHOD: Semi-structured in-depth qualitative interviews were conducted with 14 parents who had completed a short-term EFST program (2-day group training and 6 h of supervision). Interview transcripts were analyzed using a reflexive thematic analysis approach. RESULTS: A total of 14 parents (40% men, four couples, Mage = 39.5, SD = 4.4) participated in the study. Our analysis resulted in the following three themes: (1) "Coming home" as a parent, with the following subthemes: (a) New ways of being with their child and (b) Parents' painful inner world; (2) Reclaiming parenthood-applying new tools and learning in challenging situations; and (3) This is us-changing the heart of the story. The first theme was related to the descriptions of the changes that emerged in parents' inner lives, the second revolved around the employment of their skills intuitively and creatively based on what was required by the challenging situations, and the third theme referred to new discoveries on family dynamics. CONCLUSION: Parents' experiences of having wisdom and calmness inside them (being) and doing parenting differently, as well as the changed perspectives of the family (living), resonate with the theoretical ground of emotion-focused therapy (EFT). The findings also indicate that therapists should be aware of potential parental distress when working in view of changing unpleasant emotions in such skill-based programs.

Perfectionistic Individuals' Understanding of How Painful Experiences Have Shaped Their Relationship to Others.

Background: Perfectionism is increasing over time and associated with various mental health problems. Recent research indicates adverse childhood experiences may play a role in the development of perfectionism. In addition, perfectionism is marked by interpersonal problems with implications for treatment outcome. Aim: This study aimed to fill an important gap in the predominantly quantitative literature field by exploring how individuals with perfectionism understand the relationship between painful experiences and how they relate to others. Method: Nine individuals with perfectionism were interviewed using McAdam's life-story interview. Thematic analysis was used to analyze the interviews. Results: Four themes emerged: "A childhood with big responsibilities," "I am still the responsible one," "Keeping others at a distance to protect the inner self," and "Achieving physical distance to get a fresh start." These themes are grouped into two overarching themes: "You can't always trust people" and "A distancing from others." Conclusion: Findings highlight taking responsibility and social distancing serve an important function for perfectionistic individuals in response to painful relational events. We discuss how themes of control and agency impact individuals' relationship to mental health and turning toward others for help. The findings provide greater complexity to understanding perfectionism as a "barrier to treatment."

Experiences of Norwegian Mothers Attending an Online Course of Therapeutic Writing Following the Unexpected Death of a Child.

The unexpected death of a child is one of the most challenging losses as it fractures survivors' sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The "both and" of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: "careful optimism" and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self.

Finding focus in a difficult landscape: Therapists' experiences with challenging video guidance processes for parent-infant dyads.

Marte Meo video guidance uses filmed interaction of the actual parent-infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent-infant dyads may illuminate important aspects of the method itself as well as the therapists' role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent-infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent-infant dyads where child protective issues arise, where caregivers' insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists' role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.

La guía de video Marte Meo usa interacciones filmadas de las propias díadas. Explorar los retos que en la guía surgen de las díadas progenitor-infante pudiera dar luz al papel de los terapeutas y requisitos, así como a importantes aspectos del método mismo. Esto podría llevar al desarrollo del método y una práctica mejorada, sin embargo, hasta el presente ha sido poco estudiada. Exploramos cómo los hábiles terapeutas experimentan y manejan los retos o los fallos en los procesos de guía. Analizamos entrevistas con 13 terapeutas/supervisores de Marte Meo usando análisis temáticos de reflexión basados en el equipo de trabajo. Se identificaron cuatro temas principales: promover el crecimiento de la relación dentro de un contexto coercitivo; construir una alianza en la que los progenitores se sientan seguros; prestar atención a momentos positivos en vidas difíciles; y manejar sentimientos intensos como terapeuta. Nuestros resultados muestran que el terapeuta experimenta retos éticos y terapéuticos específicos con un vulnerable subgrupo de díadas progenitor-infante donde surgen asuntos de protección al niño, donde las inseguridades de los cuidadores impiden la relación terapéutica, y donde los cuidadores tienen problemas de relación o de salud mental no resueltos. El papel de los terapeutas se convierte en esencial y exigente con respecto a la alianza, a las intervenciones terapéuticas, así como a la propia necesidad de regulación, supervisión y estructura. La temprana identificación de estas díadas pudiera facilitar una mejor adaptación a la guía del video. Nuestros resultados sugieren la necesidad de estructuras de apoyo, supervisión clínica y entrenamiento para manejar estos retos.

La guidance interactive par vidéo Marte Meo ("Par mes propres forces") utilise une interaction filmée de vraies dyades. L'exploration des défis qui se posent dans la guidance de dyades parent-bébé peuvent illuminer le rôle des thérapeutes ainsi que les besoins et les aspects importants de la méthode en elle-même. Cela pourrait mener au développement de la méthode et à une pratique améliorée mais n'a jusque-là guère été abordé. Nous explorons ici comment des thérapeutes expérimentés vivent et gèrent les processus de guidance qui forment un défi ou qui échouent. Nous avons analysé des entretiens avec 13 thérapeutes/superviseurs Marte Meo utilisant une analyse thématique de réflexion et menée en équipe. Quatre thèmes principaux ont été identifiés: la promotion de la croissance relationnelle dans un context coercif; la construction d'une alliance que les parents trouvent sûre; le fait de voir des moments positifs dans des vies difficiles; et le fait d'avoir à faire à des sentiments intenses en tant que thérapeute. Nos résultats montrent que les thérapeutes font l'expérience de défis thérapeutiques spécifiques et de défis éthiques avec un sous-groupe vulnérable de dyades parent-bébé lorsque des problèmes de protection de l'enfant se posent, dans un contexte ou les insécurités des personnes prenant soin de l'enfant enfreignent la relation thérapeutique et où les personnes prenant soin de l'enfant peuvent avoir des problèmes relationnels ou de santé mentale qui n'ont pas été résolus. Le rôle des thérapeutes devient central et exigeant pour ce qui concerne l'alliance, les interventions thérapeutiques et son propre besoin de régulation, de supervision et de structure. Une identification précoce de ces dyades pourrait faciliter une meilleure adaptation de la guidance par vidéo. Nos résultats suggèrent qu'il est nécessaire d'avoir des structures de soutien, une supervision clinique et une formation afin de faire face à ces défis.

Participant experiences of change in mindfulness-based stress reduction for anxiety disorders.

AIM: To explore experiences of change among participants in a randomized clinical trial of mindfulness-based stress reduction (MBSR) for anxiety disorders. METHOD: Semi-structured interviews were conducted to explore the subjective experiences of change for individuals with anxiety disorders after a course in MBSR. Interviews were analysed employing hermeneutic-phenomenological thematic analysis. RESULTS: Five main themes were identified: 1) Something useful to do when anxiety appears, 2) Feeling more at ease, 3) Doing things my anxiety wouldn't let me, 4) Meeting what is there, and 5) Better-but not there yet. Most participants used what they had learned for instrumental purposes, and described relief from anxiety and an increased sense of personal agency. A few reported more radical acceptance of anxiety, as well as increased self-compassion. CONCLUSION: Participants of MBSR both describe mindfulness as a tool to "fix" anxiety and as bringing about more fundamental change towards acceptance of their anxiety. The complexity of reported change corresponds with better handling of areas representing known transdiagnostic features of anxiety disorder, such as dysfunctional cognitive processes (including attentional biases), emotional dysregulation, avoidance behaviours, and maladaptive self-relatedness. This supports MBSR as a transdiagnostic approach to the treatment of anxiety disorders.

Opening Up: Clients' Inner Struggles in the Initial Phase of Therapy.

OBJECTIVE: To explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy. METHODS: Two psychotherapy sessions of clients (N = 11) were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients' immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis. RESULTS: The data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. The overarching theme was "Holding back and struggling to open up," which included four subthemes: (a) fearing the intensity and consequences of negative emotions; (b) experiences of being incapable and bodily stuck; (c) being insecure about one's worthiness and right to share inner experiences with the therapist; and (d) struggling with feeling disloyal to loved ones. CONCLUSION: The participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work.

Antipsychotic treatment - a systematic literature review and meta-analysis of qualitative studies.

Background: The literature on antipsychotic medication in psychosis lack systematization of the empirical knowledge base on patients' subjective experiences of using antipsychotic drugs. Such investigations are pivotal to inform large-scale trials with clinically relevant hypotheses and to illuminate clinical implications for different sub-groups of individuals.Aims: To re-analyze and summarize existing qualitative research literature on patient perspectives of using antipsychotic medication.Method: A systematic literature search was performed in September 2018 (Protocol registration no. CRD42017074394). Using an existing framework of meta-analyzing qualitative research, full text evaluation was conducted for 41 articles. Thirty-two articles were included for the final synthesis.Results: Four meta-themes were identified: (1) short-term benefits; (2) adverse effects and coping processes; (3) surrender and autonomy; (4) long-term compromise of functional recovery.Conclusions: While largely positive about acute and short-term use, patients are more skeptical about using antipsychotic drugs in the longer term. The latter specifically relates to processes of functional and social recovery. The clinical conversations about antipsychotic medication need to include evaluations of contexts of patient experience level, patient autonomy processes, patient values and risk preferences, and patient knowledge and knowledge needs in addition to assessing the severity of symptoms of psychosis.

Becoming Aware of Inner Self-Critique and Kinder Toward Self: A Qualitative Study of Experiences of Outcome After a Brief Self-Compassion Intervention for University Level Students.

This qualitative study investigated ways in which student participants in a three-session self-compassion course became more compassionate toward themselves and challenges related to this change. Ninety-four participants completed an online survey and 12 participants were interviewed face-to-face. First, a thematic analysis of the responses from the online survey was conducted, and then sorted by frequency, indicating their representativeness in the written responses. The following themes were identified: (1) being more supportive and friendlier toward self, (2) being more aware of being too hard on oneself, (3) feeling less alone when having painful feelings, (4) having more acceptance of painful feelings, and (5) feeling more stable and peaceful. These five most frequent themes served as a basis for a structured phenomenological analysis in the next analytic stage. They were used as a template for a content analysis of the interview material. Subsequently, a phenomenological analysis was conducted on the interview transcripts covering the five thematic areas.

"You Feel They Have a Heart and Are Not Afraid to Show It": Exploring How Clients Experience the Therapeutic Relationship in Emotion-Focused Therapy.

Background: The therapeutic relationship is regarded as an important source of change in emotion-focused therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have specifically investigated how clients experience the role of the relationship in EFT. Aim: The purpose of the present study was to explore what clients experienced as helpful or hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety, and severe self-criticism. Methods: We interviewed 18 clients after a clinical trial of time-limited EFT, to explore their experiences of the relationship with their therapist during treatment. The interviews were analyzed using hermeneutic-phenomenological thematic analysis (Braun and Clarke, 2006; Binder et al., 2012). Results: We identified four main themes: (1) Forming a trusting relationship or finding it hard to connect, (2) Collaborating and struggling to find new ways to relate to painful feelings, (3) Alliance ruptures and needs for repair when working with distressing emotions, and (4) The significance of new relational experiences. Conclusion: Clients described therapists' genuineness and the establishment of trust in the relationship as important preconditions to open up to vulnerability and painful feelings, and engaging fully in specific EFT interventions. The findings also indicate that the therapists need to be mindful of different client preferences and monitor potential alliance ruptures when working to change distressing emotions in therapy.

Both sides of the story: Exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder.

OBJECTIVE: What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD. METHODS: A two-staged mixed methods design was used to identify the participants who reported the highest (n = 7) and lowest (n = 7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology. RESULTS: We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life. CONCLUSIONS: MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.

An open trial of mindfulness-based stress reduction for young adults with social anxiety disorder.

The present study investigated mindfulness-based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty-three young adults in a higher education setting underwent a standard eight-week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self-compassion, and self-esteem. Using intention-to-treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self-compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance-based interventions for SAD.

Mindfulness Based Stress Reduction for Academic Evaluation Anxiety: A Naturalistic Longitudinal Study.

Mindfulness based stress reduction (MBSR) for academic evaluation anxiety and self-confidence in 70 help-seeking bachelor's and master's students was examined. A repeated measures analysis of covariance on the 46 students who completed pretreatment and posttreatment measures (median age = 24 years, 83% women) showed that evaluation anxiety and self-confidence improved. A growth curve analysis with all 70 original participants showed reductions in both cognitive and emotional components of evaluation anxiety, and that reduction continued postintervention. Although more research is needed, this study indicates that MBSR may reduce evaluation anxiety.

What Brings You Here? Exploring Why Young Adults Seek Help for Social Anxiety.

Social anxiety disorder typically manifests in young adulthood, but there is an absence of qualitative research on the actual experiences of young adults suffering with this disorder. The aim of the present study was to investigate the lived experiences of 29 Norwegian university students who were seeking professional help for symptoms of social anxiety. We conducted in-depth interviews prior to a clinical trial. The interviews were transcribed and analyzed using a team-based thematic analysis method based on a hermeneutic-phenomenological epistemology. We identified five themes: (a) from being shy to interpreting anxiety as a mental health problem, (b) experiencing emotions as threatening and uncontrollable, (c) encountering loneliness as relationships fall away, (d) hiding the vulnerable self from others, and (e) deciding to face social fears in the future. We relate our findings to existing theory and research, discuss our process of reflexivity, highlight study limitations, and suggest implications for future research.

Facing the fear of failure: An explorative qualitative study of client experiences in a mindfulness-based stress reduction program for university students with academic evaluation anxiety.

The aim of this qualitative study was to investigate the subjective experiences of 29 university students who participated in an 8-week mindfulness-based stress reduction (MBSR) program for academic evaluation anxiety. Participants who self-referred to the Student Counseling Service underwent individual semi-structured interviews about how they experienced the personal relevance and practical usefulness of taking the MBSR program. Interviews were transcribed and analyzed through a team-based explorative-reflective thematic approach based on a hermeneutic-phenomenological epistemology. Five salient patterns of meaning (themes) were found: (1) finding an inner source of calm, (2) sharing a human struggle, (3) staying focused in learning situations, (4) moving from fear to curiosity in academic learning, and (5) feeling more self-acceptance when facing difficult situations. We contextualize these findings in relation to existing research, discuss our own process of reflexivity, highlight important limitations of this study, and suggest possible implications for future research.