Back to the basics: Addressing our individual and societal despair.

It started with a simple question on social media, "How is everybody doing?" (Elmo [@elmo], 2024). With this basic check-in from one of our most beloved Sesame Street characters, Elmo was able to reach millions of people and elicit responses that gave words to the feelings that the authors have been personally experiencing and noticing within my behavioral health (BH) colleagues and patients for some time now. Quite simply, we are struggling. Responses to Elmo's collective check-in demonstrated the depths of the current human experience, ranging from individual sadness, trauma, existential crises, despondence, mere survival, disbelief, and societal despair. Resilience for BH providers is possible if we return to the basics, what we are foundationally trained to do, and what Elmo reminded us works so well: facilitate human connection within ourselves, with our colleagues, with our patients, and to continue to advocate for this connection at a systemic level. Exploring fundamental questions about our well-being, showing empathy for each other's pain, and openly acknowledging our shared struggles allows for a way through this, together. As we practice these efforts at the individual level, broader policies to support the BH system must follow to offer an effective, resilient, and enduring BH system necessary for the world we live in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veterans' perspectives on discussing moral injury in the context of evidence-based psychotherapies for PTSD and other VA treatment.

OBJECTIVE: We examined Veterans' perspectives on discussing moral injury in veterans affairs (VA) evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) and other VA treatment. METHODS: Fourteen male warzone veterans (ages 25-74) who completed an EBP for PTSD within the past year participated in semistructured interviews related to discussing moral injury in VA treatment (e.g., EBPs for PTSD, chaplaincy). Qualitative interviews were evaluated using a thematic analysis. RESULTS: Four themes were identified; moral injury is often not identified or discussed during therapy, therapeutic relationships can promote or inhibit discussion of moral injury, treatment has limited impact on moral injury, and it is difficult to cope with moral injury even after treatment. CONCLUSION: The majority of Veterans interviewed identified moral injury persisting within a year of completing a PTSD EBP. These findings highlight the value of asking about, assessing, and treating moral injury in Veterans. Our results suggest the importance of developing specific moral injury interventions for warzone Veterans.

Unpacking the layers: a meta-ethnography of cancer survivors' loneliness.

PURPOSE: To review the empirical qualitative literature on cancer survivor's experiences with loneliness to inform assessments and interventions for improving cancer survivors' social well-being. METHODS: A rigorous systematic review of qualitative studies published in five databases between 1993 and 2016 was conducted. Three coders reviewed 285 titles and abstracts and, after applying a critical review process, 20 manuscripts were synthesized using meta-ethnography. RESULTS: The synthesis of the 20 studies provided a framework for understanding survivors' layers of loneliness at the level of the individual, their social support system, the healthcare system, and society. Internally, survivors described loneliness resulting from feelings of inauthenticity, of being alone in their cancer experience, and of lack of control. In their social networks, survivors attributed loneliness to others' avoidance, misperceptions of cancer, and others' failure to recognize the effects of cancer after active treatment. Unmet needs after treatment contributed to feelings of loneliness within the healthcare system. Further, societal stigma around cancer and pressures to experience growth after cancer created another layer of loneliness. The results suggest the need to move beyond an individual level perspective in assessing and treating loneliness in cancer survivors. CONCLUSIONS: This meta-ethnography presents an integrated framework of loneliness in cancer survivors as a multi-layered experience. Implications for Cancer Survivors Conceptualizing loneliness from a systemic perspective adds missing pieces to the loneliness puzzle by encouraging assessment and intervention at interacting levels of functioning; considering how individuals respond to and are affected by their social systems can deepen our understanding of cancer survivorship.