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2 results

  • Chapter 2 - Feeling Valued

  • from Part I - Understanding and Promoting Mattering
  • Isaac Prilleltensky, University of Miami, Ora Prilleltensky, University of Miami
  • Book:
    How People Matter
    Published online:
    20 May 2021
    Print publication:
    17 June 2021, pp 25-44

  • Summary

    The need to feel valued derives from three motives: survival, social, and existential. The attachment of a newborn to caregivers is very much a survival need. Without the love and care of parents, a baby cannot survive. The social need is expressed in the desire to belong to a group and to derive relational value from associations with friends and family. Finally, the existential motive operates through dignity and fairness. These three sets of motives are separate but complementary. If the first reason for needing to feel valued concerns survival motives, the second one pertains to social drives. The need to belong is closely related to the need to matter. Both derive from the need to validate our identity, and our existence, through interpersonal affirmation. If secure attachment to the mother accounts for the need for survival early in life, affiliation to a collective guarantees protection against enemies, scarcity, and natural disasters. However, belongingness is not just a protective mechanism – it is also a means of flourishing. Finally, we can think of dignity as the backbone of mattering.

  • Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial

  • Karen E. Steinhauser, Karen M. Stechuchak, Katherine Ramos, Joseph Winger, James A. Tulsky, Maren K. Olsen
  • Journal:
    Palliative & Supportive Care / Volume 18 / Issue 6 / December 2020
    Published online by Cambridge University Press:
    05 November 2020, pp. 648-657
  • Objective

    Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness.

    Method

    Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace.

    Results

    Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (<5 on POMS subscale) and depression (<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference −0.4 [95% CI, −1.6, 0.8], p = 0.49) or seven weeks (15.2 vs.15.4; between-group difference −0.2 [95% CI, −1.5, 1.0], p = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, −1.2, 1.7], p = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference −1.0 [95% CI, −2.7, 0.7], p = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales.

    Discussion

    In early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.