The concepts of metacognitive refection, refection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive refection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive refection in the concept of metacognition and moving beyond it to engage in cycles of refection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive refection works is elusive. Debates address whether metacognition drives refection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related refection, to self-refection, and finally to metacognitive refection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive refection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive refection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.
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Young widowhood, conceptualized as the loss of one’s spouse before the age of 50, is a profoundly painful and distressing loss (Den Elzen, 2017, 2018). The literature on young widowhood shows the death of a partner generally causes a fragmentation of the self, as it violates expectations of the normal life cycle, namely growing old together (Haase and Johnston, 2012; Levinson, 1997). Premature loss of one’s spouse tends to be experienced by the surviving partner as distressing or traumatizing, such as having witnessed their suffering in illness or through accident (Den Elzen, 2018) or in struggling with unfinished business (Holland et al, 2020). Whilst post-traumatic stress is well-known and has been widely researched across various disciplines, the concept of post-traumatic growth is much newer and by contrast has received less attention. PTG was introduced as a scholarly concept by Tedeschi and Calhoun in the mid-1990s and is defined as a positive psychological change as a result of the struggle with highly challenging life events (2004). Calhoun and Tedeschi’s notion of PTG has been backed by a recent systematic review. In the first meta-analysis of moderate-to-high PTG, Wu et al. found that of the 10,181 subjects, about 50% experienced PTG (2019). They also reported that women, young people and victims of trauma experienced higher levels of PTG than men, the elderly and those who experienced indirect trauma. PTG has attracted some controversy, with some researchers questioning its scientific validity (Jayawickreme and Blackie, 2014). Others caution against the minimization of people’s suffering. Hayward is a trauma counsellor who advises approaching PTG carefully, highlighting that if it is introduced with clients too early it can "often be construed as minimizing someone's pain and suffering and minimizing the impact of the loss" (cited in Collier, 2016, n.p.). In addressing the critique of PTG, Calhoun and Tedeschi (2006) emphasize that the focus on investigating positive psychological change following trauma does not deny the common and well-documented negative psychological responses and distress following severe life stresses: “Negative events tend to produce, for most persons, consequences that are negative” (p.4). They argue however, and their research supports this finding, that for many people distressful events can foster positive psychological changes. We view PTG as a possibility following (profound) loss, and emphasize that PTG may continue to co-exist with painful and/or unresolved emotions regarding the loss itself. We conceptualize PTG as a continuum and not as an either/or binary with grief. Further, we wish to highlight that PTG is a highly individual process that depends on many factors, and we are not suggesting that the absence of PTG is to be seen as a failure. This chapter intends to contribute to the study of PTG through a person-centered approach. The most used method to assess PTG is the 21-item posttraumatic growth inventory developed by Calhoun and Tedeschi in 1996 (Jayawickreme & Blackie, 2014). Self-reported posttraumatic growth has been the foundation of PTG research, which has aimed to identify to what extent PTG evokes improved psychological and physical health. In discussing our own creative narrative processes of PTG, our practice-led-research lens aims to contribute to research on how PTG might be fostered. We propose a Writing-for-wellbeing approach in this context and explore what it offered us both as writers and widows and what it might offer the field of Writing-for-wellbeing and by extension clinical and scholarly practice.
Stress is increasingly being recognized as one of the main factors that is negatively affecting our health, and therefore there is a need to regulate daily stress and prevent long-term stress. This need seems particularly important for adults with mild intellectual disabilities (MID) who have been shown to have more difficulties coping with stress than adults without intellectual disabilities. Hence, the development of music therapy interventions for stress reduction, particularly within populations where needs may be greater, is becoming increasingly important. In order to gain more insight into the practice-based knowledge on how music therapists lower stress levels of their patients with MID during music therapy sessions, we conducted focus group interviews with music therapists working with adults with MID (N = 13) from different countries and clinical institutions in Europe. Results provide an overview of the most-used interventions for stress reduction within and outside of music. Data-analysis resulted in the further specification of therapeutic goals, intervention techniques, the use of musical instruments, and related therapeutic change factors. The main findings indicate that music therapists used little to no receptive (e.g., music listening) interventions for stress reduction, but preferred to use active interventions, which were mainly based on musical improvisation. Results show that three therapy goals for stress relief could be distinguished. The goal of “synchronizing” can be seen as a sub goal because it often precedes working on the other two goals of “tension release” or “direct relaxation,” which can also be seen as two ways of reaching stress reduction in adults with MID through music therapy interventions. Furthermore, the tempo and the dynamics of the music are considered as the most important musical components to reduce stress in adults with MID. Practical implications for stress-reducing music therapy interventions for adults with MID are discussed as well as recommendations for future research.
