Athletes\' stories about their experiences in elite sport inevitably evoke the notion of meaning, a concept, which has appeared in many shapes and forms within sport psychology. Qualitative scholarship, for example, has generated a large literature base on the meaning of experience (i.e., implicit meaning) in elite sport. However, the experience of meaning(fulness) (i.e., existential meaning) has received less scholarly attention and has rarely been the explicit study object. To assist theorizing and the empirical investigation of meaning and purpose in elite sport in these early stages, we take stock of the emerging body of literature in sport psychology. The article has three parts: Firstly, we distinguish between implicit and existential meaning to delineate our study object. Secondly, we introduce psychological theory to show how existential meaning can be conceptualized (e.g., dimensions, sources, crisis of meaning). Thirdly, we analyzed 23 studies in a narrative review approach to understand how meaning (n=17) and purpose (n=6) in elite sport have been understood, and what we know about these concepts empirically. The current scholarship revealed itself heterogenous in terms of study designs, methodologies, theoretical frameworks, and conceptualizations of meaning and purpose. Findings are discussed in eight overarching themes (e.g., moments when meaning and purpose are questioned; as mechanism and indicator of growth following adversity) to map the reviewed literature comprehensibly and to provide a foundation for applied work. The article concludes by highlighting unresolved issues and proposing future directions for studying and applying existential meaning in elite sport.

UNASSIGNED: Occupational therapy\'s connection to positivist science predates the profession\'s formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.
UNASSIGNED: This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession\'s preoccupation with positivist science has obscured.
UNASSIGNED: This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.
UNASSIGNED: Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.
UNASSIGNED: The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

Dame Cicely Saunders\' conceptualization of \'total pain\', or \'total suffering\', is one of her most significant and lasting contributions to the field of palliative care. It was Saunders\' unique combination of knowledge and experiences as a trained social worker, nurse and physician that influenced her understanding of suffering specific to a life-limiting illness as being multi-dimensional: that suffering may be simultaneously physical, psychological, emotional, social, spiritual and/or existential in nature. \'Total pain\' remains a highly relevant and significant concept within palliative care and Saunders\' lasting contributions are to be revered. This paper invites us to reconsider one particular aspect of Saunders\' conceptualization: that patients\' \'mental reactions\' to their anticipated dying/death is a key contributor to their \'total pain\'. Drawing upon Saunders\' works from the late 1950s to the early 2000s, this paper details the socio-historical manifestation of this aspect of \'total pain\' within Saunders\' writings, including influences from her Christian religion and Viktor Frankl, and its enduring impact on palliative care philosophy, practice, and discourse. Then, drawing upon patient stories rooted in my own clinical experiences over a 10 year period as a hospice social worker, I suggest that this particular feature of Saunders\' \'total pain\' may, unintentionally, work to pathologize both the patient for whom suffering persists and remains unsolvable, and the palliative care clinician who may struggle to relieve it - and why it therefore stands to be revisited. It is my sincere hope and intention that ongoing reverence for Saunders\' significant contributions can sit alongside respectful reconsideration.

OBJECTIVE: We aimed to examine the efficacy of Meaning and Purpose (MaP) Therapy in promoting posttraumatic growth and meaningful life attitudes (choices and goal seeking) in people living with advanced cancer.
METHODS: Patients with a prognosis ≥ 1 year were stratified across two sites and randomised to receive MaP therapy and regular oncology/palliative care (Intervention) or usual care (Control). They completed measures at baseline (t0), post-intervention (12 weeks, t1) and 12 weeks later (t2). Our primary outcome was posttraumatic growth (PTGI); secondary outcome measures included life attitudes (LAPR), spiritual wellbeing (FACIT-Sp), anxiety, demoralization and depression.
BACKGROUND: ACTRN12618001751268, 7 January 2019.
RESULTS: We consented 107 from 404 eligible patients (26.5%) and randomised 55 to MaP Invention (35 completing t1, 25 t2) and 52 to Control (32 completing t1, 25 t2). Fidelity of the intervention was sustained. PTGI mean scores were significantly higher post-intervention on analysis by covariance (Cohen\'s d = 0.7 at t1 & d = 0.5 at t2). Secondary measures were significant, including LAPR (d = 0.4) and FACIT-Sp (meaning subscale d = 0.4; total d = 0.4). Participants completing six sessions achieved more noteworthy effect sizes.
CONCLUSIONS: This brief, structured individual intervention shows promise for sustaining sense of coherence, meaning and choices in life despite living with advanced cancer.

This article investigated constructions of evil among deployed Swedish veterans. Six cases were used to demonstrate common themes of these constructions: humans are capable of everything; anyone can be violated, even killed; evil and cruelty comes in many forms; coldness/cynicism; exhausting to witness suffering and pain; and existential rumination. The impact of these can affect a veteran\'s identity and their notions of self. However, processing encounters with evil is seen, in some Christian perspectives, as an essential prerequisite for spiritual growth, and this might be potentially important to supporting the emergence of spiritual veteran identities. A pastoral care giver or military chaplain can serve as an existential conversation partner who can assist veterans when approaching such experiences and their potential impact. This may be especially fertile in secular contexts, where pastoral wisdom and ontological approaches can be hard to find in the everyday lives of veterans.

OBJECTIVE: A sense of existential vulnerability is embedded in parenthood transition. It is linked to meaning in life, relationship changes, awareness of death, and sometimes a transcendent belief. Nevertheless, in most maternity service guidelines, the existential aspects of life are not an explicit focus. Therefore, this study aimed to explore how health professionals in maternity services experience and understand existential aspects of parenthood transition among new parents.
METHODS: Data were generated through a user-involving two-phase process inspired by action research consisting of three focus group interviews with health professionals (n = 10) and, subsequently, a theatre workshop for parents, health professionals, and researchers (n = 40). Between the two phases, case narratives were constructed using information from the interviews and, in collaboration with a dramatist, dramatized and then played out at a workshop by professional actors. We used thematic analysis for all data.
RESULTS: We identified five themes in the data material: 1. Death and fragility in maternity care, 2. Existential aspects in camouflage, 3. Existential and spiritual aspects of being professional in maternity care, 4. Talking about existential aspects of care, 5. Equipped for providing existential care?
CONCLUSIONS: Existential aspects were often recognized during birth, specially in traumatic situations or discerned in the physical and non-verbal relational energy between the birthing woman and midwife or partner. Less often, existential aspects were recognized during pregnancy and the post-partum period.

UNASSIGNED: Going through a liver transplantation is by many recipients considered mentally and emotionally burdensome.
UNASSIGNED: The aim of this study was to explore individuals\' mental, emotional and existential experiences living with a liver transplant during a period of approximately ten years.
UNASSIGNED: The methodology in this study is based on Gadamer\'s hermeneutics. Galvin and Todres\' conceptual framework on well-being was applied in the interpretation process.
UNASSIGNED: Both researchers conducted interviews, which took the form of conversations. We made use of Brinkmann and Kvales\' three types of interpretation.
UNASSIGNED: The study was approved by the Ombudsman for Privacy of the Norwegian Social Data Services and is based on informed consent and confidentiality.
UNASSIGNED: Three themes emerged through interpretation: 1. From great suffering to gratitude and a humble attitude towards life. 2. From living in uncertainty to leading a normal life. 3. From hopelessness and anxiety to an indifferent attitude towards life.
UNASSIGNED: This study showed that the process of receiving a new liver and living with it, had changed most of the participants\' attitudes towards life in a humble way. Some persons struggled with life and experienced depression anxiety, as well as lack of energy.

A narrative review was conducted on research surrounding children\'s and adolescents\' experiences of emotional and mental health and wellbeing in relation to climate change; we also explored potential connections to existential themes.
Children and adolescents represent a vulnerable group in relation to experiencing negative mental health impacts due to climate change. Further, this population experiences a wide range of emotions in relation to climate change, with most research reporting on worry and anxiety. Several studies that explored associations between such emotions and mental health outcomes found positive associations. Additionally, research suggests that there is an existential underpinning to how climate change is experienced by children and adolescents. Although important contributions have been made in recent years, knowledge gaps remain. An understanding of the psychological responses children and adolescents have in relation to climate change is needed to inform practice and policy. This may be supported by an existential framework.

Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care.
We sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services.
Using a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4-7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors.
While one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%-25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores.
As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.

In a previous paper in Philos Ethics Humanit Med, the 1937 Swedish novel Sömnlös (Swedish for sleepless) by Vilhelm Moberg was used as background for a thought experiment, in which last century\'s progresses concerning the safety of sleeping pills were projected into the future. This gave rise to a theoretical discussion about broad medico-philosophical questions such as (among other things) the concept of pharmaceuticalisation.
In this follow-up paper, the theme of insomnia in Sömnlös is complemented by a discussion of the concept of nostalgia. The core of the paper is a theoretical discussion about the benefits and risks of nostalgia, bringing together some aspects of recent psychological research about the construct of nostalgia with the main story line of the novel.
Nostalgia is portrayed as being, in some sense at least, ultimately beneficial for the protagonist of Sömnlös. This is congruent with recent psychological research. However, the story also shows that nostalgia may lead to problematic behaviours, at least when viewed from a virtue ethics perspective. Hence, nostalgia is both what leads the protagonist into ethically problematic behaviour and that which (paradoxically) ultimately saves him from his initial lack of courage, justice, temperance and practical wisdom. Moreover, the protagonist does not only \"grow\" ethically but also existentially. Hence, the novel opens up the possibility that insomnia and nostalgia might be viewed as bearers of important existential information (cf. sociologist of religion Peter L. Berger and his concept of \"signals of transcendence\").