Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

Background: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).

Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).

Method: Participants with symptoms meeting criteria for SAD (N?=?137) were randomly assigned to the 12-week-treatment groups (n?=?53 for each condition) or a waitlist control (n?=?31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.

Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.

Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.     

Effect of Make Parenting a Pleasure on Parenting Skills and Parental Depression

Abstract

This paper explores a feasibility trial examining the effects of the Make Parenting A Pleasure (MPAP), a 12-week parent training program designed to promote family resilience by strengthening the following factors: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence in children. Fifty-nine (59) participants were assigned to either a treatment group (n?=?32) or a waitlist control group (n?=?27). Results showed that participants in the MPAP treatment group demonstrated an increase in parenting skills and child development knowledge as well as a decrease in parental depression when compared to waitlist control group participants. Results emphasize the importance of promoting resiliency by supporting parents through direct instruction and skill development.     

Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial

Background: In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.

Methods: Fifty-two overweight/obese adults (Age: M?=?47?years, SD?=?13.5; female?=?67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6?weeks, while the other half remained in their groups regardless of weight loss.

Results: There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC?=?4.9% vs. BWLP?=?7.8%; p?=?.10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p?<?.01).

Conclusion: There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.     

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout.

Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT).

Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21.

Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d?=?0.66), cynicism (d?=?0.87) and personal accomplishment (d?=?0.75).

Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.     

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation.

Design: Divorced mothers and children (age 9–12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families.

Main Outcome Measures: Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task.

Results: Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group.

Conclusions: Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.     

Randomized controlled trial evaluating the effectiveness of a web-based stress management program among community college students

Background and Objectives: This study evaluated the effectiveness of a web-based stress management program among community college students that focused on increasing perceived control over stressful events. Design: Students (N = 257) were randomly assigned to a Present Control Intervention or a Stress-information only comparison group. Methods: Primary outcomes were perceived stress and stress symptoms; secondary outcomes were depression and anxiety. Self-report measures were completed online at preintervention, postintervention, and three-week follow-up. Intervention effects were estimated using linear mixed models. Seventy-five percent of the sample (n = 194) completed the pretest and comprised the intent-to-treat sample. Results: Participants in the intervention group reported significant increases in present control, and significant decreases in all four primary and secondary outcome measures from baseline to postintervention and follow-up. Within-group effect sizes were small to medium at postintervention (mean d = –.34) and follow-up (mean d = –.49). The mean between-group effect size on the four outcome measures was d = .35 at postintervention but d = .12 at follow-up, due to unexpected decreases in distress in the comparison group. Conclusions: Our online program is a cost-effective mental health program for college students. Limitations and future direction are discussed.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial

Objective: To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis.

Design: Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models.

Main outcome measures: Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data.

Results: Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19).

Conclusion: The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.     

Symptoms,blood-pressure information and mood effects on symptom recall

Abstract

After completion of an illness symptom checklist (PILL) covering the previous three months, 97 nor-motensives were allocated to either experimental (false pressor feedback, n=42), or information control (accurate pressor feedback, n = 55), groups. The median reported symptom score divided high from low symptom subjects. All were given standard cuff blood pressure (BP) assessment and were normotensive. However, experimental subjects were misinformed that their BP was raised while information control subjects were told their BP was normal. Subsequently, subjects completed the state anxiety form of the State-Trait Personality Inventory, the PILL, and were asked about their belief of the ascribed BP label (normo/hypertensive) and then any perceived causal relationship between their BP and symptoms. Experimental subjects had significantly higher anxiety scores but no change in symptom recall after pressor feedback, whereas control subjects showed lower anxiety scores and decreases in symptom recall.

A post hoc treatment control (no pressor information) group (n = 20) excluded effects of BP labeling on post-BP scores, and a post hoc symptom control group (n = 55) ensured that symptom levels were representative of the normal population. The majority of subjects in both groups rejected any association between BP labels and symptoms. Data are discussed in the light of Leventhal's models of illness representation.     

Value Hierarchies of French Catholics Committed to the Fight Against AIDS

Summary

An attempt was made to create the social satiation effect via vicarious learning. Second-grade boys and girls from middle class homes in a Jerusalem school observed other children being administered a short treatment in which the stimulus word Yafeh (“Good”) was presented by E twice (low-satiation) or 20 times (high-satiation). Immediately thereafter, E administered to the observers a 75-trial binary discrimination task, to test the efficacy of the word Yafeh as a reinforcer. The control groups consisted of Ss treated and tested by the same E. A typical satiation effect (i.e., decreased performance of the group presented with 20 stimuli) was observed for the control groups, but no difference was found between groups of Ss observing the high- and low-satiation treatments. It was thus concluded that social satiation had not been learned vicariously. The post-treatment inquiry on the Ss who were observed by the experimental Ss revealed that these children were aware of the frequency of stimuli presented in the treatment. However, the cognitive mechanism hypothesized to mediate the social satiation effect—perceived lack of contingency—was not confirmed by their verbal reports.     

Factors Determining National Stereotypes

Summary

In order to test various explanations of the fact that perceived competence appears to correlate positively with altruism, Ss were given false feedback as to their competence on a “visual creativity” test and then asked to help with a second task, writing creative color names. Three groups of Ss who were told they were competent were given reduced cost, increased happiness, and increased responsibility as reasons for helping; the other three groups were given no explanations, but were told that their competence was high, or low, or given no information. The three explanation groups helped more than the other three groups, and the reduced cost group helped more than the other five. The three dependent measures of helping (percentage of helpful Ss, duration of help, and magnitude of help) proved differentially sensitive to treatment and sex differences. Only the latter two measures showed greater helping in the reduced cost group; only the magnitude measure showed significantly greater helping for males than females.     

The Hepatitis C treatment experience: Patients’ perceptions of the facilitators of and barriers to uptake,adherence and completion

Objective: This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program.

Design: Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC).

Main outcome measures: To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion.

Results: Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system.

Conclusion: To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies.     

Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors)

ABSTRACT

Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition–change were more prevalent in group treatment.     

The relationships between family functioning and attachment orientations to post-traumatic stress symptoms among young adults who were evacuated from Gaza Strip settlements as adolescents

Background and Objectives: This study examined post-traumatic stress disorder (PTSD) symptoms among young adults that were evicted from their residences in Gaza settlements (“Gush Katif”) as adolescents and actively participated in the resistance events. Furthermore, we examined the moderating role of exposure to forced relocation on the association between attachment orientations and family functioning and PTSD symptoms. Design: We conducted a correlative, cross-sectional study in 2013. Methods: Participants were Israeli evicted residents (ER group; N = 102), comparison groups of evicted nonresidents (ENR group; N = 27), and nonevicted nonresidents (NENR group; N = 53). All participants completed a battery of self-reported questionnaires. Results: The ER group reported a higher number of PTSD symptoms as compared to the comparison groups. However, ER participants did not differ from ENR and NENR participants in their perception of family functioning. Importantly, the group (ER vs. NENR) moderated the association between attachment-anxiety and PTSD symptoms and between family adaptability and PTSD symptoms. Conclusions: Nine years after the forced relocation from Gaza settlements, young adults that were evicted from their residences as adolescents suffer from PTSD symptoms that are more related to the relocation itself than the stress entailed in the resistance events.     

The distribution of repressive coping styles among non-metastatic and metastatic breast cancer patients as compared to non-cancer patients

Abstract

Recent investigations have shown increased disease progression among breast cancer patients with a “repressive” coping style characterized as: passive, conforming, inclined to deny physical symptoms and emotionally unexpressive. The Millon Behavioral Health Inventory (MBHI) scales which delineate three discrete repressive coping styles include the: Introversive, Cooperative and Respectful. Forty-four women recently diagnosed (within four weeks) with non-metastatic (N=32) or metastatic (N=12) breast carcinoma, responded to the MBHI upon admission for treatment of their disease at a cancer treatment unit. All subjects received mastectomy as well as chemotherapy, radiation and/or endocrine therapy. These 44 Cancer patients were compared to 34 control subjects, comprising women who were seen at a colposcopy clinic for follow-up of a suspicious pap smear which was ultimately shown to be benign or consisted of mild dysplasia. Non-metastatic, metastatic and control subjects were compared with respect to coping style and psychological distress. The breast cancer patients were more likely to employ a repressive coping style as compared to non-cancer patients who utilized a “sensitizing” coping strategy predominantly. Cancer patients with the most severe prognosis (metastasis) were the only group within the study to attain a clinically significant mean base rate score on the respectful scale. Results suggest that the incidence of repressive coping styles may be disproportionately high among breast cancer patients.     

Psychoimmunology and aids: Psychological distress and herpes simplex virus in human immunodeficiency virus infected individuals

Abstract

No studies investigating the relationship of herpesviruses and psychological distress in Human Immunodeficiency Virus (HIV) infection are available in the literature. Antibody titers for Cytomegalovirus (CMV), Epstein-Barr (EBV) and Herpes Simplex virus (HSV) were assessed from sera drawn at the lime of psychological testing for one hundred HIV seropositive subjects. Increased psychological distress was correlated with increased titers of antibody to HSV, but not to CMV or EBV. Psychological distress may play a role in the devastating HSV infections experienced by immune deficient individuals. A stress mediated reactivation/potentiation hypothesis is discussed, where distress reactivates latent HSV which in turn potentiates HIV replication. These results may have implications for treatment of individuals co-infected with HIV and HSV.     

Assessment of self and others during treatment for anorexia nervosa

Abstract

Repertory grids were used to compare a group of anorexic women (n = 12) with normal-weight (n = 12) and dieting (n = 10) control groups. Anorexics differed from both control groups in their perceptions of themselves and others. The constructs used were more meaningful to anorexics than to either control group. The way in which anorexics saw themselves differed from the way in which clinicians have indicated in the literature that they see their anorexic patients. Some constructs adopted a differential meaning and relevance for observer and observed when applied to the anorexic condition. The discrepancies between internally defined and externally imposed interpretations of construct meaning may help to explain why resistance to treatment and high relapse rates are encountered in anorexic women.     

The role of self-compassion during difficult economic times

Background and objectives: The negative effects of the financial crisis of 2007/2008 are still being felt today as seen in the relatively high levels of youth unemployment in many countries. As a result, many young people experience high stress levels when facing an uncertain and precarious job market.

Methods: Participants were 178 undergraduate students (79% female; M_age?=?20.00, SD?=?4.29) who were randomly assigned to read a news article that documented an uncertain financial future with limited job opportunities (the economic stress group), or an article that documented a tour of the Royal Canadian Mint (the control group). The role of self-compassion was explored in its relation to distress.

Results: Correlational and hierarchical regression analyses indicated that, in the economic stress group, self-compassion negatively predicted anxiety above and beyond self-esteem and familial support. In the control group, however, self-compassion did not negatively predict anxiety above and beyond self-esteem and familial support. Additionally, structural equation modeling indicated that self-compassion was directly associated with lower anxiety and indirectly related to anxiety through perceptions of financial threat.

Conclusions: These findings suggest that self-compassion may be an important resource that is associated with less distress during times of economic threat.