A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.     

An Examination of the Effects of Stress Management Training for Japanese College Students of Social Work

The purpose of the present study was to examine the effects of a stress-management program for college students of social work on their perception of mental stress and stress-coping strategies. Students in a stress-management group received progressive muscle training, cognitive-behavioral skills training, and assertion training for 14 weeks. Their life events, stress symptoms, and stress-coping skills (active and passive coping skills), evaluated on the first and last days of program, were compared with those of a control group. The effect of the participants' trait anxiety on those variables was also examined. Because the stress-management program in the present study focused on coping strategies, it was expected that the students' coping skills would change. The results showed that passive coping skills of students in the stress-management group had decreased after the program.     

Intervention for infants with brain injury: results of a randomized controlled study

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother-infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study. The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome.     

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.     

Trait anxiety moderation of the effects of life stress on state anxiety

Many theories of anxiety have predicted and much previous research has indicated a person × situation interaction between stressors and trait anxiety. This study examined the hypothesized role of individual differences in trait anxiety in the relationship between naturally occurring stressors and state anxiety scores. Two hundred eighty-seven college undergraduates completed the State-Trait Anxiety Inventory, which provides both state and trait anxiety measures, and the Life Experiences Survey, which provides a measure of the amount of stress a person has undergone in the previous year. Trait anxiety scores were divided into quartiles and correlations between state anxiety scores and Life Experiences Survey scores and multiple regressions for trait anxiety and life stress to predict state anxiety were computed within each quartile. The results were that only in the first quartile was there a significant correlation between life stress and state anxiety, which was contrary to the predictions of state-trait anxiety theory. The validity of state-trait anxiety theory, as it relates to life stress, was questioned.     

Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans – results from a randomized control study

Even 30 or more years after the end of a war, veterans can suffer from post-traumatic stress disorder (PTSD). In the present study, we explored the influence on symptoms of PTSD among Iranian veterans of the Iran–Iraq war of mindfulness-based cognitive therapy (MBCT) as add-on to a standard treatment with citalopram. Forty-eight male veterans with PTSD (mean age: 52.97 years) took part in this eight-week intervention study. Standard treatment for all patients consisted of citalopram (30–50 mg/day at therapeutic dosages). Patients were randomly assigned either to the treatment or to the control condition. Treatment involved MBCT delivered in group sessions once a week. Patients in the control condition met at the hospital with the same frequency and duration for socio-therapeutic events. At baseline and at study completion, patients completed questionnaires covering symptoms of PTSD, depression, anxiety, and stress. At study completion after eight weeks, scores for PTSD (re-experiencing events, avoidance, negative mood and cognition, hyperarousal), depression, anxiety, and stress were lower, but more so in the intervention than the control group. Data suggest that, as adjuvant to standard SSRI medication, MBCT is an effective intervention to significantly reduce symptoms of PTSD, depression, anxiety, and stress among veterans.     

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.     

A controlled trial of an internet-based intervention program for cannabis users

In the last decade, several programs for the treatment of cannabis-related disorders were developed. Until now, no information is available on the efficacy of Internet-based counseling approaches for this target group. This article describes the evaluation of "quit the shit," a web-based intervention developed to help young people to quit or reduce their cannabis use significantly. Cannabis users seeking web-based treatment were included in a two-arm controlled trial conducted on a website for drug-related information and prevention. After the baseline assessment, members of the treatment condition were randomized to a 50-day intervention program. Other trial participants were put on a waiting list. A post-test was conducted 3 months after randomization. Of all 1,292 subjects included in the trial, a total of 206 participants took part at the post-test. Per-protocol- and intention-to-treat analyses were conducted. Members of the treatment condition showed a significantly stronger reduction in cannabis use (primary outcome) than the control group. In the per-protocol analyses, moderate-to-strong effects were found for the reduction of the frequency and the reduction of the quantity of consumed cannabis. Small-to-moderate effects were observed on the secondary outcomes (use-related self-efficacy, anxiety, depression, and life satisfaction). Despite limitations concerning the interpretation of the results, the intervention seems to offer an effective treatment option for persons with cannabis-related problems.     

It Pays to Pay Attention: A Mindfulness-Based Program for Injury Prevention With Soccer Players

The aim of this study was to examine the extent to which a mindfulness-based program could reduce the number of sport injuries in a sample of soccer players. A total of 41 junior elite soccer players were randomly assigned to the treatment or the attentional control group. The treatment group took part in a 7-session program based on the mindfulness, acceptance, and commitment approach. The attentional control group was offered 7 sessions of sport psychology presentations with a particular focus on soccer. There were no statistically significant differences in injury rates between the two groups, U(39) = 149.50, z = ?1.77, p =.077, but there was a medium effect size (adjusted Cohen's d = ? 0.59), approx. 80% confidence interval for d [?0.37, ?0.74]. Moreover, 67% of the players in the mindfulness group remained injury free in comparison to 40% in the control group. This result implies that an intervention program focusing on strategies for improving attention could decrease injury risk. Recommendations include applying mindfulness exercises in athletes’ daily training to help lower injury risk.     

Effects of the Early Prevention Program “Keiner FÄllt Durchs Netz” (“Nobody Slips Through the Net”) on Child,Mother, and Their Relationship: A Controlled Study

The study investigated the effects of a German family‐supporting prevention program “Keiner fällt durchs Netz” (KfdN; “Nobody Slips Through the Net”) after the child's first year in the sample of 152 psychosocially stressed mothers and children who took part in this program and 150 mothers and children from comparison‐group families. The improved level of development posited in the children after intervention as compared to children from the comparison group was confirmed in the social development area (d = .35). In addition, mothers in the KfdN group judged their 1‐year‐old children to be less “difficult” compared to the assessments of the mothers in the comparison group (d = .24). Due to the intervention, the dysfunctionality of the mother–child interaction was reduced (mothers’ self‐assessment, d = .27). No intervention effects were found in for degree of maternal stress. The expected intervention effects in maternal sensitivity were not empirically confirmed. The results suggest that the KfdN intervention exerted a direct positive influence on childhood traits such as social development and temperamental “difficulty” and also positively influenced the mothers’ perceptions or attitudes toward their children's conduct.     

The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children

Research has demonstrated an association between perfectionism and depressive and anxious symptoms in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression, and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms.     

Effectiveness of a Mindfulness-Based Program on School Children's Self-Reported Well-Being: A Pilot Study Comparing Effects With An Emotional Literacy Program

This pilot study aimed to test the well-being effects of a locally developed mindfulness-based program tailored for New Zealand elementary school children in comparison with an active control condition. It was hypothesized that significantly greater well-being change scores would be observed for the mindfulness group. Students (n = 106) between 9 and 11 years old were allocated by their classroom to either the 8-week mindfulness-based program or an 8-week emotional literacy program. Self-reported well-being and mindfulness measures were collected at baseline and upon program completion. Measures were administered at 12 weeks postprogram to the mindfulness group only. One-way analyses of covariance were used for the main analyses, with corresponding baseline scores entered as covariates. Both programs led to significant increases in well-being outcomes, but significantly greater changes were observed for the mindfulness group (general well-being covariate-adjusted change scores were 4.49 [SE = 0.64] for the mindfulness-based program vs. 2.63 [SE = 0.63] for the emotional literacy program). Mindfulness scores significantly increased for the mindfulness group only. There was evidence of student acceptability of the mindfulness-based program and some indication of sustainability of effects at 12 weeks. The study adds to previous research that highlights beneficial well-being effects of mindfulness-based interventions in the classroom. Further research should evaluate potential long-term effects and delivery training.     

Stress-management interventions in the workplace: Stress counselling and stress audits

Within the field of stress-management intervention, there have been substantial disagreements on the 'right' approach. Some argue for counselling and stress-management training, while other argue for more substantive organisational change through stress audits. It is argued that both are important in meeting the needs of individuals and organisations.     

Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study

This study examined whether giving activity feedback to obese, sedentary adults with Type 2 diabetes would improve their adherence to a home-based walking program. 49 subjects were recruited. Ten failed a treadmill cardiovascular test. Another 9 dropped out before the intervention, and 4 dropped out during the intervention. The remaining 26 adults (14 women, 12 men; age M = 48.1 yr., SD = 7.1) received behavioral counseling monthly for 3 mo. regarding exercise. All subjects wore a triaxial accelerometer during these 3 months. Randomly, half of the subjects were blind to the data from the accelerometers, i.e., no feedback, and had counseling based on their self-report diaries. The other half had access to the accelerometer data, got a computerized graph of their physical activity for the period between counseling sessions, and had counseling based on these objective data, i.e., feedback. The feedback group showed an increase in exercise over the 3 mo. The nonfeedback group showed an increase in activity at 1.5 mo. but reverted to their baseline exercise levels at 3 mo. However, analysis of variance showed there was at least an 8% probability that this effect was due to chance, so the hypothesis that feedback would improve exercise adherence could not be supported. Further studies with larger sample sizes and greater control of experimental conditions are needed to determine the utility of objective activity feedback.     

Effects of Physical Exercise on Resources Evaluation,Body Self-Concept and Well-Being Among Older Adults

This study addressed the effects of a 14-week moderate physical activity program on resources evaluation, body self-concept and other health-related psychological variables among older adults. In a quasi-experimental design participants were divided into three groups and completed questionnaires twice, before ( t 1) and after ( t 2) the 14-week program. The experimental group participated in a supervised mixed exercise program of moderate intensity. The placebo attention control group took part in a foreign language course. The no intervention control group did not get any intervention/attention at all. The dependent variables were resources evaluation, body self-concept, trait anxiety, and psychosomatic complaints. Using the pretest data as covariates multivariate analyses of covariance revealed significant improvements in body self-concept in the experimental group compared to the control groups. No other significant differences could be detected. Results point to the positive effects of exercise on body self-concept even among older adults.     

A randomised wait list-controlled pre–post–follow-up trial of a gratitude diary with a distressed sample

In a randomised wait list-controlled trial with repeated measures pre-, post- and follow-up design, participants (N = 109) with a current self-reported diagnosis of an anxiety disorder and/or depression, took part in an internet-based study. After completing a three-week gratitude diary returning participants had lower scores on measures of depression, anxiety, stress and perceived sleep difficulties and higher scores on a measure of subjective well-being than immediately pre-intervention. At three-week follow-up depression and sleep scores for returning participants were no longer significantly different from pre-intervention, however, improvements for subjective well-being and stress at post-intervention were maintained. At follow-up anxiety scores had not only been maintained but had improved significantly beyond post-intervention results. Intention to treat analyses were conducted and provided support for most completer results. Differences between the two sets of analyses are discussed below. This trial provides support for the use of gratitude diaries as an intervention with distressed populations.     

Temporal relationships of self-efficacy and social support as predictors of adherence in a 6-month strength-training program for older women.

The present study investigated how self-efficacy and social support predicted adherence to a strength training program for elderly women over two time periods in the initial 6 mo. of the program. Participants were 30 elderly women volunteers aged 75 to 80 who completed measures of barrier self-efficacy and general social support at baseline and 3 mo. later. Social support from the program was also measured at 3 mo. Adherence to the program was measured by attendance. Hierarchical regression equations were utilized to identify the contributions of self-efficacy and social support for adherence at 0 to 3 mo. and 4 to 6 mo. For prediction of the first 3 mo. of adherence, both self-efficacy and social support contributed significant unique variance towards the total explained variance of 36%. For the 4- to 6-mo. period, self-efficacy explained significant (12%) variance in adherence even when controlling for the previous 3-mo. adherence. Inclusion of general social support and social support from the program, however, did not account for significant variance. Researchers must continue to examine self-efficacy and social support in exercise adherence within various time periods among older adults to develop effective intervention strategies.     

Personality and relaxation therapy: changes among clinical and normal subjects

There are increasing numbers of self-referral stress-management programs, a few of which use group-relaxation techniques, but few data are available on the personalities of the symptomatic and asymptomatic clients who attend or on any changes in personality after the program. Scores on the Eysenck Personality Inventory, Multiple Health Locus of Control, and State-Trait Anxiety Inventory as well as demographic information were obtained from 255 adults who attended a 10-session, university-based, group-relaxation program. The symptomatic clients reported significantly less anxiety, less neuroticism, were more extraverted and ascribed less of their behavior to chance at a 1 month post-treatment follow-up than at intake. The small group of asymptomatic clients also reported less anxiety and neuroticism at the follow-up. There were no sex differences on the Eysenck inventory or the anxiety scales but there were for the Multiple Health internal and control scales. It was concluded that group relaxation appeared to improve mental health scores effectively for both stressed and nonstressed adults and that age was significantly related to some personality scores.     

Outcomes of a traditional weight control program and a nondiet alternative: a one-year comparison.

The purpose of this study was to evaluate the effectiveness of a traditional weight control program and nondiet alternative in improving behavioral (e.g., restrained, emotional, and external eating), psychological (e.g., body preoccupation, physical self-esteem), and biomedical (e.g., body weight, blood pressure, cholesterol) outcomes. There were 2 intervention groups--traditional weight control (TWC) and Diet Free Forever (DFF); a nonvolunteer comparison group; and a control group, all made up of employees of 3M (N = 357). The 2 intervention groups participated in 10-week eating programs. Outcome variables were assessed at baseline, at 10 weeks for the intervention groups only, and again at 1 year. At baseline, the 2 intervention groups had higher restrained, external, and emotional eating scores, greater body preoccupation, and lower physical self-esteem than the comparison and control groups. They also weighed more. At 1 year, both intervention groups had decreased their body preoccupation and increased their physical self-esteem. Participants in the DFF program reduced their restrained eating, whereas those in the TWC program increased their restrained eating. Neither eating program had an impact on the biomedical outcomes.