Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

Likening stairs in buildings to climbing a mountain: Self-reports of expected effects on stair climbing and objective measures of effectiveness

Objectives

Health promotion agencies advocate use of mountain climbing goals to encourage regular stair climbing, a current public health target. This paper tests effects of a mountain climbing campaign on objective measures of stair use for the first time.

Design

Field interview and quasi-experimental, interrupted time-series study.

Method

In field interviews, a convenience sample (n = 1350) responded to questions about different goals, i.e., heights of climb, to encourage stair use in buildings. Subsequently, a point-of-choice intervention with the main message ‘Take the stairs to the top of this building once a day and in a year, you would have climbed Mount Everest almost twice’ was tested in a 12-floor worksite. A no-message baseline was followed by installation of the intervention.

Results

Stair ascent (n = 62,716) and descent (n = 61,218) at the ground floor was measured with automated counters at baseline (11 days) and during the intervention (18 days). The majority of interviewees (60%) chose a message based on climbing Mt. Everest as the most motivating, with only 5% of interviewees not motivated by any climbing goal. Nonetheless, the subsequent intervention using the mountain climbing goal had no effect on stair climbing (OR = 0.96). As the campaign specifically targeted stair ascent, it failed to influence the behaviour with the greater public health dividend.

Conclusion

The discrepancy between pre-testing and the campaign may reflect the fact that performance goals can only be achieved at the end of the task and may not be continually rewarded during accumulation of behaviour towards the goal.     

Avatar‐based counselling for young people within school counselling. Qualitative analysis of client experience

Background

This study is a qualitative analysis of clients’ experiences of a new avatar based counselling intervention, based on the ‘ProReal’ software ( www.proreal.world ). The intervention was piloted in eight secondary schools in the UK in 2016.

Aims

Twenty‐nine participants (53% of the full sample) were interviewed about their use of the software, experience of the intervention, process of change and views about its helpfulness.

Materials and Methods

Interviews were semi‐structured and were analysed using thematic analysis.

Results

The analysis shows that the intervention was potentially attractive to these clients, particularly those enthusiastic about digital software and clients who found visual communication helpful. The software provided additional opportunities for clients to communicate their inner worlds to the counsellor and supported the development of insight. Male clients, in particular, commented on its helpfulness.

Discussion

There is an indication that digital imagery supported the process of change in counselling and the development of meaning bridges: both internally and with the counsellor (Stiles, 2011; Stiles et al., 1990). However, the software could be experienced as an obstacle when clients wanted to talk about specific problems or ‘vent’ their feelings. All clients who reported that they did not find the software helpful were female. There were a number of suggestions about developing the software to increase opportunities for expression as well as appropriateness for clients from different minority ethnic backgrounds.

Conclusion

Use of digital software in counselling has a potential to enhance communication and support a process of change, particularly with male clients, those who find visual communication helpful, and clients enthusiastic about digital technology. Further research is needed to develop the intervention and compare it to the use of other creative media in counselling.     

A randomized pilot study of anger treatment for Iraq and Afghanistan veterans

Objective

Anger and aggression are serious problems for a significant proportion of veterans who have served in combat. While prior research has suggested that cognitive behavioral treatments may be effective for anger problems, there are few controlled studies of anger treatment in veterans and no studies of anger treatment focusing exclusively on veterans from the Iraq and Afghanistan wars. This randomized pilot study compared an adapted cognitive behavioral intervention (CBI) to a supportive intervention (SI) control condition for the treatment of anger problems in veterans returning from deployment in Iraq or Afghanistan.

Methods

25 veterans with warzone trauma, problems with anger, and one or more additional hyperarousal symptoms were randomized and 23 started treatment (CBI, n = 12; SI, n = 11). Outcome measures were administered at pre- and post- treatment and at 3 months post-treatment.

Results

CBI was associated with significantly more improvement than SI on measures of anger and interpersonal functioning. Gains were maintained at follow-up.

Conclusions

Findings suggest that CBI may be more effective than an active control providing psychoeducation, relaxation, and supportive therapy for treating anger problems in returning veterans. The findings need to be replicated in an adequately powered and more diverse sample.     

Working adults’ well‐being: An online self‐help goal‐based intervention

An online self‐help goal‐setting and planning (GAP) intervention to improve working adults’ well‐being was tested using a longitudinal, randomized crossover design. The study sought to (1) test the effectiveness of the intervention relative to wait‐list controls; and (2) test the stability of effects over a 3‐month follow‐up period. Participants were recruited from the UK Civil Service and were randomized to either a GAP intervention or a wait‐list control condition. Wait‐list participants then crossed‐over to receive GAP. Relative to wait‐list controls (N = 149), GAP participants (N = 158) reported significantly higher levels of positive affect (PA) and flourishing, but similar levels of negative affect (NA) and life satisfaction immediately after the intervention. Longitudinal data were analysed for the whole sample (N = 307). Compared to the start of the intervention, participants reported an increase in PA and flourishing directly after the intervention and 3 months later. NA and life satisfaction showed no change by the end of the intervention, but had improved by 3‐month follow‐up. Completing more modules predicted post‐intervention improvements in well‐being, accounting for pre‐intervention well‐being levels. The online self‐help format allowed the intervention to be offered with minimal therapeutic support, enabling convenient access by a large group of employees. The study provides an example of a successful adaptation of a clinically proven well‐being intervention to make it accessible to working adults.

Practitioner points

• Well‐being interventions proven in clinical settings can be effectively adapted for use in workplace settings with only minor alterations.
• Brief, online self‐help interventions can improve working adults’ well‐being.
• Goal‐based interventions can improve working adults’ well‐being when focused towards goals that are aligned with personal values and have been chosen by the individual.

     

An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students

Objective

Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.

Method

Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.

Results

Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.

Conclusions

This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.     

Self-help for binge eating disorder in primary care: A randomized controlled trial with ethnically and racially diverse obese patients

Objective

The objective was to examine the effectiveness of a self-help treatment as a first line primary care intervention for binge eating disorder (BED) in obese patients. This study compared the effectiveness of a usual care plus self-help version of cognitive behavioral therapy (shCBT) to usual care (UC) only in ethnically/racially diverse obese patients with BED in primary care settings in an urban center.

Method

48 obese patients with BED were randomly assigned to either shCBT (N = 24) or UC (N = 24) for four months. Independent assessments were performed monthly throughout treatment and at post-treatment.

Results

Binge-eating remission rates did not differ significantly between shCBT (25%) and UC (8.3%) at post-treatment. Mixed models of binge eating frequency determined using the Eating Disorder Examination (EDE) revealed significant decreases for both conditions but that shCBT and UC did not differ. Mixed models of binge eating frequency from repeated monthly EDE-questionnaire assessments revealed a significant treatment-by-time interaction indicating that shCBT had significant reductions whereas UC did not during the four-month treatments. Mixed models revealed no differences between groups on associated eating disorder psychopathology or depression. No weight loss was observed in either condition.

Conclusions

Our findings suggest that pure self-help CBT did not show effectiveness relative to usual care for treating BED in obese patients in primary care. Thus, self-help CBT may not have utility as a front-line intervention for BED for obese patients in primary care and future studies should test guided-self-help methods for delivering CBT in primary care generalist settings.     

Elternschaft, Krebs und Kindersorgen

Background

The diagnosis of parental cancer may destabilize the whole family, parents and children as well. The Hamburg children of somatically ill parents (COSIP) intervention supports parental skills and adaptation of children to the situation. There is currently no evidence for criteria to determine which family members should be involved in the COSIP intervention, predominantly the parents (parent setting), the children (child setting) or both (family setting).

Aim of the study

Data from a multicentre study were analyzed with respect to the predominant intervention settings, the correlation between setting and aims of intervention as well as variables that predict the involvement of children in the intervention.

Material and methods

A total of 203 documented cases were analyzed. Different variables that had been documented by the therapists were included in a regression analysis model in order to identify predictive variables.

Results

In 142 cases the intervention was carried out in a specific intervention setting. In 57?% of the cases children were involved (32?% family setting and 25?% child setting). A systematic relationship between the reported intervention aims and the intervention setting was not detected. The most powerful predictor was the existence of emotional problems of children as reported by the child itself.

Conclusions

Decision-making on intervention settings should therefore take the assessment of emotional symptoms of children by the means of age-appropriate self-reporting tools into consideration. Further investigations are needed to reveal variables concerning needs, motivation and capabilities of the family members as well as institutional conditions.     

Empowering public service workers to face bystander conflict: Enhancing resources through a training intervention

Public service employees work in occupations that are accompanied with high psychosocial risks. Police, firefighters, and paramedics are increasingly being confronted with argumentative, conflicting bystanders that frustrate them in executing their task. We developed a resource‐enhancement intervention and tested its usefulness for securing employees’ effective functioning and well‐being in bystander conflict. In a simulation‐based pre‐test post‐test control group design, paramedics in the intervention condition received training about how to increase their resources in terms of conflict management efficacy, perspective taking, task support, and emotional support. For those in the control condition, no such training was provided. Comparing pre‐ and post‐test measures (n = 81) of the participants in the intervention and control groups, we found evidence that the intervention successfully increased employees’ resources over time. Moreover, we found considerable support for a positive link between these resources and employees’ affective well‐being and job dedication. Thus, our study suggests that a resource‐enhancing intervention can serve as an important means to protect public service employees against the deleterious effects of bystander conflict.

Practitioner points

• A resource‐enhancing intervention can protect public service employees against the deleterious effects of bystander conflict.
• Resources related to dealing with a hindering bystander, as well as resources facilitating the continuation of the primary task, are positively associated with employees’ affective well‐being, job dedication, and job performance.

     

Internetbasierte Vorbereitung auf eine station?re psychosomatisch-psychotherapeutische Behandlung

Background

Encouraged by promising results of online aftercare programs, this study adapted the concept of internet-based minimal interventions in order to use the time between referral and actual admission to inpatient treatment. The online intervention includes information about the hospital and the treatment and sections which aim to enhance motivation, provide support and allow contact.

Methods

A comprehensive cohort study was conducted with 379 participants in the randomized subcohort. Primary endpoint was the speed of change of the physical, mental and social impairment and of the psychological well-being in the first 2 weeks of inpatient treatment as well as the rates of reliable change 2 weeks after admission.

Results

Both the control and intervention group of the randomized subcohort showed statistically significant improvements in health status. No significant difference in the rate of change was found. The degree of achieved improvement in the physical impairment was equal to the expected intervention effect. A difference in the rates of change was found for the psychological well-being: the intervention group showed 19% more reliable improvements.

Conclusions

The study design and the contents of the intervention were accepted by the patients. The internet-based intervention can help to prepare for treatment and to shorten the settling-in period.     

Views on aging and emotional benefits of physical activity: Effects of an exercise intervention in older women

Objectives

This intervention study evaluated the effects of exercise in old age on views on one’s own aging and on direct approach motivation for physical activity. It further examined the mechanism between these variables.

Design

Two hundred forty-seven healthy women aged 70−93 years were randomized to an exercise course (n = 86), an active (n = 85), or a passive control group (n = 76) for a 6-month participation in Berlin, Germany. Activity interventions (3 × 1.5 h/wk) were conducted using standardized manuals.

Method

Group differences in changes of views on aging and direct approach were evaluated by analyses of covariance adjusted for baseline. A mediating effect of direct approach between exercise participation and views on aging was tested with percentile-based bootstrapping.

Results

In contrast to both the active and the passive control groups, higher direct approach, F(2, 226) = 6.97, p = .001, and less aging dissatisfaction, F(2, 225) = 5.39, p = .005, were observed in the exercise group after 6 months. Exercise had an indirect beneficial effect on aging dissatisfaction through direct approach, B = −0.31, 95% CI = −0.68 to −0.05.

Conclusion

In women above 70 years, exercise participation increases direct approach motivation which in turn leads to lower aging dissatisfaction. This shows that exercise holds the potential to overcome subjective ageist bias.     

Effects of a cognitive specific imagery intervention on the soccer skill performance of young athletes: Age group comparisons

Objectives

The primary purpose of the present study was to examine the effects of a cognitive specific (CS) imagery intervention on the soccer skill performance of young athletes aged 7-14 years and determine if performance varied with age.

Design

Participants were 143 soccer athletes belonging to 16 different teams. Teams were randomly assigned to either a cognitive specific (CS) or motivational general-arousal imagery intervention.

Methods

Athletes were administered the SIQ-C and tested on the soccer skill to determine baseline performance. Following their imagery intervention, athletes were tested on the same soccer skill, and completed the SIQ-C a second time.

Results

The results indicated that only the younger athletes (7-10 years) receiving CS imagery performed faster following their intervention. Moreover, only the 7-8 year old athletes in the CS imagery condition significantly increased their use of CS imagery over time.

Conclusions

These findings suggest that young athletes who use CS imagery will benefit from a CS imagery intervention, thus implying that mental skills training should begin at a young age if athletes are to maximize the benefits of such training.     

Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

Ressourcenaktivierung bei Patienten

Background

Starting from Klaus Grawe’s draft of a general psychotherapy, the patient’s resources and resource-activating interventions have received increasing attention in empirical research.

Objective

The effectiveness of standardized writing instructions for the activation of patients’ resources before participating in internet chat aftercare groups for psychosomatic patients was examined.

Method

In a randomized controlled trial writing instruction for the activation of patients’ resources was given in 52 out of 102 internet chat aftercare sessions. The effects of this minimal intervention on the patients’ activity and the number of positive emotion words expressed during the chat session were examined. Additionally, the effects on patients’ self-esteem, attachment, orientation, control and well-being after the group sessions were assessed.

Results

Patients reported higher levels of self-esteem, orientation, control and well-being after chat sessions with a resource-activating intervention. No differences between intervention and control groups were detected on the text-based variables activity and number of positive emotion words.

Conclusions

Standardized minimal interventions for the activation of patients’ resources seem to be promising for enhancing the effectiveness of therapeutic Internet chat groups.     

The effect of the two-chair dialogue intervention on self-compassion - adding an emotional evocative component to a basic Rogerian condition

Objective

How people relate to themselves when facing distress or failure influences general psychological well-being and vulnerability to psychological disorders. The aim of the present study was to explore the effect of an emotionally evocative intervention on self-compassion.

Methods

The data were retrieved from a larger study of Emotion-Focused Therapy (EFT) utilising a multiple baseline design comparing two treatment phases. The baseline phase consisted of 5, 7 or 9 therapy sessions where the therapist solely adhered to Rogerian relational conditions, as prescribed in EFT. A two-chair dialogue intervention was then added for five sessions. The sample consisted of 18 self-critical clients with clinically significant symptoms of depression and/or anxiety. The “Self-Compassion Scale” (SCS) was administered pre, mid and post therapy.

Results

The baseline phase did not lead to significant changes in self-compassion. However, the addition of the two-chair dialogue was associated with a significant increase in self-compassion. This increase was due to reductions in the negative subscales, especially the isolation subscale.

Conclusion

The emotionally evocative two-chair dialogue was associated with a significant change in self-to-self relating, compared to relational conditions alone. The two-chair dialogue, thus, seems to be a promising intervention for promoting healthier self-to-self relating.     

A Test of Two Positive Psychology Interventions to Increase Employee Well-Being

Purpose

Despite an abundance of organizational research on how contextual and individual difference factors impact well-being, little research has examined whether individuals themselves can take an active role in enhancing their own well-being. The current study assessed the effectiveness of two simple, self-guided workplace interventions (“gratitude” and “social connectedness”) in impacting well-being.

Design/Methodology/Approach

Sixty-seven university employees participated in one of the two self-guided interventions for 2 weeks and completed self-report measures prior to the intervention, immediately following the intervention, and one-month post-intervention. Growth curve modeling was used to examine the effects of each intervention.

Findings

Partially supporting hypotheses, the gratitude intervention resulted in significant increases in positive affective well-being and self-reported gratitude but not did significantly impact negative affective well-being or self-reported social connectedness. The social connectedness exercise did not significantly impact any of those four outcomes. However, both interventions related to a reduction in workplace absence due to illness.

Implications

The study suggests that self-guided, positive psychology interventions (particularly gratitude) hold potential for enhancing employee well-being. Because the interventions are short, simple, and self-guided, there is little in the way of costs or drawbacks for organizations. Thus, these types of interventions seem like a potentially useful component of workplace wellness initiatives.

Originality/Value

This study is one of the few to examine whether self-guided, positive psychology interventions can enhance well-being. Moreover, this is the first study to examine a social connectedness workplace intervention and the first to demonstrate effects on illness-related absence.     

The Servant Leadership Survey: Development and Validation of a Multidimensional Measure

Purpose  

The purpose of this paper is to describe the development and validation of a multi-dimensional instrument to measure servant leadership.     

A General Structure of Job Performance: Evidence from Two Studies

Purpose  

The purpose of this study is to test alternative models of job performance based on competing categorization criteria.     

Effects of Job Satisfaction and Conscientiousness on Extra-Role Behaviors

Purpose  

Objective of this study was to examine conscientiousness as a moderator of the relationship between job satisfaction and extra-role behaviors.     

How Benefit Information and Demographics Influence Employee Recruiting in Mexico

Purpose  

To examine the impact of benefit information in recruitment advertisements on job pursuit intentions.