The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.     

Factors associated with school nurses’ HPV vaccine attitudes for school-aged youth

School nurses are at the intersection of the healthcare and school communities, thus, they can be considered opinion leaders in providing health advice – including information about the human papillomavirus (HPV) vaccine – to parents and students. This study examined school nurses’ attitudes toward the HPV vaccine based on age, years as a school nurse, geographic location, urban vs. rural work setting, HPV and vaccine knowledge, perception of role as opinion leaders, and school district support in providing health education. Participants (n = 413) were systematically sampled from the National Association of School Nurses’ membership and completed a web-based survey. Multiple regression was used to predict positive HPV vaccine attitudes. The model was statistically significant accounting for 50.8% of the variance (F [9, 400] = 45.96, p < .001). Positive attitudes regarding the HPV vaccine were predicted by higher HPV and vaccine knowledge (β = .096, p < .001) and stronger perceptions of role as opinion leaders for the vaccine (β = .665, p < .001). No other variables were found to be statistically significant. These results suggest knowledge is essential in predicting positive attitudes, but not the strongest predictor as perceptions of role as opinion leaders was more crucial in terms of predicting school nurses’ positive attitudes towards HPV vaccine. Despite school nurses being seen as champions for adolescent vaccines, they need additional professional development to increase their HPV vaccine knowledge and attitudes to encourage parents and adolescents to consider the uptake of HPV vaccination. To engage school nurses’ in promoting HPV vaccine uptake, interventions need to focus on increasing school nurses’ perception of their role as opinion leaders for HPV vaccine and knowledge to increase positive attitudes towards HPV vaccination for youth.     

Relationships between work-related characteristics,needs satisfaction,motivation and mental health in midwifery students

The present study examined the relationships between work-related characteristics in internships, psychological needs satisfaction, motivation and mental health using a partial least squares path modeling. Midwifery students (N = 214; M_age = 22.8 years) from three French schools completed different questionnaires online. Results showed (1) the importance of work resources (work control and social support) as protective factors of psychological needs satisfaction; and (2) the role of competence need satisfaction through motivation in the relationships between work resources and mental health. Midwifery schools should pay more attention to these two results, and take them into account in midwifery students’ training.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Randomized Effectiveness Trial of an Internet,Pure Self-Help,Cognitive Behavioral Intervention for Depressive Symptoms in Young Adults

This study evaluated an Internet-delivered, cognitive behavioral skills training program versus a treatment-as-usual (TAU) control condition targeting depression symptoms in young adults aged 18 to 24 years. Potential participants were mailed a recruitment brochure; if interested, they accessed the study website to complete an online consent and baseline assessment. Intervention participants could access the website at their own pace and at any time. Reminder postcards were mailed periodically to encourage return use of the intervention. The pure self-help intervention was delivered without contact with a live therapist. The primary depression outcome measure was the Patient Health Questionnaire, administered at 0, 5, 10, 16, and 32 weeks after enrollment. A small but significant between-group effect was found from Week 0 to Week 32 for the entire sample (N = 160, d = .20, 95% confidence interval [CI] 0.00–0.50), with a moderate effect among women (n = 128, d .42, 95%C1 = 0.09–0.77). Greater depression reduction was associated with two measures of lower website usage, total minutes, and total number of page hits. Although intervention effects were modest, they were observed against a background of substantial TAU depression pharmacotherapy and psychosocial services. Highly disseminable, low-cost, and self-help interventions such as this have the potential to deliver a significant public health benefit.     

The Treatment Acceptability/Adherence Scale: Moving Beyond the Assessment of Treatment Effectiveness

It is becoming more broadly recognized that beyond effectiveness, the acceptability of interventions for anxiety disorders is an important consideration for evidence-based practice. Although advances in treatments for anxious psychopathologies have demonstrated that cognitive-behavioural interventions are more desirable than other types of psychotherapy or pharmacotherapy, there continue to be problems with adherence and dropout. It has been suggested that low treatment acceptability may be partially responsible for high dropout rates. Although a number of preliminary investigations in this domain have been conducted, further progress is hampered by the absence of a single self-report measure that assesses both acceptability and anticipated adherence. Therefore, the current paper aimed to test the psychometric properties of the newly developed Treatment Acceptability/Adherence Scale (TAAS). In two studies of brief cognitive-behavioural interventions, the TAAS was administered immediately following the therapy session. In Study 1 (N = 120 non-clinical undergraduates), the therapy included two variants of an exposure-based intervention for contamination fear. In Study 2 (N = 27 individuals with obsessive-compulsive disorder), the therapy was a cognitively based intervention evaluating a novel treatment technique for checking compulsions. Measures of convergent and divergent validity were included. Results demonstrated that the TAAS exhibited sound psychometric properties across the two samples. It is hoped that this measure will help clinicians to predict and intervene when a treatment is not acceptable and/or when the client anticipates poor adherence to it. Furthermore, the TAAS may aid researchers in continuing to improve upon effective interventions for anxiety and related disorders.     

It’s good to do good and receive good: The impact of a ‘pay it forward’ style kindness intervention on giver and receiver well-being

Despite the popularity of the ‘pay it forward’ (PIF) concept in textbooks and popular culture, to date, no study has tested the effectiveness of a brief, one-time PIF activity on the well-being of those who do good and those who receive good. To test this, 83 undergraduates (‘givers’) performed random kind acts for 1.5 h. PIF resulted in a wide range of well-being benefits for givers (e.g. greater positive and lower negative affect), with females showing greater positive affect benefits. Receivers of kindness (N = 1014) also benefited as evidenced by greater smiling behavior and more sincere smiles vs. controls (N = 251). Of the 48 receivers who completed a follow-up online questionnaire, the majority indicated that they would also PIF, with almost 40% indicating that they already had. Results indicate that a one-time brief PIF intervention can have broad benefits for those involved.     

Mentoring Nurses in Familial Cancer Risk Assessment and Counseling: Lessons Learned From a Formative Evaluation

Background. As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Methods. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. Results. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.     

Deployment trauma and seeking treatment for PTSD in US soldiers

Many service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.     

Psychosocial mediators of a theory-based resistance training maintenance intervention for prediabetic adults

Objective: Examine psychosocial mediators of the effects of high vs. low-dose resistance training (RT) maintenance interventions among older (ages 50–69), overweight and pre-diabetic adults.

Design: Participants (N = 123) completed a three-month supervised RT initiation phase and were subsequently randomised (time 1) to high or low-dose six-month unsupervised RT maintenance interventions (time 2), followed by a six-month no-contact phase (time 3).

Main Outcome Measures: Online measures of putative mediators and RT behaviour.

Results: RT intervention condition (high vs. low dose) had significant effects on change from time 1 to time 2 in behavioural expectation, self-regulation and perceived satisfaction (f² = .04–.08), but not outcome expectancies, RT strategies or behavioural intentions (f² ≤ .02). Change in each of the putative mediators, except for outcome expectancies (f² ≤ .02), had significant effects on RT behaviour at times 2 (f² = .12–.27) and 3 (f² = .23–.40). In a multiple mediation model, behavioural expectation (f² = .11) and self-regulation (f² = .06) mediated the effects of RT intervention condition on time 2 RT behaviour, whereas perceived satisfaction did not (f² = .01). Self-regulation was a significant mediator of intervention effects on time 3 RT behaviour (f² = .11), but behavioural expectation and perceived satisfaction were not (f² = .04).

Conclusions: Findings suggest that behavioural expectation and self-regulation are appropriate targets for RT maintenance interventions among at-risk older adults.     

Depression and literacy are important factors for missed appointments

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.     

Can psychological interventions increase optimism? A meta-analysis

Greater optimism is related to better mental and physical health. A number of studies have investigated interventions intended to increase optimism. The aim of this meta-analysis was to consolidate effect sizes found in randomized controlled intervention studies of optimism training and to identify factors that may influence the effect of interventions. Twenty-nine studies, with a total of 3319 participants, met criteria for inclusion in the analysis. A significant meta-analytic effect size, g = .41, indicated that, across studies, interventions increased optimism. Moderator analyses showed that studies had significantly higher effect sizes if they used the Best Possible Self intervention, provided the intervention in person, used an active control, used separate positive and negative expectancy measures rather than a version of the LOT-R, had a final assessment within one day of the end of the intervention, and used completer analyses rather than intention-to-treat analyses. The results indicate that psychological interventions can increase optimism and that various factors may influence effect size.     

A Threatened Identity: The Mental Health Status of Syrian Refugees in Egypt and Its Etiology

This study utilized the development-based trauma framework on identity traumas to study the cumulative effects of trauma on the identities of Syrian refugees. Participants included 196 Syrian refugees residing in Cairo, Egypt (Mean age = 35.99, SD = 11.05). The rate of post-traumatic stress disorder was 33.5%, and the rate of depression was around 30%; the level of comorbidity was high with a high rate of suicidal plans or attempts (13.7%). Analyses indicated that existential annihilation anxieties, moderated by identity salience, mediated the effects of cumulative trauma on mental health. The results confirmed the utility and validity of the identity trauma model and provided evidence of the dire mental health needs of Syrian refugees.     

Looking forward to tomorrow: The buffering effect of a daily optimism intervention

This research demonstrates the effectiveness of a brief daily self-applied optimism intervention in an adult normal population. Participants completed Life Orientation Test-Revised, Positive and Negative Affect Scale, Satisfaction with Life Scale, and Burnout Measure scales before, immediately after, and one month after the intervention. At baseline, optimism intervention group (N = 36) and control group (N = 41) were statistically similar on the variables of interest. At post-test, and also one month later, the intervention group demonstrated reduced pessimism, negative affect, and emotional exhaustion, although optimism, positive affect, and life satisfaction did not increase. Higher initial optimism increased the intervention effect for the optimism group, but not for the control group, by diminishing negative affect and emotional exhaustion, and increasing optimism. Sixty-one percent of the activities mentioned by the control group participants focused on duties and work, compared to 28% in the optimism condition. No correlations were found between initial optimism or pessimism, and the type of activities mentioned.     

Delivering your daily dose of well-being to the workplace: a randomized controlled trial of an online well-being programme for employees

The purpose of this study was to evaluate a newly developed brief, cost-effective, flexible, and broadly accessible online programme designed to enhance employee well-being. Considering the demands of the working world, the development of the positive intervention (PI) programme was based on empirical findings and latest theoretical advances from the field of positive psychology, namely the PERMA model of well-being. The new PERMA-based programme’s effectiveness to increase employee well-being was evaluated with a longitudinal field experiment, including a wait list control group and an already established PI programme (i.e., gratitude programme) for comparison (three-armed randomized controlled trial; n = 303, N_male = 99, N_female = 203, M_age = 41.16, SD = 12.26). Repeated measures analyses of variance (ANOVAs) supported that on average, participants of the gratitude programme and the PERMA-based programme reported significant increases in employee well-being after the intervention, as compared to no increases in the wait list control group. The significant increases yielded small effect sizes for general subjective well-being and medium effect sizes for work-related subjective well-being. Post-hoc analyses controlling for baseline well-being also supported the efficacy of the PIs. Contrary to the prediction of the PERMA-based programme’s superiority, participants of both online PI programmes reported similar gains in employee well-being components. Practical implications, limitations, and future research are discussed.     

Incongruence between workload and occupational norms for time pressure predicts depressive symptoms

Workplace aggression poses a significant challenge to organizations due to its potential impact on employees' mental and physical well-being. Using two studies, this article investigates whether emotion regulation could alleviate the negative effects of exposure to workplace aggression on employees' experience of strain, among social workers (N = 77) and emergency services personnel (N = 70). As predicted from coping theories of emotion regulation, Studies 1 and 2 showed that using the emotion regulation strategy of reappraisal during interactions with individuals from inside the organization (e.g., coworkers or managers) attenuated the workplace aggression–strain link. Conversely, but consistent with emotional labour theories of emotion regulation, engaging in reappraisal and suppression during interactions with legitimate outsiders (e.g., clients or patients) strengthened the workplace aggression–strain link. The findings have implications for both theory and practical interventions regarding workplace aggression.     

Equine Facilitated Therapy for Children and Adolescents: A Qualitative Pilot Study

Despite recent growth in the use of equine facilitated therapy (EFT), and its potential to be an effective alternative to traditional therapeutic interventions, the literature has not yet provided a convincing explanatory account of the practices implemented within EFT. In this study, the author investigates consistency of clinical practices within the Equine Assisted Growth and Learning Association (EAGALA) model of EFT. Semi-structured interviews were conducted with mental health professionals and equine specialists (N = 10) from six Australian EFT clinics. Thematic analysis of data revealed: an absence of an underpinning theoretical model; variations between clinical practices; lack of parental involvement in therapy for children/adolescents; and inadequate research into perceived mechanisms of change driving EFT. This article concludes with a set of recommendations directed at EFT practitioners in order to increase the rigor of practice and maximize the potential of this intervention.     

Gratitude reception and physical health: Examining the mediating role of satisfaction with patient care in a sample of acute care nurses

ABSTRACT

Literature examining well-being benefits of gratitude experiences is currently thriving in psychological science. However, evidence of the physical health benefits of gratitude remains limited. Research and theory in affective science suggests an indirect relationship between gratitude and physical health. This study examines how receiving expressions of gratitude predicts physical health outcomes in a sample of acute care nurses over time. Registered nurses (N = 146) practicing in Oregon completed weekly surveys over 12 consecutive weeks describing their positive and negative events, health, and work-related experiences. Multilevel mediation models revealed that being thanked more often at work was positively related to a nurse’s satisfaction with the care they provided within that week, which subsequently predicted sleep quality, sleep adequacy, headaches, and attempts to eat healthy. These findings contribute to literature demonstrating the health benefits of gratitude by indicating that benefactors may experience improvements in subjective physical health through positive domain-relative satisfaction.     

Randomized controlled trial of an intervention to change cardiac misconceptions in myocardial infarction patients

There is converging evidence that changing beliefs about an illness leads to positive recovery outcomes. However, cardiac misconceptions interventions have been investigated mainly in Angina or Coronary Heart Disease patients, and less in patients following Myocardial Infarction (MI). In these patients, cardiac misconceptions may play a role in the adjustment or lifestyle changes. This article reports a randomized controlled trial of an intervention designed to reduce the strength of misconceptions in patients after a first MI. The primary outcome was the degree of change in misconceptions and the secondary outcomes were: exercise, smoking status, return to work and mood (anxiety and depression). Patients in the intervention condition (n = 60) were compared with a control group (n = 67) receiving usual care. Both groups were evaluated at baseline and 4, 8 and 12 months after hospital discharge. There was a significant time-by-group interaction for the total score of cardiac misconceptions. Patients in the intervention group significantly decreased their total score of cardiac misconceptions at 4 months compared with the control group and this difference was sustained over time. Patients in the intervention group were also more likely to exercise at the follow-up period after MI than the control group. This intervention was effective in reducing the strength of cardiac misconceptions in MI patients and had a positive impact on health behaviour outcomes. These results support the importance of misconceptions in health behaviours and the utility of belief change interventions in promoting health in patients with Myocardial Infarction.