Responding to the Psychological Needs of Health-Care Workers During the COVID-19 Pandemic: Case Study from the Medical College of Wisconsin

With the advent of the novel coronavirus (COVID-19) pandemic, health-care workers have been faced with an inordinately high level of trauma as frontline providers. The Medical College of Wisconsin (MCW) partnered with affiliate hospitals and community partners to mobilize a matrix of available support and interventions to deliver psychological services to reach all levels of health-care providers in timely, accessible formats. While virtual peer support groups were the most utilized resource among the support group options, other opportunities also provided unique benefits to learners whose education had been disrupted by the pandemic. Mental health must be prioritized for health-care workers in the event of future public health crises. Lessons learned from this pandemic indicate that it is critical to involve learners early on in the process in order to meet their educational needs and to increase access to evidence-based care.

     

Implementing Skills for Psychological Recovery at a Psychology Training Clinic During COVID-19

The COVID-19 global pandemic has disrupted the routine provision of community mental health services, which is especially concerning given that emerging data suggest a rise in mental health concerns related to the COVID-19 crisis (Xiong et al., 2020). Thus, it seems imperative to provide trauma-informed services that are tailored to clients’ coping with the pandemic and can be effectively delivered via telehealth. The goals of these important services would be to mitigate current distress, help prevent the onset of long-term mental health problems, and facilitate client safety during a public health crisis. The present article provides an overview of adoption and telehealth implementation of the Skills for Psychological Recovery (SPR) secondary prevention program within a psychology training clinic. Initial clinical outcome data supported the program’s success in reducing mental health symptoms among individuals in psychological distress due to the COVID-19 crisis; however, the results were more striking for adults than for youths. The article concludes with recommendations for broader implementation and future directions for clinicians, supervisors, organizations, and researchers.     

Emotionally Focused Couple Therapy with Couples Facing Terminal Illness

Research on effective therapeutic interventions for couples dealing with terminal illness is scant. Changes in daily routine, added responsibilities, role changes, and the grief process are all contributors to the enormous stress and emotional strain felt by these couples. Couples where one partner is terminally ill may experience anger, depression, guilt, and anxiety. The authors propose that emotionally focused couple therapy (EFT), originally developed by Greenberg and Johnson (Emotionally focused therapy for couples, Guilford Press, New York, NY, 1988) may be effective in addressing this distress and in facilitating the grieving and support process in couples dealing with terminal illness. EFT is a systemic, experiential form of therapy that builds upon Bowlby’s (Attachment and loss: Volume I: Attachment, Basic Books, New York, NY, 1969) attachment theory. By exploring the emotional experience of both partners it may be possible to re-structure the couple’s emotional partnership and support the grief process for both partners.     

Coping concordance in couples

Romantic partners' daily coping behavior can be viewed as a context for one's own coping. These three studies found that individuals were more likely to cope actively, seek support, or use alcohol, food, and drugs as means of coping when they perceived their partners doing so on a given occasion (Study 1, a cross‐sectional study) and when their partners reported using these strategies (Studies 2 and 3, longitudinal couples studies). These effects were evident regardless of whether or not one partner was dealing with an acute stressor (Study 2) or if both partners were dealing with day‐to‐day hassles (Study 3). Although these patterns are correlational, they raise important questions about how individuals choose to cope with acute stressors.     

Posttraumatic Cognitions and Depressive Symptoms in War and Disaster Affected Widows in Sri Lanka: The Role of Community Support

In this study the authors evaluated the associations between war- and disaster-related problems and indicators of psychological distress (posttraumatic cognitions and culturally-specific symptoms of depression) among a sample of Tamil widows in the Eastern Provence of Sri Lanka. Furthermore, community support was evaluated as a mediator of these associations. Surveys were administered to women (N?=?156) in an interview format by trained research assistants who were native Tamil speakers. Mediation hypotheses were evaluated using path analysis. Results showed that war-related problems, but not disaster-related losses, was significantly associated with community support and posttraumatic cognitions, such that higher number of war-problems was associated with lower community support and more posttraumatic cognitions. Community support had a significant negative association with posttraumatic cognitions and depression. Additionally, we found evidence that war-related problems was indirectly associated with depression through community support. Although the magnitude of associations was small, results suggest that contextual problems resulting from years of armed conflict may be associated with less support from one’s community which, in turn, is associated with increased psychological distress. Limitations and implications for intervention and future research are discussed.     

Loss and Resilience in the Time of COVID-19: Meaning Making,Hope, and Transcendence

This article addresses the many complex and traumatic losses wrought by the COVID-19 pandemic. In contrast to individually based, symptom-focused grief work, a resilience-oriented, systemic approach with complex losses contextualizes the distress and mobilizes relational resources to support positive adaptation. Applying a family resilience framework to pandemic-related losses, discussion focuses on the importance of shared belief systems in (1) meaning-making processes; (2) a positive, hopeful outlook and active agency; and (3) transcendent values and spiritual moorings for inspiration, transformation, and positive growth. Practice guidelines are offered to facilitate adaptation and resilience.     

Religious support and psychosocial well-being among a religious Jewish population

The three subscales of the Religious Support Scale assess perceived support from a person’s religious community, religious leaders, and God. This three-factor structure was replicated in the current study with a sample of 277 religious Jewish persons residing in Israel. Hierarchical canonical analysis showed that, even after controlling for general social support, Religious Leader and God Support were related to lower emotional distress, Religious Leader and Religious Community Support contributed to a higher level of life satisfaction, and Religious Community and God Support contributed to the prediction of perceived health. Findings are discussed in terms of religious support’s generalizability as a psychosocial resource for persons of various faiths.     

Effects of Testimonial Inconsistencies and Witness Group Identity on Mock‐Juror Judgments1

We examined the interaction of testimonial consistency and witness group identity on mock jurors' judgments of witness effectiveness, probability that the defendant committed the crime, and verdict. In a 3 × 2 (Witness Group Identity × Testimonial Consistency) between‐groups design, 180 mock jurors heard a trial of a person charged with assault. Although both variables affected judgments, group‐identity effects were weak when testimony was characterized by inconsistencies, and they were stronger when testimony was internally consistent but ambiguous. The judgment patterns were consistent with predictions from Chaiken, Liberman, and Eagly's (1989) heuristic‐systematic processing theory, suggesting that heuristic processing would bias systematic processing when the evidence was not decisive.     

Achieving Effective Remote Working During the COVID-19 Pandemic: A Work Design Perspective

Existing knowledge on remote working can be questioned in an extraordinary pandemic context. We conducted a mixed-methods investigation to explore the challenges experienced by remote workers at this time, as well as what virtual work characteristics and individual differences affect these challenges. In Study 1, from semi-structured interviews with Chinese employees working from home in the early days of the pandemic, we identified four key remote work challenges (work-home interference, ineffective communication, procrastination, and loneliness), as well as four virtual work characteristics that affected the experience of these challenges (social support, job autonomy, monitoring, and workload) and one key individual difference factor (workers’ self-discipline). In Study 2, using survey data from 522 employees working at home during the pandemic, we found that virtual work characteristics linked to worker's performance and well-being via the experienced challenges. Specifically, social support was positively correlated with lower levels of all remote working challenges; job autonomy negatively related to loneliness; workload and monitoring both linked to higher work-home interference; and workload additionally linked to lower procrastination. Self-discipline was a significant moderator of several of these relationships. We discuss the implications of our research for the pandemic and beyond.     

How Do Partners Find out About the Risk of Huntington’s Disease in Couple Relationships?

Whilst a growing body of work has explored family communication about Huntington’s disease and how at-risk individuals learn about their risk, the experience of telling a partner and partners’ experiences of finding out about this potentially devastating hereditary illness have received little attention. This study describes the experiences of partners in finding out about Huntington’s disease and any impact on couple’s relationships/marriages. We undertook a thematic analysis of qualitative interviews which explored the dynamics of partners’ marriages after predictive testing and partners’ views of genetic counseling. A main theme from partners’ accounts was how they found out about their spouse’s risk of Huntington’s disease and the impact this had on marital relations. The analysis revealed four types of disclosure experiences: (1) marital secrets; (2) alerting, but not telling; (3) knowing and seeing; (4) marital ignorance. Our findings demonstrate that partners’ experiences of (non)disclosure about the risk of HD within marriages is an important factor which contributes to couples’ coping or marital problems. Exploring how spouses found out about their partner’s risk of HD will illuminate issues about a couple’s past and future patterns of communication and their coping strategies. A practical and ethical implication is the extent to which genetic counselors should inform partners about the course and nature of Huntington’s disease when a partner is the support person for the individual being tested.     

Participatory Organizational Change in Community-Based Health and Human Services: From Tokenism to Political Engagement

Community psychologists have long worked with community-based human service organizations to build participatory processes. These efforts largely aim at building participatory practices within the current individual-wellness paradigm of human services. To address collective wellness, human service organizations need to challenge their current paradigm, attend to the social justice needs of community, and engage community participation in a new way, and in doing so become more openly political. We use qualitative interviews, focus groups, organizational documents, and participant observation to present a comparative case study of two organizations involved in such a process through an action research project aimed at transforming the organizations’ managerial and practice paradigm from one based on first-order, ameliorative change to one that promotes second-order, transformative change via strength-based approaches, primary prevention, empowerment and participation, and focuses on changing community conditions. Four participatory tensions or dialectics are discussed: passive versus active participation, partners versus clients, surplus powerlessness versus collective efficacy, and reflection/learning versus action/doing.     

Community cohesion during the first peak of the COVID-19 pandemic: A social antidote to health anxiety and stress

Social support gained through community ties has been pivotal in dealing with stressful events. A cross-sectional community sample (N = 2,329) was gathered to assess community cohesion buffering against heath anxiety and perceived stress during the first peak of the pandemic in the UK, using structural equation modeling analyses. Community cohesion acted as a protective mechanism against both health anxiety and stress during the first national lockdown. A strong positive association was also found between health anxiety and stress. Stress and health anxiety scores peaked in the first weeks of the imposed quarantine; as the lockdown was extended, participants reported lower stress, health anxiety and community cohesion scores. The reduction of community cohesion scores was greater for those younger than 45 while the positive association between stress and health anxiety was stronger among males during the lockdown. While community cohesion effects against health anxiety were enhanced for females, community's buffering against stress were greater for males. Strengthening citizens' psychological sense of community through the publicization and support of local initiatives and mutual-aid groups and utilizing methodically green (and blue) spaces to boost neighborhood attraction might be viable strategies within which stress and health anxiety can be suppressed. Conversely, allowing community, regional and national cracks to deepen can exacerbate the impact of stressful events experienced during the COVID-19 pandemic.     

A Dyadic Analysis of the Between‐ and Within‐System Alliances on Distress

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This study examines the relationship between the therapeutic alliance and distress using the couple rather than the individual as the unit of analysis. One hundred and seventy‐three couples receiving treatment for relational distress at two university clinics participated in this study. The actor–partner interdependence model was used to analyze the relationship of each partner's between‐ and within‐system alliance scores and distress at session four. Results provide support for actor effects on relational distress for both male and female partners and for actor effects on psychological distress for female partners. Limited support was found for partner effects on distress. Furthermore, results indicate that the alliance between partners is a stronger predictor of improvement in early sessions in comparison with the alliance between the individual and the therapist.     

Psychosocial response to COVID‐19 pandemic in India: Helpline counsellors’ experiences and perspectives

The COVID‐19 pandemic presents a threat to physical and psychosocial health of individuals. In lieu of the subsequent lockdown and containment measures, helpline counselling becomes a viable method of accessing psychosocial services during the pandemic. The present paper describes experiences of counsellors working with a special COVID‐19 counselling helpline initiated by iCALL, a national‐level technology‐assisted counselling service of the Tata Institute of Social Sciences, India, which aims to address the psychosocial impact of the pandemic and the lockdown. The paper is based on two focus group interviews held with 11 counsellors during the initial two months of the helpline's functioning. Findings of the study highlight the diverse profile of the callers, with individuals belonging to different strata of society and to marginalised communities. The nature of concerns presented by the callers were often a mix of psychological, relational and practical issues. The resultant distress emanated from an interplay of these factors with the relational contexts, their social locations and social structures the individuals were embedded in. This highlighted the need for conceptualising and responding from a psychosocial lens, whereby interventions involved traditional counselling approaches and strategies for addressing determinants of distress by connecting callers to required ground‐level resources. Counsellors’ engagement with this process impacted their professional and personal selves, necessitating the need for structured and continuous training, supervision and support. At a larger level, the counsellors’ narratives asserted the need for adopting a psychosocial paradigm for conceptualising and addressing mental health concerns in India.     

Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents', Community Workers' and Service Providers' Perspectives

The impact of community stigmatisation upon service usage has been largely overlooked from a social identity perspective. Specifically, the social identity‐mediated mechanisms by which stigmatisation hinders service use remain unspecified. The present study examines how service providers, community workers and residents recount their experience of the stigmatisation of local community identity and how this shapes residents' uptake of welfare, education and community support services. Twenty individual and group interviews with 10 residents, 16 community workers and six statutory service providers in economically disadvantaged communities in Limerick, Ireland, were thematically analysed. Analysis indicates that statutory service providers endorsed negative stereotypes of disadvantaged areas as separate and anti‐social. The awareness of this perceived division and the experience of ‘stigma consciousness’ was reported by residents and community workers to undermine trust, leading to under‐utilisation of community and government services. We argue that stigmatisation acts as a ‘social curse’ by undermining shared identity between service users and providers and so turning a potentially cooperative intragroup relationship into a fraught intergroup one. We suggest that tackling stigma in order to foster a sense of shared identity is important in creating positive and cooperative service interactions for both service users and providers. Copyright © 2014 John Wiley & Sons, Ltd.     

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple‐based intervention for BED. Vocally encoded emotional arousal was measured during couples’ (n = 11) conversations about BED. As predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients’ and their own distress. After treatment, partners’ arousal was no longer associated with the patients’ emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners’ emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple‐based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.     

‘How can we help when she won't tell us what's wrong?’ Professionals working with South Asian women who have experienced sexual abuse

In this paper, we explore some of the issues facing professionals in the UK currently involved in providing services for South Asian women who have experienced sexual abuse. The study describes part of a wider Economic and Social Research Council funded project, based upon interviews and focus groups with both professionals and women survivors of sexual abuse. Drawing on semi‐structured interviews and two focus groups with 37 professionals including psychological therapists, refuge and project workers, from a range of organisations, our aim in this paper is to provide a discursive analysis of some of the key dilemmas faced by professionals working with sexual abuse in South Asian communities by exploring two central interpretive repertoires: ‘culture not self’ and ‘symptom talk as solution’. The analysis indicates that professionals face a series of dilemmas when working with South Asian women survivors. They highlight the tension between individualised models of personhood in many psychological therapies and the challenge to these by South Asian communities who hold a more relational view of the person. One of the strategies used by professionals to work with the tensions between ‘culture’ and the ‘reality’ of the survivor's pain was the translation of women's distress into symptoms of mental disorder. However, the consequences of this intervention raised some serious issues, including further pathologisation and stigma. The implications of these findings will be discussed in terms of how to understand the experiences of South Asian women from a more socially grounded perspective and to explore the issues they face in accessing and receiving appropriate services to deal with the aftermath of sexually abusive experiences. Copyright © 2006 John Wiley & Sons, Ltd.     

PMS as a Gendered Illness Linked to the Construction and Relational Experience of Hetero-Femininity

The majority of research conducted to date on premenstrual distress has focused on heterosexual women. Drawing on research with lesbian and heterosexual self-defined PMS (premenstrual syndrome) sufferers and their partners, we argue that this negates the role played by hetero-patriarchal constructions of both femininity and premenstrual change in the lived experience of premenstrual distress. Negative constructions of PMS and over-responsibility within the home, commonly found in heterosexual relationships, exacerbate distress and result in women being pathologised premenstrually. Conversely, support and understanding offered by partners, more common in lesbian relationships, reduces guilt and self-pathologisation, allowing women to engage in coping strategies premenstrually, such as taking time out to be alone, or engage self-care. These patterns of relational negotiation of women’s premenstrual change can be contextualised within broader cultural representations of hetero-normativity, which provide the context for gendered roles and coping.     

When a Non-resident Worker is a Non-resident Parent: Investigating the Family Impact of Fly-In,Fly-Out Work Practices in Australia

Non-resident work practices, which involve prolonged separations from family, long-distance commuting between home and remote work sites and long work hours across compressed rosters, are now commonplace in Australia. This study examined the impact of these work arrangements, often termed Fly-In/Fly-Out (FIFO), on children and families, and to identify family-related and employment-related factors that influence child and family outcomes. Anonymous online surveys containing measures of family and couple relationship quality, child behavioral and emotional adjustment, parenting and personal adjustment were completed by 232 partners of FIFO workers, 46 FIFO workers, and a comparison group of community parents (N = 294 mothers, N = 36 fathers). There were no differences between FIFO partners and community parents on family or couple relationship quality, parenting competence and child behavioral or emotional difficulties. FIFO partners reported higher levels of personal emotional problems and greater usage of harsh discipline practices than community mothers, while FIFO workers reported greater work to family conflict and alcohol use than community fathers. Regression analyses on the FIFO partners sample indicated that child and family functioning were best predicted by family factors, including harsh parenting and parental emotional adjustment. Implications of the findings for the design and provision of family-based support for FIFO families are discussed.