A stress management programme for Crohn's disease

The present study was designed to assess the effectiveness of techniques of behavioural assessment and treatment of Crohn's disease (CD). On the assumption that stress events have a pronounced influence on the life of Crohn's patients, we proposed stress management treatment. This is intended to control stress and improve patients' personal and social competence. Forty-five patients with Crohn's disease were randomly assigned to one of three treatment groups, two experimental groups: stress management and self-directed stress management, and a control group: conventional medical treatment. The subjects underwent eight individual sessions which were specific to each condition. All subjects completed symptom monitoring diaries. The subjects who received training in stress management experienced a significant post-treatment reduction of tiredness (P < 0.1), constipation (P < 0.1), abdominal pain (P < 0.5) and distended abdomen (P < 0.5). The subjects who received training in self-directed stress management experienced a significant reduction in tiredness (P < 0.1) and abdominal pain (P < 0.5). No significant changes were observed in symptomatology in the conventional medical treatment group. Similar results were obtained in the 12 month follow-up.     

Measuring coping flexibility

Abstract

The present study examined coping flexibility and correlates of this style of approaching stressful situations. Two methods for assessing coping flexibility, the Flex (Schwartz and Daltroy, 1991) and a modification of the Ways of Coping Checklist (Folkman and Lazarus. 1980) were administered to 28 men and 32 women, who were also asked questions about their age, gender, style of impression management (self-monitoring and social desirability), and basic personality variables from the Multidimensional Personality Questionnaire (Tellegen. 1982). Subjects responded to four common scenarios described by a 2 (social/nonsocial) × 2 (minor/major) matrix. Gender differences were not found for the Flex, but men exhibited more flexibility than did women when determined by the WOC range score. Older subjects exhibited smaller ranges on both the Flex and the WOC, suggesting that they were less flexible in coping than were younger subjects. Correlations with the Self-Monitoring scale approached significance for the Flex and were significant for the WOC. Greater flexibility was associated with greater well-being and achievement and negatively correlated with stress reactions and alienation.     

The effectiveness of smoking cessation programs: Determinants and outcomes

Abstract

In this review, smoking cessation is discussed from a stress and coping perspective. Nicotine has been found to produce potentially reinforcing effects. Smoking cessation is best characterized as a process with various stages, of which the stage of relapse remains a major area for intervention research. Mood and expectancies appear to be major determinants of behavior in this stage. Social support apparently still needs conceptual refinement before it may be applied effectively in interventions. Effects of multicomponent treatment has been found to be increased when combined with nicotine replacement therapy. Notwithstanding the sometimes modest quit rates, smoking cessation has been found to be cost-effective among high-risk groups, both from an economical and health perspective. New research should focus on emotional and cognitive processes involved in cessation, in particularly self-efficacy expectations. While public policies may be most efficient in reducing the number of smokers in our society, an increasing number of smokers will be confronted with the addictive character of their smoking.     

OTR Burnout

When job stress beconies chronic, it can result in the syndrome of burnout. This is characterized by feelings of reduced personal accomplishment, emotional exhaustion, and depersonalizing attitudes towards patients and colleagues. This pilot study explored burnout in a sample of hospital-based registcrcd occupational therapists employed in Virginia. Scores from 129 OTRs on the Maslach Burnout lnventory and a demographic data sheet were analyzed. Burnout scores were compared for OTRs working in physical disabilities, mental health, and developmental disabilitics. Also, the subjects were compared bascd on time spent in direct patient scrvice. The sample rcported moderate levels of burnout. The only statistically significant finding was that the OTRs who spent the least time with patients reported more depersonalization (intensity only) than their peers. Thc results did not replicate those from a previous report that psychiatric occupational therapists arc experiencing more burnout than other occupational therapists. Much further research appears to bc needed on the topic.     

SLIPA^TM喉罩在眼外科手术中的应用

探讨SLIPA^TM喉罩用于全麻眼外科手术对患者血流动力学、呼吸功能和围术期并发症的影响。60例ASA Ⅰ或Ⅱ级在全麻下实施眼外科手术的患者,随机分为SLIPA^TM通气道组（30例）和气管内插管组（30例）。在麻醉诱导前（T0）、插入SLIPA“通气道／气管导管后即刻（T1）、插入SLIPA^TM通气道／气管导管后5...     

The Role of Human Resource Practices in Reducing Occupational Stress and Strain

The current study examined the occupational stress-strain relationship among a sample of 109 white-collar employees in Singapore. Participants completed a survey that assessed the presence of 8 human resource practices (job training, communication, job redesign, promotional opportunities, employee involvement, family-friendly policies, pay systems, and individual-focused stress interventions [SMIs]), 2 major stressors (role overload and responsibility), 2 types of strain (vocational and interpersonal), and organizational commitment. Results indicate that human resource (HR) practices did not reduce the sources of stress (role overload and responsibility) within the workplace. However, there was a direct negative relationship between HR practices and interpersonal strain. In particular, family-friendly practices, job training, and SMIs reduced interpersonal strain. An examination of vocational strain showed that it was negatively associated with SMIs and job training. In addition, organizational commitment mediated the relationship between HR practices and vocational strain. It was concluded that HR practices may be effective as part of a symptom-directed approach to stress intervention and that further replication of these results in both Asian and Western samples is required.     

The coherence of memories for trauma: Evidence from posttraumatic stress disorder

Participants with posttraumatic stress disorder (PTSD) and participants with a trauma but without PTSD wrote narratives of their trauma and, for comparison, of the most-important and the happiest events that occurred within a year of their trauma. They then rated these three events on coherence. Based on participants’ self-ratings and on naïve-observer scorings of the participants’ narratives, memories of traumas were not more incoherent than the comparison memories in participants in general or in participants with PTSD. This study comprehensively assesses narrative coherence using a full two (PTSD or not) by two (traumatic event or not) design. The results are counter to most prevalent theoretical views of memory for trauma.     

Autobiographical memory for stressful events: the role of autobiographical memory in posttraumatic stress disorder

To provide the three-way comparisons needed to test existing theories, we compared (1) most-stressful memories to other memories and (2) involuntary to voluntary memories (3) in 75 community dwelling adults with and 42 without a current diagnosis of posttraumatic stress disorder (PTSD). Each rated their three most-stressful, three most-positive, seven most-important and 15 word-cued autobiographical memories, and completed tests of personality and mood. Involuntary memories were then recorded and rated as they occurred for 2 weeks. Standard mechanisms of cognition and affect applied to extreme events accounted for the properties of stressful memories. Involuntary memories had greater emotional intensity than voluntary memories, but were not more frequently related to traumatic events. The emotional intensity, rehearsal, and centrality to the life story of both voluntary and involuntary memories, rather than incoherence of voluntary traumatic memories and enhanced availability of involuntary traumatic memories, were the properties of autobiographical memories associated with PTSD.     

Glucocorticoids are required for extinction of predator stress-induced hyperarousal

Background

The role of glucocorticoids in extinction of traumatic memories has not been fully characterized despite its potential as a therapeutic target for acquired posttraumatic stress disorder (PTSD). The predator stress paradigm allows us to determine whether glucocorticoids mediate the extinction of both context-dependent and context-independent fear memories.

Methods

Male C57BL/6J mice were exposed to a predator (cat) then repeatedly exposed to the predator stress context in the absence of the cat. Context-dependent (associative) fear memory was assessed as suppression of activity during re-exposure to the predator stress context without the cat (extinction trials). Context-independent fear (non-associative) was assessed seven days after extinction trials using measures of hyperarousal and anxiety-like behaviours in environments unlike the predator stress context. To assess the role of glucocorticoids, mice were injected with metyrapone (50 mg/kg) 90 min prior to extinction trials in predator stressed mice and context-dependent and context-independent fear memories were assessed. Finally, metyrapone-treated predator stressed mice were injected with corticosterone (5 or 10 mg/kg) immediately following extinction trials and context-dependent and context-independent fear memories were assessed.

Results

Repeated re-exposure to the predator stress context without the cat present extinguished context-dependent fear memory, and also reduced hyperarousal, a generalized, chronic PTSD-like symptom. We show that extinction of context-independent predator stress-induced hyperarousal is dependent on endogenous glucocorticoids during the extinction trials. Furthermore, the inhibition of extinction by metyrapone on startle amplitude was reduced by exogenous administration of corticosterone following extinction trials. Overall, these data implicate glucocorticoids in the extinction of hyperarousal, a core symptom of PTSD.     

Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology

This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.