Effectiveness of a smartphone-based worry-reduction training for stress reduction: A randomized-controlled trial

Objective: Perseverative cognition (e.g. worry) and unconscious stress are suggested to be important mediators in the relation between stressors and physiological health. We examined whether a smartphone-based worry-reduction training improved a physiological marker of stress (i.e. increased heart rate variability [HRV]) and unconscious stress.

Design: Randomised-controlled trial was conducted with individuals reporting work stress (n = 136). Participants were randomised to the experimental, control or waitlist condition (resp. EC, CC, WL). The EC and CC registered emotions five times daily for four weeks. The EC additionally received a worry-reduction training with mindfulness exercises.

Main Outcome Measures: Primary outcome was 24-h assessments of HRV measured at pre-, mid- and post-intervention. Secondary outcomes were implicit affect and stress. Effects on heart rate and other psychological outcomes were explored.

Results: A total of 118 participants completed the study. No change from pre- to post-intervention was observed for the primary or secondary outcomes. The change over time was not different between conditions.

Conclusion: Findings suggest that the training was ineffective for improving HRV or psychological stress. Future studies may focus on alternative smartphone-based stress interventions, as stress levels are high in society. There is need for easy interventions and smartphones offer possibilities for this.     

Assessment and treatment of low-rate high-intensity problem behavior.

Functional analysis of low‐rate aggression was conducted during extended observation periods and showed behavior to be maintained by positive reinforcement. Treatment consisted of variable‐momentary differential reinforcement of other behavior and was successful in reducing problem behavior throughout these extended observation periods.     

Daily emotional dynamics in depressed youth: a cell phone ecological momentary assessment study

This study used a new cell phone ecological momentary assessment approach to investigate daily emotional dynamics in 47 youths with major depressive disorder (MDD) and 32 no-psychopathology controls (CON) (ages 7-17 years). Information about emotional experience in the natural environment was obtained using answer-only cell phones, while MDD youths received an 8-week course of cognitive behavioral therapy and/or psychopharmacological treatment. Compared with CON youths, MDD youths reported more intense and labile global negative affect; greater sadness, anger, and nervousness; and a lower ratio of positive to negative affect. These differences increased with pubertal maturation. MDD youths spent more time alone and less time with their families than CON youths. Although differences in emotional experiences were found across social contexts, MDD youths were more negative than CON youths in all contexts examined. As the MDD participants progressed through treatment, diagnostic group differences in the intensity and lability of negative affect decreased, but there were no changes in the ratio of positive to negative affect or in measures of social context. We discuss methodological innovations and advantages of this approach, including improved ecological validity and access to information about variability in emotions, change in emotions over time, the balance of positive and negative emotions, and the social context of emotional experience.     

The experiences of therapy from the perspectives of carers of people with dementia: An exploratory study

Design: Interviews were conducted with six carers of people with dementia about their experience of receiving counselling/psychotherapy. Interviews were conducted in the carer's own home, and data were analysed thematically using a narrative approach. Findings: Three themes were identified from the data: ‘Still doing the best I can’ (identified as losses and processes of personal growth); ‘Feeling connected and being understood’ (identified as attributes believed to be important within the therapeutic relationship); and ‘Wanting to share information’ (identified as sharing information with someone ‘neutral’). Carers placed emphasis on the age of the therapist and the amount of therapist self‐disclosure. Attending counselling and/or psychotherapy also helped the carer to find a ‘safe space’ to disclose and share concerns. Discussion: Carer loss and personal growth are explored, together with the importance of building therapeutic relationships and, for the therapist, seeking supervision when managing personal self‐disclosure. The theme of therapist self disclosure is explored together with the importance of therapists seeking supervision when managing personal self‐disclosure.     

Teaching Approaches and Occupational Therapy Psychoeducation

Abstract

Patient education has become an important feature of any treatment program. Psychoeducational procedures dominate the treatment used by occupational therapy practitioners in psychiatric rehabilitation. Occupational therapy literature frequently describes the content of psychoeducational programs but rarely examines the teaching approach therapists use in them. It is necessary, therefore, to begin carefully questioning how we are approaching psychoeducation and justifying it as a method compatible with our basic philosophical principles and our growing understanding of occupation. Three approaches to teaching are examined and contrasted with occupational therapy values: the executive approach, the therapist approach, and the liberationist approach. Each of these approaches points to dramatically different outcomes of the therapeutic process. Ultimately, they bring into question the way in which we build a relationship with our clients. The liberationist approach is proposed as the best guide of how and why to use psychoeducation in the quest for providing authentic occupational therapy.     

Understanding the utility of emotional approach coping: evidence from a laboratory stressor and daily life

Background: Dispositional emotional approach coping (EAC) marks an adaptive tendency to process and express emotions. EAC's association with cognitions, affect, and intra- and interindividual characteristics that may account for its utility was examined in response to an acute stressor and in daily life. Design: This study included a laboratory stress task and ecological momentary assessment. Methods: Healthy undergraduate students (n = 124; mean age: 20; women: 56%) completed a laboratory component (baseline survey, speech stress task, pre- and posttask measures) and five subsequent days of surveys via palm pilot (six surveys/day). Results: Controlling for sex, neuroticism, and social support, greater EAC was associated with more positive cognitive appraisals, personal resources, and positive affect and less-negative affect during the lab stressor, and with more perceived control and positive affect in daily life. Significant EAC × sex interactions were found for poststressor affect: men with high EAC reported more positive affect and women with high EAC reported less negative affect. Conclusions: Findings provide support that EAC's utility may be independent of intra- and interindividual characteristics, and that men and women may benefit from EAC in different ways in regards to affect. The proclivity to use EAC may come with a resiliency that protects against stress and promotes general well-being.     

Domestic Violence

Summary

In this paper, the authors outline their experience in incorporating a curriculum on domestic violence into an urban family practice residency program. Based on the concept that in order to successfully develop such a curriculum, it is necessary to address the “culture of the organization,” joint educational strategies that in-elude resident education as well as faculty development were considered. A research question was designed to inquire as to the difference in the level of knowledge about domestic violence in family practice faculty as compared to residents prior to the introduction of educational strategies. The authors describe curriculum goals and objectives and outline specific teaching methods as well as the evaluation instrument utilized in the study to measure actual difference in knowledge between faculty and residents about domestic violence with a focus specifically on spousal abuse. Their conclusions point to the need for an educational strategy that includes emphasis on the faculty-resident interface which utilizes both traditional and non-traditional integrated formats in order to successfully train residents in the identification and treatment of domestic violence.     

Does the burden of the experience sampling method undermine data quality in state body image research?

Despite growing popularity of experience sampling methodology (ESM) for evaluations of state-based components of body image, there have been concerns that the frequent repeated measurement might encourage problematic responding resulting in low data quantity and/or quality. Using a sample of 105 women (mean age = 24.84), this study used multilevel modelling to investigate whether (a) there were changes in compliance or response variability across a 7-day period, and (b) whether such changes are explained by participant characteristics. Present findings suggest that demands of ESM protocol undermine quantity more so than quality of obtained data. Decline in procedural compliance across the testing period correlated with BMI and body shame, whereas reduced variability in state-based assessments did not adversely impact the strength of association between state body satisfaction ratings and other variables in the dataset. The authors make several recommendations for ensuring the quality of ESM-based data in future studies.     

The relationship of children's hope to pediatric asthma treatment adherence

This study investigated the relationship between hope and adherence to a daily inhaled steroid regimen among 48 asthma patients ages 8–12 years old who participated in a 14 day adherence assessment. Participants completed the Children's Hope Scale, and parents completed a questionnaire aimed at demographic and disease-related information. Adherence was measured by electronic monitoring of the use of the participant's metered-dose inhaler. A multivariate model predicting nonadherence was built, including FEV₁ in the first step and children's hope level in the second step. This model was a significant predictor of adherence (Nagelkerke R ²?=?0.24, p?=?0.01). No other demographic or psychosocial variables were significant predictors of adherence. These findings highlight the need to attend to psychosocial predictors of adherence, specifically hope, and may help practitioners target these factors in their efforts to increase adherence among pediatric asthma patients.     

Episodes of momentary resilience in daily life are associated with HRV reductions to stressful operations in firefighters: an ambulatory assessment approach using bayesian multilevel modeling

ABSTRACT

Background: Resilience is discussed to constitute a protective buffer against stress, thus fostering health. Methods: This study aimed to assess resilience both via traditional questionnaire and in everyday life on a momentary basis, and to relate these measures to autonomic functioning (heart rate variability, HRV) in 38 male firefighters during a weekday. Stressful operations, non-stressful operations and routine work at the firestation were coded during 24 hours. Momentary negative affect, feelings of resilience, and HRV were recorded via ecological momentary assessment. Findings: Questionnaire-assessed resilience was significantly positively associated with aggregated momentary resilience (r = .58, p < .001), but unrelated to HRV. However, controlling for multiple confounders (e.g., age, smoking, bodily movement, waist-to-height ratio) momentary resilience was associated with attenuated HRV and lower negative affect during stressful encounters only. Discussion: The findings suggest that momentary feelings of resilience are accompanied by vagal withdrawal to stress, possibly indicating psychological flexibility and adaptive responding to stress.