Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial.

Research has shown that mindfulness-based treatment interventions may be effective for a range of mental and physical health disorders in adult populations, but little is known about the effectiveness of such interventions for treating adolescent conditions. The present randomized clinical trial was designed to assess the effect of the mindfulness-based stress reduction (MBSR) program for adolescents age 14 to 18 years with heterogeneous diagnoses in an outpatient psychiatric facility (intent-to-treat N = 102). Relative to treatment-as-usual control participants, those receiving MBSR self-reported reduced symptoms of anxiety, depression, and somatic distress, and increased self-esteem and sleep quality. Of clinical significance, the MBSR group showed a higher percentage of diagnostic improvement over the 5-month study period and significant increases in global assessment of functioning scores relative to controls, as rated by condition-na?ve clinicians. These results were found in both completer and intent-to-treat samples. The findings provide evidence that MBSR may be a beneficial adjunct to outpatient mental health treatment for adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training.

Preparation for the role of therapist can occur on both professional and personal levels. Research has found that therapists are at risk for occupationally related psychological problems. It follows that self-care may be a useful complement to the professional training of future therapists. The present study examined the effects of one approach to self-care, Mindfulness-Based Stress Reduction (MBSR), for therapists in training. Using a prospective, cohort-controlled design, the study found participants in the MBSR program reported significant declines in stress, negative affect, rumination, state and trait anxiety, and significant increases in positive affect and self-compassion. Further, MBSR participation was associated with increases in mindfulness, and this enhancement was related to several of the beneficial effects of MBSR participation. Discussion highlights the potential for future research addressing the mental health needs of therapists and therapist trainees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness-based stress reduction as a method for personnel development: A pilot evaluation.

Mindfulness-Based Stress Reduction (MBSR) is a potential candidate for learning to cope with stress in a high-stress professional environment. In a pilot study the authors evaluated the potential of MBSR for stress management. Workers participated in an MBSR training for stress-related problems (treatment, n = 12) or waited for such a course (control, n = 11). The authors conducted interviews and measured coping and well-being. Qualitative interviews indicated that subjects had attained more awareness of work-related problems contributing to stress and had grown more critical toward their work environment. In the treatment group, positive strategies of coping with stress increased and negative strategies of coping decreased (significant difference at post treatment: p = .039 compared to control). Eighty-two percent of the participants reported having reached their personal goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder.

Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional responding by modifying cognitive–affective processes. Given that social anxiety disorder (SAD) is characterized by emotional and attentional biases as well as distorted negative self-beliefs, we examined MBSR-related changes in the brain–behavior indices of emotional reactivity and regulation of negative self-beliefs in patients with SAD. Sixteen patients underwent functional MRI while reacting to negative self-beliefs and while regulating negative emotions using 2 types of attention deployment emotion regulation—breath-focused attention and distraction-focused attention. Post-MBSR, 14 patients completed neuroimaging assessments. Compared with baseline, MBSR completers showed improvement in anxiety and depression symptoms and self-esteem. During the breath-focused attention task (but not the distraction-focused attention task), they also showed (a) decreased negative emotion experience, (b) reduced amygdala activity, and (c) increased activity in brain regions implicated in attentional deployment. MBSR training in patients with SAD may reduce emotional reactivity while enhancing emotion regulation. These changes might facilitate reduction in SAD-related avoidance behaviors, clinical symptoms, and automatic emotional reactivity to negative self-beliefs in adults with SAD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An exploration into occupational stress experienced by HIV health care professionals who work within genitourinary medicine settings.

The present study investigates the occupational stress of health care workers involved with HIV care in genitourinary medicine (GUM) outpatient departments. Sixteen nursing and 14 medical staff completed the P. Gray-Toft and J. G. Anderson (1981) occupational stress inventory. This assesses 7 potential sources of stress (death and dying, uncertainty regarding treatment, inadequate preparation, lack of support, conflict with others, conflict with physicians, and workload). The mean scores obtained revealed a preponderance of low-stress scores for both medical and nursing staff. Analyses of variance and covariance further demonstrated that, in general, levels of stress did not differ within or between the occupational groups. However, sources and characteristics of stress were different between nurses and doctors. In this group of health care professionals, their work with HIV-positive patients within the GUM outpatient setting may be instrumental in limiting levels of stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies and collective efficacy as mediators between stress appraisal and quality of life among rescue workers.

Fire-fighters, paramedics, and emergency medical technicians routinely confront potentially traumatic events in the course of their jobs. The mediation role of coping strategies and collective efficacy in the relationship between stress appraisal and quality of life was examined (compassion satisfaction, compassion fatigue, and burnout) in a correlational study. Participants were 463 Italian rescue workers (fire fighters and different categories of emergency health care professionals). Participants filled out measures of stress appraisal, collective efficacy, coping strategies, and quality of life. The results showed that emotion and support coping, self-blame coping, and self-distraction mediated the relationship between stress appraisal and compassion fatigue. Moreover, collective efficacy, self-blame coping, and religious coping mediated the relationship between stress appraisal and burnout. Finally, collective efficacy, self-blame coping, and problem-focused coping mediated the relationship between stress appraisal and compassion satisfaction. Cognitive restructuring and denial did not mediate the relation between stress appraisal and any of the quality of life dimensions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The biological properties of Rahnella aquatilis strains isolated in different regions

This study examines stress in the parents of adolescents and young adults with an intellectual disability and compares it with stress reported by parents with offspring without an intellectual disability. An initial qualitative pilot study lead the authors to Baine et al's Stress Scale. The Baine et al scale is relatively new and addresses aspects of stress not previously investigated among the parents of people with an intellectual disability, namely, stress from the difficult relationship with health professionals and service providers and negative community attitudes to people with an intellectual disability. Because of the relevance to nurses, particular interest is paid to stress from the relationship parents have with health professionals and service providers. The study found significantly greater stress in the parents of young people with an intellectual disability in all aspects of stress examined, including stress from the individual with the disability, internal family stress, stress from the financial strain of having a family member with a disability, stress from community attitudes and stress perceived from the relationship with health professionals and service providers. These findings are distressing in the light of government and service agency policies of community care and independent living. This paper makes recommendations relevant to nurses and identifies difficulties for parents of young people with an intellectual disability in the implementation of current government policy.     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Passage meditation reduces perceived stress in health professionals: A randomized, controlled trial.

The authors evaluated an 8-week, 2-hr per week training for physicians, nurses, chaplains, and other health professionals using nonsectarian, spiritually based self-management tools based on passage meditation (E. Easwaran, 1978/1991). Participants were randomized to intervention (n = 27) or waiting list (n = 31). Pretest, posttest, and 8- and 19-week follow-up data were gathered on 8 measures, including perceived stress, burnout, mental health, and psychological well-being. Aggregated across examinations, beneficial treatment effects were observed on stress (p = .0013) and mental health (p = .03). Treatment effects on stress were mediated by adherence to practices (p = .05). Stress reductions remained large at 19 weeks (84% of the pretest standard deviation, p = .006). Evidence suggests this program reduces stress and may enhance mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confronting health care realities: A reply to Sank (1997).

The author responds to L. I. Sank's (1997) proposal that an effective way to oppose the continuing growth of managed behavioral health care is to lodge professional ethics complaints against licensed behavioral health professionals acting as case managers. The author argues that this is not only a patently ineffective strategy, it also ignores the obvious—that no amount of effort by behavioral health professionals can turn back the clock and reimpose the fee-for-service system apparently favored by a majority of professionals in independent practice. It would behoove psychologists and other mental health professionals, then, to acknowledge the contributions of managed care to clinical and fiscal accountability as well as the problems arising from managed care models and methods of implementation. More important, they should consider what they can do to influence the shape of the service delivery systems of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma, change, and psychological health in the 21st century.

The impact of stressful life events on health has been the object of inquiry for decades. Health care professionals have studied how stressful life events may precipitate or contribute to the onset of illness. Traumatic events and experiences can profoundly affect physical and psychological well-being, which in turn may predispose an individual to greater resilience or greater vulnerability to life stresses. Examined herein is the relationship between life stresses--including social stressors, political stressors, and environmental stressors--and the critical health related issues that psychologists need to prepare for in both the science and the practice of psychology over the next decade and during the 21st century. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The SAFE Program: A family psychoeducational curriculum developed in a Veterans Affairs medical center.

One of the unintended positive consequences of deinstitutionalization and managed care restrictions has been an increased awareness of the impact of serious mental illness on the family. The Support and Family Education (SAFE) Program: Mental Health Facts for Families is a 14-session curriculum of monthly workshops for caregivers. In contrast to similar programs, the SAFE Program is facilitated by mental health professionals, is not diagnostic specific, and includes attention to posttraumatic stress disorder. Three years of outcome data reveal that program attendance is related to increased understanding of mental illness and enhanced awareness of Veterans Affairs resources. Workshop attendance is positively correlated with improvements in participants' self-care. The entire SAFE Program manual is available free of charge on the Internet (http://w3.ouhsc.edu/safeprogram). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal and environmental predictors of posttraumatic stress in emergency management professionals.

Among first responders and other emergency workers in the disaster ecology, an understudied group is that of emergency management professionals (EMP). These individuals share many of the same role conflicts and ambiguities as do health care workers and as a group have been part of national discussions about their role in post-Katrina recovery. Though they have frequent exposures to professional stressors, little is known about the personality traits, cultural issues, and role conflicts that might contribute to their ability to withstand posttraumatic stress symptoms or to grow from their work roles. This research explored 3 models that attempt to explain how previously identified personality traits and role issues such as trauma exposure, burnout, and compassion satisfaction among similar helpers and first responders might predict posttraumatic stress symptoms in EMPs. A sample of 197 participants was recruited using an online methodology, and data were analyzed using hierarchical regression. The results supported a model containing neuroticism and extraversion, trauma exposure frequency, burnout, and compassion satisfaction, accounting for the most variance in predicting PTSD symptoms. Neuroticism, burnout, and compassion satisfaction were found to be significant individual positive predictors, whereas ethnic identity did not significantly contribute to variance or serve as a moderator with trauma exposure. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Screening women for chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays

This study illustrates that cultural differences arise among similarly trained health professionals. Health professionals must learn to communicate sensitively with colleagues from other cultures, to respect their values, and to recognize and resolve cultural differences that affect patient care. In this shrinking, multicultural world, health professionals cannot afford the comfortable illusion that all similarly trained practitioners share the same values about the care of patients and professional conduct.     

Review of Post-traumatic stress disorder and telling the trauma story.

Reviews the video, Post-traumatic stress disorder and telling the trauma story produced by Frank Ochberg. This set of videotapes is intended to aid mental health professionals by providing them with effective therapeutic treatments and educational materials in order to help them understand the nature of PTSD and post-traumatic therapy. In the first video tape, Ochberg covers a wide range of information about the stress response syndrome. The second videotape, is more highly focused on a technique for assisting patients in the recall and processing of traumatic memories. Overall, the reviewer believes that the material in these tapes is concisely presented with excellent case illustration and that reviewing them will help professionals gain new insight to PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally competent health care: a challenge for nurses in Saudi Arabia

An emerging global reality is the presence of a culturally diverse workforce in health care environments. Not only are nurses delivering care to culturally diverse clients, the nurses themselves may come from different cultural and educational backgrounds. In order to provide culturally competent health care, such diversity must be molded into professional collaboration and respect. To date, health care to the citizens of Saudi Arabia has been provided largely by a foreign labor force, the vast majority of whom are non-Arabic speaking. This paper explores a number of strategies aimed at educating expatriate non-Saudi health professionals in the provision of culturally competent and culturally congruent health care. Leininger's transcultural health care theory is identified as the framework for achieving this goal. The theory has proved to be of great relevance in a hospital setting where some 40 different nationalities are represented among the work force. In such a setting, the potential for cultural conflict and stress is very real. Health professionals new to the Kingdom are introduced to the cultural dimensions of health care as it relates to patient care modes, as well as living and working together in a transcultural environment. Transcultural nursing is a major component of a professional nurse practice model which provides a visionary perspective for nursing care. Within the practice model, transcultural care principles are used to guide education, clinical practice and nursing research. Furthermore, Leininger's theory serves to grasp a comprehensive view of generic (folk) and professional health systems and to identify ethical issues confronted by nurses in the transcultural setting.     

The impact of PTSD, depression, and substance use disorders on disease burden and health care utilization among OEF/OIF veterans.

Growing evidence suggests that posttraumatic stress disorder (PTSD) is associated with poorer health status (e.g., more medical disease, physical symptoms, and sick visits to health care professionals) among veterans who served in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq. We investigated whether PTSD, depression, and substance use disorders independently predicted health status over time among OEF/OIF veterans. Information regarding psychiatric and medical conditions and health care utilization was culled for 4,463 OEF/OIF veterans enrolled in Veterans Administration primary care for a period of 6 years. Data were analyzed using multilevel modeling and generalized estimating equations. Results suggest that PTSD, depression, and substance use disorders are independently associated with increased medical disease burden and mental health care utilization but not increased medical health care utilization. The association between PTSD and medical disease burden strengthened over time. These data suggest that OEF/OIF veterans with PTSD may be at risk for increasingly poorer physical health in terms of medical disease burden over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)