Stress Management Interventions in the Dutch Domiciliary Care Sector: Findings From 81 Organizations.

This study evaluated the effectiveness of a large-scale job stress reduction program implemented in the Dutch domiciliary care sector. The employees of 81 organizations were interviewed twice (only nurses in executive jobs; total sample size exceeded 26,000). Organizations that implemented many interventions were expected to be more successful in reducing job stress than were other organizations. It was found that (a) levels of job stress decreased during the observed interval; (b) organizations with many suboptimal scores on selected work characteristics took, on average, more measures to reduce job stress than others; (c) organizations usually implemented a wide variety of measures; and (d) work-directed (but not other) interventions were linked to job stress reduction. The effects of these interventions, however, were weak. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing HIV-Risk Behavior Among Adults Receiving Outpatient Psychiatric Treatment: Results From a Randomized Controlled Trial.

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention. (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)     

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 cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial.

Objective: This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) for individuals with a diagnosis of cancer. Method: Participants (N = 115) diagnosed with cancer, across site and stage, were randomly allocated to either the treatment or the wait-list condition. Treatment was conducted at 1 site, by a single therapist, and involved participation in 8 weekly 2-hr sessions that focused on mindfulness. Participants meditated for up to 1 hr daily and attended an additional full-day session during the course. Participants were assessed before treatment and 10 weeks later; this second assessment occurred immediately after completion of the program for the treatment condition. The treatment condition was also assessed at 3 months postintervention. All postinitial assessments were completed by assessors who were blind to treatment allocation. Results: There were large and significant improvements in mindfulness (effect size [ES] = 0.55), depression (ES = 0.83), anxiety (ES = 0.59), and distress (ES = 0.53) as well as a trend for quality of life (ES = 0.30) for MBCT participants compared to those who had not received the training. The wait-list group was assessed before and after receiving the intervention and demonstrated similar change. Conclusions: These improvements represent clinically meaningful change and provide evidence for the provision of MBCT within oncology settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 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)     

The Employee Assistance Program: A Systems Intervention Model for Health Care Settings.

The August 1979 special issue of Professional Psychology on psychologists in health care settings covered activities of psychologists in a variety of such settings. The importance of a "life-space developmental frame of reference" is described by Donald Wertlieb (1979) in "A Preventive Mental Health Paradigm for Health Care Psychologists." We should like to respond to his argument for a preventive health frame of reference by drawing your attention to the employee assistance program as one such prevention and early intervention model for both the academic and nonacademic staffs of universities and colleges. The University of Missouri-Columbia Employee Assistance Program (EAP) is an example of such a program. We have recently completed our fourth year of operation and have provided services during these 4 years to over 500 faculty, staff, and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Treatments for Cannabis Dependence: Findings From a Randomized Multisite Trial.

This study evaluated the efficacy of 2 brief interventions for cannabis-dependent adults. A multisite randomized controlled trial compared cannabis use outcomes across 3 study conditions: (a) 2 sessions of motivational enhancement therapy (MET); (b) 9 sessions of multicomponent therapy that included MET, cognitive-behavioral therapy, and case management; and (c) a delayed treatment control (DTC) condition. Participants were 450 adult marijuana smokers with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis of cannabis dependence. Assessments were conducted at baseline, and at 4, 9, and 15 months postrandomization. The 9-session treatment reduced marijuana smoking and associated consequences significantly more than the 2-session treatment, which also reduced marijuana use relative to the DTC condition. Most differences between treatments were maintained over the follow-up period. Discussion focuses on the relative efficacy of these brief treatments and the clinical significance of the observed changes in marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Living Well With a Disability Health Promotion Intervention: Improved Health Status for Consumers and Lower Costs for Health Care Policymakers.

Objective: Investigate effectiveness of a health promotion intervention for adults with mobility impairments. Study Design: Interrupted time series, staggered baseline quasi-experimental with random assignment to treatment start date. Setting: 9 Centers for Independent Living in 8 states. Participants: Adults with mobility impairments living independently (N = 188). Intervention: Living Well With a Disability: Facilitated group health promotion (16 hr over 8 weeks). Main Outcomes Measures: Secondary conditions, symptom days, health care utilization. Results: Reductions in limitation from secondary conditions, symptom days, and health care utilization over the intervention period. Effects on secondary conditions maintained for 12 months. Overall cost savings of $807 per person (total for sample = $151,716) projected from reductions in health care utilization of study sample. Conclusions: Health promotion interventions can increase quality of life while helping to control health care costs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation Psychologist as Health Care Executive: A Platform for Professional Diversification.

These are the best and worst of times in health care. Technological advances are offset by critical staff and cash shortages. Strong leadership is needed to navigate these challenges, yet the industry faces a widening leadership void. The effective psychologist possesses 5 specific competencies ("planks") that are well matched for success as a health care executive: clinical, relational, analytical, methodological, and ethical. By applying these competencies, rehabilitation psychologists can enhance their organizations and open new pathways for personal and professional growth. A 6th competency, financial, represents a unique "give and take" position that is portrayed through a replication and extension of J. G. Wiggins's (1994) analysis of careers in psychology. It is concluded that advocacy for our clients, our field, and ourselves is served by rehabilitation psychologists' achieving health care executive positions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Divided No More: Psychology's Role in Integrated Health Care.

Health-care providers increasingly recognize the need to address behavioural and emotional influences on physical health in order to provide quality and cost-effective services. As behaviour change experts, psychologists can be critically important in new models of integrated care that focus on both physical and psychological health. However, to be effective, psychologists must be prepared to address the major issues facing health-care systems today and be willing to re-examine and modify current modes of education and practice. This article describes important trends affecting health care and the ways in which psychologists could contribute. Lastly, two psychologists involved in new models of integrated care describe their training and the challenges and rewards of their current activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed Care Viewed From the Ivory Tower: Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author believes that Sanchez and Turner presented an overly optimistic picture of behavioral managed care based, in part, on various misconceptions. Discussion focuses on examining/correcting those misconceptions. The author states that it is understandable that a graduate student and a university professor, neither of whom has worked extensively in private practice, would have misconceptions about how managed care works and its impact on the profession. What the author finds disconcerting, however, is that Sanchez and Turner's article, with a number of misperceptions, got published when 90% of the articles submitted get rejected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting U.S. Health Care Needs: A Challenge to Psychology.

Is there really a growing need for primary care psychologists? U.S. population health statistics reveal a great deal of variability in the care Americans receive and in their associated health outcomes. Members of minority groups, the inner-city poor, and rural Americans bear a disproportionate burden of ill health. The decreasing pool of primary care physicians is documented as well as is the growing pool of nonphysician primary care providers. The need to expand the nature of psychological interventions in primary care is examined, and change in the training of professional psychologists is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary: Health care for the whole person.

This article summarizes the rationale for and history of Ronald F. Levant's 2005 American Psychological Association Presidential Initiative, "Health Care for the Whole Person," from which this special section originated. This initiative was intended to have both practice and policy implications in the application of the biopsychosocial model. The articles in this series present the rationale for and details of this integrated model in terms of research, economics, rural applications, and women's health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as Leaders of Multidisciplinary Chronic Pain Management Teams: A Model for Health Care Delivery.

Psychologists have the potential to improve the quality of life of chronic pain patients by intervening not only through direct services but also by using their training for promoting proactive leadership in multidisciplinary teams and in the larger health care environment. To significantly impact pain management, psychologists must not only deliver state-of-the-art care but also take an active role in directing the design, implementation, and evaluation of these programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)