Integrating Positive and Clinical Psychology: Viewing Human Functioning as Continua from Positive to Negative Can Benefit Clinical Assessment, Interventions and Understandings of Resilience

Stress, Professional Burnout, and Employee Efficiency in the Greek National Organization for the Provision of Health Services

BACKGROUND

Workplace stress and burnout in the Greek healthcare system had been considered severe even before the high pressure of the COVID-19 pandemic. We aimed to investigate occupational quality of life and burnout effects on workplace errors among the administrative staff in the Greek healthcare system.

METHODS

We enrolled 120 administrative healthcare employee participants between April and May 2019. Occupational burnout was assessed using the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale.

FINDINGS

Inadequate staffing, a low sense of well-being, exhaustion, and low family income were associated with workplace errors. Increased workload and staff shortages were associated with occupation related quality of life.

CONCLUSIONS

Targeted interventions supporting healthcare staff mental health are warranted.

APPLICATION TO PRACTICE

Wellness and professional burnout can affect professional efficiency and are associated with workplace errors in the healthcare sector. Targeted interventions are warranted to support the mental health of healthcare staff during work and to prevent incidents of post-traumatic stress. Shortages of staffing may lead to an increase in the cost of the provided services.

Influence of well-being and quality of work-life on quality of care among healthcare professionals in southwest, Nigeria

The Nigerian healthcare industry is bedevilled with infrastructural dilapidations and a dysfunctional healthcare system. This study investigated the influence of healthcare professionals' well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. A multicentre cross-sectional study was conducted at four tertiary healthcare institutions in southwest, Nigeria. Participants' demographic information, well-being, quality of life (QoL), QoWL, and QoC were obtained using four standardised questionnaires. Data were summarised using descriptive statistics. Inferential statistics included Chi-square, Pearson's correlation, independent samples t-test, confirmatory factor analyses and structural equation model. Medical practitioners (n = 609) and nurses (n = 570) constituted 74.6% of all the healthcare professionals with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants' well-being = 71.65% (14.65), QoL = 61.8% (21.31), QoWL = 65.73% (10.52) and QoC = 70.14% (12.77). Participants' QoL had a significant negative correlation with QoC while well-being and quality of work-life had a significant positive correlation with QoC. We concluded that healthcare professionals' well-being and QoWL are important factors that influence the QoC rendered to patients. Healthcare policymakers in Nigeria should ensure improved work-related factors and the well-being of healthcare professionals to ensure good QoC for patients.

Rumination Mediates the Relationship Between Childhood Traumas with Cognitive Defusion, Acceptance, and Emotion Regulation: A Qualitative and Quantitative Study

This study examines the intermediary role of rumination in the relationship between childhood traumas in young adults and cognitive defusion, psychological acceptance, and suppression which is one of the emotion regulation strategies. In the quantitative stage of the study formed according to the explanatory sequential design, the intermediary role of rumination by using a structural equation model while in the qualitative stage, the intermediary role of rumination was analyzed through interviews using the interpretive phenomenology design. Personal Information Form, Childhood Trauma Scale, Short Form Ruminative Response Scale, Acceptance and Action Form II, Drexel Defusion Scale, and Emotion Regulation Scale were used in the research. At the end of the research, it was determined that childhood traumas have a negative effect on cognitive defusion and acceptance, while they have a positive effect on suppression. It was seen that rumination has a partial intermediary role in the relationship of childhood traumas with cognitive defusion, acceptance, and suppression. As a result of the qualitative analysis, twelve themes such as "Constantly thinking about the past, not being able to move away from childhood traumas, not being able to forgive their parents, inability to get rid of negative thoughts, living in the past, moving away from a value-driven life, false expression of emotion, suppression of emotions, emotions reflected in behavior, coping with negative emotions and desired emotion regulation" emerged concerning participants' experiences of cognitive defusion, acceptance, and suppression. Although one of the purposes of using AAQ-II in the study was to support discussions about the scale via qualitative results, this was a limitation for the study. Therefore, although a high rate was obtained, it is not possible to infer that childhood traumas and rumination can explain acceptance behaviors. For this, much more quantitative and qualitative studies are needed. Other qualitative research findings are thought to support quantitative research findings.

Psychosocial working conditions as determinants of concerns to have made important medical errors and possible intermediate factors of this association among medical assistants - a cohort study

OBJECTIVE

We sought to examine the association of psychosocial working conditions with concerns to have made important medical errors and to identify possible intermediate factors in this relationship.

METHODS

We used data from 408 medical assistants (MAs) in Germany who participated in a 4-year prospective cohort study (follow-up period: 03-05/2021). Psychosocial working conditions were assessed at baseline by the effort-reward imbalance questionnaire and by a MA-specific questionnaire with seven subscales. MAs reported at follow-up whether they are concerned to have made an important medical error throughout the last 3 months, 12 months or since baseline (yes/no). These variables were merged into a single variable (any affirmative response vs. none) for primary analyses. Potential intermediate factors measured at baseline included work engagement (i.e., vigor and dedication, assessed by the UWES), work satisfaction (COPSOQ), depression (PHQ-2), anxiety (GAD-2) and self-rated health. We ran Poisson regression models with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). Doing so, we employed the psychosocial working condition scales as continuous variables (i.e. z-scores) in the primary analyses. Potential intermediate factors were added separately to the regression models.

RESULTS

Poor collaboration was the only working condition, which was significantly predictive of the concern of having made an important medical error (RR = 1.26, 95%CI = 1.00-1.57, p = 0.049). Partial intermediate factors in this association were vigor, depression and anxiety.

CONCLUSION

We found weak and mostly statistically non-significant associations. The only exception was poor collaboration whose association with concerns to have made an important medical error was partially explained by vigor and poor mental health.

Psychological health, wellbeing and COVID-19: Comparing previously infected and non-infected South African employees

Most COVID-19 and work-related well-being research is centred around the adverse effects on employees' psychological well-being and is not focused on the work-related well-being of those infected by SARS-CoV-2. Furthermore, COVID-19 and work-related well-being research is generally aimed at healthcare workers. The current study focused on investigating the difference in the level of burnout, anxiety, depression and stress between previously infected and uninfected participants. This study used a cross-sectional survey design and non-probability quota sampling to collect data. A retrospective pre-post design was used to determine the difference between the level of burnout of the participants before and after infection. Working adults in South Africa were targeted and divided into those previously infected (n = 245) and those not yet infected with COVID-19 (n = 221). Participants completed questionnaires relating to burnout, depression, anxiety, and stress. A comparison of means revealed a significant increase in burnout after being infected. Infected participants had significantly higher burnout, anxiety, depression, and stress levels than their non-infected counterparts. Emotional exhaustion, withdrawal, and stress were the most prevalent psychological ill-health problems. The results of this study indicated that a SARS-CoV-2 infection has a detrimental impact on participants' psychological well-being and mental health compared to their own initially reported levels of burnout before infection, as well as compared to the levels of burnout, depression, anxiety and depression of the non-infected participants. Based on the findings, specific recommendations to industrial psychologists were made to manage the psychological impact of COVID-19 on employees.

Character strengths and mental health as complex systems: a network analysis to identify bridge strengths

The network approach poses an alternative focus to understand psychological constructs as emerging from mutual interactions among indicators. Network psychometrics has been applied to psychopathology to unravel the connections between symptoms, but it can also be applied to the study of well-being. The role of character strengths in mental health is at the forefront of research attention. Previous findings suggest that heart character strengths are more predictive of mental health than mind character strengths. Nevertheless, researchers have rarely applied the network approach in this context. The present study examines, from the network approach, the connections between heart and mind character strengths and mental health. Building upon the dual-factor model of mental health, positive (i.e., happiness and life satisfaction) and negative indicators (i.e., depression) were included in the assessment of this construct. A sample of 597 Spanish undergraduates (M = 23.52; SD = 5.25; 75.6% females) completed cross-sectional self-report measures. Network analysis was used to estimate a network composed of two communities: character strengths and mental health. We used centrality analysis to calculate the importance of each node and bridge centrality to examine the interactions between the communities. The results indicated that the heart strengths of love, zest, hope, and gratitude reported the highest bridge strength centrality, suggesting that they played an intermediary role activating and deactivating components of mental health. Adopting the network approach to explore the connections between character strengths and mental health can help design focused intervention strategies in psychology.

Assessment of burnout and pandemic fatigue among pharmacy leadership in the Veterans Health Administration healthcare system

PURPOSE

Factors associated with burnout in Veterans Health Administration (VHA) pharmacy leadership positions were examined during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A questionnaire was distributed to all pharmacy executives of the VHA healthcare system. It collected demographic and employment characteristics, career satisfaction and work-related variables, indicators of burnout using validated single-item measures adapted from the Maslach Burnout Inventory, and the impact of the COVID-19 pandemic on psychosocial and work-related variables. A χ2 test with Bonferroni correction was used to evaluate the data. Burnout was defined as a score of 4 or greater on either of the 2 single-item validated statements adapted from the Maslach Burnout Inventory to assess emotional exhaustion and depersonalization.

RESULTS

In total, 407 (of 1,027; 39.6%) VHA pharmacy leaders representing Veterans Integrated Service Network pharmacy executives, chiefs of pharmacy, associate chiefs of pharmacy, and inpatient and outpatient supervisors completed the survey. The overall prevalence of burnout was 68.6% using the aggregate measure of emotional exhaustion or depersonalization. Pharmacy leaders who worked more than 60 hours a week reported significantly greater rates of burnout than those who worked 40 to 60 hours a week (86.7% vs 66.9%, χ2 = 7.34, degrees of freedom = 1, P < 0.05). Those experiencing increased workload related to COVID-19 also reported high burnout rates (72.1%, χ2 = 16.40, degrees of freedom = 1, P < 0.001). Burnout scores were similar across groups when respondents were stratified by leadership position, gender, age, or years in position.

CONCLUSION

As of March 2021, two-thirds of pharmacy leaders were experiencing burnout. It is important for healthcare system leadership to identify patterns of burnout among their pharmacy leaders to ensure a productive and sustainable workforce.

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.

Mental health among the general population and healthcare workers during the COVID-19 pandemic: A meta-analysis of well-being and psychological distress prevalence

The COVID-19 pandemic has constituted a global health crisis that has threatened the mental health of individuals worldwide. The present paper sought to systematically review and meta-analyze studies reporting the prevalence during the COVID-19 pandemic of well-being and psychological distress as defined by the dual-continua model, which includes (absence of) psychological distress and (presence of) well-being among the general population and healthcare workers. Systematic searches were conducted in various databases: PubMed, PsycINFO, Scopus, and Web of Science from inception until 6 December 2020. From a total of 158 studies (N = 880,352) included in the meta-analysis, only seven reported the prevalence of well-being. A random-effect model was used to estimate the pooled prevalence among the general population and healthcare workers on depression (25%; 31%), anxiety (27%; 31%), stress (35%; 32%), and well-being (52%; 45%), respectively. Sub-group analyses based on region, income, percentage of women, preparedness of country to respond to COVID-19, and economic vulnerabilities were conducted in order to examine sources of heterogeneity in psychological distress. Results revealed differences among the two groups and indicated that disparities in terms of preparedness to fight the pandemic can distinctly affect mental health in the general population and healthcare workers. Addressing mental health during and after a health crisis should be in the spotlight of the international and national public health agenda. Considering the protective role of well-being to minimize psychological symptoms, mental health policies during the COVID-19 should include strategies to combat the psychological consequences of the pandemic by promoting well-being practices.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02913-6.

Associations between critical consciousness and well-being in a national sample of college students during the COVID-19 pandemic

Critical consciousness (CC) may promote well-being, particularly during the COVID-19 pandemic. In a national survey of 707 college students conducted in April 2020, we first validated the Short Critical Consciousness Scale (ShoCCS) among youth groups not often specifically examined in CC measurement (i.e., Asian, immigrant-origin, LGBQ+, and women youth). Next, we examined associations between ShoCCS subscales and validated measures of both anxiety (Generalized Anxiety Disorder-7) and hopefulness (The Individual-Differences Measure in Hopefulness). The ShoCCS achieved measurement invariance across racial/ethnic groups and immigrant-origin status, and partial invariance among LGBQ+ and women-identifying youth. We found critical reflection and action associated with anxiety for the full sample, but no evidence of moderation by sociodemographic factors. ShoCCS subscales were differentially associated with hopefulness for Asian youth and LGBQ+ youth. This study contributes to the evolution of CC measurement and extends the field by identifying well-being associations during the onset of the COVID-19 pandemic.

Emotional Justice as an antidote to loneliness: children's books, listening and connection

Loneliness is intimately related to the ongoing epidemics of systemic forms of oppression, including white supremacy, capitalism, heteropatriarchy and settler colonialism. The epidemic of loneliness has only intensified and grown during the isolation engendered by the COVID-19 pandemic. In this article, we aim to think about how children's picturebooks wrestle with explaining loneliness and its antidotes (connection, community) and how these picturebooks are themselves manifestations of ongoing conversations related to Emotional Justice. We conclude by reviewing a number of children's books in order to think about how the picturebook might itself be an artifact that helps to fight feelings of loneliness as well as teaching children and adults alike about the importance of connection.

In good times and in bad: A longitudinal analysis of the impact of bereavement on self-esteem and life satisfaction in couples

This study examines the impact of bereavement on self-esteem and life satisfaction in both partners of a romantic couple. We investigate the moderating effects of the type of the lost relationship (close family, close friends/others) and romantic relationship characteristics (daily social support, responsiveness-closeness, self-disclosure). We examined 1238 individuals in 619 male–female couples from the ages 18 to 81 ( M [ SD] = 31.97 years [13.26]). Both partners completed questionnaires at two assessments that were 20 months ( SD = 2.02 months) apart, in between which n = 216 individuals were bereaved. Actor–partner interdependence models showed that bereavement did not predict later self-esteem or life satisfaction in either of the partners. The relationship characteristics and the type of lost relationship did not moderate the effects. The subjective meaning and distress of the loss predicted later self-esteem and life satisfaction. The self-esteem increase was larger for bereaved with a positive/neutral than for bereaved with a negative meaning of the bereavement. We found a partner effect on self-esteem for the group of bereaved who reported a negative meaning of the bereavement. The findings demonstrate that bereavement can impact romantic partners' self-esteem and that the subjective experience of bereavement helps understand individual differences in the effect of bereavement on self-esteem and life satisfaction.

Metta-Based Therapy for Chronic Depression: a Wait List Control Trial

Objectives

Current treatments for chronic depression have focused on reducing interpersonal problems and negative affect, but paid little attention to promoting prosocial motivation and positive affect. Following this treatment focus, the objective of the present study was to examine whether the combination of metta (Loving Kindness) group meditation and subsequent tailored individual therapy focusing on kindness towards oneself and others (metta-based therapy, MBT) shows greater improvements in depressive symptoms than a wait list control group in patients with chronic depression.

Methods

Forty-eight patients with DSM-5 persistent depressive disorder were randomly assigned to MBT or a wait list control condition. Outcome was assessed after group meditation, after subsequent individual therapy, and at 6-month follow-up. The primary outcome measure was an independent blind rating of depressive symptoms at post-test. Secondary outcome included changes in self-reported depression, behavioral activation, rumination, social functioning, mindfulness, compassion, and clinician-rated emotion regulation.

Results

Mixed-design analyses showed significant differences between MBT and WLC in changes from pre- to post-test in clinician-rated and self-rated depression, behavioral activation, rumination, social functioning, mindfulness, and emotion regulation. Most of the changes occurred during group meditation and were associated with large effect sizes. Improvements were maintained at 6-month follow-up.

Conclusions

The results provide preliminary support for the effectiveness of MBT in treating chronic depression.

Trial Registration

ISRCTN, ISRCTN97264476.

Do Positive Psychology Interventions Impact on the Subjective Wellbeing and Depression of Clients? A Systematic Methodological Review

Mental health services are placing a greater emphasis on wellbeing and recovery. The current research investigated if positive psychology interventions (PPIs) increase peoples’ subjective wellbeing and reduce clinical depression. A systematic methodological review was conducted on randomized-control-trials with people attending clinical services. Five databases were searched. A hand search was then completed on the reference lists of the identified articles and the associated journals. Eleven research interventions were reviewed. PPIs were found to significantly increase wellbeing, relative to controls and there were fewer studies indicating a difference in decreasing depression. However, subsequent analysis revealed that the interventions were heterogeneous which limits the drawing of definitive systematic conclusions. A methodological evaluation also found that there were recurring issues: in delivering the interventions, measuring subjective wellbeing, and applying the design. Thus, the methodological quality of the research interventions, as measured by the current review was low. There is emerging evidence that PPIs improve peoples’ mental health. However, there is scope to standardize and to improve the quality of the research interventions.

Impact on Mental Well-Being and Resilience of Patients with Multiple Chronic Conditions in Different Periods during the Coronavirus Disease 2019 Outbreak in Taiwan

Concerns over the coronavirus disease 2019 (COVID-19) pandemic and control measures have affected the routine outpatient visits of individuals with comorbidities and their mental well-being. From October 2019 to August 2020, this cross-sectional study enrolled 135 patients who sought medical attention at a medical center in Taiwan. This period covered the early (October to December 2019), peak (January to April 2020), and late (May to August 2020) periods of the COVID-19 outbreak in Taiwan. The demographic data, social support data, activities of daily living (ADL), resilience scale scores, and mental well-being scale scores of the participants were compared. There were no statistically significant differences in the participation rate, demographic data, and social support data between the three periods. The correlation analysis confirmed significant negative relationships between the number of COVID-19 cases and outpatient department visits per month (r = −0.764, p < 0.001), emergency department visits per month (r = −0.023, p < 0.001), ADL (r = −0.257, p = 0.03), resilience scale (r = −0.390, p < 0.001), and mental well-being scale (r = −0.475, p < 0.001). In conclusion, the severity of the COVID-19 outbreak in Taiwan was associated with declines in the ADL, mental well-being, and resilience of patients who sought medical attention.

Fear of happiness through the prism of the dual continua model of mental health

OBJECTIVE

Two studies were conducted to investigate fear of happiness through the lens of the dual continua model of mental health.

METHODS

In Study 1, we examined whether depression (indicator of mental illness) and happiness (indicator of mental health) predicted fear of happiness through a Structural Equation Model. In Study 2, we ran a quasi-experimental design to examine differences in affect (positive and negative), happiness and depression when engaging in either fearless or fearful beliefs of happiness.

RESULTS

Fear of happiness was positively and negatively predicted by depression and happiness, respectively. Fearless individuals reported higher positive affect and happiness, and lower negative affect and depression, than fearful individuals.

CONCLUSIONS

Fearing happiness might act as a maladaptive self-verifying motive to enhance one's perspective of the world. Given the likelihood of modifying maladaptive cognitive patterns, we highlight different psychological interventions that can address the negative impact of fearful beliefs of happiness.

Defining and measuring "psychological flexibility": A narrative scoping review of diverse flexibility and rigidity constructs and perspectives

Psychological flexibility (PF) is a popular construct in clinical psychology. However, similar constructs have existed since the mid-20th century, resulting in different terms, definitions and measures of flexibility, hindering the advancement of the field. The main measure of PF - the Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) - has also been heavily criticized. To move towards definitional consensus and improved measurement, we surveyed the literature to map PF and related-terms, examine definitional overlaps, and assessthe psychometric quality of prominent flexibility measures. A scoping review was conducted in two databases (PsycNET and SCOPUS). Twenty-three flexibility constructs appeared across 220 articles, and twelve measures were included and rated for quality. PF, psychological inflexibility (PI), and cognitive flexibility (CF) were most prominent. Definitional similarities among prominent flexibility constructs emerged, namely handling distress or interference, taking action, and meeting goals or values. The Personalized Psychological Flexibility Index (PPFI; Kashdan, Disabato, Goodman, Doorley, & McKnight, 2020) appears to be the best measure available to assess PF. Problems with the current use of the AAQ-II were apparent, hindering current knowledge of PF. Definitional consensus and measurement development are vital to advance the field. To this end, recommendations and next steps for researchers and practitioners are outlined.

The Good Enough Parenting early intervention schema therapy based program: Participant experience

Background and objectives

Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood. An early intervention parenting program has been developed to help parents meet these core emotional needs in order to prevent the development of psychopathology in the first place. The program, Good Enough Parenting, is equally focused on reducing problems and strengthening parenting practices, regardless of where the child is on the “disordered to well-being continuum”. This study aims to explore “patient experience” by users of this program. Best clinical research guidelines advocate that participants should be used as collaborators rather than pure recipients; this process should predate large scale trials.

Design

An exploratory qualitative study with 55 parent-participants of Good Enough Parenting was conducted.

Methods

One-to-one interviews were conducted with participants, using critical incident technique and guided by semi-structured interview schedule, to explore their experiences with the program. Transcripts were then analyzed using thematic analysis.

Results

Coding showed a high degree of inter-rater reliability (kappa value of 0.78). The themes that emerged were Cultivating Awareness of Parents’ Own Schemas, Cultivating Intentionality, Working through Developmental Issues, Responses to Challenges at Home, Performing Multiple Roles, and the Learning Process. Participants overwhelmingly reported satisfaction within these key themes.

Conclusions

The results support the development of the program and the choice of “participant reported outcome measures” for use in subsequent randomized controlled trials.

Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test

Pathological worry is characterized by an inability to distract or disengage from worry, and this uncontrollability is the defining feature of generalized anxiety disorder (GAD). The present study assessed a novel computerized strategy that targets these attention difficulties. Worry Disengagement Training (WDT), which involves alternating between writing about one's worry and positive topics, was evaluated in a sample with elevated worry (N = 50), most of whom met for GAD diagnosis (66%). Compared to waitlist, WDT led to increased ability to disengage from in vivo worry on a breath focus task, resulting in fewer negative intrusions (β = -.29, p = .02; sr² = .08). Relative to waitlist, WDT also led to lower self-reported general worry (β = -.36, p = .001, sr² = .14) and depressive symptoms (β = -.25, p = .02, sr² = .07). These effects remained in the subset of participants meeting criteria for GAD. WDT did not impact anxious arousal, suggesting some specificity of effects. These findings provide preliminary support for WDT as an effective strategy to increase disengagement ability and reduce worry and depression. Limitations and future directions are discussed.

The Pain-to-Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain

Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being. Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia. Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34-0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41. Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.

Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention

Background

Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students.

Methods

The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention.

Results

We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β = 2.43, 95% CI 2.08–2.79, d = 1.55, p < .001), T3 (unadj. β = 2.81, 95% CI 2.42–3.21, d = 1.71, p < .001) and T4 (unadj. β = 2.75, 95% CI 2.31–3.19, d = 1.52, p < .001). Knowledge increased significantly post-intervention (T2 unadj. β = 1.14, 95% CI 0.82–1.46, d = 0.86, p < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β = 2.77, 95% CI 1.82–3.73, d = 0.90, p < .001 and T4 unadj. β = 2.54, 95% CI 1.45–3.62, d = 0.65, p < .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material.

Conclusions

We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-05948-2.

A Low-Intensity Internet-Based Intervention Focused on the Promotion of Positive Affect for the Treatment of Depression in Spanish Primary Care: Secondary Analysis of a Randomized Controlled Trial

Background: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care; most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%-39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p < 0.001, R2 = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.

What Is Gratitude? Ingratitude Provides the Answer

Current scholarship on “gratitude” has largely ignored its opposite – ingratitude. As a result, gratitude is no longer distinguishable from constructs such as appreciation and happiness. This was not the case over previous centuries – ingratitude was viewed as something monstrous, a failure to reciprocate would loosen the bonds holding society together. The opposite, gratitude, was seen as a virtue. Reciprocity has come under attack because “obligation” has been understood in only one of two possible senses. The first relates to contracts and justice – one has a heteronomous obligation to pay off a debt or fulfill a contract. The second is a sense of obligation that comes from within, autonomously – the desire to help those that have helped us. Here, we argue, is where gratitude and ingratitude are situated. This view has two important consequences; one relates to the measurement of gratitude and the other to raising youth to be grateful people.

Questionnaire for the Assessment of Self-Disgust: The psychometric testing among mental disorders in China

Research on self-disgust is relevant to psychopathologic tendencies because it has been shown to play a critical role in several mental disorders. Examining self-disgust and exploring its role in mental health are significant goals. The purpose of this study was to translate the Questionnaire for the Assessment of Self-Disgust (QASD) into Chinese and evaluate its validity and reliability. The translation and validation of the QASD were guided by the World Health Organization's Process of Translation and Adaptation of Instruments. Three phases were undertaken: (a) professional translation and expert panel review, (b) pretesting, and (c) psychometric evaluation. The psychometric evaluation was tested among 1,068 patients who were recruited from two psychiatric hospitals and three psychological clinics of tertiary hospitals. In this study, multigroup confirmatory factor analysis (CFA) supported the two-factor structure of the original QASD construct. Measurement invariance showed that the QASD is invariant across the patients with heterogeneous mental health diagnoses. The correlation of QASD with the Self-Esteem Scale (SES) and the Trait Anger Scale (TAS) showed that it has good convergent validity and discriminative validity. Internal consistency and test-retest yielded acceptable results. Thus, the findings suggest that the Chinese version of the QASD is a reliable and valid instrument with adequate psychometric properties for assessment of self-disgust among patients with mental disorders in China.

A retrospective investigation of the impact of ‘eventing phase (dressage, show-jumping and cross-country)’ on pre-competition anxiety and self-confidence

Working in the discipline of eventing (the triathlon of equestrian sport), the present study aims to extend current literature on the use of psychological skills within equestrian sports, by understanding and identifying differences in levels of self-confidence and competitive anxiety. Each eventing phase (dressage, show-jumping and cross-country) was considered and its impact on anxiety and self-confidence analysed. Level of competition was considered a covariate and its effect on specific eventing phases and any associated influence on anxiety and self-confidence within eventing phase was analysed. An experimental, 3×3 factorial, within-subjects design was used. 57 participants (52 female and 5 male; 18 professional, 36 amateur and 3 undefined) completed the Revised Competitive Sport Anxiety Inventory 2 (CSAI-2R), a 17-item questionnaire measuring anxiety and self-confidence. Descriptive statistics identified the show-jumping phase had the largest impact on rider somatic anxiety (SA) and cognitive anxiety (CA). The cross-country phase had the highest self-confidence mean score. Spearman’s rank correlations showed both SA and CA were debilitative for all competition levels. Both SA and CA were found to be more debilitating in the show-jumping phase when self-confidence was low. MANCOVA analysis showed that eventing phase had significant effect on anxiety and self-confidence when controlling for level of competition. Dependent on the eventing phase riders are competing in, they experience different levels of arousal and self-confidence. When SA and CA are a debilitative source of anxiety, this could result in rider muscle tension which is not conducive to effective horse-rider communication. Coaches or sports psychologists should consider how to help riders manage their anxiety levels in relation to the competition phase, with the intention of enhancing self-confidence and enabling facilitative SA and CA in preparation for eventing performance.

Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study

BACKGROUND

Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers.

AIMS

To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia.

METHOD

A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis.

RESULTS

Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals).

CONCLUSIONS

Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences.

DECLARATION OF INTEREST

None.

Recovery from mood and anxiety disorders: The influence of positive mental health

BACKGROUND

Mood and anxiety disorders are associated with growing burden of disease. Recent evidence shows that monitoring and enhancing positive mental health might be one direction to reduce this burden. The aim was to determine whether positive mental health predict recovery from mental disorders.

METHODS

The study population consisted of 414 participants with a 12-month disorder from the representative general population Netherlands Mental Health Survey and Incidence Study-2. Independent positive mental health indicators were mental well-being, its subscales emotional, social and psychological well-being and the category flourishing mental health. Recovery was defined as no longer fulfilling DSM-IV criteria of the index disorder 3 years later.

RESULTS

Despite meeting the criteria of a 12-month mental disorder, 19% with anxiety disorder were flourishing and 14% with mood disorder. Logistic regression analyses controlled for sociodemographics, physical health, life-events, service use, psychotropic medication, comorbidity and clinical severity showed that positive mental health positively influenced recovery from anxiety disorder (mainly by emotional and psychological well-being) and did not influence recovery from mood disorder.

LIMITATIONS

The results are not generalizable to psychiatric patients in treatment settings and might differ for specific disorders within each DSM-IV category.

CONCLUSIONS

Clinicians are encouraged to measure positive mental health in their patients and to improve positive mental health particularly in people with an anxiety disorder. The non-significant relation between positive mental health and recovery from mood disorder warrants further research, for example through using more in-depth assessment of positive mental health components and by investigating recovery from less severe mood disorders.

Distinguishing between the concepts of supply chain agility and resilience

Purpose

The purpose of this paper is to add clarity to the multidimensional concepts of agility and resilience. In addition, this paper seeks to clarify the differences and similarities between the two concepts by integrating the distinct bodies of knowledge on agility and resilience.

Design/methodology/approach

A multidisciplinary systematic literature review is conducted. The concept of agility is explored through a review of the sports science, manufacturing, organizational, information systems and information systems development and supply chain literature bases. The concept of resilience is investigated through a review of the psychological and psychopathological, ecological, economic, organizational and supply chain literature bases.

Findings

Examining the complex relationship between the two constructs led to the emergence of six major dimensions to capture the concept of agility (i.e. ability to quickly change direction, speed/accelerate operations, scan the environment/anticipate, empower the customer/customize, adjust tactics and operations (flexibility), and integrate processes within and across firms). Similarly, six dimensions were uncovered for resilience (i.e. ability to resist/survive disruptions, avoid the shock altogether, recover/return to original form following disruption, speed/accelerate operations, adjust tactics and operations (flexibility) and scan the environment/anticipate). Agility and resilience were found to share three common dimensions (i.e. ability to adjust tactics and operations (flexibility), speed/accelerate operations and scan the environment/anticipate).

Practical implications

The identification of the common characteristics of agility and resilience carries important managerial implications from a resource allocation perspective. Allocating resources to the development of the common characteristics of agility and resilience can help firms maximize the impact of such investments. That is, by investing in the common characteristics of both they can improve supply chain agility and supply chain resilience. If firms approach the development or improvement of supply chain agility or resilience independent from one another, without an awareness of the common characteristics, they could be duplicating their investments resulting in supply chain redundancies and inefficiencies.

Originality/value

Not having a clear and comprehensive understanding of the similarities and differences between agility and resilience is problematic from a theoretical perspective. A clear understanding of what each construct represents provides a platform for building generalizable theory by helping researchers operationalize these constructs in a consistent manner. Further, providing a generalizable, comprehensive and multidisciplinary perspective on agility and resilience within supply chain management literature can help increase the visibility of the field of supply chain management across other disciplines as scholars outside the field of supply chain management can utilize the results of this research effort.

Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy

Previous research suggests that a stronger focus on positive emotions and positive mental health may improve efficacy of Cognitive Behavior Therapy (CBT). Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT (P-CBT; CBT in a solution-focused framework, amplified with optional positive psychology exercises) versus traditional, problem-focused CBT (T-CBT). Forty-nine patients with major depressive disorder (recruited in an outpatient mental health care facility specialized in mood disorders) received two treatment blocks of eight sessions each (cross-over design, order randomized). Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first, but significantly more in P-CBT compared to T-CBT during the second treatment block. Rate of improvement on the less-frequently measured secondary outcomes was not significantly different. However, P-CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Effect sizes for the combined treatment were large (pre-post Cohen's d = 2.71 for participants ending with P-CBT, and 1.85 for participants ending with T-CBT). Positive affect, optimism, subjective happiness and mental health reached normative population averages after treatment. Overall, findings suggest that explicitly focusing on positive emotions efficiently counters depressive symptoms.

The Curious Neglect of High Functioning After Psychopathology: The Case of Depression

We address a key issue at the intersection of emotion, psychopathology, and public health-the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.

Positive Variables in Adult Patients Who Are at Different Stages of a Naturalistic Psychotherapeutic Treatment

This study aimed twofold: 1) to study some positive variables (three paths to well-being, life satisfaction, overall well-being and meaning of life) in adult patients who are at different stages of a naturalistic cognitive behavioral psychotherapeutic treatment and 2) to analyze their relationship with the progress during treatment, therapeutic alliance and adherence to treatment from the therapist´s perspective. The sample was composed of 85 outpatients who were in psychotherapeutic treatment. Patients completed the Three Pathways to Well-being Scale, Meaning in Life Questionnaire, Satisfaction with Life Scale, Well-being Index and Symptom Checklist-90-Revised. Therapists completed treatment related data and an opinion survey of patient´s progress, adherence to treatment and therapeutic relationship. Findings showed positive variables to be higher at the final stage of psychotherapy, particularly higher satisfaction with life, engagement, well-being, and presence of meaning in life. Higher positive variables were moderately associated with more progress during treatment according to therapist’s perspective; however a low association was found with adherence to treatment and therapeutic relationship. No differences were found in positive variables according the type of prevalent symptoms.

Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful?

Background

Sonographers report high levels of burnout. For those working in obstetric ultrasound, one frequently cited stressor is the delivery of bad or difficult news. Training in news delivery may reduce sonographer stress levels, but no studies have investigated sonographer experiences of this training.

Aims

To investigate sonographer experiences of difficult news delivery training and preferences for training techniques, and to assess whether news delivery training is associated with lower burnout and higher wellbeing.

Methods

A cross-sectional survey measured occupational characteristics, news delivery training experiences and preferences, burnout (on two dimensions of exhaustion and disengagement), and general mental wellbeing.

Results

Ninety sonographers (85 female; mean age = 47) responded. The majority of participants thought training in difficult news delivery had improved their practice. Preferred training techniques were observation of clinical practice and receiving service-user input. Eighty per cent of participants were experiencing exhaustion, 43.3% were experiencing disengagement and 88.9% could be classed as having a minor psychiatric disorder. Having received difficult news delivery training was associated with lower levels of disengagement, even when other variables were controlled for.

Discussion

News delivery training is perceived to be effective by sonographers and may help to reduce sonographer burnout levels.

Positive emotion in distress as a potentially effective emotion regulation strategy for depression: A preliminary investigation

OBJECTIVES

Emotion regulation utilizing positive emotion during negative emotional states might be one of the effective ways to alleviate depression and anxiety problems among people with emotional disorders. This study examined the psychometric properties and incremental validity of the Positive Emotion In Distress Scale (PEIDS), a newly developed self-report scale, in a sample of university students in Japan.

DESIGN AND METHODS

To examine the psychometric properties of the PEIDS, the scale was completed by Japanese university students (396 men and 363 women; mean age of 19.92). Participants additionally answered the Emotion Regulation Questionnaire, Rumination and Reflection Questionnaire - Shorter Version, Affective Style Questionnaire, Positive and Negative Affective Schedule, and Hospital Anxiety and Depression Scale. The survey was conducted at two time points separated by 1 month to assess test-retest reliability and validity of the PEIDS.

RESULTS

Exploratory and confirmatory factor analyses confirmed a one-factor structure. Reliability was confirmed by high internal consistency and test-retest stability; the convergent and discriminant validity was confirmed by correlations with related and unrelated variables. The results of hierarchical regression analyses demonstrated that positive emotion in distress might predict depression above and beyond the effect of baseline depression and other common emotion regulation strategies.

CONCLUSIONS

The PEIDS showed acceptable reliability and validity within young adults and a non-clinical population in Japan. Further research will be needed to examine the effect of positive emotion among clinical populations.

PRACTITIONER POINTS

Previous research suggests that positive emotions play a key role in recovery from depression and anxiety problems through some forms of psychotherapy. The Positive Emotion In Distress Scale (PEIDS) measures individual differences regarding the extent to which people can experience positive emotions in negative emotional states. Results suggested that the subjective rating of the ability to experience positive emotions in distress might alleviate depression prospectively but not anxiety problems. The effect of positive emotion in distress demonstrated to have beyond the effects of other emotion regulation strategies.

Exploring the Incorporation of a Positive Psychology Component in a Cognitive Behavioral Internet-Based Program for Depressive Symptoms. Results Throughout the Intervention Process

Traditionally, evidence-based treatments for depression have focused on negative symptoms. Different authors describe the need to include positive affect as a major target of treatment. Positive psychology aims to fill this gap. Reaching everyone in need is also important, and Internet-based interventions can help in this task. The present study is a secondary analysis derived from a randomized controlled trial aimed to test the efficacy of an Internet-based intervention for patients with depressive symptoms. This intervention consisted of an 8-module Internet-based program that combined four modules based on cognitive-behavioral therapy strategies and four modules based on positive psychology strategies. The main goal of this secondary analysis is to report the data collected after each module from the participants who completed the intervention, explore the changes throughout the intervention process, and examine the changes observed in the different variables before versus after the introduction of the positive psychology component. A total of 103 patients completed the intervention. At pre-, post-intervention, and post-module evaluations, they completed positive and negative affect, depression, and anxiety measures. Negative affect and anxiety decreased significantly during the implementation of the cognitive-behavioral therapy and positive psychology modules. However, depression and positive affect improved only after the introduction of the positive psychology modules. This is the first study to explore, throughout the intervention process (module by module), the incorporation of a positive psychology component in an Internet-based program. Results suggest that positive psychology techniques might have an impact on clinical symptomatology, and they emphasize the need to include these techniques to achieve a more profound change in positive functioning measures.

Clinical Trial Registration: NCT02148354 (http://ClinicalTrials.gov/ct2/show/NCT02148354).

Development and Validation of the Positive Parenting Schema Inventory (PPSI) to Complement the Young Parenting Inventory (YPI) for Schema Therapy (ST)

The factor structure of an initial item pool of 207 positive parenting items was investigated (Manila; n = 520, 538) to develop the Positive Parenting Schema Inventory. Single group and multigroup confirmatory factor analyses of the Positive Parenting Schema Inventory showed invariance of the factor structure in six out of the seven levels on two other independent samples (Eastern, Indonesia; n = 366, 383; Western, the United States; n = 204, 214). Good values for reliability were obtained for its seven subscales (50 items) using coefficient omegas (.71 to .95). Evidence of validity based on test content, response processes (item responses to desired inferences), internal structure (exploratory and confirmatory factor analyses), relations to other variables (correlations with other instruments), and consequences of testing (correlations with positive schemas) were demonstrated. A core tenet of schema therapy theory was supported in that recall of past positive parenting patterns were associated with current levels of positive schemas.

GET.HAPPY - Acceptance of an internet-based self-management positive psychology intervention for adult primary care patients with mild and moderate depression or dysthymia: A pilot study

INTRODUCTION

A growing number of internet interventions have been shown to help in alleviating symptoms of depression. So far, only little research has focused on other methods than CBT. The present study aimed to investigate the level of satisfaction with a positive psychology online training among patients with mild and moderate depression or dysthymia. Secondary outcome measures included changes in symptom severity, health related quality of life, and negative effects.

METHODS

A total of 81 participants were allocated to the intervention. They were asked to complete online questionnaires and were called by one of the study psychologists at baseline, at post-treatment, and at follow-up (3 months after completion of the intervention). Shorter questionnaires were administered after each module.

RESULTS

Overall satisfaction was promising. While participants seemed to be very satisfied with many aspects of the program itself, they were slightly less satisfied with its impact on the problems they sought to solve. Overall, negative effects attributed to the program were small with one exception. At post-treatment, 22.6% of the participants felt that they or their problems were not taken seriously by the program. Symptom severity decreased over time with mild to moderate effect sizes. There was a moderate increase in satisfaction with mental health at both post-treatment and follow-up.

CONCLUSIONS

The online program investigated here may be a useful resource-oriented addition to the standard treatment of depression.

Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions

Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff.

Does optimism weaken the negative effects of being lonely on suicide risk?

The present study investigated loneliness and optimism as predictors of suicide risk, specifically, depressive symptoms and suicidal ideation, in 457 Hungarian college students. Beyond the expected role of loneliness in suicide risk, being optimistic buffered the positive association between loneliness and suicide. The findings implicate the importance of fostering optimism for potentially lowering suicide risk among lonely college students.

A Field Experimental Design of a Strengths-Based Training to Overcome Academic Procrastination: Short- and Long-Term Effect

This study reports on the effect of a newly developed 4-week strengths-based training approach to overcome academic procrastination, given to first-year elementary teacher education students (N = 54). The training was based on a strengths-based approach, in which elements of the cognitive behavioral approach were also used. The purpose of the training was to promote awareness of the personal strengths of students who experience academic procrastination regularly and to teach them how to use their personal strengths in situations in which they usually tend to procrastinate. With a pretest-posttest control group design (two experimental groups: n = 31, control group: n = 23), the effect of the training on academic procrastination was studied after 1, 11, and 24 weeks. Results of a one-way analysis of covariance revealed a significant short-term effect of the training. In the long term (after 11 and 24 weeks), the scores for academic procrastination for the intervention groups remained stable, whereas the scores for academic procrastination for the control group decreased to the same level as those of the intervention groups. The findings of this study suggest that a strengths-based approach can be helpful to students at an early stage of their academic studies to initiate their individual process of dealing with academic procrastination. The findings for the long term show the importance of measuring the outcomes of an intervention not only shortly after the intervention but also in the long term. Further research is needed to find out how the short-term effect can be maintained in the long-term.

The Center for Epidemiologic Studies-Depression (CES-D) scale measures a continuum from well-being to depression: Testing two key predictions of positive clinical psychology

BACKGROUND

Two core but untested predictions of Positive Clinical Psychology (PCP) are that (1) Many psychiatric problems can be understood as one end of bipolar continua with well-being, and (2) that reducing psychiatric symptoms will provide an equal (near linear) decrease in risk for several other psychiatric variables, irrespective of position on continua.

AIMS

We test these predictions in relation to a purported well-being/depression continuum, as measured by the Center for Epidemiologic Studies-Depression (CES-D), a popular measure of depressive experiences in research and clinical practice.

METHOD

A large (N=4138), diverse sample completed the CES-D, which contains a mixture of negatively worded and positively worded items (e.g., "I felt sad," "I enjoyed life"). The latter are conventionally reverse scored to compute a total score. We first examined whether purportedly separate well-being and depression CES-D factors can be reconceptualised as a bipolar well-being/depression continuum. We then characterised the (linear or nonlinear) form of the relationship between this continuum and other psychiatric variables.

RESULTS

Both predictions were supported. When controlling for shared method bias amongst positively worded items, a single factor well-being/depression continuum underlies the CES-D. Baseline levels on this continuum are found to have near linear relationships with changes in anxiety symptoms, aggression, and substance misuse over time, demonstrating that moving from depression to well-being on the CES-D provides an equal decrease in risk for several other psychological problems irrespective of position on the continuum.

LIMITATIONS

The CES-D does not measure well-being as comprehensively as established scales of well-being.

CONCLUSIONS

Results support calls for mental health services to jointly focus on increasing well-being and reducing distress, and point to the value of early intervention and instilling resilience in order to prevent people moving away from high levels of well-being.

Opportunities and Challenges for the Emerging Field of Positive Emotion Regulation: A Commentary on the Special Edition on Positive Emotions and Cognitions in Clinical Psychology

The importance of developing a better understanding of positive emotion regulation in both healthy and clinical populations is now recognised. This special edition brings together leading figures in the positive emotion regulation field and has contributions characterizing positive phenomena, differentiating them from negative phenomena, and evaluating underlying psychological mechanisms that drive these phenomena. This commentary reviews these articles to highlight challenges and opportunities for this emerging field, including the need to better characterize positive phenomena, to be more explicit about how the links between negative and positive phenomena are conceptualised, to evaluate more robustly underlying mechanisms, to standardize measurement of positive constructs, and to ensure that these scientific findings lead to meaningful changes in real-world policy and practice.