Cognitive-behavioural training to change attributional style improves employee well-being, job satisfaction, productivity, and turnover

Use of cognitive-behavioral career coaching to reduce work anxiety and depression in public employees

BACKGROUND

Public employees worldwide are increasingly concerned about work anxiety and depression. Cognitive-behavioral career coaching has emerged as a promising strategy for addressing these mental health disorders, which can negatively impact on a person's overall well-being and performance.

AIM

To examine whether cognitive-behavioral career coaching reduces work anxiety and depression among Nigerian public employees.

METHODS

A total of 120 public employees (n = 60) suffering from severe anxiety and depression were randomly assigned to the treatment or control groups in this study. Cognitive behavioral coaching was provided twice a week to those in the treatment group, whereas no treatment was given to those in the control group. As part of the study, the Hamilton Anxiety Rating Scales and Beck Depression Inventory were used to collect data.

RESULTS

Analysis of covariance of the data from participants indicates a significant effect of cognitive-behavioral career coaching on work anxiety and depression.

CONCLUSION

Insights into the underlying mechanisms by which cognitive behavior career coaching exerts its effects have been gained from this study. Also, the study has gathered valuable data that can inform future practice and guide the development of strategies for supporting mental health at work.

Health Management: Evaluating the Relationship between Organizational Factors, Psychosocial Risks at Work, Performance Management, and Hospital Outcomes

Introduction-Health system (HS) health organizations are complex and are in constant dynamic interaction with multiple elements, including political, environmental, societal, legal, and organizational factors, along with human components, such as human resources, patients, and other stakeholders. Objective-This research aimed to study three HS organizations, identifying and characterizing the elements of health organizations and the factors related to professionals, determining their influence on economic and financial performance results, as well as results related to the professionals and to the patients comprising the institutions. Method-A quantitative study was conducted in which data were collected through questionnaires from various sources to better understand and characterize the factors related to organizations, professionals, and patients (470 health professionals and 768 patients). To test the integrated evaluation model for health organizations, path analysis was used. Results-The results reveal that the organizational culture (OC) presents a positive relationship between the professional's quality of life (QL) and the performance management (PM) of the professionals, along with a negative relationship with the psychosocial work risks (PWR). There is also a relationship between the OC and patient satisfaction (PS), professional job satisfaction (PJS), and economic and financial results (EFR). In the relationship between the processes and the results, there are significant relationships between PM and PJS and PWR and PJS. In terms of the results, there is a significant relationship between the EFR and the PS. Conclusions-This study contributes to a deeper knowledge of the factors that influence the quality of health organizations and their results and produces recommendations for health organizations to address the current challenges.

The impact of psychological capital on green and organizational performance: Empirical research measuring psychological and subjective health of green building industries

Introduction

Green building (GB) technologies have been introduced to reduce the negative effect of the building and construction industry on the economy, the ecosystem, and society. A more thorough and accurate knowledge of the factors for implementation is required to stimulate the wider adoption of GB technologies. The theoretical framework for this study is developed using psychological capital (PC), self-determination theory (SDT), and green theory. The study addresses gaps in the research in this field. The effect of PC on psychological health (PH), green innovation ambidexterity (GIA), and subjective health (SH), and the impact of GIA on green performance (GP) are determined. The effect of PH and SH on organizational performance (OP) is also determined.

Methods

The information for this study is collected from a variety of sources in the Chinese GB industry. The subjects for this study are Chinese employees of GB-based companies. Using a convenience sampling method, a total of 504 employees were selected. The employees' answers to a restricted, self-administered survey are used to generate the data.

Results

Data from this study shows that PC has a significant effect on GIA, SH, and PH and that GIA has a substantial impact on GP. Both SH and PH significantly affect OP.

Discussion

This study encourages managers in the green building industry to support fresh concepts in order to gain a competitive edge by implementing and promoting innovative cultures, especially in terms of service delivery and customer understanding, because innovation plays a critical role in these industries.

Impostor Phenomenon and L2 willingness to communicate: Testing communication anxiety and perceived L2 competence as mediators

The Impostor Phenomenon (IP) describes experiences of perceived intellectual fraudulence despite the existence of objectively good performances, and it is a robust predictor of experiences and outcomes in higher education. We examined the role of the IP in the domain of second language (L2) acquisition by testing its relations with a robust predictor of L2 use, willingness to communicate (WTC). We collected self-reports of 400 adult Iranian L2 learners and tested the associations between the IP and WTC. As expected, we found a negative association between IP and WTC (r = -0.13). When testing a mediation model with perceived competence and communication anxiety as parallel mediators, we found evidence for full mediation via perceived competence. Our findings show the importance of considering self-evaluations in the domain of L2 acquisition. Further implications and limitations are discussed.

Assessing the Core Variables of Business Managers' Intuitive Decision Ability: A Review and Analysis

Business decisions are frequently based on informed intuition in contrast to a formal analysis. Early man used simple intuition, but through time knowledge increases allowed decision makers (DMs) to move to 'objectively informed intuition' (OII). This uses inherent and learnt cognition at both unconscious and conscious levels. A model of business OII is proposed and evaluated using as variables the managers' personal characteristics and their unique set of objectives. The resultant equation allows assessing decision quality and provides a framework for DMs to work on improvements relative to their objectives. The literature suggests OII stems from a DM's makeup (business related phenotype), training and experience in a dynamic trio leading to the defining equation. Analyses show business related phenotype is the most important determinant as well as confirming the proposed theory on the determinants of OII success. Practical methods of improving OII are reviewed, and issues worth further investigation outlined. This research is the first encompassing quantitative relationships explaining business OII quality thus enabling improving OII. Suggested further research may refine the equation and expand its core base. This work involves a range of disciplines as different aspects of human characteristics impact on how decisions are made.

A Two-Stage SEM-Artificial Neural Network Analysis of the Engagement Impact on Employees' Well-Being

Employees' engagement (EE) and well-being (WB) are considered two interesting issues by many scientific researchers and practitioners within organizations. Most research confirms a positive correlation between EE and WB. EE is an essential premise for specific dimensions of employees' WB. At the same time, satisfied and physically and mentally healthy employees increase EE, both EE and WB thus being fundamental to individual and organizational performance. This paper aims to evaluate the relationships between EE and WB and between the dimensions of these two complex constructs. These relationships were assessed based on data obtained from a sample of 269 employees in Romania, using as a method a mix of analyses based on structural equation modeling (SEM) and artificial neural network analysis (ANN). The results highlighted a positive two-way relationship between EE and WB. Among the dimensions of EE, motivation and work environment are those that ensure a more pronounced perception of WB by the employee. Emotional WB, occupational WB, and social WB are the dimensions of WB with a significant influence on the general level of EE.

Comparison of Two Approaches to Enhance Self-Esteem and Self-Acceptance in Chinese College Students: Psychoeducational Lecture vs. Group Intervention

Objective

Self-esteem and self-acceptance are not only basic features but also influential factors of mental health. The present study aimed at assessing the effects of psychoeducational lecture and group intervention on self-esteem and self-acceptance in Chinese college students.

Methods

A total of 149 Chinese college students who participated in a mental health course were randomly class-based assigned into the psychoeducational lecture group (n = 62) and the self-focused intervention group (n = 87). The lecture group received 6-session psychoeducational lectures on overview of mental health, campus adaptation, stress adjustment, self-understanding, emotion management, and interpersonal relationships. The self-focused intervention group was treated with self-related group activities involving aspects of self-knowledge, self-feeling, and self-regulation for six sessions. Pre- and post-intervention measurements were taken with Rosenberg Self-Esteem Scale and Self-Acceptance Questionnaire for both groups.

Results

Self-esteem significantly increased in both groups after six sessions. However, the enhancement of self-acceptance was more robust for the self-focused intervention group than the psychoeducational lecture group.

Conclusion

The psychoeducational lecture and self-focused intervention were effective approaches to improve self-esteem for Chinese college students. With respect to self-acceptance, self-focused group intervention might have a more prominent effect.

Employee Engagement and Wellbeing in Times of COVID-19: A Proposal of the 5Cs Model

The COVID-19 pandemic has had an unprecedented impact on the labor market. The psychological pressure and uncertainty caused by the current changing workplace environment have led to negative consequences for workers. Considering the predictive relationship between employee engagement and wellbeing and in light of this unprecedented situation that affects workers of all the industries worldwide, this study aims to identify the key main drivers of employee engagement that can lead to employee wellbeing in the current context. Through a literature review, a theoretical model to strengthen engagement in times of COVID-19 is proposed. The main factors are conciliation, cultivation, confidence, compensation, and communication. Whereas prior to the pandemic, firms had already understood the need to achieve this, it is now considered a vital tool for staff health and wellbeing. This article makes two main contributions. First, it provides a model for boosting employee engagement, and therefore, wellbeing. Second, managerial suggestions are made to apply the theoretical model.

Building relationships through accountability: An expanded idea of accountability

Previous literature has focused on how external forces impose accountability on individuals (i.e., holding individuals to account), but has not considered the possibility of internal, personal accountability. We explain how an internalized sense of accountability, which we term internally assumed accountability, can enrich our understanding of why some organizational members might assume ownership for organizational problems, even ones that they did not actually cause. We offer a typology of accountability in organizations based on contrasting relationship norms and personal orientations. Our article concludes with a discussion on connections between different kinds of accountability and stakeholder relationships, suggesting a number of avenues for further investigation and practice.

Career Adaptability, Work Engagement, and Employee Well-Being Among Chinese Employees: The Role of Guanxi

The present study examined whether and how career adaptability predicts employee well-being (EWB) based on career construction theory. A three-wave questionnaire design was used to collect the data, and 338 employees participated in the study. The results suggest that career adaptability has a significant effect on work engagement, which, in turn, predicts EWB. In addition to developing a mediation model, we tested the effect of guanxi as a moderator on the former part of the model. Thus, a moderated-mediation model was constructed in this research. In addition to the finding of the mediating role of work engagement, the discussion of guanxi represents a more important novel aspect that draws attention to contextual factors that may shape how employees respond to career adaptability. The results revealed that the indirect effect of career adaptability on EWB through work engagement when guanxi is low is stronger than that when guanxi is high. Furthermore, we discuss the limitations of this study and the implications for future research on career adaptability and EWB.

The impact of financial satisfaction on well-being of Canadian military members

Introduction: The ability to attain financial satisfaction is becoming progressively difficult due to increasing living standards, costs, and accruement of debt. Military members are arguably at greater risk of being dissatisfied with their current financial situation and suffering from financial strain and psychological distress due to the demands of a military lifestyle. Methods: The present study aimed to explore the predictive relationships between financial satisfaction and daily coping ability on two facets of well-being – life satisfaction and psychological distress – among Canadian military personnel. Results: The hierarchical regression results demonstrated that financial satisfaction was a significant predictor of life satisfaction and psychological distress. Moreover, daily coping ability played a vital role in improving participants’ life satisfaction and reducing psychological distress, above and beyond the positive impact of financial satisfaction. Discussion: The qualitative difference between the predictors and outcome variables as well as directions for future research are discussed.

Exploring Blue- and White-Collar Employees' Well-Being at Work System

The aim of this study was to examine occupational group-related differences in well-being at work (WBW) indicators ranging from real accidents, absences and retirement to experienced pleasure at work. Occupational group included two categories: blue- and white-collar employees. The study is based on analysing national statistics or ones of various industrial sectors (Study 1), or bases on findings of questionnaires in Finnish case companies (N=7) (Studies 2 and 3). WBW questionnaires answered by 3500 employees. Analysis utilised data that employees of two occupational groups, or company and national statistics revealed about WBW. Analysis was based on factors related to employee, task, tool, organisation and work environment (traditional work system (WS)), psychosocial factors, and information and communication within WS. The biggest and statistically significant differences were emphasised in results and discussion. Although two groups' roles and tasks provide reasons for many differences, the ones should be measured, thoroughly discussed and consciously managed.

Web-Based Training Program Using Cognitive Behavioral Therapy to Enhance Cognitive Flexibility and Alleviate Psychological Distress Among Schoolteachers: Pilot Randomized Controlled Trial

Background

Schoolteachers are known to be faced with various stresses in their work. A simple, less onerous, and effective intervention technique that can enhance the stress management skills, particularly, cognitive flexibility, of schoolteachers is needed.

Objective

This study aimed to determine whether stress management training using a Web-based cognitive behavioral therapy (CBT) program is effective for enhancing the cognitive flexibility of schoolteachers and alleviating their subjective distress.

Methods

This study was conducted in a random controlled design covering public elementary schoolteachers. Teachers allocated to the intervention group received 120 min of group education and completed homework using a Web-based CBT program that lasted for 3 months. The items of outcome evaluation were cognitive flexibility and subjective distress, and the efficacy of intervention was evaluated at 3 months after intervention.

Results

A total of 240 participants were randomly allocated to the intervention group (120 individuals) and the control group (120 individuals). On the basis of the principle of intention to treat, the intervention group and the control group were compared regarding the amount of change from before intervention to after intervention, using a general linear model. Scores of cognitive flexibility and subjective distress were significantly more improved in the intervention group than in the control group.

Conclusions

The results of this study suggest that simple stress management training using a Web-based CBT program in elementary schoolteachers enhances cognitive flexibility and alleviates subjective distress.

Relationship between work-family balance and job satisfaction among employees in China: A moderated mediation model

Previous studies have revealed the association between work-family balance and job satisfaction. The present research further explored the underlying mechanism of this association and aimed to provide a moderated mediation model to explain if personality traits moderate the relationship between work-family balance and job satisfaction through work engagement. A cross-sectional study was conducted in which 263 employees from a petrochemical enterprise in China completed self-report questionnaires including the Work-Family Balance Scale, the Utrecht Work Engagement Scale, the Big Five Inventory-10, and the Job Satisfaction Scale. Hierarchical regression analysis and structural equation modeling showed that work engagement partially mediated the relationship between work-family balance and job satisfaction, and the indirect effect was further moderated only by extraversion. Therefore, an integrative moderated mediation model was proposed wherein work-family balance boosts job satisfaction by first enhancing employees' work engagement, while the indirect effect was in turn moderated by extraversion. The results suggest that interventions for improving job satisfaction may be enhanced by targeting work engagement, especially for employees with higher extraversion.

The mediating role of job satisfaction in the relationship of vertical trust and distributed leadership in health care context

Purpose

This study aims at investigating the effect of vertical trust on distributed leadership (DL) and performance as mediated by job satisfaction, and further to observe the role of DL in carrying out the effect of satisfaction on employees’ performance.

Design/methodology/approach

As grounded in the organizational citizenship behavior (OCB) literature, the author proposes that employees’ participation in DL should be viewed as an extra role behavior, as leadership functions are not directly related to their job description. The study uses large-scale survey data from a study in one of Denmark’s largest public hospitals (N = 1,439).

Findings

The results of structural equation modelling (SEM) analysis showed that job satisfaction mediates the relationship between vertical trust and DL, and DL had a positive impact on job performance. Furthermore, the results showed that job satisfaction had a positive impact on DL and employees’ performance. Moreover, DL has positively affected employees’ performance, and it carries the impact of job satisfaction on performance.

Research limitations/implications

The study showed that trust and job satisfaction are important triggers of DL. Furthermore, results are interesting because literature so far has shown an insignificant relationship between satisfaction and performance. Here, the author establishes that the satisfaction–performance relationship is mediated by DL. The findings should motivate health care organizations to introduce structures and educate formal leaders so that DL can be enabled.

Originality/value

This should be the first study that relates trust and DL in an empirical manner. As grounded in the OCB literature, results also showed the significance of job satisfaction as a mediator variable.

Psychological and Work Stress Assessment of Patients following Angioplasty or Heart Surgery: Results of 1-year Follow-up Study

The aim of this study was to explore changes in subjective psychological health and perceived work stress among patients who returned to work (RTW) after a multidisciplinary cardiac rehabilitation (CR) following cardiac interventions. A total of 108 patients were evaluated at the beginning of their CR, at 6 and 12 months after discharge. Self-report questionnaires were used to assess depression, anxiety, illness perception and work stress at each time stage. Results showed reports of depressive symptoms significantly decreased (p < 0.05) and subjective mental (p = 0.001) and physical health (p < 0.001) improved over time. Patients revealed a decrease in Type A behaviour pattern (p < 0.001) and in job satisfaction levels (p = 0.01), greater internal locus of control (p < 0.01) and increased use of the coping strategy 'Involvement' (p < 0.01). Major findings are that cardiac patients had an improvement in subjective psychological health and did not perceive increased work stress after their RTW. Patients' psychological health and work stress need to be assessed during the CR and should be also carefully monitored after the RTW in order to identify patients' psychological and work-related barriers and facilitate a safe and successful work reintegration.

Stable personal attributes and a resilient approach to work and career

Orientation: Recent research has suggested that personal resilience should be viewed in terms of process and outcome. This has implications for the study of resilience in the work context.Research purpose: The main research aim was to explore, at a detailed level, relationships between enduring personal characteristics and a resilient approach to work and career.Motivation for the study: Moving away from the idea of resilience as a specific trait or set of traits raises the question of how general personality and ability constructs influence a resilient approach.Research approach, design and method: This was an exploratory, quantitative study involving predictor (ability and personality) and criterion (satisfaction and involvement) data for 168 senior managers in five businesses within a retail and distribution group.Main findings: Evidence was found for differential relationships between personal attributes and a resilient approach (measured in terms of positive vs. negative perspectives on work and career). For example, the personality factor of Openness to Experience was negatively related to Organisation and Career Satisfaction, but positively related to Career and Job Involvement.Practical/managerial implications: In designing selection, development and employee survey procedures, organisations need to be aware of the differential nature of the relationships between attributes and a resilient approach to work and career.Contribution/value-add: The study brings together recent research on resilience, personal attributes and work outcomes, and supports the potential of general attribute models for studying and improving the process of developing and exercising a resilient approach in the work context.

Leaders Enhance Group Members' Work Engagement and Reduce Their Burnout by Crafting Social Identity

Previous research has examined burnout and work engagement as a function of demands and resources at work. Yet we know little about the ways in which these are determined by people's social experience as a member of their workgroup as shaped, in particular, by leaders' management of shared identity. To address these issues, we propose a model in which leaders' identity entrepreneurship (the degree to which the leader promotes understanding of shared group identity) impacts on group performance through burnout and work engagement. We tested our model in a field study with 641 participants from the US working population who responded to their workgroup leader and indicated their health. Results indicated that when leaders acted as identity entrepreneurs, group members not only reported higher group performance but also experienced less burnout and were more engaged at work. Moreover, the relationship between identity entrepreneurship and group performance was mediated by an increase in work engagement and a reduction in burnout both of which in turn facilitated group performance. These findings suggest that what it means for health-protective leaders to be ‘transformational’ is being capable of facilitating the development of a special sense of ‘us' that they and group members share.

Attributional style and depression in multiple sclerosis: the learned helplessness model

Several etiologic theories have been proposed to explain depression in the general population. Studying these models and modifying them for use in the multiple sclerosis (MS) population may allow us to better understand depression in MS. According to the reformulated learned helplessness (LH) theory, individuals who attribute negative events to internal, stable, and global causes are more vulnerable to depression. This study differentiated attributional style that was or was not related to MS in 52 patients with MS to test the LH theory in this population and to determine possible differences between illness-related and non-illness-related attributions. Patients were administered measures of attributional style, daily stressors, disability, and depressive symptoms. Participants were more likely to list non-MS-related than MS-related causes of negative events on the Attributional Style Questionnaire (ASQ), and more-disabled participants listed significantly more MS-related causes than did less-disabled individuals. Non-MS-related attributional style correlated with stress and depressive symptoms, but MS-related attributional style did not correlate with disability or depressive symptoms. Stress mediated the effect of non-MS-related attributional style on depressive symptoms. These results suggest that, although attributional style appears to be an important construct in MS, it does not seem to be related directly to depressive symptoms; rather, it is related to more perceived stress, which in turn is related to increased depressive symptoms.

Overall well-being as a predictor of health care, productivity, and retention outcomes in a large employer

Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance.

Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial

Background

Interventions to promote mental well-being can bring benefits to the individual and to society. The Internet can facilitate the large-scale and low-cost delivery of individually targeted health promoting interventions.

Objective

To evaluate the effectiveness of a self-directed Internet-delivered cognitive-behavioral skills training tool in improving mental well-being in a population sample.

Methods

This was a randomized trial with a waiting-list control. Using advertisements on a national health portal and through its mailing list, we recruited 3070 participants aged 18 or over, resident in England, and willing to give their email address and access a fully automated Web-based intervention. The intervention (MoodGYM) consisted of 5 interactive modules that teach cognitive-behavioral principles. Participants in the intervention arm received weekly email reminders to access the intervention. The control group received access to the intervention after the trial was completed and received no specific intervention or email reminders. Outcomes were assessed by using self-completion questionnaires. The primary outcome was mental well-being measured with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Secondary outcomes were Center for Epidemiologic Studies Depression scale (CES-D) depression scores, Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety scores, EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) quality of life scores, physical activity, and health service use. All outcomes were measured at baseline, and at 6- and 12-week follow-ups.

Results

A total of 1529 (49.80%) participants completed final follow-up at 12 weeks. Retention was 73.11% (1123/1536) in the control arm and 26.47% (406/1534) in the intervention arm. No relationship between baseline measures and withdrawal could be established. The analysis of WEMWBS mental well-being scores using a linear mixed model for repeated measures showed no difference between intervention and control group at baseline (difference –0.124 points, 95% CI –0.814 to 0.566), and significant improvements for the intervention group at 6 weeks (2.542 points, 95% CI 1.693-3.390) and at 12 weeks (2.876 points, 95% CI 1.933-3.819). The model showed a highly significant (P<.001) intervention by time interaction effect. There were also significant improvements in self-rated scores of depression and anxiety. Given the high level of attrition, a sensitivity analysis with imputed missing values was undertaken that also showed a significant positive effect of the intervention.

Conclusions

Participants allocated to the intervention arm had an average increase of approximately 3 points on the WEMWBS scale compared to no increase for participants in the control group. Three points on this scale is approximately one-third of a standard deviation. In a low-cost automated intervention designed to shift the population distribution of mental well-being, a small difference per individual could yield a major benefit in population terms. In common with other Web-based interventions, there were high rates of attrition. Further work is needed to improve acceptability, to evaluate against placebo effect, and to disaggregate the effect on mental well-being from the effect on depression and anxiety.

Trial Registration

International Standard Randomised Controlled Trial Number Register ISRCTN 48134476; http://www.controlled-trials.com/ISRCTN48134476 (Archived by WebCite® at http://www.webcitation.org/6DFgW2p3Q)

Managing Voluntary Turnover Through Challenging Assignments

This study examines employees’ challenging assignments as manageable means to reduce turnover intentions, job search behaviors, and voluntary turnover. Results indicate that challenging assignments are negatively related to turnover intentions and job search behaviors and that these relationships are mediated by on-the-job learning. Moreover, results show that an increase in challenging assignments over time is negatively related to voluntary employee turnover, when controlling for employees’ initial turnover intentions and job search behaviors. A decrease in challenging assignments is positively related to voluntary turnover, when controlling for employees’ initial turnover intentions and job search behaviors. These results suggest that challenging assignments may be a valuable tool for managers and their organizations to lower voluntary employee turnover.

Culturally focused wellness intervention for American Indian women of a small southwest community: associations with alcohol use, abstinence self-efficacy, symptoms of depression, and self-esteem

PURPOSE

This study examined the influence of a culturally focused wellness intervention on alcohol consumption, alcohol abstinence self-efficacy, depression, and self-esteem among women of a small American Indian community in the southwestern United States. Participation in two intervention approaches was compared: a curriculum-based health promotion–only approach and health promotion combined with cognitive-behavioral skills building (CBSB).

DESIGN

The wellness intervention was tested in a prospective, randomized, two-group design with repeated measures. There was no control group.

SETTING

An American Indian community in the Southwest.

SUBJECTS

American Indian women, ages 18 to 50 (N = 268).

INTERVENTION

A 10-session culturally focused curriculum-based health promotion intervention, with a CBSB component, was developed using a community-based participatory research process. Comparisons were made between those who attended the health promotion plus CBSB intervention and those who attended the intervention without the CBSB component.

MEASURES

Information regarding demographics, substance use, alcohol consumption, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem was collected through a structured interview.

ANALYSIS

Regression was used to evaluate the effect of the intervention on alcohol consumption, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem in CBSB and non-CBSB groups.

RESULTS

Although there were no significant differences between the CBSB and non-CBSB groups, the results indicate a significant decrease in alcohol consumption and symptoms of depression, and a significant increase in alcohol abstinence self-efficacy and self-esteem, from baseline to the 6-month follow-up for both groups.

CONCLUSION

Evidence suggests that this culturally focused health promotion intervention has a positive impact on alcohol use, alcohol abstinence self-efficacy, depressive symptoms, and self-esteem among American Indian women.

Improving health and productivity of depressed workers: a pilot randomized controlled trial of telephone cognitive behavioral therapy delivery in workplace settings

OBJECTIVE

To examine the feasibility of telephone-delivered cognitive behavioral therapy (T-CBT) in an occupational context, with reference to participant recruitment, treatment adherence, follow-up and effect.

METHOD

Eligible participants comprised all employees of a large communications company with authorized work absence due to mild/moderate mental health difficulties over a 10-month period. Fifty-three consenting participants were centrally randomized to 12 weeks T-CBT or usual care, with minimization on age, gender and illness severity. Primary (symptom severity) and secondary outcomes (self-rated work performance and productivity) were measured at baseline and 3-months via postal questionnaires. Intention-to-treat analysis comprised multiple regression modeling with adjustment for missing response predictors, minimization variables and baseline values.

RESULTS

Twenty-three employees attended one or more T-CBT sessions. T-CBT was associated with medium-large effects sizes on clinical outcomes (0.63-0.77) and work productivity scores (0.75-0.88). Twenty-one patients failed to return 3-month primary outcome data. Non-respondents were more likely to be male and more severely ill.

CONCLUSION

Delivery of T-CBT in an occupational context is feasible with evidence of potential effect. Larger-scale trials are warranted. These studies demand assertive outreach or telephone-based assessment strategies in order to maximize participant recruitment and follow-up.