The effects of a stress-management training program in individuals at risk in the community at large

Coronavirus Trauma and African Americans' Mental Health: Seizing Opportunities for Transformational Change

The COVID-19 pandemic is a natural disaster of historic proportions with widespread and profound psychological sequelae. African Americans fall ill and die more than whites from COVID and more survivors and loved ones face psychological risk. African Americans also experience greater personal, social, and financial stress even when not personally touched by COVID illness, and they are again vulnerable as COVID diminishes African American community’s capacity for mutual support. Enactment of the American Rescue Act of 2021 can moderate if not eliminate African Americans’ greater adversity and greater psychological challenge; other provisions can move the mental health treatment system beyond its previous failure to reach African Americans as it constructively responds to the crisis that COVID presents. From outreach through trusted community actors and institutions for meeting African Americans’ needs of varying intensity and duration, and by providing a spectrum of evidence supported interventions—culturally adapted as needed—newfound success can mark a turning point toward new approaches and lasting success.

Building Resilience: The Conceptual Basis and Research Evidence for Resilience Training Programs

The relationship between adverse experiences and later development has been explored by many researchers, leading to the conceptualization of resilience as a factor explaining the normal or optimal development of some individuals exposed to adversity. Today many different interventions exist aiming to improve the ability of individuals to respond to adversity. In this narrative literature review, we evaluate the literature surrounding resilience and resilience training, discussing the quality of the evidence supporting resilience training, theoretical and practical differences between types of training, and the impact of resilience and psychological training on outcome measures across a variety of settings. The results of our review show that the quality of the literature is mixed, resilience training is not well differentiated from other forms of training, and that the impact of psychological training on later functioning depends heavily on the type of outcome measured and the setting of the training. Further research must be conducted prior to the implementation of resilience training programs in order to assure their efficacy and effectiveness in proposed contexts.

The Effectiveness of Group Training of CBT-Based Stress Management on Anxiety, Psychological Hardiness and General Self-Efficacy Among University Students

Background:

Admission to university is a very sensitive period of life for efficient, active, and young workforces in any country, and it is mostly associated with many changes in social and human relationships. These changes lead to anxiety in students. Moreover, humans need certain functions in order to adaptively deal with different life situations and challenges. By training stress management, these functions can help human acquire the required abilities.

Objective:

The present study was aimed at investigating the effectiveness of stress management training in anxiety, psychological hardiness, and general self-efficacy among university students.

Method:

The study was a quasi-experimental intervention (pretest-posttest-follow-up) including a control group, it was a fundamental applied study. The statistical population consisted of all students of Islamic Azad University, Karaj, Iran. Convenient sampling was employed to select 30 students who were divided into an experimental group (n=15) and a control group (n=15). Before stress management training, both groups filled out Beck Anxiety Inventory, Long and Goulet scale of psychological hardiness, and General Self-efficacy Scale (GSE-10). Afterwards, the experimental group was provided with stress management training. And after the experiment, the abovementioned questionnaires and scales were responded by the two groups. Finally the collected data were analyzed and compared using one-way MANOVA.

Results:

The results of MANOVA indicated that there was a significant difference between the two groups in terms of anxiety, hardiness, and general self-efficacy (p<0.001).

Conclusion:

According to the results of the present study and those of previous investigations that are in agreement with those of the present study, it can be concluded that stress management among university students cause anxiety to drop; moreover, it enhances their psychological hardiness and self-efficacy. In regard with the role and importance of stress management, training this skill should be included in educational plans of university.

The Effect of Self-Care Education on the Awareness, Attitude, and Adherence to Self-Care Behaviors in Hospitalized Patients Due to Heart Failure with and without Depression

Background

Cardiovascular diseases are among somatic disorders and psychological factors affect their onset, exacerbation, and treatment. This study was conducted on the hospitalized patients who had heart failure with and without depression. The study criteria was to evaluate the effect of self-care education on awareness, attitude, and adherence to self-care behaviors on these patients.

Materials and Methods

In this quasi-experimental study, seventy patients with heart failure that met the inclusion criteria were recruited through purposive sampling method. They were assigned in to two equal size groups regarding their depression status. First, the eligible patients were selected; then Beck Depression Inventory was done on the patients followed by examination by the clinical psychologist. Patients with average and higher scores were classified in the depressed group and others who got lower than average scores were classified as the non -depressed group. A questionnaire containing items related to awareness, attitude, and adherence to self-care behaviors was used to collect the data. First, self-care behavior was determined and then a four-sessions of educational intervention were held individually for both groups. The second round of questionnaires were completed at patients’ home twelve weeks after the discharge. The Collected data was analyzed using independent-samples and paired-sample t tests, Chi square, and statistical analysis of covariance (ANCOVA) tests through SPSS (version 21, SPSS Inc., Chicago, IL, USA).

Results

After the educational sessions, the statistical analysis showed significant differences in the mean scores of awareness, attitude, and adherence to self-care behaviors between the two groups (P<0.0001).

Conclusion

Self-care behavior education had lower effects on the depressed patients with heart failure. Therefore, before providing education for these patients, it is necessary to consider their psychological problems such as depression.

Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers

This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT.

Evaluation of a school-based health promotion programme for adolescents aged 12–15 years with focus on well-being related to stress

OBJECTIVE

The aim of this study was to evaluate a school-based adolescent health promotion programme with focus on well-being related to stress.

STUDY DESIGN

Interventional and evaluative with tests before and after the intervention. The study was performed in two secondary schools in a town on the west coast of Sweden.

METHODS

A health promotion programme comprising massage and mental training was implemented for a single academic year in one school (intervention school, 153 participants) in order to strengthen and maintain well-being. No intervention was implemented in the other school (non-intervention school, 287 participants). A questionnaire was developed and tested, resulting in 23 items distributed across the following six areas: self-reliance; leisure time; being an outsider; general and home satisfaction; school satisfaction; and school environment.

RESULTS

A pre- and postintervention comparison of the six areas was made within each school. In the intervention school, the boys maintained a very good or good sense of well-being related to stress in all six areas, while the girls' sense of well-being was maintained in five areas and deteriorated in one area. In the non-intervention school, the boys maintained a very good or good sense of well-being related to stress in four areas and deteriorated in two areas, while the girls' sense of well-being was maintained in two areas and deteriorated in four areas.

CONCLUSION

Massage and mental training helped to maintain adolescents' very good or good sense of well-being related to stress. A questionnaire with acceptable validity and reliability was developed and tested in order to evaluate the health promotional approach. However, there is a need for further study to develop both the intervention and the questionnaire for young people.

Improvement of balance between work stress and recovery after a body awareness program for chronic aspecific psychosomatic symptoms

OBJECTIVE

A 3-day residential body awareness program (BAP) was developed to teach people with chronic aspecific psychosomatic symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The long-term effects of the program in improving the balance between work stress and recovery are presented in this study. The intervening effect of 'improved balance' on quality of life is also analysed.

METHODS

A pre-post design is used with post-measures at 2 and 12 months after the program, without controls (n = 122). Mean age is 42.5 years (S.D. = 9.0) and 60% of participants are female.

RESULTS

The results show participants become more active physically and socially, and at the same time take the opportunity to recover. There was a difference measured in changing balance for participants who are fully employed and participants who are not working or are working part-time due to health problems: the second group reintegrated into work, the first group spent more time socialising inside the family. Personal goals are realised by 85% of the participants. Realising personal goals and becoming more active is a mediating factor for increasing quality of life. The majority of the measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants also confirm these effects.

DISCUSSION AND CONCLUSION

Evaluation of the BAP gives evidence to conclude that this program leads to long-term effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. Two and 12 months after the 3-day program, they changed their behaviour to a more active lifestyle and increased self-management in coping with stress and psychosomatic symptoms.

PRACTICE IMPLICATIONS

By paying more attention to the balance between work stress and recovery, patient educators may be able to increase their effectiveness. Personal goal realization can be effective in guiding people by getting them out of the negative spiral.

Technological innovations in clinical assessment and psychotherapy

In this paper the application of computer technology and the use of the Internet in mental health care are critically reviewed. A number of on-line screening devices have been developed for anxiety disorders, mood disorders, and substance abuse disorders, with great potential for clinical practice. On line assessment is generally equivalent to clinical assessment. A number of studies have shown that self-help treatment programmes on stand-alone computers are as effective as routine clinical care. The Internet enhances the therapeutic possibilities of computers by offering feedback of therapists and more tailor-made treatment. A number of randomized clinical trials (RCTs) have shown that Internet-based treatment is more effective than no-treatment and as effective as face-to-face treatment. Research so far has been limited to anxiety disorders, burn-out, depression, headache, insomnia, tinnitus and obesity. Further, exposure through virtual reality has been found effective in a number of RCTs in specific phobias, but results with respect to the effects of the use of virtual reality techniques to other disorders are inconclusive. It is concluded that computer-driven assessment and treatment has many advantages and few disadvantages. A number of reasons are discussed which will preclude large-scale implementation of computer-driven assessment and therapy in the near future.

A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis

A growing literature reports that stressful life events are associated with exacerbation and the subsequent development of brain lesions in patients with multiple sclerosis (MS). The evolution an MS exacerbation occurs over a period of many months and involves many different biological processes that change over time. Likewise, the experience of stress also occurs over time, with an onset, a shift from acute to chronic in some cases, and resolution. Each of these phases is associated with unique biological features. Thus, the impact of stress on MS exacerbation may depend on the temporal trajectories of stress and MS exacerbation, and when the intersection between these two trajectories occurs. This paper presents a temporal model, along with three different temporal relationships and associated mechanisms by which stress may impact MS exacerbation. These include the onset of a stressor, which may be mediated by mast cell activation, the point that a stressor begins to become chronic, which may be mediated by glucocorticoid resistance in immune cells, and the resolution of the stressor, which may be mediated by a drop in cortisol. These three hypotheses are not necessarily mutually exclusive. Data on psychosocial mediators and moderators are also briefly reviewed and future research directions are discussed.

Teacher stress and coping strategies used to reduce stress

This pilot study investigated teachers' symptoms of stress and their coping strategies. Measurements of 'stress levels' and 'coping strategies' used were acquired by constructing a questionnaire made up of four individual standardized questionnaires. The data were analysed by a series of correlational analyses that highlighted significant relationships between ways of coping and levels of distress. Differences between the stress-related areas were measured using the Friedman test and Wilcoxon signed rank test for hierarchy. The findings implied that 'escape avoidance', 'accepting responsibility' and 'uncontrolled aggression' were used as negative coping strategies and only one strategy, 'exercise', was indicated to be an effective way of coping. The teachers' strategies were examined for similarities and differences with those recommended by occupational therapists. This pilot study was limited to two schools and it is recommended that it be extended to better generalize the results. Furthermore, ways of coping, as measured by psychological measures, do not seem to reduce stress so it is possible that the activity-based Stress Management Questionnaire, as advocated by Stein et al. (2003), might be more advantageous.

The long-term lasting effectiveness on self-efficacy, attribution style, expression of emotions and quality of life of a body awareness program for chronic a-specific psychosomatic symptoms

OBJECTIVE

A 3-day residential body awareness program (BAP) was developed to teach people with chronic a-specific psychosomatic symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The long-term effects of the program on body awareness, psychological factors, psychosomatic symptoms and quality of life for people with CAPS are presented in this study.

METHODS

A pre-post design is used with post-measures 2 and 12 months after the program, without controls (n = 122). Mean age is 42.5 (S.D. = 9.0) and 60% is female.

RESULTS

The results showed an increase of body awareness, self-efficacy, expression of emotions and quality of life. Stress-related symptoms decreased and the attribution style was found to be less depressive. Participants achieved significantly higher levels of functioning at 2 months which increased significantly more at 12 months. The majority of the measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Spouses of the participants also confirm the found effects.

DISCUSSION AND CONCLUSION

Evaluation of the BAP gives evidence to conclude that this program leads to the theoretically expected long-term effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. Two and 12 months after the 3-day program, they are more capable of self-management in coping with stress and psychosomatic symptoms.

PRACTICE IMPLICATIONS

This article sheds new light on the difficulties that individuals with psychosomatic symptoms and their professional interventionists encounter when attempting to manage the chronicity of the problems. By paying more attention to learning self-management by increasing body awareness and self-efficacy, patient educators may be able to increase their effectiveness.

The self-reported health condition of women after their participation in a stress management programme: a pilot study

From a public health perspective, it is important to develop effective measures to deal with stress which are based on the individual's participation, such as stress management provided in group sessions. Therefore, the aim of the present study was to compare and evaluate the self-reported health condition of women in terms of their general symptoms, stress and sense of coherence (SOC) after participation in a stress management programme. The intervention, which had a modified crossover design and involved 40 women divided into two groups (G1 and G2), comprised eight meetings, the content of which was both theoretical and practical, and included information about stress, stress management, massage and mental training. A questionnaire was filled in on three occasions: before and after the intervention (8 weeks later), and after another 8 weeks (16 weeks later). The questionnaire contained 60 items comprising background factors, general symptoms, stress and SOC. No significant differences existed between the groups at baseline. In favour of the intervention, significant differences were found between the groups with regard to fewer general symptoms (P = 0.035) as well as a tendency to stress reduction (P = 0.060). A comparison within groups showed that both groups had a significant reduction in symptoms after the intervention (G1, P = 0.002; and G2, P = 0.003) and in reduced stress (both P = 0.001). After a further 8 weeks, both groups still showed significantly fewer general symptoms and reduced stress, as well as significant improvements with regard to SOC (G1, P = 0.012; and G2, P = 0.026). These findings indicate that the combination of mental training and massage in this stress management programme had a positive influence on the women's health condition. The pilot study design could be used in a full-scale study with randomised groups.

The short-term effects of a body awareness program: better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms

A three-day residential Body Awareness Program (BAP) was developed to teach people with Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The short-term effects of the program for people with CAPS are presented in this study. The design is a non-control group design with pre- and post-measures (2 months after the program). The sample for this paper was formed by 187 participants. The mean age is 42.3 (S.D. = 8.9), and 57% is female. The results showed decreased stress-related symptoms, increased quality of life, increased self-efficacy, less depressive attribution style, more expression of emotions, and a positive change of lifestyle. Most of these measured changes can be interpreted as clinically relevant outcomes with medium-to-large effect sizes. Personal pre-training goals were attained by 85% of the participants. Spouses also confirmed the found effects. Evaluation of the BAP gives enough evidence to conclude that this program leads to positive effects in CAPS. Participants react more adequately to disturbances between daily workload and the capacity to deal with this load. They are more capable of self-management in coping with stress and psychosomatic symptoms. Conclusions are drawn about the prevention by early interventions for patients with a-specific physical symptoms.

Predictors of postconcussion symptom complex in community dwelling male veterans

The presence of a persistent postconcussion symptom complex (PPCSC) was examined in a non-referred sample of male veterans with a history of mild head injury and a comparison group without a history of head injury. Hierarchical logistic regression procedures were used to determine possible predictors of PPCSC using variables supported by previous research (i.e., preexisting psychiatric difficulties, demographic and social support variables, and history of an accidental injurious event). Although PPCSC was common in all groups (23% of the total sample), a significantly greater proportion of individuals in the mild head injury with loss of consciousness group (37.2%) had PPCSC compared with three other groups (head injury without loss of consciousness = 26.1%; motor vehicle accident without head injury = 23%; and control = 17.3%). However, the most salient predictors of PPCSC were early life psychiatric difficulties such as anxiety or depression, limited social support, lower intelligence, and interactions among these variables. The predictive value of loss of consciousness was significant, but low (1.4% of unique variance). The findings provide support for the premise that PPCSC is mediated in part by individual resilience, preexisting psychological status, and psychosocial support.

Randomized Controlled Trial of Internet-Based Stress Management

This study investigated the effects of an internet-based self-help stress management program with a randomized controlled design. Of 85 participants, 26% dropped out, leaving a final sample of 63 participants with 23 in the treatment group and 40 in the waiting list control group. Treatment included applied relaxation, problem solving, time management and cognitive restructuring. All information and treatment interventions were provided via the internet. Results were evaluated with the Perceived Stress Scale and the Hospital Anxiety and Depression Scale. Improvements were seen in both groups, with greater improvements in the self-help treatment group. It is concluded that the internet can be used to provide stress management techniques and result in stress relief. However, spontaneous improvement, differential dropout rate and compliance need to be monitored in future studies.

Somatization and symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic

The authors assessed data from 1,148 outpatients in a 10-week medical symptom reduction program to determine the effectiveness of a behavioral medicine intervention among somatizing patients. The program included instruction in the relaxation response, cognitive restructuring, nutrition, and exercise. Before and after the intervention, the patients were evaluated on the Symptom Checklist-90 Revised (SCL-90R), the Medical Symptom Checklist, and the Stress Perception Scale. They were divided into high- and low-somatizing groups on the basis of the pretreatment SCL-90R somatization scale. At the end of the program, physical and psychological symptoms on the Medical Symptom Checklist and the SCL-90R were significantly reduced in both groups, with the reductions greater in the high-somatizing group. Improvements in stress perception were about the same in both groups, but the absence of an untreated control group precluded estimates of how much the improvements resulted from the behavioral medicine intervention and how much from natural healing over time.

Depression and education as predicting factors for completion of a behavioral medicine intervention in a mind/body medicine clinic

The authors compared characteristics of 1,012 outpatients completing a 10-week behavioral medicine intervention with 300 outpatients who dropped out. They administered the Symptom Checklist-90 Revised (SCL-90R) before and after the program. Patients who completed the treatment, compared with dropouts, tended to be more highly educated, married, and gainfully employed. Their pretreatment scores on the SCL-90R were significantly lower than those of the dropouts on somatization, depression, and obsessive-compulsive scales and on the global severity index. Multiple logistic regression analysis indicated that lower depression and higher education marked the group who completed the intervention in contrast to the dropouts. After the intervention, all of the SCL-90R scores were significantly lower among patients who completed the treatment. Pre- to postintervention score changes were not significantly associated with the number of sessions attended. The findings suggest that the intervention had salutary effects in patients with mind/body distress and that its effectiveness was not diminished by a few absences. Depressed or less educated patients might benefit from preparatory interventions or from a modified approach to their treatment.