Too stressed to de-stress? The experience of work stress and recovery among attorneys during the COVID-19 pandemic

It is well-established that legal professionals experience high stress and often high rates of associated health problems. Much less is known about attitudes and behaviours around stress prevention in this occupation. Our study examined views of stress and recovery among 131 U.S. attorneys. In open-ended data, attorneys commonly expressed that their job is very demanding, and it impacts their health. Many respondents felt it was important to manage their stress but had difficulty doing so. Quantitative analyses showed that attitudes about stress (stress-related comparisons, viewing stress as achievement, stress-related impression management, and stigma around stress concerns) demonstrated several significant relationships with perceived stress, recovery experiences, remorse for relaxation, and work-family conflict. Our findings suggest that practical interventions to support the health and well-being of legal professionals may need to target the workload norms, as well as attitudes and beliefs about the normalness of high stress and insufficient recovery.

Modification in Psychophysiological Stress Parameters of Soldiers after an Integral Operative Training Prior to a Real Mission

(1) Background. Military personel could be defined as “Tactical Athletes”. However, experimental evidence about the effects of new HIIT trainings in comparison with traditional training schedules is lacking. The aim of this study was to experimentally analyze the modifications on psycho-physiological and performance response of soldiers after completing experimental integral operative training. (2) Methods. A total of 43 male subjects of a special unit force of the Spanish armed forces were randomly selected and assigned into the experimental and control groups assessed after training and after deploying in a real operation area. The experimental group underwent an integral operative pre-mission 6-week training (IOT), and the control group, the 6-week traditional training. (3) Results. HIIT-based integral operative training significantly improved combat performance (melee combat score) and the psychophysiological stress response, as measured by heart rate variability indexes. (4) Conclusion. This study provides experimental evidence supporting a new integral operative effective for improved autonomic regulation, reduced perceived stress, melee and close-quarter combat techniques, in addition to aerobic and anaerobic performance and lower body strength in comparison with the traditional training.

Pre-deployment programmes for building resilience in military and frontline emergency service personnel

BACKGROUND

Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post-traumatic stress and even post-traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these "pre-deployment resilience-building programmes".

OBJECTIVES

The objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention.

SEARCH METHODS

Studies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020.

SELECTION CRITERIA

Only studies that used a randomised controlled trial (RCT)/cluster-RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers.

DATA COLLECTION AND ANALYSIS

Studies that met the inclusion criteria were assembled. Data extracted included methods, participants' details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post-traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self-efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results.

MAIN RESULTS

All 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress-management programmes, mindfulness and relaxation programmes, neuropsychological-based programmes, and psychoeducational-informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self-efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre-specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life. Resilience Eight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness-based interventions. Symptoms of post-traumatic stress Our narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively. PTSD caseness Four studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology-orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post-traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress-management programme reported that, when baseline differences in rates of pre-deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group. Given the diversity of intervention designs and theoretical orientations used (which included stress-management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre-deployment programmes at reducing symptoms of post-traumatic stress and PTSD cannot be confidently offered.

AUTHORS' CONCLUSIONS

While a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience-building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post-traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre-/post-means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience-building programmes as a prophylactic approach to employment-related critical incident traumas.

Irrational beliefs, depression, anxiety, and stress among university students in Hong Kong

Academic stress, depression, and anxiety among university students has been a great concern globally. Literature review shows that university students may harbor irrational beliefs that could play a significant role in causing emotional disturbances. Objective: The aims of this study were to examine the relationship of irrational beliefs with emotional disturbances in university students, and the differences in irrational beliefs and depression, anxiety, and stress between students with different socio-demographic and academic backgrounds. Participants and method: Data was collected from 655 local Hong Kong university students. Results and conclusions: University students having higher levels of irrational beliefs were more likely to have depression, anxiety, and stress. Two-way MANOVA results showed that second-year students had more awfulizing beliefs than third-year students in the faculties of Engineering and Education. Results of ANOVA and the Independent Sample t-test revealed that male students, students from low income families, Law students, those pursuing 5-year programs, or those in the second year of study were likely to have more irrational beliefs. In addition, male students, medical students, those studying 5-year programs were found having significantly higher levels of depression, anxiety, and stress. Limitations and implications were discussed.

Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis

BACKGROUND

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

METHODS

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

RESULTS

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

CONCLUSION

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.

The role of place, people and perception in law student well-being

There is a growing body of international research examining psychological distress in law students. Generally, the studies have tended to be either very narrow, focussing on a single law school, or very broad, targeting all law students regardless of their institutional affiliation. This study adds to the existing literature by examining the levels of psychological distress of law students at two quite different law schools in Australia. An online survey was used to assess self-reported emotional well-being, university appraisal, university belongingness, perceptions of competitiveness and supportiveness, perceived sources of pressure, and motivations for studying law in 225 law students. Consistent with prior research, the data reflect lower levels of well-being in law student participants compared to the general public. However, the factors that appear to affect the students' well-being differed slightly between the two participant cohorts. For the law school that caters more to mature age and online students, the students' perception of their overall law school experience, belongingness, and support are important factors. Whereas for the law school that caters more to high achieving younger students, the competitiveness and perceived lack of support within the law school environment appear to have a greater influence on the students' self-reported well-being. In addition, across both participant cohorts, self-imposed pressure was notably high. Overall, the results of the study reported in this article provide valuable insights into the external and internal factors underpinning the well-established heightened levels of psychological distress in Australian law students.

Improving the professional competency of psychiatric nurses: Results of a stress inoculation training program

It is essential to conduct cognitive-behavioral interventions on nurses' professional competency. The present study aimed to evaluate the impact of a stress inoculation training (SIT) on professional competency of psychiatric nurses. This was an experimental study, in which 70 psychiatric nurses were allocated to two intervention and control groups (35 in each group) using cluster random design. A SIT program was conducted for the intervention group. Data were gathered by competency inventory for registered nurse (CIRN) before and one month after SIT. The participants in the intervention group reported higher scores on professional competency and its dimensions compared to those in the control group one month after SIT. The increased scores of professional competency and its dimensions after using the SIT implied the effectiveness of this method in enhancing the professional competences of psychiatric nurses. The higher efficiency of SIT can be determined by its application in diverse domains of medical professions.

A Meta-analysis of universal mental health prevention programs for higher education students

This meta-analysis investigated the effectiveness of universal mental health prevention programs for higher education students on a range of adjustment outcomes. A systematic literature search identified 103 controlled published and unpublished interventions involving college, graduate, or professional students. As hypothesized, skill-training programs that included a supervised practice component were significantly more effective overall (mean effect size = 0.45, confidence interval (CI) = 0.39 to 0.52) compared to skill-training programs without supervised practice (0.11, CI = -0.01 to 0.22) and psychoeducational (information-only) programs (0.13, CI = 0.06 to 0.21). When comparisons on specific outcomes were possible, skill-training programs including supervised practice were significantly more effective than the other two groups of programs in reducing symptoms of depression, anxiety, stress, and general psychological distress, and in improving social-emotional skills, self-perceptions, and academic behaviors and performance. The magnitude of effects achieved in several outcome areas is comparable to or higher than that reported in other reviews of universal programs, suggesting that skill-training programs for higher education students that incorporate supervised practice now join the ranks of other effective preventive mental health interventions. This review offers several recommendations to improve the experimental rigor of future research.

Current, Continuous, and Cumulative Trauma-Focused Cognitive Behavior Therapy: A New Model for Trauma Counseling

The current dominant focus on treating single past traumas rarely addresses current, ongoing, or continuous interpersonal, intergroup, and systemic traumas or their cumulative and proliferation dynamics. The goal of this paper is to close this gap by introducing an alternative model that addresses these trauma types. The model incorporates eight precognitive, cognitive, behavioral, and social interventions. The behavioral interventions are (1) prioritizing safety and (2) addressing threats through behavior skills training inclusive of regulating personal and group-based emotions. The precognitive components are (3) stimulating the will to live and positive dispositional qualities and (4) identity work. The cognitive components are (5) psychoeducation, (6) stress inoculation, and (7) trauma narration. The social intervention is (8) advocacy, social justice and reconnecting to social networks. We discuss the evidence for each component and provide a case example to illustrate the model's utility. We also discuss future directions for research and model development.

The Mindful Way Through the Semester: An Investigation of the Effectiveness of an Acceptance-Based Behavioral Therapy Program on Psychological Wellness in First-Year Students

First-year students in higher education deal with an increasing number of mental health issues. Cost-effective and time-efficient programs that ease transitions and reduce risk of depression are needed. To date, programs informed by both cognitive-behavioral and acceptance-based-behavioral therapy (ABBT) approaches have produced some positive outcomes, but methodological limitations limit their utility. The aim of the present study was to address some of these limitations, by developing and preliminary testing the efficacy of a one-session ABBT intervention with first-year undergraduates and first-year law students. Ninety-eight first-year students were randomly assigned to receive either a single-session 90-min ABBT workshop within their first month of school or to a waitlist control condition. Students who received the intervention reported significantly less depression and more acceptance. Moreover, increase in acceptance over the course of the semester was associated with reductions in depression. Implications of these findings for future interventions are discussed.

Interventions to reduce stress in university students: a review and meta-analysis

BACKGROUND

Recent research has revealed concerning rates of anxiety and depression among university students. Nevertheless, only a small percentage of these students receive treatment from university health services. Universities are thus challenged with instituting preventative programs that address student stress and reduce resultant anxiety and depression.

METHOD

A systematic review of the literature and meta-analysis was conducted to examine the effectiveness of interventions aimed at reducing stress in university students. Studies were eligible for inclusion if the assignment of study participants to experimental or control groups was by random allocation or parallel cohort design.

RESULTS

Retrieved studies represented a variety of intervention approaches with students in a broad range of programs and disciplines. Twenty-four studies, involving 1431 students were included in the meta-analysis. Cognitive, behavioral and mindfulness interventions were associated with decreased symptoms of anxiety. Secondary outcomes included lower levels of depression and cortisol.

LIMITATIONS

Included studies were limited to those published in peer reviewed journals. These studies over-represent interventions with female students in Western countries. Studies on some types of interventions such as psycho-educational and arts based interventions did not have sufficient data for inclusion in the meta-analysis.

CONCLUSION

This review provides evidence that cognitive, behavioral, and mindfulness interventions are effective in reducing stress in university students. Universities are encouraged to make such programs widely available to students. In addition however, future work should focus on developing stress reduction programs that attract male students and address their needs.

An evaluative review of outcome research on universal mental health promotion and prevention programs for higher education students

OBJECTIVE

This review is the first large-scale attempt to evaluate the effectiveness of universal promotion and prevention programs for higher education students on a range of adjustment outcomes.

PARTICIPANTS/METHODS

The current review examined 83 controlled interventions involving college, graduate, and professional students, with a focus on 3 main outcomes: social and emotional skills, self-perceptions, and emotional distress.

RESULTS/CONCLUSIONS

Skill-oriented programs that included supervised practice demonstrated the strongest benefits, thus showing promise as a successful mental health promotion and preventive intervention. In comparing different intervention strategies, mindfulness training and cognitive-behavioral techniques appear to be the most effective. Furthermore, interventions conducted as a class appear to be effective, suggesting the potential for exposing higher education students to skill training through routine curricula offerings. This review offers recommendations for improving the experimental rigor of future research, and implications for enhancing campus services to optimize student success in psychosocial--and thus ultimately academic--domains.

Comparison of Eye Movement Desensitization and Reprocessing and Biofeedback/Stress Inoculation Training in Treating Test Anxiety

Eye movement desensitization and reprocessing (EMDR) and Biofeedback/Stress Inoculation Training (B/SIT) treatment and no treatment (NT) were compared in reducing test anxiety. Thirty college students with high test anxiety were randomly assigned to each condition. Pre-post assessments were conducted using the Test Anxiety Inventory (TAI), State-Trait Anxiety Inventory (STAI), Rational Behavior Inventory (RBI), and Autonomic Perception Questionnaire (APQ). Treatment therapists were licensed professionals with at least 2 years experience in their respective modality. Statistical analysis using a two-way analysis of variance with repeated measures found significant interactions between time (pre-post) and treatment conditions for all measures except the RBI. Post hoc Newman–Keuls analyses were conducted on the change scores, indicating that both EMDR and B/SIT significantly reduced test anxiety. EMDR generally outperformed B/SIT.

The effects of a stress inoculation training program for civil servants in Japan: a pilot study of a non-randomized controlled trial

The aim of this study was to examine the effects of a stress inoculation training program for civil servants through a non-randomized trial. We divided 140 civil servants into two groups (an intervention group and a waiting list control group), and carried out three sessions with the intervention group at intervals of four weeks. The sessions included lectures on responses to stress and coping skills, problem-solving training, group discussions and self-monitoring. Data from 65 subjects in the intervention group and 63 subjects in the waiting list group were analyzed using two-way analysis of covariance (ANCOVA). The intervention group showed statistically significant development of problem-solving skills and positive cognition, with a significant effect remaining one month after the intervention. The effect sizes in the intervention group showed a small-to-medium change in problem-solving coping and small changes in positive cognitive coping. However, no interventional effects were seen in terms of response to stress and health competence. As the number of existing studies on job stress management for workers is limited, further research in this field is necessary, including examination of the frequency and methods of intervention sessions, the effects of intervention by gender, etc.

Effect of Brief Behavioral Intervention Program in Managing Stress in Medical Students from Two Southern California Universities

The study aims to assess 1) the prevalence of stress among a group of third and fourth year medical students (MS) from two Southern California universities and 2) the effect of a brief behavioral intervention program (BBIP) on stress management among the students instructed on stress intervention techniques. The stress level was determined by using the General Well Being Scale (GWBS), a self-report questionnaire designed by the National Center for Health Statistics.1 The stress testing was done prior to the psycho-educational lecture on stress. The prevalence of stress and the variation of stress based on gender, academic year (third vs. fourth year) and time of testing (beginning vs. end of rotation) was measured in 104 medical students. To assess the effect of the psycho-educational lectures on stress, the last 32 students who rotated in our service had the pre-test and the lecture at the beginning of the rotation and the post-test at the end of the rotation. Among the medical students studied, 53/104 (51%) reported stress; among this group, 20/53 (37.7%) reported severe stress or distress. The prevalence of stress in this group of students was not significantly different if the stress level was measured at the beginning (46.9%) vs. the end of the rotation (52.8%, p = 0.57). The total stress score was lower (suggesting higher stress) in the fourth vs. third year MS (69.7+/-16.3 vs. 73.2+/-12.7, p=0.2), and in female students vs. male students (69.9+/-14.5 vs. 73.7+/-13.8, p=0.17). Female students, when compared to their male counterparts, had a lower anxiety score (12.2+/-4.4 vs. 15.4+/-4.3, p p0.005), consistent with higher anxiety level, since the polarity for the anxiety questions is reversed. Among the students who had both a pre and post-test (N=32) after the BBIP (deep diaphragmatic breathing, self-control relaxation, walking meditation), the reported stress decreased from 46.9 % (15/32) to 21.9% (7/25) (p 0.05). In addition, scores indicated that the brief behavioral intervention program significantly decreased the anxiety level and improved the positive well-being. Our study showed that stress is very prevalent among the medical students tested, affecting 51% of the students. Among those who reported stress, 37.7% reported distress. Female students reported a higher level of anxiety compared to their male colleagues. Following the implementation of a brief behavioral program, the prevalence of stress in this group of students decreased by 46.7 %. This was associated with a decrease in the reported anxiety and an increase in the positive well-being. Since stress is very prevalent among medical students, increased awareness of stress and early intervention may prevent burnout, improve job satisfaction and ultimately improve health care delivery.