Hooking the Self Onto the Past: How Positive Autobiographical Memory Retrieval Benefits People With Social Anxiety

Do people with social anxiety (SA) benefit from positive memory retrieval that heightens self-relevant meaning? In this preregistered study, an analog sample of 255 participants with self-reported clinically significant symptoms of SA were randomly assigned to retrieve and process a positive social-autobiographical memory by focusing on either its self-relevant meaning (deep processing) or its perceptual features (superficial processing). Participants were then socially excluded and instructed to reimagine their positive memory. Analyses revealed that participants assigned to the deep processing condition experienced significantly greater improvements than participants in the superficial processing condition in positive affect, social safeness, and positive beliefs about others during initial memory retrieval and in negative and positive beliefs about the self following memory reactivation during recovery from exclusion. These novel findings highlight the potential utility of memory-based interventions for SA that work by "hooking" self-meaning onto recollections of positive interpersonal experiences that elicit feelings of social acceptance.

Stress Inoculation in Police Officers Using Virtual Reality: A Controlled Study

Policing is a highly demanding and stressful profession. Virtual reality (VR) has emerged as a promising tool for enhancing stress management programs, including for police officers. The use of VR in combination with biosensors enables measurement of psychophysiological responses such as peripheral temperature (PT) and skin conductance level (SCL). This study investigated the psychophysiological responses of police officers exposed to a VR scenario simulating a car accident. The study included a total of 63 police officers from the Public Security Police. Participants were divided into three groups based on their police divisions: the Investigation Brigade of Traffic Accidents, the Traffic Surveillance Squad (TSS), and a control group from the Lisbon Metropolitan Command. The results indicated that the VR environment effectively induced psychophysiological arousal, particularly in less experienced officers (TSS), that is, there were significant group differences in mean SCL and PT, showing this group with higher SCL and lower PT during the VR exposure. These results support the potential of VR as a stress inoculation strategy for training police officers and highlight the complex nature of stress responses that are influenced by individual factors and psychopathology.

Stress and sport performance: a PNEI multidisciplinary approach

Stress control is essential for avoiding a state of anxiety in sport competitions, as this state may have negative effects on other psychological variables of athletes, decreasing their self-confidence and harming their attentional control. In the present contribution a distress intervention model developed from a PNEI perspective will be sketched out. Our theoretical-methodological proposal consists of the definition of an integrated protocol of psycho-biological assessment and intervention on the allostatic load and on the levels of distress/eustress detectable in the sport environment, in relation to the person's health/well-being condition and the impact of this condition on the quality of sport performance. This paradigm has the potential to explore both the psychological dimension of stress management and the psycho-educational and psycho-physical dimension, according to a truly integrated approach to the athlete's health and psychophysical well-being. Its multidisciplinary nature requires close cooperation between different professional figures, such as the mental coach, psychologist, nutritionist, osteopath, and physiotherapist, as well as biologists, physicians and kinesiologists, both in planning and in implementation and monitoring at all stages. The potential impact of the model on sport performance will be deeply discussed.

Systematic Adaptation of the JOBS Program for Use with Adults with Visual Impairments

Introduction

The purpose of this study was to use a systematic process to adapt the JOBS program, an evidence-based job search intervention, for use with unemployed adults with visual impairments and implementation via videoconferencing.

Method

The Planned Adaptation approach, an established framework for adapting evidence-based practices, guided the adaptations. The four-step Planned Adaptation process comprised examining the program's theory of change, identifying population differences, adapting the program content, and adapting the evaluation strategy.

Results

The original JOBS program has five key components, two critical causal mechanisms, and several potential moderators. Differences between the original and new target populations include needs, experiences, and employment barriers. Adaptations included activity changes, new processes to enhance outcomes, and changes to the implementation procedures. The evaluation plan for the adapted program includes a pilot study to test the updated activities, processes, and procedures, followed by an efficacy study to assess outcomes.

Discussion

The JOBS program was a strong candidate for systematic adaptation due to its theoretical foundation, thorough documentation, and established active ingredients. Stakeholder input increased the relevance and feasibility of the adaptations. Future research is needed to evaluate the adapted program and its outcomes.

Application for Practitioners

After completion of the evaluation plan, the new JOBS adaptation will be available for practitioners to use with adults with visual impairments. Practitioners may find the Planned Adaptation approach useful for adapting other programs to better meet the needs of the population they serve.

Sense of community and anxiety during a global pandemic: The role of world assumptions in couples

The current study was designed to examine the role of sense of community at the outset of COVID-19 pandemic-related shutdowns as a longitudinal predictor of anxiety in couples. We also sought to investigate whether self-reported changes in perceived levels of benevolent world assumptions would serve as an indirect conveyor of this association. Data were collected at three time points during the first 6-months of pandemic shutdowns in the US and the current study utilized responses from 535 heterosexual cisgender couples. Mplus was used to path model lagged associations between sense of community at wave 1, world assumptions at waves 1 and 2 and anxiety symptoms at all three waves for both partners. Findings demonstrated direct effects within men and women with a stronger sense of community at wave 1 relating to lower anxiety at waves 2, and within women this effect extended to wave 3. Further, we found that a higher sense of community at wave 1 in men associated with perceived strengthening of benevolent world assumptions at the next wave for men and women. We noted that perceived strengthened benevolent world assumptions at wave 2 associated with lower anxiety at wave 3 within men. Indirect effects showed that a stronger sense of community at wave 1 associated with lower anxiety at wave 3 within men.

Stress Impact and Care for COVID-19: Pilot Education and Support Course Decreases Burnout Among Nursing Students

BACKGROUND

Nurses and nursing students have been at the forefront of the fight against COVID-19, often working in conditions that produce stress injuries and burnout. Early recognition and mitigation of stress and emotional trauma help prevent burnout.

AIMS

To evaluate the effectiveness of an online 8-hour stress awareness course and associated 1-hour support group in reducing stress and burnout among nursing students.

METHODS

We conducted a program evaluation for an online stress awareness pilot course offered to nursing students. The course, and associated support groups led by trained psychiatric mental health nurse practitioner students, included a common language for talking about stress, screening tools for recognizing stress injuries, and strategies for improving self-care. Students completed pre- and post-course surveys. Outcome measures included changes on course learning objectives, level of burnout, health-related locus of control, and experiences of stress and coping.

RESULTS

Nursing students (n = 360) enrolled in the course, and 224 (62%) completed pre- and post-course surveys. Sixty percent rated the course excellent or very good. Depression Anxiety and Stress Scales and Impact of Event Scale Revised scores were within established normal ranges. There was a significant increase in all nine course learning objectives (p < .001) and decreased signs of stress (p < .001). Students' level of burnout decreased by odds ratio = 0.58 (95% CI: [0.4, 0.9], p < .006).

CONCLUSIONS

Nursing leaders can use psychoeducational strategies to mitigate the impact of stress, build confidence, and support nursing students entering the workforce during these unprecedented times.

School principals' mental health and well-being under threat: A longitudinal analysis of workplace demands, resources, burnout, and well-being

Schools are critical organisational settings, and school principals face extreme stress levels. However, there are few large-scale, longitudinal studies of demands and resources that drive principals' health and well-being. Using the Job Demands-Resources (JD-R) framework, we evaluated longitudinal reciprocal effects over 3 years relating to job demands, job resources (resilience), job-related outcomes (burnout and job satisfaction), and personal outcomes (happiness and physical health) for a nationally representative sample of 3683 Australian school principals. Prior demands and resources led to small changes in subsequent outcomes, beneficial effects of resources, and adverse effects of demands, particularly for job-related outcomes. Furthermore, we also found reverse-reciprocal effects, prior outcomes (burnout and job satisfaction) influencing subsequent job characteristics. However, in response to substantively and theoretically important research questions, we found no support for Yerkes-Dodson Law (nonlinear effects of demands) or Nietzsche effects and inoculation effects (that which does not kill you, makes you stronger; manageable levels of demands build resilience). Relating our study to new and evolving issues in JD-R research, we offer limitations of our research-and JD-R theory and research more generally-and directions for further research in this essentially unstudied application of JD-R to school principals' mental health and well-being.

Tailored support for preparing employees with cancer to return to work: Recognition and gaining new insights in an open atmosphere

BACKGROUND

A considerable number of cancer survivors face difficulties in returning to work (RTW). More insight is needed on how to support employees shortly after cancer treatment and help them make the transition back to work.

OBJECTIVE

To gain an in-depth understanding of how and under what circumstances a Cancer & Work Support (CWS) program, which assists sick-listed employees with cancer in preparing their RTW, works.

METHODS

A qualitative design was used, inspired by Grounded Theory and Realist Evaluation components. Semi-structured interviews were conducted with RTW professionals (N = 8) and employees with cancer (N = 14). Interview themes covered experiences with CWS, active elements, and impeding and facilitating factors. Interviews were transcribed and analyzed by multiple researchers for contextual factors, active mechanisms, and the outcomes experienced.

RESULTS

Respondents experienced the support as human centered, identifying two characteristics: 'Involvement' ('how' the support was offered), and 'Approach' ('what' was offered). Four themes were perceived as important active elements: 1) open connection and communication, 2) recognition and attention, 3) guiding awareness and reflection, and 4) providing strategies for coping with the situation. Variation in the experiences and RTW outcomes, appeared to be related to the personal, medical and environmental context.

CONCLUSION

Both professionals and employees really appreciated the CWS because it contributed to RTW after cancer. This research shows that not only 'what' RTW professionals do, but also 'how' they do it, is important for meaningful RTW support. A good relationship in an open and understanding atmosphere can contribute to the receptiveness (of employees) for cancer support.

Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy

Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.

It's worth the trouble: Stressor exposure is related to increased cognitive reappraisal ability

Recent theories propose moderate (compared to high or no) stressor exposure to promote emotion regulation capacities. More precisely, stressful situations are expected to serve as practice opportunities for cognitive reappraisal (CR), that is, the reinterpretation of a situation to alter its emotional impact. Accordingly, in this study, we expect an inverted U-shaped relationship between exposure to daily hassles and performance in a CR task, that is, best reappraisal ability in individuals with a history of moderate stressor exposure. Participants (N = 165) reported the number of daily hassles during the last week as indicator of stressor exposure and completed the Script-based Reappraisal Test (SRT). In the SRT, participants are presented with fear-eliciting scripts and instructed to either downregulate negative affect via reappraisal (reappraisal-trials) or react naturally (control-trials). Two measures indicate CR ability: (1) reappraisal effectiveness, that is, the difference between affective ratings in reappraisal- and control-trials and (2) reappraisal inventiveness, that is, the number of valid and categorically different reappraisal thoughts. Multiple regression analyses revealed positive linear, but not quadratic, relationships of exposure to daily hassles and both indicators of CR ability. Potential benefits of stressor exposure for emotion regulation processes are discussed.

Challenge Demands and Resilience

Abstract. This study investigates the relationship of challenge demands (i. e., time pressure, job complexity) on employee resilience. We provide insights into potential pathways (i. e., learning, cognitive irritation) for how challenge stressors influence employee resilience. We employed a two-wave, time-lagged design to examine the influences of challenge stressors and explanatory pathways on employee resilience 2 months later. The data from 359 participants (52.1 % male) were analyzed using a Bayesian time-lagged path model. Results indicate that time pressure and job complexity are negatively related to employee resilience via cognitive irritation. In contrast, we found a positive, indirect effect of job complexity and resilience via learning. This paper contributes to existing employee resilience and stress research by highlighting the roles of learning and cognitive irritation to explain the relationships of challenge stressors on employee resilience. Moreover, the results provide us with a deeper understanding of which factors foster or drain employee resilience.

Emotions in simulation-based education: friends or foes of learning?

In simulation-based education, there is growing interest in the effects of emotions on learning from simulation sessions. The perception that emotions have an important impact on performance and learning is supported by the literature. Emotions are pervasive: at any given moment, individuals are in one emotional state or another. Emotions are also powerful: they guide ongoing cognitive processes in order to direct attention, memory and judgment towards addressing the stimulus that triggers the emotion. This occurs in a predictable way. The purpose of this paper is to present a narrative overview of the research on emotions, cognitive processes and learning, in order to inform the simulation community of the potential role of emotions during simulation-based education.

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.

Perception during use of force and the likelihood of firing upon an unarmed person

Stress can impact perception, especially during use-of-force. Research efforts can thus advance both theory and practice by examining how perception during use-of-force might drive behavior. The current study explored the relationship between perceptual judgments and performance during novel close-combat training. Analyses included perceptual judgments from close-combat assessments conducted pre-training and post-training that required realistic use-of-force decisions in addition to an artificially construed stress-inoculation event used as a training exercise. Participants demonstrated significant reductions in situational awareness while under direct fire, which correlated to increased physiological stress. The initial likelihood of firing upon an unarmed person predicted the perceptual shortcomings of later stress-inoculation training. Subsequently, likelihood of firing upon an unarmed person was reduced following the stress-inoculation training. These preliminary findings have several implications for low or zero-cost solutions that might help trainers identify individuals who are underprepared for field responsibilities.

Virtual reality for the enhancement of emotion regulation

In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.

A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel

The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.

24 h-Heart Rate Variability as a Communication Tool for a Personalized Psychosomatic Consultation in Occupational Health

New tools for non-specific primary prevention strategies covering somatic and mental health in occupational medicine are urgently needed. Heart rate variability (HRV) reflects the capacity of the body to adapt to environmental challenges and of the mind to regulate emotions. Hence, a 24 h-measurement of HRV offers a unique possibility to quantify the interaction between situation-specific emotional regulation within a specific psychosocial environment and physiological state, thereby increasing self-perception and inducing motivation to change behavior. The focus of the present study represents such a 24 h-measurement of HRV and its presentation as a comprehensive graph including protocol situations of the client. A special training program for occupational health physicians and questionnaires for clients were developed and administered. The article reports the first data of the study "healthy leadership and work - body signals for managers and employees", an investigator-initiated, interventional, single-arm, open (non-blinded), multicenter, national trial with 168 participants. They reported a significantly improved perception of their bodily needs after the consultation (from Median = 7, interquartile range 5-8 to Median = 8, interquartile range 7-9; scale range from 1 to 10; p < 0.001, Wilcoxon rank test; effect size 0.49). The 16 occupational health physicians stated that the measurement of HRV was very well suited to enter into dialog with the managers and was feasible to show interactions between situations, thoughts, feelings, and bodily reactions. Taken together, we show that a 24 h-HRV-measurement can be a feasible and effective approach for holistic, psychosomatic primary prevention in occupational medicine. We discuss possible mechanisms for improving the individual health via the consultation, containing mindset and improved ANS activity.

Stress as tool or toxin: physiologic markers and subjective report in neonatal simulation

BACKGROUND

Cognitive appraisal of stress can influence performance. Increased awareness could facilitate titration to optimal stress levels. This study's primary aim was to investigate whether physiologic variables change with increasingly stressful simulations. Secondary aims include effect of stress on procedural competency and whether individuals recognize their experienced stress.

METHODS

This was a single-center, mixed-method, simulation-based study. Participants completed three scenarios requiring resuscitation under increasingly stressful conditions. Wearable biometric devices recorded physiologic parameters. Subjects completed surveys assessing knowledge and perceived stress. Intubation success or failure was noted. Heart rate variability (HRV) analysis was used as a proxy for stress.

RESULTS

Twelve participants completed the study. Survey analysis revealed progressive amplification of endorsement of affective states associated with stress. Median low frequency (LF)/high frequency (HF) ratio from scenario 1 (median = 2.29, IQR = 1.97, 3.91) was significantly lower than scenario 2 (median = 4.7, IQR = 2.32, 8.35, p = 0.04) and scenario 3 (median = 4.63, IQR = 2.2, 7.43, p = 0.04). Changes in HRV were noted during all scenarios irrespective of subjective self-assessment of stress. Procedural proficiency suffered during more stressful scenarios.

CONCLUSIONS

This study demonstrates alterations in subjective assessment and objective physiologic data in simulations with increasing stress. HRV is useful as a proxy for stress response and does not always correlate with perception.

Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial

Objective: Recent trials have demonstrated efficacy of cognitive behavioral therapy (CBT) in medicated adults with ADHD. Efficacy of CBT in unmedicated versus medicated adults remains mostly unknown. We evaluated the effects of group CBT alone versus combined with medication on ADHD symptoms and functional outcomes in adult patients. Method: Eighty-eight adults with ADHD received 12 manualized group CBT sessions, accompanied by individual coaching, either without (n = 46) or with (n = 42) medication. Treatment effects were evaluated following treatment and 3-month and 6-month follow-up using un-blinded self-report and observer ratings. Results: CBT + medication resulted in greater improvements than CBT alone in ADHD symptoms, organizational skills, and self-esteem. Group differences diminished over follow-up, as the CBT alone group continued improving, while the combined group maintained the gains. Conclusion: CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.

Reliability and Validity of the Vicarious Trauma Organizational Readiness Guide (VT-ORG)

The Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment of an organization's readiness to address vicarious trauma (VT), which is exposure to the traumatic experiences of people served. This study reports on the psychometric properties of the VT-ORG. Employees of first responder agencies (e.g., law enforcement, fire, emergency services) and victim assistance agencies are at a high risk for vicarious traumatization, which can lead to PTSD, substance use, and suicidal ideation, among other negative impacts. Organizations that do not address VT may see such effects as employee turnover, reduced efficiency, and negative work environments. The VT-ORG is an assessment tool designed to help organizations complete the first step of organizational change-conducting a needs assessment. Study participants were 3,018 employees across 13 first responder and victim assistance agencies who completed the 67-item VT-ORG and additional measures for evaluation of its validity and reliability. The VT-ORG was found to have excellent internal consistency (Cronbach's α = .98). A structural equation model demonstrated that the subscales of the VT-ORG predicted criterion measures of turnover intention, compassion satisfaction, and organizational resilience, with an overall model fit of CFI = .99, RMSEA = .053. This study found the VT-ORG to be a reliable and valid assessment of organizational responses to vicarious trauma.

Truck attack: Fear of ISIS and reminder of truck attacks in Europe as associated with psychological distress and PTSD symptoms

Following an ISIS attack, the present study examined the association between psychological distress and severe stress symptoms with vulnerability variables: i.e. Physical proximity to the site of the terror attack, Associative memory of prior events, Danger perception and ISIS anxiety. Using an online survey, 397 adult participants were recruited, Seventy-two hours after an ISIS terror attack, and filled out Psychological distress Patient Health Questionnaire 4 and severe stress symptoms questionnaire as well as physical proximity to the site of the terror attack, associative memory of prior events, danger perception and ISIS anxiety scales. Physical proximity to the site of the terror attack and ISIS anxiety were found to be significantly associated of both psychological distress and severe stress symptoms. Regarding danger perception, only danger perception of terror attacks was associated with both psychological distress and with severe stress symptoms. Lastly, whereas being reminded of the 2014 Jerusalem tractor attack (tapping to association via location) was neither associated with psychological distress nor with severe stress symptom, the reminder of the truck attack in Berlin (tapping into association by recency and similarity) was associated with psychological distress but not with severe stress symptoms. The importance of the findings is discussed.

How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening

BACKGROUND

Exposure to demands is normally considered to drain resources and threaten wellbeing. However, studies have indicated a resilience-strengthening role for stressors.

OBJECTIVES

This paper introduces a unifying model, including five testable hypotheses regarding how resilience can be strengthened progressively via exposure to life-stressors.

METHODS

We review and synthesize relevant scholarship that underpins the Systematic Self-Reflection model of resilience-strengthening.

RESULTS

The model highlights the importance of a specific meta-cognitive skill (self-reflection on one's initial stressor response) as a mechanism for strengthening resilience. The Systematic Self-Reflection model uniquely proposes five self-reflective practices critical in the on-going adaptation of three resilient capacities: (1) coping resources, (2) usage of coping and emotional regulatory repertoire, and (3) resilient beliefs. The self-reflective process is proposed to strengthen a person's resilience by developing insight into their already-present capacities, the limitations of these capacities, and by stimulating the search for person-driven alternative approaches.

CONCLUSION

This model extends the existing scholarship by proposing how the experience of stressors and adversity may have resilience-strengthening opportunities. The implication of this model is that engaging with stressors can have positive consequences for longer-term healthy emotional development if scaffolded in adaptive reflective practices.

Teaching Slaughter: Mapping Changes in Emotions in Veterinary Students during Training in Humane Slaughter

As part of their training, Dutch veterinary students learn how to carry out the humane slaughter of livestock, which many students consider emotionally challenging. The aims of this study were to plot changes in self-reported emotions in veterinary students at different time points during an educational program on humane slaughter using emotion cards and to assess the change in reported emotions after adding a video and a short period of self-reflection to the program. Emotions were mapped in five groups of students at the beginning, middle, and end of the program by asking them to select from 40 cards depicting emotions in photo and text. Then two changes were made to the course program: a video of an expert slaughterman stunning and bleeding a bovine was shown, and the students were requested to spend 2 minutes picturing themselves carrying out the same procedures. To evaluate the effect of these improvements to the course, the following five groups of students were asked in the same way to indicate their emotions at the same three time points. Adding the video and short period of self-reflection did not change the emotions reported by students. Our results indicate that instruction in humane slaughter techniques involves a significant mental challenge for students. The use of emotion cards by teachers could provide useful insights into emotional aspects of the more challenging programs for students.

[Cluster-randomized, controlled evaluation of stress management training for high school students]

Cluster-randomized, controlled evaluation of stress management training for high school students Abstract.

OBJECTIVE

One fifth of German adolescents show elevated levels of mental health problems. The development of mental health problems is often closely related to experiences of stress. Hence, fostering competences in coping with stress offers an approach for counteracting the development of psychological problems. The aim of the present study is to test a stress management training of 3 x 90 minutes in a German high school, 11^th grade.

METHOD

A cluster-randomized, controlled design was used. The primary outcome was stress. Secondary outcome criteria were knowledge about stress, coping behaviour, emotional and behavioural problems as well as health-related quality of life. Students from twenty-one courses from four schools participated in the study.

RESULTS

The sample comprised 286 students (58.25 % girls; mean age 16.58 ± 0.65). Changes in stress levels from pre- to post-evaluation did not differ significantly between intervention and control group. With regard to secondary criteria, apart from a significant increase in knowledge no further effects were observed. An exploratory moderation analysis hints at a positive association between baseline levels of stress and effectiveness of the training.

CONCLUSIONS

The results question whether the universal application of a brief cognitive behavioural intervention is appropriate to prevent stress in this population. Future research should, inter alia, investigate the potential of indicated prevention regarding stress.

Coping strategies as mediators in relation to resilience and posttraumatic stress disorder

BACKGROUND

Resilience has been shown to protect against the development of posttraumatic stress disorder (PTSD) in the aftermath of trauma. However, it remains unclear how coping strategies influence resilience and PTSD development in the acute aftermath of trauma. The current prospective, longitudinal study investigated the relationship between resilience, coping strategies, and the development of chronic PTSD symptoms.

METHODS

A sample of patients was recruited from an emergency department following a Criterion A trauma. Follow-up assessments were completed at 1-, 3-, and 6-months post-trauma to assess PTSD symptom development (N = 164).

RESULTS

Resilience at 1-month positively correlated with the majority of active coping strategies (all p < .05) and negatively correlated with the majority of avoidant coping strategies (all p < .05), as well as future PTSD symptoms (p < .001). Additionally, all avoidant coping strategies, including social withdrawal, positively correlated with future PTSD symptoms (all p < .01). After controlling for demographic and clinical variables, social withdrawal at 3-months fully mediated the relationship between resilience at 1-month and PTSD symptoms at 6-months.

LIMITATIONS

Limitations include participant drop out and the conceptual overlap between avoidant coping and PTSD.

CONCLUSIONS

These data suggest that resilience and social withdrawal may be possible therapeutic targets for mitigating the development of chronic PTSD in the aftermath of trauma.

The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial

BACKGROUND

Active 'hands-on' participation in the 'hot-seat' during immersive simulation-based training (SBT) induces stress for participants, which is believed to be necessary to improve performance. We hypothesized that observers of SBT can subsequently achieve an equivalent level of non-technical performance as 'hot-seat' participants despite experiencing lower stress.

METHODS

We randomized 37 anaesthesia trainees into two groups to undergo three consecutive SBT scenarios. Eighteen 'hot-seat' trainees actively participated in all three scenarios, and 19 'observer' trainees were directed to observe the first two scenarios and participated in the 'hot-seat' only in scenario 3. Salivary cortisol (SC) was measured at four time points during each scenario. Primary endpoint for stress response was the change in SC (ΔSC) from baseline. Performance was measured using the Anaesthetist's Non-Technical Skills (ANTS) Score.

RESULTS

Mean SC increased in all participants whenever they were in the 'hot-seat' role, but not when in the observer role. Hot-seat ΔSC (mcg/dL) for scenarios 1, 2, and 3 were 0.122 (p = 0.001), 0.074 (p = 0.047), and 0.085 (p = 0.023), respectively. Observers ΔSC (mcg/dL) for scenarios 1, 2, and 3 were -0.062 (p = 0.091), 0.010 (p = 0.780), and 0.144 (p = 0.001), respectively. Mean ANTS scores were equivalent between the 'hot-seat' (40.0) and 'observer' (39.4) groups in scenario 3 (p = 0.733).

CONCLUSIONS

Observers of SBT achieved an equivalent level of non-technical performance, while experiencing lower stress than trainees repeatedly trained in the 'hot-seat'. Our findings suggest that directed observers may benefit from immersive SBT even without repeated 'hands-on' experience and stress in the hot-seat. The directed observer role may offer a less stressful, practical alternative to the traditional 'hot-seat' role, potentially rendering SBT accessible to a wider audience.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT02211378, registered August 5, 2014, retrospectively registered.

Refinement and Preliminary Testing of an Imagery-Based Program to Improve Coping and Performance and Prevent Trauma among Urban Police Officers

Police officers are regularly exposed to traumatic critical incidents. The substantial mental, behavioral, and social costs of police trauma indicate a substantial need for prevention. We have refined and enhanced a previously tested Swedish program to the harsh conditions of U.S. inner cities. The program was designed to strengthen resilience during stressful encounters and teach methods of coping after exposure, thereby preventing the emergence of maladaptive symptoms and behaviors with adverse effects on professionalism. In an uncontrolled demonstration project, junior officers were trained by senior officers to engage in imaginal rehearsal of specific dangerous situations while incorporating optimal police tactics and healthy emotional reactions. A class of 32 officers in the police academy engaged in the program, and they and the trainers reported high satisfaction with it. After their first year of field work, 22 officers were reassessed. Compared to pre-training, these officers showed significant increases in the use of positive reframing and humor and significant reductions in anxiety and alcohol use over the year. Trauma symptoms did not increase. These results offer preliminary evidence for the feasibility and effectiveness of this trauma prevention program for new police officers.

Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness

BACKGROUND

Increasing evidence indicates that individuals who develop severe mental illness (SMI) are also vulnerable to developing post-traumatic stress disorder (PTSD), due to increased risk of exposure to traumatic events and social adversity. The effectiveness of trauma-focused psychological interventions (TFPIs) for PTSD in the general population is well-established. TFPIs involve identifying and changing unhelpful beliefs about traumatic experiences, processing of traumatic memories, and developing new ways of responding to cues associated with trauma. Little is known about the potential feasibility, acceptability and effectiveness of TFPIs for individuals who have a SMI and PTSD.

OBJECTIVES

To evaluate the effectiveness of psychological interventions for PTSD symptoms or other symptoms of psychological distress arising from trauma in people with SMI.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (up until March 10, 2016), screened reference lists of relevant reports and reviews, and contacted trial authors for unpublished and/or specific outcome data.

SELECTION CRITERIA

We included all relevant randomised controlled trials (RCTs) which investigated TFPIs for people with SMI and PTSD, and reported useable data.

DATA COLLECTION AND ANALYSIS

Three review authors (DS, MF, IN) independently screened the titles and abstracts of all references identified, and read short-listed full text papers. We assessed risk of bias in each case. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) and 95% CI for continuous data, on an intention-to-treat basis. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and created 'Summary of findings' tables.

MAIN RESULTS

Four trials involving a total of 300 adults with SMI and PTSD are included. These trials evaluated three active intervention therapies: trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), and brief psychoeducation for PTSD, all delivered via individual sessions. Our main outcomes of interest were PTSD symptoms, quality of life/well-being, symptoms of co-morbid psychosis, anxiety symptoms, depressive symptoms, adverse events and health economic outcomes. 1. TF-CBT versus usual care/waiting list Three trials provided data for this comparison, however, continuous outcome data available were more often found to be skewed than unskewed, leading to the necessity of conducting analyses separately for the two types of continuous data. Using the unskewed data only, results showed no significant differences between TF-CBT and usual care in reducing clinician-rated PTSD symptoms at short term (1 RCT, n =13, MD 13.15, 95% CI -4.09 to 30.39,low-quality evidence). Limited unskewed data showed equivocal results between groups in terms of general quality of life (1 RCT, n = 39, MD -0.60, 95% CI -4.47 to 3.27, low-quality evidence), symptoms of psychosis (1 RCT, n = 9, MD -6.93, 95% CI -34.17 to 20.31, low-quality evidence), and anxiety (1 RCT, n = 9, MD 12.57, 95% CI -5.54 to 30.68, very low-quality evidence), at medium term. The only available data on depression symptoms were skewed and were equivocal across groups at medium term (2 RCTs, n = 48, MD 3.26, 95% CI -3.66 to 10.18, very low-quality evidence). TF-CBT was not associated with more adverse events (1 RCT, n = 100, RR 0.44, 95% CI 0.09 to 2.31, low-quality evidence) at medium term. No data were available for health economic outcomes. Very limited data for PTSD and other symptoms were available over the long term. 2. EMDR versus waiting listOne trial provided data for this comparison. Favourable effects were found for EMDR in terms of PTSD symptom severity at medium term but data were skewed (1 RCT, n = 83, MD -12.31, 95% CI -22.72 to -1.90, very low-quality evidence). EMDR was not associated with more adverse events (1 RCT, n = 102, RR 0.21, 95% CI 0.02 to 1.85, low-quality evidence). No data were available for quality of life, symptoms of co-morbid psychosis, depression, anxiety and health economics.3. TF-CBT versus EMDROne trial compared TF-CBT with EMDR. PTSD symptom severity, based on skewed data (1 RCT, n = 88, MD -1.69, 95% CI -12.63 to 9.23, very low-quality evidence) was similar between treatment groups. No data were available for the other main outcomes.4. TF-CBT versus psychoeducationOne trial compared TF-CBT with psychoeducation. Results were equivocal for PTSD symptom severity (1 RCT, n = 52, MD 0.23, 95% CI -14.66 to 15.12, low-quality evidence) and general quality of life (1 RCT, n = 49, MD 0.11, 95% CI -0.74 to 0.95, low-quality evidence) by medium term. No data were available for the other outcomes of interest.

AUTHORS' CONCLUSIONS

Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.

A blast from the past: Civilians immediate psychological reactions and associative memory of prior events following exploding bus in Israel

This study examined the association between self-report associative memories of prior traumatic events and psychological distress up to 48h after a terror attack. To date, the number of studies that examined this association is very small and most were conducted weeks or even months post event. For this purpose, we examined the association between self-report associative memories of prior traumatic events beyond factors such as previous exposure to trauma, political shift and sense of safety. The results showed that self-report associative memories of prior traumatic events were significantly associated with psychological distress. These results could be explained by the similarity and recency effects.

Understanding resilience: New approaches for preventing and treating PTSD

All individuals experience stressful life events, and up to 84% of the general population will experience at least one potentially traumatic event. In some cases, acute or chronic stressors lead to the development of posttraumatic stress disorder (PTSD) or other psychopathology; however, the majority of people are resilient to such effects. Resilience is the ability to adapt successfully in the face of stress and adversity. A wealth of research has begun to identify the genetic, epigenetic, neural, and environmental underpinnings of resilience, and has indicated that resilience is mediated by adaptive changes encompassing several environmental factors, neural circuits, numerous neurotransmitters, and molecular pathways. The first part of this review focuses on recent findings regarding the genetic, epigenetic, developmental, psychosocial, and neurochemical factors as well as neural circuits and molecular pathways that underlie the development of resilience. Emerging and exciting areas of research and novel methodological approaches, including genome-wide gene expression studies, immune, endocannabinoid, oxytocin, and glutamatergic systems, are explored to help delineate innovative mechanisms that may contribute to resilience. The second part reviews several interventions and preventative approaches designed to enhance resilience in both developmental and adult populations. Specifically, the review will delineate approaches aimed to bolster resilience in individuals with PTSD. Furthermore, we discuss novel pharmacologic approaches, including the N-methyl-d-aspartate (NMDA) receptor ketamine and neuropeptide Y (NPY), as exciting new prospects for not only the treatment of PTSD but as new targets to enhance resilience. Our growing understanding of resilience and interventions will hopefully lead to the development of new strategies for not just treating PTSD but also screening and early identification of at-risk youth and adults. Taken together, efforts aimed at dissemination and implementation of novel interventions to enhance resilience will have to keep pace with the growth of new preventive and treatment strategies.

The Integrated Problem-Solving Model of Crisis Intervention: Overview and Application

Crisis intervention is a role that fits exceedingly well with counseling psychologists' interests and skills. This article provides an overview of a new crisis intervention model, the Integrated Problem-Solving Model (IPSM), and demonstrates its application to a specific crisis, sexual assault. It is hoped that this article will encourage counseling psychologists to become more involved in crisis intervention itself as well as in research and training in this important area.

Persuading Others to Avoid Persuasion: Inoculation Theory and Resistant Health Attitudes

Inoculation theory, a theory of conferring resistance to persuasive influence, has established efficacy as a messaging strategy in the health domain. In fact, the earliest research on the theory in the 1960s involved health issues to build empirical support for tenets in the inoculation framework. Over the ensuing decades, scholars have further examined the effectiveness of inoculation-based messages at creating robust positive health attitudes. We overview these efforts, highlight the structure of typical inoculation-based health messages, and describe the similarities and differences between this method of counter-persuasion and other preparatory techniques commonly employed by health researchers and practitioners. Finally, we consider contexts in which inoculation-oriented health messages could be most useful, and describe how the health domain could offer a useful scaffold to study conceptual issues of the theory.

Effectiveness of a problem-solving based intervention to prolong the working life of ageing workers

BACKGROUND

An ageing workforce combined with increasing health problems in ageing workers implies the importance of evidence-based interventions to enhance sustainable employability. The aim of this study is to evaluate the effectiveness of the 'Staying healthy at work' problem-solving based intervention compared to business as usual.

METHODS

This study was designed as a quasi-experimental trial with a one-year follow-up. Measurements were performed at baseline, three and twelve months. The problem-solving based intervention provides a strategy for increasing the awareness of ageing workers of their role and responsibility in living sustainable, healthy working lives. The primary outcomes were work ability, vitality and productivity. Secondary outcomes were perceived fatigue, psychosocial work characteristics, work attitude, self-efficacy and work engagement.

RESULTS

Analyses were performed on the 64 workers in the intervention and 61 workers from the business as usual group. No effects on productivity (OR = 0.83, 95% CI 0.23-3.00) and adverse effects on work ability (B = -1.33, 95% CI -2.45 to -0.20) and vitality (OR = 0.10, 95% CI 0.02-0.46) were found. Positive results were found for the work attitude secondary outcome (B = 5.29, 95% CI -9.59 to -0.99), the self-efficacy persistence subscale (B = 1.45, 95% CI 0.43-2.48) and the skill discretion subscale of the Job Content Questionnaire (B = 1.78, 95% CI 0.74-2.83).

CONCLUSION

The results of the problem-solving intervention showed no positive effects on the three outcome measures compared to business as usual. However, effectiveness was shown on three of the secondary outcome measures, i.e. work attitude, self-efficacy and skill discretion. We presume that the lack of positive effects on primary outcomes is due to programme failure and not to theory failure.

TRIAL REGISTRATION

The trial is registered with the Dutch Trial Register under number NTR2270 .

World assumptions, religiosity, and PTSD in survivors of intimate partner violence

Intimate partner violence (IPV) is among the most frequent types of violence annually affecting women. One frequent outcome of violence exposure is posttraumatic stress disorder (PTSD). The theory of shattered world assumptions represents one possible explanation for adverse mental health outcomes following trauma, contending that trauma disintegrates individuals' core assumptions that the world is safe and meaningful, and that the self is worthy. Research that explores world assumptions in relationship to survivors of IPV has remained absent. A more consistent finding in research on IPV suggests that religiosity is strongly associated with survivors' reactions to, and recovery from, IPV. The present study found that world assumptions was a significant mediator of the relationship between IPV exposure and PTSD symptoms. Religiosity was also significantly, positively related to PTSD symptoms, but was not significantly related to amount of IPV exposure. Though African American women reported more IPV exposure and greater religiosity than European American women in the sample, there were no interethnic differences in PTSD symptom endorsement. Implications of these findings are discussed.

Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults

BACKGROUND

Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This is an update of a Cochrane review first published in 2005 and updated in 2007.

OBJECTIVES

To assess the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD).

SEARCH METHODS

For this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) all years to 12th April 2013. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). In addition, we handsearched the Journal of Traumatic Stress, contacted experts in the field, searched bibliographies of included studies, and performed citation searches of identified articles.

SELECTION CRITERIA

Randomised controlled trials of individual trauma-focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non-trauma-focused CBT (non-TFCBT), other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and present-centred therapy), group TFCBT, or group non-TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician-rated traumatic-stress symptoms.

DATA COLLECTION AND ANALYSIS

We extracted data and entered them into Review Manager 5 software. We contacted authors to obtain missing data. Two review authors independently performed 'Risk of bias' assessments. We pooled the data where appropriate, and analysed for summary effects.

MAIN RESULTS

We include 70 studies involving a total of 4761 participants in the review. The first primary outcome for this review was reduction in the severity of PTSD symptoms, using a standardised measure rated by a clinician. For this outcome, individual TFCBT and EMDR were more effective than waitlist/usual care (standardised mean difference (SMD) -1.62; 95% CI -2.03 to -1.21; 28 studies; n = 1256 and SMD -1.17; 95% CI -2.04 to -0.30; 6 studies; n = 183 respectively). There was no statistically significant difference between individual TFCBT, EMDR and Stress Management (SM) immediately post-treatment although there was some evidence that individual TFCBT and EMDR were superior to non-TFCBT at follow-up, and that individual TFCBT, EMDR and non-TFCBT were more effective than other therapies. Non-TFCBT was more effective than waitlist/usual care and other therapies. Other therapies were superior to waitlist/usual care control as was group TFCBT. There was some evidence of greater drop-out (the second primary outcome for this review) in active treatment groups. Many of the studies were rated as being at 'high' or 'unclear' risk of bias in multiple domains, and there was considerable unexplained heterogeneity; in addition, we assessed the quality of the evidence for each comparison as very low. As such, the findings of this review should be interpreted with caution.

AUTHORS' CONCLUSIONS

The evidence for each of the comparisons made in this review was assessed as very low quality. This evidence showed that individual TFCBT and EMDR did better than waitlist/usual care in reducing clinician-assessed PTSD symptoms. There was evidence that individual TFCBT, EMDR and non-TFCBT are equally effective immediately post-treatment in the treatment of PTSD. There was some evidence that TFCBT and EMDR are superior to non-TFCBT between one to four months following treatment, and also that individual TFCBT, EMDR and non-TFCBT are more effective than other therapies. There was evidence of greater drop-out in active treatment groups. Although a substantial number of studies were included in the review, the conclusions are compromised by methodological issues evident in some. Sample sizes were small, and it is apparent that many of the studies were underpowered. There were limited follow-up data, which compromises conclusions regarding the long-term effects of psychological treatment.

Evaluating the effectiveness of personal resilience and enrichment programme (PREP) for HIV prevention among female sex workers: a randomised controlled trial

BACKGROUND

Female sex workers (FSWs) are often considered as the vector, if not reservoir, of HIV and other sexually transmitted infections. Building upon the existing evidence on the role of psychological health in sexual health, the aim of this protocol is to describe a trial investigating the effectiveness of the Personal Resilience and Enrichment Programme (PREP), a resilience-promoting intervention that targets at psychological well-being i.e. self-esteem, self-efficacy and coping, to facilitate adaptation and ultimately safe sexual practices among FSWs, which could be an innovative strategy in controlling the spread of these infections.

METHODS

A total of 132 FSWs will be recruited and randomly assigned to either the intervention or usual care (control) groups in a multi-centred randomised controlled trial. Based on the resilience framework, this intervention is comprised of six weekly sessions focused on the awareness, expression and management of emotions, identifying roles and personal strengths, and effective problem-solving skills. Complex intervention assessment on both intervention process and effectiveness will be adopted when the primary outcome reduction of sexual risk behaviour and other psychological outcomes include their perceived stress, self-esteem, self-efficacy, coping overall resilience, and psychological distress will be measured at baseline, post-treatment and 3-month post-intervention and differences assessed by ANOVA. The relationship of resilience factors, psychological health and HIV preventive behaviours will be evaluated using structural equation modelling.

DISCUSSION

It is anticipated that this study will increase our understanding of the relationships between individual resilience attributes, positive adaptation, psychological health and sexual health practices. If successful, this programme will provide an innovative direction for HIV prevention by applying the personal resilience factors to promote both psychological well-being and safe sex for this high risk population.

TRIAL REGISTRATION

ChiCTR-PRC-13003091.

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.