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Bhamani SS, Van Parys AS, Arthur D, Letourneau N, Wagnild G, Degomme O. Promoting mental wellbeing in pregnant women living in Pakistan with the Safe Motherhood-Accessible Resilience Training (SM-ART) intervention: a randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:452. [PMID: 38951777 PMCID: PMC11218085 DOI: 10.1186/s12884-024-06629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/09/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The negative impact of adverse perinatal mental health extends beyond the mother and child; therefore, it is essential to make an early intervention for the management of mental illness during pregnancy. Resilience-building interventions are demonstrated to reduce depression and anxiety among expectant mothers, yet research in this field is limited. This study aims to examine the effect of the 'Safe Motherhood-Accessible Resilience Training (SM-ART)' on resilience, marital adjustment, depression, and pregnancy-related anxiety in a sample of pregnant women in Karachi, Pakistan. METHOD In this single-blinded block randomized controlled study, 200 pregnant women were recruited and randomly assigned to either an intervention or a control group using computer-generated randomization and opaque sealed envelopes. The intervention group received the SM-ART intervention consisting of six, weekly sessions ranging from 60 to 90 min. Outcomes (Resilience, depression, pregnancy-related anxiety and marital harmony) were assessed through validated instruments at baseline and after six weeks of both intervention and control groups. RESULTS The results revealed a significant increase in mean resilience scores (Difference:6.91, Effect size: 0.48, p-value < 0.05) and a decrease in depressive symptoms (Difference: -2.12, Effect size: 0.21, p-value < 0.05) in the intervention group compared to the control group. However, no significant change was observed in anxiety and marital adjustment scores. CONCLUSION The SM-ART intervention has the potential to boost resilience scores and decrease depressive symptoms in pregnant women and offers a promising intervention to improve maternal psychological health. TRIAL REGISTRATION NCT04694261, Date of first trial registration: 05/01/2021.
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Affiliation(s)
| | - An-Sofie Van Parys
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David Arthur
- Bermi Acupuncture & Chinese Medicine Clinic, Bermagui, NSW, Australia
- Peking Union Medical, Beijing, China
| | | | | | - Olivier Degomme
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Nordstrand AE, Bøe HJ, Hjemdal O, Huffman AH, Noll LK, Reichelt JG, Bakker LP, Anyan F. Differences in resilience profiles between military veterans and the general population: An exploratory latent profile analysis using the HUNT-4 survey. Stress Health 2024; 40:e3343. [PMID: 37929999 DOI: 10.1002/smi.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Using latent profile analyses, the current work investigated levels of adverse childhood experiences, symptoms of anxiety and depression and 3 dimensions of relational promotive factors) to identify resilience profiles in a large general population sample (N = 161,622, mean age = 53.02; SD = 17.80; 56.1% females). We then used the same method to identify the resilience profiles of military veterans (N = 386, mean age = 43.47; SD = 10.08; 9.8% females), all of whom had served in Afghanistan. A four-profile-solution was the best fitting for the general population (High resilient 30%, Moderate resilient 13%, Low resilient 53%, Work/social-based resilience 4%), while a three-profile-solution had the best fit in the veteran cohort (Family-based resilience 28%, Work/social-based resilience 62%, Hardy loners 10%). To ground the identified profiles in occupational function, we also checked how they predicted reports of sleep difficulties, job demand and job control. Despite both samples inhabiting a geographic region known for high socioeconomic similarity among residents, we found marked differences in profile-solutions between the military veterans and the general population. Our findings suggests that resilience profiles are highly influenced by cohort characteristics and the specific resources needed to manage a given stressor load. Accordingly, the generalisability of specific protective factors may be low across distinct cohorts, and reliable findings need to be obtained in specific populations as defined by stressor context, sample characteristics, and relevant outcomes.
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Affiliation(s)
- Andreas Espetvedt Nordstrand
- Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Psychological Sciences, Northern Arizona University (NAU), Flagstaff, Arizona, USA
| | - Hans Jakob Bøe
- Norwegian Armed Forces, Joint Medical Services, Oslo, Norway
- Department of Psychology, University of Oslo (UiO), Oslo, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ann Hergatt Huffman
- Department of Psychological Sciences, Northern Arizona University (NAU), Flagstaff, Arizona, USA
| | - Laura Katherine Noll
- Department of Psychological Sciences, Northern Arizona University (NAU), Flagstaff, Arizona, USA
| | | | | | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Noyola N, Ver Pault M, Hirshfeld-Becker DR, Chudnofsky R, Meek J, Wells LN, Wilens TE, Henin A. The Resilient Youth Program: a promising skills-based online program for resiliency and stress management. Behav Cogn Psychother 2024; 52:331-335. [PMID: 38282531 DOI: 10.1017/s1352465823000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Prevention programs that target resilience may help youth address mental health difficulties and promote well-being during public health crises. AIMS To examine the preliminary efficacy of the Resilient Youth Program (RYP). METHOD The RYP was delivered remotely from a US academic medical centre to youth in the community via a naturalistic pilot study. Data from 66 youth (ages 6-18, Mage = 11.65, SD = 3.02) and their parents were collected via quality assurance procedures (May 2020 to March 2021). Pre/post-intervention child/parent-reported psychological and stress symptoms as well as well-being measures were compared via Wilcoxon signed rank tests. Child/parent-reported skills use data were collected. RESULTS Among child-reported outcomes, there were significant decreases in physical stress (p = .03), anxiety (p = .004), depressive symptoms (p < .001) and anger (p = .002), as well as increased life satisfaction (p = .02). There were no significant differences in child-reported psychological stress (p = .06) or positive affect (p = .09). Among parent-reported child outcomes, there were significant decreases in psychological (p < .001) and physical stress (p = .03), anxiety (p < .001), depressive symptoms (p < .001), and anger (p < .002) as well as increased positive affect (p < .001) and life satisfaction (p < .001). Effect sizes ranged from small to medium; 77% of youth (73% of parents) reported using RYP skills. Age and gender were not associated with outcome change. CONCLUSIONS The RYP may help reduce psychological/stress symptoms and increase well-being among youth; further research is needed.
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Affiliation(s)
- Néstor Noyola
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Child Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mikayla Ver Pault
- Psychology Department, University of Rhode Island, South Kingstown, RI, USA
| | - Dina R Hirshfeld-Becker
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Child Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rana Chudnofsky
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jocelyn Meek
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda N Wells
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy E Wilens
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Child Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aude Henin
- Child Resiliency Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Child Cognitive Behavioral Therapy Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Owens RA, Houchins J, Nolan S, Smalling MM, Attia E, Fitzpatrick JJ. Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study. Holist Nurs Pract 2024; 38:E1-E9. [PMID: 37966993 DOI: 10.1097/hnp.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.
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Affiliation(s)
- Rebecca A Owens
- New York State Psychiatric Institute, New York (Drs Owens and Attia); Columbia University School of Nursing, New York, New York (Dr Houchins); Providence, Los Angeles, California (Dr Nolan); New York State Office of Mental health, Albany (Ms Smalling); and Case Western Reserve University, Cleveland, Ohio (Dr Fitzpatrick)
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Mohamed NE, Leung TM, Benn EKT, Korn TG, Ali I, Patel D, Gonzalez A, Quale DZ. Depression and anxiety among patients treated for bladder cancer: examining clinical, demographic, and psychosocial predictors. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:401-413. [PMID: 37941645 PMCID: PMC10628622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION AND OBJECTIVE The significant impact of bladder cancer and treatment on patient health related quality of life (HRQoL) and emotional wellbeing has been documented. Increasing evidence from cancer research emphasizes the importance of examining patients supportive care needs and received social support as factors that could influence their emotional adjustment. The purpose of the study was to assess the demographic and clinical predictors of depression and anxiety among bladder cancer patients and its associations with patient reported supportive care needs and perceived availability of social support. METHODS A cross-sectional design was used to investigate the study questions. Bladder cancer patients were recruited from the Bladder Cancer Advocacy Network (BCAN) to complete a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), bladder cancer patient need survey (BCNAS-32), and the social provisions scale (SPS). The inclusion criteria restricted our sample to include bladder cancer patients who were English speakers, aged 18-85 years, and were able and willing to provide informed consent. Patients who had metastatic disease, cancer recurrence, or other primary cancers at the time of assessment were excluded from the study. RESULTS Participants included 159 bladder cancer patients. The mean age was 62±9.4 years and 51% were male. Almost two-thirds (62%) of patients reported a diagnosis of muscle invasive bladder cancer (MIBC), 25% patient reported clinically significant levels of anxiety, 17% reported clinically significant levels of depression, and 13% and 17% reported abnormal borderline abnormal levels for anxiety and depression, respectively. Univariate regression analyses revealed significant associations between HADS total score, HADS depression and anxiety subscales, patient age, physical functioning/daily living needs, sexuality needs, and perceived social support with higher total scores, anxiety, and depression scores associated with younger age, higher unmet needs, and lower levels of social support. Multivariate regression analyses, showed similar findings confirming the associations depicted by the univariate regression analyses. CONCLUSIONS Bladder cancer patients experience significant levels of depression and anxiety and these levels are associated with patient age, supportive care unmet needs and lack of social support. Patient focused interventions could be tailored to address these issues with the goal to improve patient HRQoL and emotional adjustment.
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Affiliation(s)
- Nihal E Mohamed
- Department of Urology and Oncological Science, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Tung-Ming Leung
- Department of Urology and Oncological Science, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Emma KT Benn
- Center for Biostatistics and Department of Population Health Science and Policy, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Talia G Korn
- Department of Urology and Oncological Science, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Imran Ali
- Department of Medicine, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Dhruti Patel
- Department of Urology and Oncological Science, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Adam Gonzalez
- Department of Psychiatry & Behavioral Health, Renaissance School of Medicine at Stony Brook UniversityStony Brook, NY, USA
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Finkelstein-Fox L, Bliss CC, Rasmussen AW, Hall DL, El-Jawahri A, Perez GK, Traeger LN, Comander AH, Peppercorn J, Anctil R, Noonan E, Park ER. Do cancer curvivors and metavivors have distinct needs for stress management intervention? Retrospective analysis of a mind-body survivorship program. Support Care Cancer 2023; 31:616. [PMID: 37801182 PMCID: PMC11210627 DOI: 10.1007/s00520-023-08062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Cancer "curvivors" (completed initial curative intent treatment with surgery, radiation, chemotherapy, and/or other novel therapies) and "metavivors" (living with metastatic or chronic, incurable cancer) experience unique stressors, but it remains unknown whether these differences impact benefits from mind-body interventions. This study explored differences between curvivors and metavivors in distress (depression, anxiety, worry) and resiliency changes over the course of an 8-week group program, based in mind-body stress reduction, cognitive-behavioral therapy (CBT), and positive psychology. METHODS From 2017-2021, 192 cancer survivors (83% curvivors; 17% metavivors) completed optional online surveys of resiliency (CES) and distress (PHQ-8, GAD-7, PSWQ-3) pre- and post- participation in an established clinical program. Mixed effect regression models explored curvivor-metavivor differences at baseline and in pre-post change. RESULTS Compared to curvivors, metavivors began the program with significantly more resilient health behaviors (B = 0.99, 95% CI[0.12, 1.86], p = .03) and less depression (B = -2.42, 95%CI[-4.73, -0.12], p = .04), with no other significant differences. Curvivors experienced significantly greater reductions in depression (curvivor-metavivor difference in strength of change = 2.12, 95% CI [0.39, 3.83], p = .02) over the course of the program, with no other significant differences. Neither virtual delivery modality nor proportion of sessions attended significantly moderated strength of resiliency or distress change. CONCLUSION Metavivors entering this mind-body program had relatively higher well-being than did curvivors, and both groups experienced statistically comparable change in all domains other than depression. Resiliency programming may thus benefit a variety of cancer survivors, including those living with incurable cancer.
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Affiliation(s)
- Lucy Finkelstein-Fox
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA.
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Cayley C Bliss
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Autumn W Rasmussen
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel L Hall
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Giselle K Perez
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amy H Comander
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Reid Anctil
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elise Noonan
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA, 02114, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Kuhlthau KA, Traeger L, Luberto CM, Perez GK, Goshe BM, Fell L, Iannuzzi D, Park ER. Resiliency Intervention for Siblings of Children With Autism Spectrum Disorder: A Randomized Pilot Trial. Acad Pediatr 2023; 23:1187-1195. [PMID: 36460184 DOI: 10.1016/j.acap.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND /OBJECTIVES Neurotypical siblings (NT siblings) of children with autism spectrum disorder (ASD) are at elevated risk for emotional distress and adjustment problems. Resiliency is the ability to cope and adapt with ongoing stressors. We conducted a randomized waitlist-controlled pilot trial to examine the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind-body resiliency group intervention for teen NT siblings of children with ASD. METHODS We modified the Stress Management and Resiliency Training-Relaxation Response Resiliency Program for NT siblings of children with ASD (SibChat). We randomly assigned teens (aged 14-17) to immediate intervention (IG) versus waitlist control (WLC). The intervention included eight 60-minute weekly video conference group sessions. We assessed feasibility (enrollment, attendance, and retention) and acceptability (post treatment survey and weekly relaxation response practice). We explored group differences in pre-post change scores for 1) stress coping (Measure of Current Status-A) and 2) resiliency (Current Experiences Scale) using independent samples t tests and effect size calculations. RESULTS We enrolled 83% of screened eligible teens. A total of 90% IG and 75% WLC participants attended at least 6/8 sessions. Among IG participants who completed the post treatment survey, 79% reported practicing relaxation response exercises at least "a few times a week". Comparing change in baseline to time 1, the IG showed better relative changes than the WLC group in stress coping (d = 0.60) and resiliency (d = 0.24). CONCLUSIONS Our pilot trial showed promising feasibility, acceptability, and preliminary efficacy of SibChat on at least one of the 2 primary outcomes supporting further testing of the SibChat intervention. CLINICAL TRIAL REGISTRATION US National Library of Medicine. REGISTRATION NUMBER NCT04369417. https://clinicaltrials.gov/ct2/show/NCT04369417.
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Affiliation(s)
- Karen A Kuhlthau
- Division of General Academic Pediatrics (KA Kuhlthau, L Fell, and D Iannuzzi), Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, Mass.
| | - Lara Traeger
- Department of Psychiatry (L Traeger, CM Luberto, GK Perez, BM Goshe, and ER Park), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Health Promotion and Resiliency Intervention Research Program (L Traeger, CM Luberto, GK Perez, and ER Park), Massachusetts General Hospital, Departments of Psychiatry & Medicine, Boston, Mass
| | - Christina M Luberto
- Department of Psychiatry (L Traeger, CM Luberto, GK Perez, BM Goshe, and ER Park), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Health Promotion and Resiliency Intervention Research Program (L Traeger, CM Luberto, GK Perez, and ER Park), Massachusetts General Hospital, Departments of Psychiatry & Medicine, Boston, Mass; MGH Benson-Henry Institute for Mind-Body Medicine (CM Luberto, GK Perez, BM Goshe, and ER Park), Boston, Mass
| | - Giselle K Perez
- Department of Psychiatry (L Traeger, CM Luberto, GK Perez, BM Goshe, and ER Park), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; MGH Benson-Henry Institute for Mind-Body Medicine (CM Luberto, GK Perez, BM Goshe, and ER Park), Boston, Mass; Health Promotion and Resiliency Intervention Research Program (L Traeger, CM Luberto, GK Perez, and ER Park), Massachusetts General Hospital, Departments of Psychiatry & Medicine, Boston, Mass
| | - Brett M Goshe
- Department of Psychiatry (L Traeger, CM Luberto, GK Perez, BM Goshe, and ER Park), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; MGH Benson-Henry Institute for Mind-Body Medicine (CM Luberto, GK Perez, BM Goshe, and ER Park), Boston, Mass
| | - Lucy Fell
- Division of General Academic Pediatrics (KA Kuhlthau, L Fell, and D Iannuzzi), Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass
| | - Dorothea Iannuzzi
- Division of General Academic Pediatrics (KA Kuhlthau, L Fell, and D Iannuzzi), Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass
| | - Elyse R Park
- Department of Psychiatry (L Traeger, CM Luberto, GK Perez, BM Goshe, and ER Park), Massachusetts General Hospital/Harvard Medical School, Boston, Mass; Health Promotion and Resiliency Intervention Research Program (L Traeger, CM Luberto, GK Perez, and ER Park), Massachusetts General Hospital, Departments of Psychiatry & Medicine, Boston, Mass; MGH Benson-Henry Institute for Mind-Body Medicine (CM Luberto, GK Perez, BM Goshe, and ER Park), Boston, Mass
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O'Brien E, Whitman K, Buerke M, Galfalvy H, Szanto K. Life-Satisfaction, Engagement, Mindfulness, Flourishing, and Social Support: Do they Predict Depression, Suicide Ideation, and History of Suicide Attempt in Late Life? Am J Geriatr Psychiatry 2023; 31:415-424. [PMID: 36682987 PMCID: PMC10164675 DOI: 10.1016/j.jagp.2022.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults. METHODS Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt. RESULTS Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96). CONCLUSION Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.
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Affiliation(s)
- Emma O'Brien
- Department of Psychiatry (OBE, WK, SK), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathrine Whitman
- Department of Psychiatry (OBE, WK, SK), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Morgan Buerke
- Department of Psychology (BM), University of Southern Mississippi, Hattiesburg, MS
| | - Hanga Galfalvy
- Department of Psychiatry (GH), Columbia University College of Physicians and Surgeons, New York, NY; Department of Molecular Imaging and Neuropathology (GH), New York State Psychiatric Institute, New York, NY
| | - Katalin Szanto
- Department of Psychiatry (OBE, WK, SK), University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Fricchione G. Mind body medicine: a modern bio-psycho-social model forty-five years after Engel. Biopsychosoc Med 2023; 17:12. [PMID: 36997979 PMCID: PMC10060142 DOI: 10.1186/s13030-023-00268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Gregory Fricchione
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
- Harvard Medical School, Boston, USA.
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Kıllı NE, Bakır ÇN, Canbaz AA, Karabulut K, Mutlu A, Karataşlı Ş, Tekin S, Kayı İ. Resilience during the COVID-19 pandemic among people living with HIV: A cross-sectional study. Int J STD AIDS 2023:9564624231156202. [PMID: 36820627 PMCID: PMC9950817 DOI: 10.1177/09564624231156202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aims to investigate the factors shaping resilience during the COVID-19 pandemic among people living with HIV (PLWH). METHODS A total of 341 participants were included in this cross-sectional study. The online survey included scales of resilience, depression & anxiety, loneliness, social support, COVID-19 fear, stress, and sociodemographic information. RESULTS Logistic regression test results showed loneliness (OR = 2.548, 95% CI = 1.251, 5.189), social support (OR = 2.217, 95% CI = 1.148, 4.279), income (OR = 2.581, 95% CI = 1.217, 5.472), sexual orientation (OR = 2.707, 95% CI = 1.004, 7.300), age (OR = 1.044, 95% CI = 1.006, 1.083) and COVID-19 fear (OR = 0.891, 95% CI = 0.840, 0.944) were statistically significant factors associated with resilience among PLWH. CONCLUSION In conclusion, reducing COVID-19 fear by providing the correct information about the COVID-19 pandemic, fortifying the level of social support satisfaction, as well as minimising the level of loneliness have the potential to improve psychological resilience among PLWH.
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Affiliation(s)
- Nesrin Ecem Kıllı
- School of Medicine, Koç University, İstanbul, Turkey,Nesrin Ecem Kıllı, School of Medicine, Koç University, Rumelifeneri Campus, Rumelifeneri Way, İstanbul 34450, Turkey.
| | | | | | | | - Ali Mutlu
- School of Medicine, Koç University, İstanbul, Turkey
| | | | - Süda Tekin
- Department of Clinical Microbiology and Infectious Diseases, Koç University School of Medicine, İstanbul, Turkey
| | - İlker Kayı
- Department of Public Health, Koç University School of Medicine, İstanbul, Turkey
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11
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Traeger L, Styklunas GM, Park EY, Lee MT, Fricchione G, Park ER. Promoting Resilience and Flourishing Among Older Adult Residents in Community Living: A Feasibility Study. THE GERONTOLOGIST 2022; 62:1507-1518. [PMID: 35235940 DOI: 10.1093/geront/gnac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Stress Management and Relaxation Training-Relaxation Response Resiliency Program (SMART-3RP) is a mind-body group intervention that integrates relaxation training with cognitive behavioral and positive psychology techniques. This study assessed SMART-3RP feasibility, acceptability, and preliminary efficacy for enhancing resilience and flourishing among older adults in continuing care retirement communities (CCRCs). RESEARCH DESIGN AND METHODS We conducted a prospective single-arm study of SMART-3RP groups delivered by clinicians at 4 CCRCs (n = 80). Eligible residents lived in community apartments. Participants completed pre- and postintervention surveys. We evaluated attendance (hypothesis: ≥60% attend ≥6 of 9 sessions), enrollment, and retention. Mixed methods were used to explore acceptability. Paired samples t-tests were conducted to explore changes in resilience, flourishing, and key intervention targets. RESULTS From March to June 2021, we screened 89 residents with 87 (98%) consenting to participate and 80 (90%) enrolling in the study. Among 80 participants (85% female; 98% non-Hispanic White; M age = 80 years [SD = 6]), 88% attended ≥6 sessions, and 89% completed the postintervention survey. Participants found meaning in participation and practiced skills in the context of challenges such as caregiving burden or bereavement. Survey results, showing increases in resilience, flourishing, and several intervention targets, aligned with participants' perceived intervention value. DISCUSSION AND IMPLICATIONS SMART-3RP was feasible and acceptable for CCRC residents; participants perceived value in practicing mind-body strategies in a group-based setting. Preliminary evidence suggested a pattern of improvements in resilience, flourishing, and intervention targets. Findings provide insights for mind-body interventions and recommendations for adaptations to late-in-life concerns and community settings. CLINICAL TRIALS REGISTRATION NUMBER NCT04720014.
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Affiliation(s)
- Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Grace M Styklunas
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program (HPRIR), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ellen Y Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew T Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Health Promotion and Resiliency Intervention Research Program (HPRIR), Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Groves J, Luberto C, Fricchione G, Park E. Further Examination of the Psychometric Properties of the Current Experiences Scale and Model of Resiliency. Glob Adv Health Med 2022; 11:2164957X221128521. [PMID: 36213314 PMCID: PMC9536098 DOI: 10.1177/2164957x221128521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Stress-related disease is increasing, with high resilience proposed as protective. Whilst the Current Experiences Scale (CES) shows promise as a measure of resilience, its psychological correlates and relationship to psychological stress remain unclear. Objectives (1) Further explore the psychometric properties of the CES, (2) identify modifiable psychological factors associated with the CES and (3) test a previously published model for the influence of adaptive strategies and stress management factors on resiliency and stress. Methods N = 455 individuals (mean age = 47.8, 65.1% female) completed measures of adaptive strategies: mindfulness (Cognitive and Affective Mindfulness Scale-Revised), positive affect (Positive and Negative Affect Schedule) and gratitude (The Gratitude Questionnaire), stress management skills: coping (Measure of Current Status-A), depression (Patient Health Questionnaire-8) and anxiety (General Anxiety Disorder Assessment) and outcomes: resilience (CES) and stress (Perceived Stress Scale). Cronbach's alpha and confirmatory factor analysis (CFA) examined the psychometric properties of the CES. Multivariable regression identified psychological variables associated with resilience. Structural equation modelling (SEM) tested the previously published model for resilience. Results The CES and its subscales showed good internal consistency (ɑ = .75-.93). The 23-item CES produced excellent results for model fit (Root Mean Square Error of Approximation (RMSEA) = .07, Standardized Root Mean Square Residual (SRMR) = .06, Comparative Fit Index (CFI) = .99; Tucker-Lewis Index (TLI) = .99). Higher gratitude (P < .0001), mindfulness (P < .0001), positive affect (P < .0001) and coping (P < .0001) were associated with higher resilience. Depression (P = .23) and anxiety (P = .34) were not. A model of resilience which included gratitude, mindfulness, positive affect and coping as determinants of resilience and perceived stress performed well (RMSEA = .03, SRMR = .02, CFI = .99; TLI = .99). Conclusions The CES was validated in a large sample. The association of gratitude, mindfulness, positive affect and coping with resilience may guide practitioners seeking to design resilience-enhancing programs.
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Affiliation(s)
- James Groves
- Department of Social and Behavioral Sciences, Harvard University Harvard T. H. Chan School of Public Health, Cambridge, MA, USA,James Groves, Department of Social and Behavioral Sciences, Harvard University Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Cambridge, MA 02138, USA. ;
| | - Christina Luberto
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA,Benson-Henry Institute, Massachusetts General Hospital, Boston, MA, USA,Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory Fricchione
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA,Benson-Henry Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse Park
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA,Benson-Henry Institute, Massachusetts General Hospital, Boston, MA, USA,Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA, USA
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13
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Wallace ZS, Cook C, Finkelstein-Fox L, Fu X, Castelino FV, Choi HK, Perugino C, Stone JH, Park ER, Hall DL. The Association of Illness-related Uncertainty With Mental Health in Systemic Autoimmune Rheumatic Diseases. J Rheumatol 2022; 49:1058-1066. [PMID: 35365580 PMCID: PMC9525460 DOI: 10.3899/jrheum.211084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with systemic autoimmune rheumatic diseases (SARDs) face illness-related uncertainty, but little is known about the psychological profiles and psychosocial and health needs associated with uncertainty among adults with SARDs. METHODS Patients from the Massachusetts General Hospital with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), IgG4-related disease (IgG4-RD), and systemic sclerosis (SSc) completed the Mishel Uncertainty in Illness Scale, 8-item Patient Health Questionnaire depression scale, 7-item General Anxiety Disorder scale, Sickness Impact Profile, and a survey of psychosocial needs. The associations of uncertainty and self-reported needs with depression, anxiety, and sickness impact were assessed. RESULTS One hundred thirty-two patients with AAV (n = 41, 31%), IgG4-RD (n = 61, 46%), or SSc (n = 30, 23%) participated. The mean age was 64 years, 52% were female, and 83% were White. Greater illness-related uncertainty was positively correlated with higher levels of depression (r = 0.43, P < 0.001), anxiety (r = 0.33, P < 0.001), and sickness impact (r = 0.28, P = 0.001). We observed variations in these measures across SARDs, such that uncertainty was more strongly associated with depression and sickness impact in AAV or SSc compared to IgG4-RD. The primary needs that patients endorsed were services for managing physical symptoms (53%), self-care (37%), and emotional concerns (24%), with greater needs strongly associated with greater illness-related uncertainty. CONCLUSION Among patients with SARDs, illness-related uncertainty is correlated with levels of depression, anxiety, and sickness impact, as well as psychosocial needs. Findings also implicate the need for targeted interventions to address uncertainty and needs among subgroups of patients with different illness profiles.
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Affiliation(s)
- Zachary S Wallace
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Claire Cook
- C. Cook, MPH, X. Fu, MS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute
| | - Lucy Finkelstein-Fox
- L. Finkelstein-Fox, PhD, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School
| | - Xiaoqing Fu
- C. Cook, MPH, X. Fu, MS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute
| | - Flavia V Castelino
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Hyon K Choi
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Cory Perugino
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - John H Stone
- Z.S. Wallace, MD, MSc, F.V. Castelino, MD, H.K. Choi, MD, DrPH, C. Perugino, DO, J.H. Stone, MD, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School
| | - Elyse R Park
- E.R. Park, PhD, D.L. Hall, PhD, Department of Psychiatry, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel L Hall
- E.R. Park, PhD, D.L. Hall, PhD, Department of Psychiatry, Massachusetts General Hospital, and Mongan Institute, and Harvard Medical School, Boston, Massachusetts, USA.
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Esch T, Stefano GB. The BERN Framework of Mind-Body Medicine: Integrating Self-Care, Health Promotion, Resilience, and Applied Neuroscience. Front Integr Neurosci 2022; 16:913573. [PMID: 35910341 PMCID: PMC9330052 DOI: 10.3389/fnint.2022.913573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Mind-body medicine (MBM) focuses on improving our understanding of how the interactions between the brain, mind, body, and behavior can be used to promote health. In this narrative review, we present the basic principles of MBM, including the introduction of a rational framework for the implementation of MBM-based interventions. We also discuss the contributions of MBM to motivation and reward systems in the brain including those that may specifically involve the mitochondria.Results: MBM can be used to promote health in patients with chronic diseases, especially conditions identified as lifestyle-related. MBM builds on salutogenesis, which is a paradigm that focuses on health (as opposed to disease) determinants and the development of individual resilience and coherence factors as a means to reduce stress, decrease the burden of disease, and improve the quality of life. This approach involves several well-known principles of self-healing and self-care. MBM interventions typically include behavioral modification techniques in conjunction with cognitive work focused on stress regulation, exercise, relaxation, meditation, and nutrition. We suggest the use of the acronym “BERN” (Behavior, Exercise, Relaxation, and Nutrition) to summarize the operational framework of this approach.Discussion: Different BERN techniques act via shared autoregulatory central nervous system (CNS) reward and motivation circuitries. These systems rely on numerous neurobiological signaling pathways with overlapping effector molecules that converge, e.g., on nitric oxide (NO) as a common effector molecule. NO is critically coupled to reward physiology, stress reduction, and self-regulation as it modulates the responses of various mitochondrial, nuclear, and chromosomal processes within brain cells. NO has also been implicated in relevant outcomes (e.g., the placebo response).Conclusions: MBM interventions typically follow the BERN model and aim to strengthen health and resilience, and reduce stress. The mechanisms of action of these processes involve the CNS reward systems and correlate with placebo and self-healing pathways.
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Affiliation(s)
- Tobias Esch
- Institute for Integrative Health Care and Health Promotion, School of Medicine, Witten/Herdecke University, Witten, Germany
- *Correspondence: Tobias Esch
| | - George B. Stefano
- Center for Cognitive and Molecular Neuroscience, First Faculty of Medicine, Charles University, Prague, Czechia
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15
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Testing psychosocial mediators of a mind-body resiliency intervention for cancer survivors. Support Care Cancer 2022; 30:5911-5919. [PMID: 35386004 PMCID: PMC8986336 DOI: 10.1007/s00520-022-07022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 11/18/2022]
Abstract
Purpose Group-based mind–body interventions such as the Stress Management and Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP) hold promise for enhancing resiliency among cancer survivors. Mechanisms underlying improvements in psychological outcomes are theoretically established but remain unexamined empirically. Methods Adult cancer survivors (n = 105) participating in the SMART-3RP completed surveys of resiliency and five hypothesized mediators: coping (ability to relax physical tension and assertive social support-seeking), mindfulness, positive affect, and worry. Pre-post intervention changes were assessed using repeated-measures t-tests. Bivariate correlations between change scores and a more conservative within-person parallel mediation model tested covariance between resiliency and mediators. Results Participants experienced moderate to large improvements in all patient-reported outcomes (ds = 1.01–0.46). Increased resiliency was significantly associated with increases in mindfulness, positive affect, and assertive social support-seeking (rs = 0.36–0.50); smaller associations with increased relaxation and decreased worry were not significant. Mindfulness and positive affect explained the largest proportion of variance in resiliency increase in the full multivariate model. Conclusions Cancer survivors completing the SMART-3RP had increased resiliency, which was associated with improvements in mindfulness, positive affect, and the ability to assertively seek social support. Enhancing mindfulness and positive affect were critical components for enhancing resiliency. Implications for resiliency interventions with cancer survivors are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07022-5.
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