The effectiveness of group training of cognitive behavioral therapy-based stress management on anxiety, hardiness and self-efficacy in female medical students

A realist review of programs fostering the resilience of healthcare students: What works, for whom and why?

BACKGROUND

Various programs aimed at fostering the resilience of students have been implemented into healthcare undergraduate and postgraduate educational courses and degree programs. Which of these increase their participants' resilience under which circumstances, for whom and why remains uncertain.

METHODS

A realist review of articles reporting program outcomes as measures of resilience through the use of via validated psychometric surveys was conducted to investigate which contexts favour the development of resilience of healthcare and health sciences students and which mechanisms have to be activated to achieve this outcome.

RESULTS

Thirteen Context-Mechanism-Outcome Configurations were synthesised from data presented in 43 articles. These were combined with theories explaining the theoretical and psychological frameworks underpinning programs to develop a program theory of how and why resilience fostering programs work. Contexts which favour the development of resilience were the use of validated psychological frameworks as program foundation, e.g. Cognitive Behavioural Therapy, mindfulness-based training. Expert facilitation, longitudinal integration into curricula, flexible and multi-modal design and delivery, and opportunities for students to apply and practice resilience-building strategies also created favourable contexts. Meeting students' or practitioners' needs activated mechanisms of trust, engagement and recognition of a program's value and real-world benefits. An increase in resilience was achieved by students developing reflective skills, metacognitive awareness and positive habits of mind.

CONCLUSION

The program theory established via a realist review provides guidance on how the individual resilience of healthcare students can be fostered throughout their undergraduate, postgraduate degrees and early practice, potentially supporting them to flourish and remain long-term in their chosen professional roles.

Correlation between self-efficacy, parental parenting patterns, and severe depression in adolescents

BACKGROUND

Adolescence is a critical period marked by significant psychological changes. This study explores how self-efficacy and parental parenting styles may influence the risk of severe depression among teens. The hypothesis is that higher self-efficacy and authoritative parenting patterns will be negatively correlated with severe depression in adolescents.

AIM

To investigate the correlation between self-efficacy, parenting patterns and major depression in adolescents, and to provide guidance for mental intervention.

METHODS

Using a cross-sectional survey design, the data were collected through a questionnaire survey. Patients with major depression and healthy adolescents in the hospital control group were selected as the study objects. The General Self-Efficacy Scale, the Parenting Style Evaluation Scale, and the Beck Depression Inventory were used as research instruments. Data input and statistical analysis were performed, including descriptive statistics, correlation analysis, through SPSS software.

RESULTS

The study found that depressed patients had significantly lower self-efficacy than healthy controls, and parenting style was significantly associated with depressive symptoms in terms of emotional warmth and understanding, punishment severity, and denial. Specifically, parental emotional warmth and understanding were significantly negatively associated with depressive symptoms, while parental punishment severity and denial were significantly positively associated with depressive symptoms. Self-efficacy showed a significant negative correlation with depressive symptoms, indicating that higher self-efficacy had lower depressive symptoms.

CONCLUSION

Adolescent major depressive disorder patient was significantly associated with their parenting style and self-efficacy. Higher self-efficacy is associated with decreased depressive symptoms, so improving adolescent self-efficacy and improving parenting style are important.

An educational intervention to enhance self-care practices among 1st year dental students- a mixed method study design

BACKGROUND

Prevalence of rising stress among medical students has been reported widely and may jeopardize patient interaction and care. Evolving medical education needs to demonstrate compassionate self-care practices to enhance mental well-being of students. Although numerous researches have highlighted the stressors and coping strategies but no structured educational intervention has been reported so far among medical students of Pakistan. Hence, we explored if a Personal Development Plan could stimulate meaningful self-reflection and self-care practices among dental students.

METHODS

All first-year dental students of Riphah International University participated in this mandatory lesson plan. This 1-h activity every fortnightly, consisted of a thought-provoking discussion with predetermined reading material followed by SMART goal settings & later follow ups. Students were divided into 4 groups of 18-20 students with a designated trained Mentor. At the end of academic year, students were asked to submit a 500-word reflection based on their experience of understanding self-care needs (intellectual, emotional, physical, spiritual aspects). A mixed-methods embedded design was used. First a quantitative analysis of the content of all 75 students' reflections was conducted using a scoring system based on the REFLECT rubric. Then for the qualitative manual thematic analysis, the researchers exclusively used reflections that scored levels 3 and 4 on the REFLECT rubric.

RESULTS

Approximately 60% of students demonstrated an in-depth thoughtful reflection according to the REFLECT rubric. Students reflected by acknowledging the importance of self-care for their personal and professional grooming, Some observed the positive impact of working on self-determined healthy lifestyle behaviours on their physical & emotional wellbeing. They stressed the importance of physical activity, meditation and social connections in their daily life. They also reflected on reduced stress after incorporating these self-care strategies.

CONCLUSIONS

This study supports the value of incorporating self-care strategies in medical/dental curriculum to enhance personal and professional wellbeing of students and hence patient care. Students reflected on different themes of self-care related to physical, spiritual and social wellbeing. In addition, more than half of the students exhibited higher levels of reflection suggesting that these sessions contributed to action-oriented self-awareness towards holistic health.

Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study

PURPOSE

Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school.

METHOD

The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) in June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective.

RESULTS

Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers.

CONCLUSIONS

This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Psychological Network Analysis of General Self-Efficacy in High vs. Low Resilient Functioning Healthy Adults

Resilience to stress has gained increasing interest by researchers from the field of mental health and illness and some recent studies have investigated resilience from a network perspective. General self-efficacy constitutes an important resilience factor. High levels of self-efficacy have shown to promote resilience by serving as a stress buffer. However, little is known about the role of network connectivity of self-efficacy in the context of stress resilience. The present study aims at filling this gap by using psychological network analysis to study self-efficacy and resilience. Based on individual resilient functioning scores, we divided a sample of 875 mentally healthy adults into a high and low resilient functioning group. To compute these scores, we applied a novel approach based on Partial Least Squares Regression on self-reported stress and mental health measures. Separately for both groups, we then estimated regularized partial correlation networks of a ten-item self-efficacy questionnaire. We compared three different global connectivity measures-strength, expected influence, and shortest path length-as well as absolute levels of self-efficacy between the groups. Our results supported our hypothesis that stronger network connectivity of self-efficacy would be present in the highly resilient functioning group compared to the low resilient functioning group. In addition, the former showed higher absolute levels of general self-efficacy. Future research could consider using partial least squares regression to quantify resilient functioning to stress and to study the association between network connectivity and resilient functioning in other resilience factors.

The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial

Introduction

Dialysis causes many psychological and social problems, such as stress and inefficiency in patients, which should be considered in health promotion interventions. Therefore, this study aimed to determine the impact of stress management training on stress coping strategies and the self-efficacy of these patients in southeastern Iran.

Methods

This quasi-experimental study was a randomized controlled clinical trial was conducted on hemodialysis patients from December 2019 to January 2020. Patients who met inclusion criteria were selected with the convenience sampling method and divided into the two groups of intervention (n = 30) and control (n = 30) by using the block randomization method. Participants in the intervention group were trained in a stress management training program in 8 one-and-a-half-hour sessions, held twice a week. Data were measured with stress coping strategies and general self-efficacy questionnaires before, immediately, and 1 month after the intervention. SPSS18 was used for data analysis.

Results

The study results showed that the scores of stress coping strategies and the self-efficacy score in all their dimensions were significantly different between the intervention and control groups (P < 0.001).

Conclusion

The present study results showed that stress management training programs promoted stress coping strategies and self-efficacy in hemodialysis patients. Health planners and nurses are recommended to use these easy, feasible, and inexpensive interventions to reduce stress and increase self-efficacy.

Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20160914029817N10. Date of registration: October 7, 2021. URL: https://en.irct.ir/trial/58540. Registration timing: a retrospective.

The effect of group cognitive-behavioral counseling on optimism and self-esteem of women during the 1st month of marriage that referring to marriage counseling center

BACKGROUND

Quality of relationship marital status affects all aspects of family functioning, including sustainability of cohabit living, supporting children, and happiness of couples. This study was conducted to examine the effect of group cognitive-behavioral counseling on optimism and self-esteem of women during the 1^st month of marriage that referring to marriage counseling center.

MATERIALS AND METHODS

A semi-experimental study was designed by a test, posttest, and follow-up. Participants consisted of 30 women admitted to premarriage counseling center of Farsan city in 2018 with using purposive sampling by random numbers' table into experimental and control groups. The experimental group participated in eight consecutive 2-h group counseling sessions. Data collection tools were demographic questionnaire, Rosenberg's Self-Esteem Scale, and optimism designed by Mir Ahmadi (reliability and validity are calculated and was 0.96) and completed in three rounds. Women's self-esteem retested was done after 1 month. Data were analyzed with independent t-test and repeated measures ANOVA (significance level <0.005). Quantitative variables were analyzed using the Kolmogorov-Smirnov test.

RESULTS

There were no significant differences between optimism scores in the experimental (M = 150.47, standard deviation [SD] = 22.07) and control groups (M = 149.2, SD = 21.54) prior to intervention (P = 0.875). The mean optimism score was significantly different in intervention (M = 169.33, SD = 17.01) and control (M = 147.2, SD = 22.22) groups immediately after counseling (P = 0.005) and 1 month after counseling (P = 0.002, M = 171.08, SD = 17.98). The mean self-esteem scores were statistically significant in both groups immediately after counseling (P = 0.023, I: M = 37.06, SD = 8.69, C: M = 31.4, SD = 4.83) and 1 month after counseling (P = 0.028, I: M = 34.73, SD = 4.93, C: M = 30.06, SD = 4.8).

CONCLUSION

Cognitive-behavioral counseling enhances women's optimism by emphasizing the training of communication and conflict resolution skills, which leads to positive attitude and life satisfaction. Therefore, using cognitive-behavioral counseling in marriage counseling sessions can improve couples' relationships.

Comparison of the effect of cognitive-behavioral therapy and dialectical behavioral therapy on perceived stress and coping skills in patients after myocardial infarction

BACKGROUND

Among the cardiovascular diseases (CVDs), myocardial infraction (MI) is one of the main causes of mortality around the world. A diagnosis of MI may be followed by psychological problems, such as depression, anxiety, and stress. Therefore, psychological interventions can be beneficial in routine treatment. The purpose of this study was to compare the effect of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) on perceived stress and coping skills in patients after MI.

METHODS

This study was a randomized clinical trial with a pretest-posttest design and control group. The statistical population consisted of 45 patients after MI who referred to Noor Heart Clinic in Rasht, Iran, between 2018 and 2019. They were randomly divided into 3 groups of 15 individuals (2 interventions including CBT and DBT, and 1 control group). In the intervention groups, participants underwent 8 weekly 90-minute sessions. Data were collected using a 3 part self-report questionnaire including a demographic information form, the Ways of Coping Questionnaire (WCQ), and the Perceived Stress Scaleý-14 (PSS-14). The statistical methods used for data analysis included chi-square test, one-way ANOVA, repeated-measures ANOVA, and post hoc Bonferroni test.

RESULTS

We found significant main effects of group (F(2,42)=6.11; P=0.005) and time (F(2,84)=28.48; P<0.001), and a significant group-by-time interaction (F(4,84)=8.97; P<0.001) on perceived stress scores. For problem-focused coping scores, findings indicated significant main effects of group (F(2,42)=7.33; P=0.002) and time (F(2,84)=30.71; P<0.001), and a significant group-by-time interaction (F(4,84)=12.86; P<0.001). For emotion-focused coping scores, the results also indicated significant main effects of group (F(2,42) = 17.41; P < 0.001) and time (F(2,84)=31.74; P<0.001), and a significant group-by-time interaction (F(4,84)=14.90; P<0.001).

CONCLUSION

The current study revealed that DBT was more effective in improving emotion-focused coping than CBT.

Depressive Symptoms, Sleep Quality and Diet During the 2019 Novel Coronavirus Epidemic in China: A Survey of Medical Students

The psychological condition of medical students may be influenced by the 2019 novel coronavirus (COVID-19) outbreak. This study investigated the prevalence and influencing factors of depressive symptoms, poor sleep quality and poor diet in students at Kunming Medical University during the early part of the COVID-19 outbreak. A cross-sectional study was used from a questionnaire survey in February 2020. Of a total of 1,026 study participants, the prevalence of depressive symptoms, poor sleep quality, and poor diet was, respectively, 22.4, 33.2, and 17.4%. Male students and students with a low degree of focus on COVID-19 had a high risk of depressive symptoms. A high percentage of females and students in the fifth grade, as well as students with high levels of concern about the negative impact of COVID-19 on their education or employment, comprised those with poor sleep quality. Students in the fifth grade and students with high levels of concern about the negative impact of COVID-19 on their education or employment were more likely to report poor diet. This study suggests the importance of monitoring medical students' depressive state during the COVID-19 outbreak, and universities are encouraged to institute policies and programs to provide educational counseling and psychological support to help students to cope with these problems.

Implementation of the college student mental health education course (CSMHEC) in undergraduate medical curriculum: effects and insights

BACKGROUND

Extant literature reveals that medical students suffer from various mental health problems in the process of learning medicine. However, there are few studies evaluating the implementation of a mental health education course in medical curriculum. The current study aimed to test the effectiveness of an 8-week intensive mental health education course, the College Student Mental Health Education Course (CSMHEC), and to gain further insights on how the course could be improved from students' feedback.

METHODS

This is a quasi-experimental study with both quantitative and qualitative analyses. We recruited 374 first year medical students as our subjects with 188 (age = 17.97 ± 0.65 years, 37.2% male) for the experiment group and 186 (age = 18.02 ± 0.63 years, 40.3% male) for the control group. For quantitative analysis, Depression Anxiety Stress Scales-21 (DASS-21), Chinese College Student Academic Burnout Inventory (CCSABI) and Satisfaction With Life Scale (SWLS) were used and a 5-point Likert scale was used to indicate students' overall satisfaction with CSMHEC. For qualitative analysis, a thematic analysis method was adopted to gain insights from the feedback of medical students.

RESULTS

Medical students in the experiment group saw a significant decline in psychological distress (p < 0.001, d = 0.31) and academic burnout (p < 0.001, d = 1.46), while they experienced a significant increase in life satisfaction levels after the intervention (p < 0.001, d = 0.48). Compared with students in the control group, students in the experiment group had statistically significant lower levels of psychological distress (p < 0.05, d = 0.23) and academic burnout (p < 0.001, d = 0.70), but statistically significant higher levels of life satisfaction in the post-test (p < 0.01, d = 0.31). Most students in the experiment group were satisfied with CSMHEC and themes extracted in the thematic analysis shed light on how the course could be improved.

CONCLUSIONS

Implementing a mental health education course like CSMHEC in medical curriculum can be effective in helping medical students improve psychological health. More research needs to be conducted on further refinement and better design of such a course to implement in medical education.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.