Effectiveness of CancerGuides®: A Study of an Integrative Cancer Care Training Program for Health Professionals

Purpose: To determine how CancerGuidesâ®, an integrative cancer care training program, would affect participants' perception of their professional skills, their mood, use of self care and mind-body modalities, and the acceptance of integrative cancer care at their institutions. Study Design: Qualitative and quantitative measures were used during the training program and at 6-month follow-up. A focus group met before and after the training, and individual interviews of focus group participants were done at follow-up. Methods: The week-long program consisted of lectures that provided information on integrating conventional and complementary therapies into individualized programs of cancer care. Small group sessions used mind-body techniques to allow participants to understand the dilemmas faced by cancer patients. A self-report survey was administered at the training program and at 6-month follow-up. The survey included questions on the personal and professional use of modalities and on participants' sense of how well they met the course objectives. Qualitative questions addressed self-care, changes in clinical practice, and the acceptance of integrative therapies by their institutions. The Profile of Mood States was administered before and after the training. Results: Six months after the training, there was a significant increase in the use and/or recommendation of complementary and alternative medicine modalities in clinical practice and a significant increase in the personal practice of these modalities. Participants' perceived level of skill for all of the course objectives was significantly increased following the training and was maintained at 6-month follow-up. There were significant reductions in the Anger-Hostility and Tension-Anxiety subscale scores of the Profile of Mood States questionnaire. In response to qualitative questions, participants reported positive changes in patient care and in their clinical practices at 6-month follow-up. The subset of participants in the focus group interviews reported similar improvements. Thirty-five percent of those responding at follow-up reported an increase in acceptance of integrative cancer therapies at their institutions, and 77% reported making positive changes in self-care. Conclusions: Cancer-Guides provided training that allowed participants to enhance personal self-care, to interact more effectively with their patients, and to develop programs of integrative cancer care.

Integration of the biopsychosocial model: perspectives of medical students and residents

PURPOSE

To examine residents' and medical students' attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and to identify barriers to the integration of evidence-based, mind-body methods.

METHOD

A random sample of third- and fourth-year medical students and residents was drawn from the Masterfiles of the American Medical Association. A total of 661 medical students and 550 residents completed a survey, assessing attitudes toward the role of psychosocial factors and the clinical application of behavioral/mind-body methods.

RESULTS

The response rate was 40%. Whereas a majority of students and residents seem to recognize the need to address psychosocial factors, 30%-40% believe that addressing such factors leads to minimal or no improvements in outcomes. The majority of students and residents reports that their training in these areas was ineffective, yet relatively few indicate interest in receiving further training. Females are more likely to believe in the need to address psychosocial factors. Additional factors associated with greater openness to addressing psychosocial factors include (1) the perception that training in these areas was helpful, and (2) personal use of behavioral/mind-body methods to care for one's own health.

CONCLUSIONS

There is a need for more comprehensive training during medical school and residency regarding both the role of psychosocial factors in health and the application of evidence-based, behavioral/mind-body methods. The current health care structure-particularly insufficient time and inadequate reimbursement for addressing psychosocial factors-may be undermining efforts to improve patient care through inconsistent or nonexistent application of the biopsychosocial model.

Psychophysiological training of operators in adaptive biofeedback cardiorhythm control

A new individual computerized technique for psychophysiological training of operators before performing psychomotor activity on a computer model (psychomotor concentration and spatial orientation test) was developed. Qualitative criteria for the prediction of safe operator activity were formulated. Preliminary testing of operators' activity quality showed great dispersion of individual results: The amount of errors ranged from 0 to 56 and the rate of information processing varied from 1.01 up 3.56 bit/s. Subjects with initially identified respiratory sinus arrhythmia or synchronization caused by respiratory movements committed minimal recognition errors in initial stages at a high rate of information processing. The number of errors remained unchanged after the biofeedback cardio-training cycle, with the rate of information processing increasing noticeably. Subjects without inherent harmonics developed harmonics after sessions of cardiorhythm biofeedback control, and their operator activity quality improved significantly, making fewer mistakes and increasing the rate of information processing. Biofeedback control led not only to the restoration of respiratory sinus arrhythmia, a favorable diagnostic sign, as revealed by cardiorhythmograms, but also resulted in improvement of the quality of operator activity.

Effectiveness of a mind-body skills training program for healthcare professionals

CONTEXT

Because of the increased use and benefits of mind-body therapies, it is important that healthcare professionals receive training in these modalities.

OBJECTIVE

To determine whether healthcare professionals who attended the Center for Mind-Body Medicine's training program were incorporating mind-body skills into their professional or personal practices and whether they had a greater sense of life satisfaction.

DESIGN

Repeated measures analysis.

SETTING

Annual training programs were held in hotels and conference centers in the US.

PARTICIPANTS

Four hundred fifty-one healthcare professionals attended the programs from 1998 to 2001. Two hundred fifty-nine completed the one-year follow-up survey, and 307 completed the well-being survey.

INTERVENTION

The week-long program included didactic and experiential training in biofeedback, meditation, autogenics, imagery, and movement/exercise, as well as self-expression in small groups through drawings, written exercises, and genograms.

MAIN OUTCOME MEASURES

Questionnaires on previous training and personal and professional use of mind-body approaches were administered before and one year after the program. The Existential Well-Being (EWB) scale also was administered before and immediately after the training.

RESULTS

There was a significant increase in the personal use of mind-body skills and the number of participants who were teaching their clients to use all modalities and a significant decrease in the number of participants who were referring clients to others for training. Participants also had significantly higher life satisfaction scores after the program.

CONCLUSION

This professional training program was effective in promoting the personal and professional use of mind-body skills and in enhancing the personal fulfillment of trainees.

The relationship between theoretical memory psychology and art of memory: a historical analysis

The split between the theoretical branch and the practice--oriented art of memory psychology has existed for centuries. Whereas the theory of memory involved creation of elaborate models to elucidate the structure and processes of memory, in contrast the art of memory embraced techniques to enhance memory performance. One might expect a close relationship between practice and theory. This is, however, not the case. Theorists and memory artists criticized, fought, or ignored each other, as is demonstrated by examples from the 16th to the 19th century.

A "creative tension": the Royal Army Medical Corps and the interplay of psychological and physiological in the rise of a psychoanalytic synthesis, 1915-22

Secondary accounts of the impact of the First World War on psychological medicine have traditionally painted a picture of psychoanalysis as the preserve of a small number of pioneering individuals, led by William Rivers and marginalized by a Royal Army Medical Corps (RAMC) obsessed with discipline. This view ignores the climate of theoretical exchange promoted by the RAMC's concern with returning as many soldiers to the front line as possible. The RAMC approach provided new resources and a positive environment for the rise of a psycho-physical psychoanalytic synthesis, to build on the extensive work in this field in which RAMC officers were engaged from a very early stage in the war. William Rivers, despite recent popular acclaim, stood at the rearguard of this movement, in which the varied and important work of William Brown is often overlooked.

Realizing Engel's vision: psychosomatic medicine and the education of physician-healers

Many of the exciting conceptual and scientific advances in the field of psychosomatic medicine are not taught in United States medical schools. This article, based on the Presidential Address given at the Annual Meeting of the American Psychosomatic Society in Phoenix, Arizona in March 2003, reviews the rationale for integrating psychosomatic medicine into medical curricula, identifies educational needs, proposes a core curriculum, and suggests how American Psychosomatic Society members can be instrumental in curriculum development and implementation.

Health care providers' training, perceptions, and practices regarding stress and health outcomes

In order to assess health care providers' training, perceptions, and practices regarding stress and health outcomes, a survey was administered to primary care providers in the outpatient medical clinics of a southeastern urban hospital serving a predominantly African-American indigent population. One-hundred-fifty-one of 210 providers (72%) responded. Forty-two percent of respondents reported receiving no instruction regarding stress and health outcomes during their medical/professional education. While 90% believed stress management was "very" or "somewhat" effective in improving health outcomes, 45% "rarely" or "never" discussed stress management with their patients. Respondents were twice as likely to believe that counseling patients about smoking, nutrition, or exercise was more important than counseling them about stress. Seventy-six percent lacked confidence in their ability to counsel patients about stress. The majority of respondents (57%) "rarely" or "never" practiced stress reduction techniques themselves. Belief in the importance of stress counseling, its effectiveness in improving health, and confidence in one's ability to teach relaxation techniques were all related to the probability that providers would counsel patients regarding stress. There is a need for curriculum reform that emphasizes new knowledge about stress and disease, new skills in stress reduction, and more positive beliefs about mind/body medicine and its integration into the existing health care structure.

Mind, meaning and metaphor: the philosophy and psychology of metaphor in 19th-century Germany

This article explores a German philosophy of metaphor, which proposed a close link between the body and the mind as the basis for metaphor, debunked the view that metaphor is just a decorative rhetorical device and questioned the distinction between the literal and the figurative. This philosophy of metaphor developed at the intersection between a reflection on language and thought and a reflection on the nature of beauty in aesthetics. Thinkers such as Giambattista Vico, Johann Wolfgang von Goethe, Jean Paul and others laid the foundations for this philosophy and it was successively refined by Gustav Gerber, Alfred Biese and Friedrich Nietzsche. It influenced in its turn in various ways the linguistic study of metaphor and the psychology of metaphor as elaborated, for instance, by a lesser-known American scholar, Gertrude Buck. All these thinkers contributed to a philosophy and psychology of the metaphoric according to which metaphors are not only nice, but necessary for the structure and growth of human thought and language. Obvious parallels between this 19th-century philosophy of metaphor and the 20th-century theory of metaphor developed by Lakoff and his followers are examined throughout.

Comparing mind-body wellness interventions for older adults with chronic illness: classroom versus home instruction

Two versions of a multicomponent mind-body wellness intervention were tested. One hundred seventy-eight physician-referred HMO patients (mean age = 64.5) were randomly assigned to a classroom intervention, a home study intervention, or a wait-list control group. Both interventions provided instruction on mind-body relationships, relaxation training, cognitive restructuring, problem solving, communication, behavioral treatment for insomnia, nutrition, and exercise. The home version was delivered by class videotapes and readings. Compared with the control condition, both interventions led to significant decreases in self-reports of pain, sleep difficulties, and symptoms of depression and anxiety. The home course also led to a significant decrease in self-reported frequency of medical symptoms, and the classroom program resulted in a significant decrease in "chance" health locus of control beliefs. No effects were obtained for health behaviors, life satisfaction, HMO satisfaction, and other health locus of control beliefs. A lower cost, more accessible home study version of a mind-body wellness program can be an effective alternative to classroom instruction.

[Body-mediated therapies in geriatric psychiatry]

The use of body mediated therapies at the Clinical geriatric psychiatry became possible due to the convergence between multi, inter and transdisciplinary approaches and the clinical experience in this application of various therapeutic technics. This approach at the aged clinic must take into consideration the specificity of the correlation to the body of the aged person beside the advantages and the needs that resent this approaches to both the patient and his therapist.

Current advances in Alzheimer's disease. A medical model paradigm for psychiatric education

Psychiatrists have the expertise to play a major leadership role in the diagnosis and treatment of Alzheimer's disease. Psychiatry residents should be trained to recognize both the cognitive and noncognitive symptoms of this disease. Psychiatrists are in an excellent position to keep up with the rapidly expanding pharmacologic armamentarium to treat this devastating illness. Although such potentials are exciting, they undoubtedly will be complicated. Residency directors and departmental chairs should instill enthusiasm toward basic science advances and their clinical implications. Understanding the mechanisms underlying specific central nervous system illnesses should increase the likelihood of discovering the pathophysiology of others. The more psychiatrists and psychiatric residents become interested in these discoveries and the science underlying such progress in Alzheimer's disease, the better they will be able to keep up to date with progress in understanding other psychiatric disorders.

Social work in the academic medical center: advanced training--a necessity

Although the total number of social workers within the academic medical center will probably decrease because of decreasing hospital bed usage, the role for those who remain will be that of a clinical specialist, a sophisticated and adaptable practitioner who can work flexibly under minimal supervision. The valued social work practitioner will be an independent player on the health care team who assumes a significant role which no other member of that team is equipped to take. Advanced training is more important today than ever before in the evolution of social work practice in academic health care. However, this training is not now available within the parameters of the two year master's program.

Academic courses in biofeedback

The data presented here represent a sampling of the activities in programs offering academic courses in biofeedback that responded to the Education Committee's effort to develop a directory of such courses. A diversity of type and number of training experiences, equipment, resources, and approaches to training are represented. The committee is currently working on a format to share the wealth of course materials gathered in addition to the directory, which has already been published (Biofeedback Society of America, 1987).

Developing a curriculum in psychogeriatrics

Psychiatric problems are rampant among the aged, yet the psychiatric profession has not developed sufficient resources for training the necessary number of practitioners able and willing to treat elderly psychiatric patients. The management of psychiatric problems in old age differs substantially from that in younger age groups. The elderly patient is likely to have multiple needs and to require diverse services. Fundamental goals in training geriatric psychiatrists should focus on differential diagnosis and treatment, pharmacologic issues, consultation, community resources, and psychiatric, medical, and psychosocial aspects of care. The authors describe a curriculum tailored to meet these goals.