Behavioral Stress Management Research Articles

Web-Based Cognitive Behavioral Stress Management for Latino Sexual Minority Men Living With HIV and Cancer

Web-Based Cognitive Behavioral Stress Management for Latino Sexual Minority Men Living With HIV and Cancer

Effect of 3-week Behavioral Intervention to Reduce Sedentary Behavior on Body Composition and Blood Biomarkers: A Pilot Study (P16-017-19)

ObjectivesSedentary behavior has been linked to increased health risks yet few RCTs examine sedentary behavior in the context of meaningful health outcomes. Furthermore, few studies examine scalable interventions. This 3-week pilot study examined if cognitive behavioral sedentary behavior intervention (CBSB) or stress management (CBSM) intervention delivered via the internet (video) had a positive effect on sedentary behavior measured via the Sedentary Behaviour Questionnaire (SBQ) and pedometer. The study further investigated changes in body weight (∆BW), body fat mass (∆BF), fat free mass (∆FFM), total cholesterol (∆TC), triglycerides (∆TG), low-density lipoprotein (∆LDL), high-density lipoprotein (∆HDL), and fasting glucose (∆Glc). MethodsTwenty-one subjects were randomized into one of the 3 groups, control (C), CBSB, or CBSM. All subjects received educational handouts at the first assessment visit. CBSB and CBSM received one group-specific CBT video lesson weekly; C received a neutral video. Daily step count was collected throughout the study via pedometer. Blood lipid panels (TC, TG, LDL, and HDL) and Glc were collected via finger stick at baseline and after the 3-week intervention. The Kruskal-Wallis test was used to compare difference scores (between baseline and post-intervention) across groups. ResultsChange in daily step count and SBQ score did not significantly differ across groups (P = .767, P = .796 respectively). No significant group differences were found in ∆TC, ∆TG, ∆LDL, ∆HDL, and ∆Glc (P = .478, P = .499, P = .675, P = .536, P = .062 respectively). ∆BW, ∆BF, and ∆FFM were not significantly different across three groups (P = .817, P = .056, P = .069 respectively). Adherence to assigned intervention was 100%. ConclusionsIt is likely that a 3-week CBT intervention delivered remotely may have been insufficient to induce meaningful behavioral and biological change. However, excellent adherence in this pilot study provides initial proof of concept regarding the acceptability of the intervention and thus the potential for this scalable intervention to be delivered successfully. Larger studies that include health and behavioral outcomes, utilize longer and possibly higher intensity remotely delivered intervention are needed. Funding SourcesTexas Tech University.

Cognitive Behavioral Stress Management intervention in Mexican colorectal cancer patients: Pilot study.

Determine the feasibility and the preliminary effects of brief cognitive behavioral stress management (CBSM) intervention, compared with psychoeducation (PE) group in posttraumatic stress, distress, optimism, and quality of life in patients with colorectal cancer. Ninety-four patients were randomized: 40 in CBSM intervention and 54 in PE. They answered psychological questionnaires before and after the intervention and 3months later for follow-up. Of the included participants, 23.40% (22) completed the sessions (11 in each group). A significant effect was obtained in the variable of optimism F2,28 =4.0, P=0.03, ƞ2p =0.22 and a significant interaction effect between the groups in the avoidance behavior F2,28 =6.0, P=0.01, ƞ2p =0.30 and hyperactivation F2,30 =3.91, P=0.03, ƞ2p =0.20, with a large effect size in both. A significant interaction effect was found in the quality of life symptoms subscale for patients with colorectal cancer with a stoma F3,20 =21.8, P=0.00, ƞ2p =0.68. The CBSM intervention and PE are feasible therapies, albeit with some modifications. Preliminary effects are observed in the dimensions of posttraumatic stress and symptoms of quality of life.

Assessing the Effectiveness of Cognitive Behavioral Stress Management (CBSM) on Pain Perception of Cancer Patients

Background: Disease-related cancer pain is a multidimensional phenomenon. Psychological factors that may alter pain perception in cancer patients have not been well studied. The purpose of this study was to determine the effectiveness of cognitive-behavioral stress therapy on distress in patients with cancer.Patients and Methods: In a cross-sectional study of consecutive patients (32-70 years), progression of their disease was at levels 1 to 3, high cycle education, and 3 months of chemotherapy, of which 40 were randomly available to the study and allocated to two groups (20 in experimental and 20 in control groups). The instrument was a McGill pain questionnaire (1997). Data were analyzed using two methods of Kolmogorov-Smirnov inferential statistics and multivariate analysis of covariance using SPSS Ver.17.Results: Correlation analysis showed that the experimental group had a significant reduction in perception of pain, in the posttest after the experiment compared with the control group.Conclusion: The short-term cognitive-behavioral stress management program could reduce the perception of pain in cancer patients.

Relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students.

IntroductionSmartphone usage has become commonplace and impact on sleep quality among adolescents. Adolescent girls have a greater tendency toward sleep quality problems. However, relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students has not been studied.ObjectivesThis study had the two goals: to investigate the relationship between female college students' sleep quality, smartphone dependence, and health-related behaviors, and to identify predictors of sleep quality.MethodsThis study employed a cross-sectional research approach to gather 409 subjects at a junior college in southern Taiwan, and used a structured questionnaire to collect data. The questionnaire consisted of four parts: basic demographic data, the Pittsburgh Sleep Quality Index, assessment of smartphone dependence, and the Health Promoting Lifestyle Profile (HPLP). Logistic regression analysis was employed to check for any association between sleep quality and smartphone dependence or HPLP.ResultsSleep quality was significantly associated with degree of smartphone dependence, total HPLP score, and scores on the four HPLP subscales of nutritional behavior, self-actualization, interpersonal support, and stress management behavior. The lower the subjects' degree of smartphone dependence was, the better their sleep quality was. Furthermore, the degree of smartphone dependence and total HPLP score were significant predictors of sleep quality.ConclusionsSmartphone dependence is associated with poor sleep quality among female college students. Improving health-related behaviors (nutritional behavior, self-actualization, interpersonal support, and stress management behavior) can also promote improvement in sleep quality.

Female Sex is Associated With Poor Health-related Quality of Life in Children at 12 Months Post-Hematopoietic Cell Transplantation.

To study the factors associated with poorer health-related quality of life at 1-year post-allogeneic hematopoietic cell transplantation (alloHCT), a secondary analysis of a prospective feasibility study was performed. Pediatric Quality of Life Inventory questionnaires were collected in 76 children undergoing alloHCT at baseline (within 30 d before transplantation), day 100, 6 months, and 12 months posttransplantation. The global score improved post-HCT (baseline: 67.1, 12 mo: 76.6). Females (odds ratio, 6.5; 95% confidence interval, 1.002-42.17; P=0.04) and patients with low baseline scores (odds ratio, 7.2; 95% confidence interval, 1.07-48.63; P=0.04) had lower scores at 12 months post-HCT and suggest a target group for early interventions such as physical exercise, stress management, and cognitive behavior therapy.

The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women

BackgroundDysregulations in maternal hypothalamus-pituitary-adrenal function and the end product, cortisol, have been associated with a heightened risk for stress-related health complications during pregnancy and post partum. Given the adverse health impact that maternal cortisol may have on expectant mothers and their infants, empirically-based prenatal interventions are needed to target optimal management of stress and its biological effects in at-risk pregnant women, a primary example of which is cognitive behavioral stress management (CBSM). This randomized-controlled trial examined the effects of a prenatal CBSM intervention on reduction in perceived stress and regulation of salivary cortisol patterns [i.e., overall cortisol output (area under the curve), cortisol awakening response (CAR), diurnal slope] during pregnancy and the early postpartum period, as compared to a control group. MethodsOne hundred low-income pregnant women (71% Latina; 76% annual income < $20 K) with low or high anxiety during pregnancy were randomized (stratified by anxiety) to either an eight-week CBSM group intervention (n = 55) or a control group (n = 45). They provided seven salivary cortisol samples (four am samples, 12 pm, 4 pm, and 8 pm samples on one collection day) at baseline (1st trimester; < 17 weeks of gestation), after their prenatal program (2nd trimester), and also in the third trimester and at three months post partum. ResultsWomen receiving CBSM had lower perceived stress levels throughout pregnancy and early post partum compared to women in the control group (p = .020). Among women with high prenatal anxiety, those in CBSM showed a steeper decline in their diurnal cortisol at three months post partum compared to those in the control group (p = .015). Further, non-Latina women in CBSM had a lower CAR at three months post partum compared to non-Latina women in the control group (p = .025); these randomization group differences on the CAR were not observed among Latina women. ConclusionsThese findings provide preliminary support for the efficacy of prenatal CBSM interventions in improving stress outcomes among low-income pregnant women and suggest the need to test the effects of these interventions on a larger scale for improving maternal and infant health outcomes long-term.

Abstract # 2061 Brief stress management interventions after surgery improve psychological adaptation and immune cell signaling in breast cancer patients

Breast cancer (BCa) patients revealing poorer psychological adaptation after surgery show greater inflammation and have poorer long-term outcomes. Our 10-wk group cognitive behavioral stress management (CBSM) intervention showed concomitant 12-month improvements in adaptation and downregulated leukocyte pro-inflammatory and pro-metastatic and upregulated glucocorticoid (GC) regulatory and anti-viral gene expression vs psycho-education controls. In a dismantling trial (N = 183) we compared 5-wk post-surgical interventions featuring one CBSM component—Cognitive Behavioral Therapy [CBT] or Relaxation Training [RT]—vs a 5-wk Health Education (HE) control for effects on adaptation and inflammatory signaling over 12 months of BCa treatment. Since bioinformatics analysis of the 10-wk CBSM trial inferred reduced NFκB signaling underlying CBSM effects on downstream leukocyte gene expression, we extracted nuclear protein from PBMCs to determine NFκB DNA binding by electromobility shift assay. Women assigned to CBT or RT showed improved adaptation (affect and social disruption) and decreased NFκB binding over 12-months vs HE (p’s <.05). Greater adaptation at 12-months was associated with less NFκB-DNA binding. RT or CBT also showed reductions (vs HE) in ligands (s100A8/A9) for the Receptor for Advanced Glycation End Products (RAGE), which is implicated in NFκB activation and MAPK-mediated pro-metastatic processes (p < .05). Providing post-surgical BCa patients with brief stress management can improve adaptation and immune cell signaling during primary treatment, and may improve long-term health outcomes.

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

INTRODUCTION:The present study aimed to investigate the effectiveness of cognitive behavioral therapies (CBTs) for anxiety, hardiness, and self-efficacy in female students of Birjand University of Medical Sciences.MATERIALS AND METHODS:This was an interventional study. A sample of 30 participants were selected through the available sampling method and randomly assigned into experimental (CBT) and control groups (each group, 15 female student). The data collection instrument was the Beck Depression Inventory questionnaire. The questionnaires of Beck Anxiety Inventory, Ahvaz Hardiness Inventory, and Schwartz's General Self-Efficacy Scale were completed by all participants in two stages (pretest and posttest). A 6-session protocol of cognitive behavioral group therapy was performed only on the experimental group. The data were analyzed using Kolmogorov–Smirnov, Levene's F, Mbox, analysis of variance, and multivariate analysis of variance tests.RESULTS:The intervention group showed that the mean of anxiety decreased, whereas (P < 0.001) the means of hardiness and self-efficacy increased in the posttest for the experimental group (P < 0.001).CONCLUSION:Based on the obtained results, it can be concluded that CBT is an effective treatment for anxiety, hardiness, and self-efficacy. Therefore, through managing anxiety, the levels of hardiness and self-efficacy can be increased in students of university to be able to cope with the different challenges in their life.

Evaluation of program to encourage stress management behavior in IT company new employees

Evaluation of program to encourage stress management behavior in IT company new employees

Digitally Delivered Psychological Interventions for Anxiety Disorders: a Comprehensive Review.

Digital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for anxiety disorders (Social Anxiety Disorder (SAD), Health Anxiety, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Specific Phobias, Panic Disorder (PD), Generalised Anxiety Disorder (GAD)]. 68 randomised controlled trials (RCTs) were reviewed. SAD was the anxiety disorder for which the most RCTs were conducted. Overall, findings support the effectiveness of iCBT for SAD; for the remaining interventions, although some RCTs indicated significant improvement (within groups) at post-treatment and/or follow up, between group findings were less consistent and overall, methodological differences across trials failed to provide strong supporting evidence. Finally, the level of therapist contact or expertise did not appear to affect much treatment effectiveness. Additional large, methodologically rigorous trials are needed to investigate further whether different digitally delivered psychological interventions are equally effective for anxiety disorders. Moreover, further studies are pertinent in order to examine the maintenance of therapy gains after the end of treatments and understand how these work [(e.g. the influence of therapist factors, user engagement and/or satisfaction, potential access barriers and treatments with diverse population groups (e.g. BME groups)].

Abstract 16840: A Community Engagement Initiative Supporting a Culture of Heart Health

Background: Historically seen as a man’s disease, coronary heart disease (CHD) is the annual cause of death for approximately the same number of women as men. Strides have been made in raising awareness of women’s CHD risk, and national initiatives call for programs that both raise awareness and sustain engagement in heart healthy lifestyles. A gap remains between women’s personal awareness of risk and the preventative activities in which they engage. Purpose/Methods: Embracing the concept of cardiovascular health (CVH) from the American Heart Association’s Impact Goal, a coalition of community organizations partnered to launch a three pronged community engagement initiative (CEI): Follow the Fifty: Models of Heart Health . The purpose was to: raise women’s awareness of their risks for CHD; raise women’s CVH awareness, and increase women’s knowledge of evidence based activities that promote and support a culture of heart health through reducing cardiovascular risk factors (CVRF). Women participants (N=177), recruited through community advertising, became “Models of Heart Health.” The nine month CEI provided presentations on stress reduction, CVD awareness, and CVRF reduction activities; community gardens for growing heart healthy foods; and coaches paired with Models to support reducing individual CVRF. Community businesses provided CVH options: heart healthy menu choices, gym classes/memberships, group training activities. Baseline biometric data screened Models for participation (weight, BMI, blood pressure, glucose, smoking status). Models completed self-report surveys describing nutrition, physical activity, and stress management behavior changes resulting from the CEI. Focus groups were held to gather qualitative feedback. Results/Conclusions: Follow the Fifty CEI successfully raised women’s awareness of their risk for CVD and influenced personal behavior change to reduce CVRF, thereby promoting and sustaining heart health. Models reported adopting improved diet (93.6%), physical activity (84.6%), and stress management activities (52.5%). Focus groups identified themes of: “goal driven with accountability,” “ongoing process,” “being rewarded,” a sense of “sisterhood/enduring friendships,” “empowerment,” and “confidence to attain goals.” Providing women with a mechanism for decision support and self-management, while identifying and strengthening the link to community resources resulted in adoption of effective therapeutic CVD preventive behaviors, creating a culture of heart health.

A stress management intervention for adults living with HIV in Nigerian community settings: An effects study.

This study evaluated the effectiveness of a group-based cognitive-behavioral stress management intervention among community-dwelling adults living with HIV in Southeastern Nigeria. A total of 28 HIV-positive adults meeting the criteria for high perceived stress, anxiety, and depression were randomized into 1 of 2 groups: treatment group (n = 14); and no-treatment control group (n = 14). Stress level was measured using the 10-item Perceived Stress Scale (PSS-10). Depression and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale (HADS). Secondary outcome measure was Satisfaction with Life Scale (SWLS). The intervention was delivered over the course of 10 weeks, using an evidence-based cognitive-behavioral stress management manual. We employed repeated-measures between and within-subjects analysis of variance (ANOVA) and Eta squared in the analyses and interpretation of data collected from the study participants at 3 time points. Our results showed that, after benefitting from the cognitive behavioral stress management intervention, the PSS-10 and HADS scores were lowered significantly in the treatment group participants than those in the no-treatment control group during evaluations of post-treatment and 3 months follow-up outcomes. Significant improvements were also recorded in the treatment group participants' SWLS scores at post-treatment and follow-up compared with participants in the no-treatment group. The present results suggest the need for further implementation of group-based cognitive-behavioral stress management interventions for people living with HIV. Cognitive-behavioral stress management clinicians should make efforts toward identifying HIV-positive adults experiencing psychological distress and design cognitive-behavioral stress management interventions in order to better assist them.

Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: Acceptability and efficacy by race.

Relative to non-Hispanic whites (NHW), black men are disproportionately affected by prostate cancer (PC) incidence, have poorer PC outcomes, and report greater compromises in health-related quality of life. Despite these challenges, black men are underrepresented in psychosocial cancer research, possibly due to limited access to supportive oncology programs. The purpose of this article is to examine the acceptability and efficacy for reducing disease-specific distress of a tablet-delivered psychosocial intervention for older men with advanced PC (APC) and explore differences by race. Men with APC (N = 192, 37.5% black, age M = 68.84 years) were randomized to 10-week Cognitive Behavioral Stress Management (CBSM) or attention-control Health Promotion (HP), both delivered via tablets. Assessments occurred at baseline in person, weekly during the 10-week program via tablets, and at 6 and 12 months in person. Weekly session evaluations and postprogram exit surveys assessed acceptability. Efficacy was assessed with a measure of PC-anxiety validated with racially diverse PC patients using linear mixed effects modeling. Study retention and group attendance did not differ by race. CBSM and HP were both acceptable among older APC patients. Black men rated both conditions more favorably than NHW men. Men in CBSM (vs. HP) reported greater reductions in PC-anxiety at 6 months (not sustained at 12 months). Black men in CBSM reported greater decreases in PC-anxiety over time compared with all other groups. Tablet-delivered CBSM and HP were acceptable for black and NHW APC patients, although black men rated both conditions more favorably. Black men reported a unique intervention benefit related to reduced disease-specific distress.

A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing

BackgroundDistress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions.ObjectiveThe objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations.MethodsDesign and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout.ResultsThe design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization.ConclusionsInterventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors.Trial RegistrationClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB)

Effects of Appearance Stress and Appearance Management Behavior on Job-seeking Stress among Male University Students

Purpose: The purpose of this study was to investigate the effects of appearance stress and appearance managementbehavior on job-seeking stress among male university students. Methods: The participants of this cross-sectionaland descriptive study were 158 male students attending a university in K Province who completed a self-reportstructured questionnaire. The survey period was from September 19th to November 9th, 2017. Data wereanalyzed using descriptive statistics, independent t-test, one-way ANOVA, correlation and multiple linear regressionanalyses with the SPSS statistics 23 program. Results: Job-seeking stress showed significant differencesaccording to BMI (F=2.55, p=.042) and pocket money (F=3.08, p=.049). The results of the regression analysisshowed that grade (β=8.93, p=.008), pocket money (β=-5.11, p=.029), appearance stress (β=.52, p<.001),and appearance management behavior (β=.25, p=.001) were significant factors affecting jog search stress. Conclusion: The findings of this study suggest that variables such as grade, pocket money, appearance stress,and appearance management behavior significantly explain job-seeking stress among male students in college. Therefore, it is necessary to develop a program to reduce job-seeking stress for senior male students who arepreparing for employment before graduation. In addition, when organizing a program to reduce job-seeking formale university students, it is necessary to help them have a more positive evaluation of their appearance andpursue proper appearance management behaviors.

Study design and protocol for a culturally adapted cognitive behavioral stress and self-management intervention for localized prostate cancer: The Encuentros de Salud study

Almost 2.8 million men in the U.S. are living with prostate cancer (PC), accounting for 40% of all male cancer survivors. Men diagnosed with prostate cancer may experience chronic and debilitating treatment side effects, including sexual and urinary dysfunction, pain and fatigue. Side effects can be stressful and can also lead to poor psychosocial functioning. Prior trials reveal that group-based cognitive behavioral stress and self-management (CBSM) is effective in reducing stress and mitigating some of these symptoms, yet little is known about the effects of culturally-translated CBSM among Spanish-speaking men with PC. This manuscript describes the rationale and study design of a multi-site, randomized controlled trial to determine whether participation in a culturally adapted cognitive behavioral stress management (C-CBSM) intervention leads to significantly greater reductions in symptom burden and improvements in health-related quality of life relative to participation in a non-culturally adapted cognitive behavioral stress management (CBSM) intervention. Participants (N = 260) will be Spanish-speaking Hispanic/Latino men randomized to the standard, non-culturally adapted CBSM intervention (e.g., cognitive behavioral strategies, stress management, and health maintenance) or the culturally adapted C-CBSM intervention (e.g., content adapted to be compatible with Hispanic/Latino cultural patterns and belief systems, meanings, values and social context) for 10 weeks. Primary outcomes (i.e., disease-specific symptom burden and health-related quality of life) will be assessed across time. We hypothesize that a culturally adapted C-CBSM intervention will be more efficacious in reducing symptom burden and improving health-related quality of life among Hispanic/Latino men when compared to a non-culturally adapted CBSM intervention.

Recent Advances in the Understanding and Treatment of Health Anxiety

To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.

The feasibility of a group stress management Liver SMART intervention for patients with end-stage liver disease: A pilot study.

Structured, empirically supported psychological interventions are lacking for patients who require organ transplantation. This stage IA psychotherapy development project developed and tested the feasibility, acceptability, tolerability, and preliminary efficacy of an 8-week group cognitive behavioral stress management intervention adapted for patients with end-stage liver disease awaiting liver transplantation. Twenty-nine English-speaking United Network for Organ Sharing-registered patients with end-stage liver disease from a single transplantation center enrolled in 8-week, group cognitive-behavioral liver stress management and relaxation training intervention adapted for patients with end-stage liver disease. Patients completed pre- and postintervention surveys that included the Beck Depression Inventory II and the Beck Anxiety Inventory. Feasibility, acceptability, tolerability, and preliminary efficacy were assessed.ResultAttendance rate was 69.40%. The intervention was rated as "good" to "excellent" by 100% of participants who completed the postintervention survey in teaching them new skills to relax and to cope with stress, and by 94.12% of participants in helping them feel supported while waiting for a liver transplant. No adverse events were recorded over the course of treatment. Attrition was 13.79%. Anxious and depressive symptoms were not statistically different after the intervention.Significance of resultsThe liver stress management and relaxation training intervention is feasible, acceptable, and tolerable to end-stage liver disease patients within a transplant clinic setting. Anxious and depressive symptoms remained stable postintervention. Randomized controlled trials are needed to study the intervention's effectiveness in this population.

Stress and psoriasis.

The links between psoriasis and stress are complex. This article proposes a review of the literature on the relationship between stress and psoriasis. In 31-88% of cases, patients report stress as being a trigger for their psoriasis. There was also a reported higher incidence of psoriasis in subjects who had a stressful event the previous year, suggesting that stress may have a role in triggering the disease in predisposed individuals. Stress is also a consequence of psoriasis outbreaks. Understanding the role of stress makes it appropriate to target stress when proposing treatment to patients with psoriasis. Several controlled studies have demonstrated that relaxation, hypnosis, biofeedback, and behavioral and cognitive stress management therapies have been effective in people with psoriasis.