Cognitive-behavioral Strategies Research Articles

Prevalence and Associated Factors with Poor Sleep Quality in Non-Professional Caregivers.

This study aimed to determine the prevalence and associated factors of poor sleep quality in non-professional caregivers. With this purpose, cross-sectional data were collected from 201 dependent people’s family caregivers using the Pittsburgh Sleep Quality Index (PSQI), the Caregiver Burden Inventory (CBI), the General Health Questionnaire (GHQ-12), and an ad hoc questionnaire to obtain sociodemographic data. A total of 153 family caregivers were categorized as poor sleepers (PSQI > 5), resulting in a prevalence of poor sleep quality of 76.1% (95% CI = 70.5–82.5). Poor sleepers were more likely to care for persons with mental disorders (χ2 = 7.31; p < 0.01) and scored significantly higher on perceived burden (z = −4.44; p < 0.001), psychological distress (z = −6.24; p < 0.001), and in all the PSQI subscales (p < 0.001), compared with good sleepers (PSQI ≤ 5). By contrast, no differences were found between poor and good sleepers in age, gender, years providing care, and daily hours of care. Multiple linear regression analysis showed that the factors of caregiver burden (β = 0.15; p < 0.05) and psychological distress (β = 0.53; p < 0.001) were significantly associated with sleep quality in dependent people’s family caregivers. Cognitive-behavioral strategies to improve sleep quality in the primary health care of family caregivers are suggested.

Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study.

BackgroundChildhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition.ObjectiveIn this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova.MethodsLumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app’s effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined.ResultsPlaying Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data.ConclusionsThis preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch.

Coping and guilt in informal caregivers: a predictive model based on structural equations

ABSTRACT Caregivers experience great stress, and coping can be one of the factors, which determine the extent of stress. The aim of the present paper is to analyze the effects of coping strategies on distress of the older adult’s caregiver, including guilt as a mediating factor in those maladaptive strategies. The sample consisted of 201 informal caregivers of institutionalized older adults. The three constructs measured were: stress, guilt, and coping strategies. Results showed that strategies that have a better ability to reduce stress are active, positive reframing and acceptance; on the contrary, behavioral disengagement, self-distraction, self-blame and venting positively predicted the feeling of guilt that facilitated the perception of stress. Given the important association obtained between the experience of guilt and psychological distress in caregivers, it could be relevant to develop psychoeducational interventions with caregivers including techniques to reduce this feeling of guilt and develop cognitive behavioral strategies that facilitate adaptation.

Obesity: Treatments, Conceptualizations, and Future Directions for a Growing Problem.

Simple SummaryThe pyramid of interventions in the management of obesity include, diet restriction, diet therapy, physical exercise, anti-obesity drugs, prebiotics, probiotics, bariatric surgery, and cognitive behavioral strategies. Behavioral strategies that are being applied by predominantly private medical groups focusing on psychological assessments is appreciable; however, they are not replicated by all medical establishments, especially non-private health care institutions. This multifaceted disease has many treatment options; however, these options are not being fully implemented, especially in poor areas globally. Despite the upsurge in the market and expenditures in anti-obesity treatments currently available in economically stable areas of the world, obesity is still increasing at epidemic levels. The aim of this paper is to briefly highlight the anti-obesity treatments used presently and their inefficiency in isolation as individual treatments for obesity due to multifactorial causes. This report emphasizes that even focusing on psychological screening may not be enough to control this epidemic without further government and community cooperation. This report also presents novel strategies and radical thinking to include and amend successful interventions. Furthermore, we present details for incorporating web-based counseling and artificial intelligence to make treatments feasible, accessible, and cost-effective for all populations. We hope this paper will stimulate further debate and increase awareness in relation to the obesity problem and treatment strategies.Interventions in obesity management include nutritional selection, diet restriction, and physical exercise, followed by cognitive behavioral strategies, pharmacology, and surgery towards the tapered treatment end of the obesity pyramid of interventions. Calorie restriction, regular exercise, and several weight reducing drugs, including probiotic and prebiotic use, are increasing in the market as potential anti-obesity treatments all over the world. Despite these efforts, obesity is increasing and is at epidemic levels. We propose here that there should be a multicomponent individual specific treatment approach for treating this multifactorial pathogenesis, incorporating psychological assessment as a first step that may help to reduce the prevalence of this alarming epidemic. We also believe that focusing on psychological screening may not be enough to control this epidemic without government and community cooperation and intervention. Additionally, we suggest that it is imperative to take advantage of the developments in web-based counseling and artificial intelligence expansion in combination with available anti-obesity treatments to make treatments feasible, accessible, and cost-effective for populations of all ages. The purpose of this paper is to increase awareness and stimulate debate in relation to this growing problem.

Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia.

Background:About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia.Objective:To determine predictors of improved outcomes following a multicomponent treatment program.Design:We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program.Setting:Tertiary care center.Patients:This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program.Intervention:An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention.Measurements:Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program.Results:The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up.Limitations:Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression.Conclusions:The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes.Registration:Specific registry and specific study registration number—Institutional Review Board—(IRB# 19-000495).Funding Source:No funding.

A case of an adult with attention deficit/hyperactivity disorder in which interventions to improve recognition of the disorder and cognitive-behavioral strategies led to employment and subsequent job retention

A case of an adult with attention deficit/hyperactivity disorder in which interventions to improve recognition of the disorder and cognitive-behavioral strategies led to employment and subsequent job retention

Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial.

BackgroundThe prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process.ObjectiveThis 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer.MethodsParticipants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated.ResultsThis study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing.ConclusionsThis study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance.Trial RegistrationClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610International Registered Report Identifier (IRRID)DERR1-10.2196/34502

A Systematic Review of Interventions Targeting Criminogenic Risk Factors Among Persons With Serious Mental Illness.

Individuals with serious mental illness are overrepresented in the criminal justice system. Research has found that interventions targeting risk factors for recidivism (i.e., criminogenic risks) reduce justice involvement in the general correctional population. However, more needs to be learned regarding use of these interventions among individuals with serious mental illness. To this end, this systematic review synthesized research on interventions that target criminogenic risk factors and are delivered to justice-involved individuals with serious mental illness. A systematic search of six computerized bibliographic databases from inception to 2021 yielded 8,360 potentially relevant studies. Title and abstract screening, full-text reviews, and data extraction were performed independently, and discrepancies were resolved through discussion. To identify additional articles meeting inclusion criteria, experts in the field were contacted, and reference-harvesting techniques were used. Study quality was assessed with the Mixed Methods Appraisal Tool. Twenty-one studies were identified that evaluated nine interventions delivered to justice-involved individuals with serious mental illness. All identified programs targeted criminogenic risk factors, were group based, and used cognitive-behavioral strategies. Study quality was moderate to high. Interventions were associated with improvements in recidivism, violence, and criminogenic risk factors. This review is the first to evaluate interventions targeting criminogenic risks among justice-involved individuals with serious mental illness. Findings suggest that outcomes associated with these interventions are promising. Given the overrepresentation of persons with serious mental illness in the criminal justice system, these findings provide an important step toward identifying services that curb justice involvement in this population.

Further validation of the Treatment Self-Regulation Questionnaire for assessing motivations for responsible drinking: A test of self-determination theory.

Alcohol protective behavioral strategies (PBS) are cognitive-behavioral strategies used before, during, and/or after drinking to reduce alcohol use and alcohol-related problems. Self-determination theory (SDT) provides a potentially useful framework to understand motivations for responsible drinking, which is operationalized in the present study as PBS use. In the present study, we examined the relation of motivations for responsible drinking, as assessed by the Treatment Self-Regulation Questionnaire (TSRQ), with other SDT constructs (psychological need satisfaction and dispositional autonomy) and PBS use. A sample of 507 college students who reported consuming alcohol at least once in the past 3 months were recruited from a random sample of students enrolled at a Hispanic serving institution to complete an online survey. Consistent with SDT and previous studies of the TSRQ, we found support for a 4-factor structure of the TSRQ. The TSRQ demonstrated measurement invariance across several sociodemographic subgroups within the sample (e.g., biological sex, age, year in school), supporting the use of the TSRQ across these subgroups. Further, consistent with SDT-based hypotheses, greater psychological need satisfaction and dispositional autonomy were related to more self-determined motivations for responsible drinking. Also consistent with SDT, more self-determined motivations for responsible drinking were related to more frequent PBS use. The present findings further support the utility of the TSRQ for assessing motivations for responsible drinking and support SDT as a framework for understanding responsible drinking. Future directions for research applying SDT to understand and promote responsible drinking among college students are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Postoperative Nursing Experience Applying Swanson`s Caring Theory in a Teenager With Pectus Excavatum

A nursing experience applying Swanson`s caring theory in the care of a teenage patient who received Nuss procedure for his pectus excavatum is described in this article. After the operation, the patient suffered from postoperative pain, lack of knowledge, and body-image disturbance. These symptoms influenced the patient`s physical and mental health, and prompted the author to do an in-depth investigation and discussion of this case. The nursing period lasted from July 3rd to 10th, 2019. The author conducted a comprehensive nursing assessment using observation, interviews, listening, and telephone interviews. The major problems identified were acute pain, lack of knowledge, and body-image disturbance. During the nursing period, the author established a good therapeutic relationship with the patient. The author applied Swanson`s caring theory to understand the patient`s healthcare needs and provide appropriate care. The author discussed the treatment direction with the patient, applied cognitive-behavioral strategies to relieve pain, educated the patient on developing and implementing individualized rehabilitation plans to establish correct posture in daily activities, and helped the patient adapt to post-operative changes in appearance and maintain a positive attitude toward the future. The age gap between the author and the patient required that the author spend additional time communicating with the patient to encourage him to open up his mind. It is recommended that hospitals offer youth communication skills lessons for nurses to enhance their communication and care skills with people of different age groups. In sharing this nursing experience, we hope to provide medical staff with a reference for caring for adolescent patients with disease-related body-image disturbance.

Exploring former NCAA Division I college athletes’ experiences with post-sport physical activity: A qualitative approach

Researchers have found that former collegiate athletes (FCAs) exhibit unfavorable changes in physical and mental health later in life, which may be exacerbated by physical inactivity following retirement from college sport. Despite past sports training, FCAs are as active or less active than non-athlete alumni, with some not meeting the current Physical Activity (PA) Guidelines for Adults. Researchers suggest promoting PA in FCAs to prevent future health concerns (e.g., worsening body composition, physical function, depression). Prior to intervention development, a deeper understanding of FCAs’ experiences with PA post-sport and program characteristics they consider effective is warranted. Seventeen insufficiently active former National Collegiate Athletic Association Division I athletes participated in semi-structured interviews exploring their experiences with post-sport PA and perceptions of effective program characteristics. Using Consensual Qualitative Research Procedures, five domains were constructed. This manuscript overviews the first three of these domains, which pertain to participants’ experiences with post-sport PA: (a) transitional lifestyle shifts that affected PA behavior; (b) barriers affecting PA choices and behavior post-sport; and (c) enablers affecting PA choices and behavior post-sport. All FCAs discussed needing a break to physically and mentally recover following sports retirement. Participants identified similar barriers to being active (e.g., time constraints, resource availability) following this break to those reported by non-athletic populations. Furthermore, FCAs prioritized activities they enjoyed, were influenced by past sports participation, and made them “feel” healthy and included in a group. Translating cognitive-behavioral strategies utilized to enhance sports performance may be viable in promoting PA maintenance in this population post-sport-retirement. Lay summary: Seventeen former college athletes (FCAs) participated in semi-structured interviews exploring their experiences with physical activity (PA) post-sport and perceptions of PA promotional factors. Recognizing barriers, enablers, and transitional experiences regarding PA represents a critical step in developing effective PA interventions for FCAs. IMPLICATIONS FOR PRACTICE Former Division I college athletes indicated their population is susceptible to similar PA barriers faced by non-athletic adult populations. Cognitive behavioral strategies demonstrated to be efficacious in other adult populations may benefit FCAs. Many cognitive behavioral strategies used to enhance sports performance for athletes in college are applicable to PA promotion outside of sport. Mental performance consultants (MPCs) who work with this population may consider transferring the use of these strategies to focus on PA promotion in athletes transitioning out of sport. Former Division I athletes indicated completing exercise over general PA to attain long-term health benefits, but lacked solid goals that could guide their behavior. Focusing on cognitive-behavioral strategies that maintain exercise behavior may be the most viable way to improve long-term health and activity levels. As such, multi-disciplinary teams involving MPCs and exercise professionals may be warranted.

Cognitive-behavioral aspects in the effectiveness of foreign language training of students of a non-linguistic university

The article analyzes the impact of the cognitive-behavioral characteristics of students from a non-linguistic university on the level of success in learning a foreign language. The purpose of this article is to identify the patterns of the cognitive-behavioral parameters of decision-making in the conditions of choosing between various alternative reactions and their relationship with the effectiveness of foreign language training of students from a non-linguistic university. To study behavior patterns, the method of parameterizing was used such as an important component of any activity, as decision-making by modeling situations under conditions of free, probabilistic and conditional choice. The study involved freshmen and sophomores from a medical university, who were studying foreign languages. The simulation of the follow-up of the stimulus presented revealed a low level of voluntary attention in the students with low performance, especially in a situation of imposed rhythm. Naturally, there is the hypothesis that in this group, their own cognitive style is dependent on environmental conditions, so this must be taken into account in the learning process. The results obtained indicate that the presence of universal differentiated cognitive-behavioral strategies are important in the case of successful / unsuccessful command of a foreign language.

Are online mental health interventions for youth effective? A systematic review

Objectives This systematic review aims to examine the effectiveness of online mental health interventions for youth. Methods We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. Results Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. Conclusions Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.

Pain coping strategies and their association with quality of life in people with Parkinson's disease: A cross-sectional study.

ObjectiveTo develop multidimensional approaches for pain management, this study aimed to understand how PD patients cope with pain.DesignCross-sectional, cohort study.SettingMonocentric, inpatient, university hospital.Participants52 patients with Parkinson’s disease (without dementia) analysed.Primary and secondary outcome measuresMotor function, nonmotor symptoms, health-related quality of life (QoL), and the Coping Strategies Questionnaire were assessed. Elastic net regularization and multivariate analysis of variance (MANOVA) were used to study the association among coping, clinical parameters, and QoL.ResultsMost patients cope with pain through active cognitive (coping self-statements) and active behavioral strategies (increasing pain behaviors and increasing activity level). Active coping was associated with lower pain rating. Regarding QoL domains, active coping was associated with better physical functioning and better energy, whereas passive coping was associated with poorer emotional well-being. However, as demonstrated by MANOVA, the impact of coping factors (active and passive) on the Short Form 36 domains was negligible after correction for age, motor function, and depression.ConclusionPassive coping strategies are the most likely coping response of those with depressive symptoms, whereas active coping strategies are the most likely coping response to influence physical function. Although coping is associated with pain rating, the extent that pain coping responses can impact on QoL seems to be low.

Management of Common Psychiatric Illnesses on Pediatric Medical Floors

Pediatric consultation-liaison (CL) psychiatry focuses on the treatment of mental health difficulties in physically ill children. This article focuses on three diagnoses that a pediatric CL psychiatrist commonly encounters: delirium, somatic symptom and related disorders (SSRD), and pediatric medical traumatic stress (PMTS). Delirium is an acute cerebral dysfunction secondary to an organic cause and can present with agitation, sleep disruption, disorientation, inattention, perceptual disturbances or apathy, and withdrawal. The management of delirium involves the treatment of underlying medical causes by environmental modifications and pharmacological strategies. SSRDs present with medically unexplained symptoms in which physical examination and laboratory testing do not justify a diagnosis of a known medical illness. Cognitive-behavioral therapy has the most evidence for the treatment of SSRDs, whereas pharmacological interventions have insufficient evidence in improving core symptoms of SSRDs. PMTS is defined as a set of posttraumatic stress symptoms (PTSS) in response to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Brief, focused cognitive-behavioral strategies delivered in a family-centered approach can prevent or reduce symptoms. [ Psychiatr Ann . 2021;51(10):473–481.]

A controlled trial of Cognitive Behavioural Therapy-based strategies for insomnia among in-school adolescents in southern Nigeria

BackgroundSleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria.MethodsThis was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5 weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep.ResultsParticipants were aged 13–17 years (M = 14.9, SD = 1.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34) = 1.10, p = 0.0001, (ηp2 = 0.59}, shorter SOL {F (1, 33) = 1.41, p = 0.0001, ηp2 = 0.39}, longer TSD {F (1, 33) = 1.03, p = 0.0001, ηp2 = 0.47}, lower depressive symptoms {F (1, 31) = 1.32, p = 0.002 (ηp2 = 0.34}, higher knowledge of sleep {F (1, 34) = 1.02, p = 0.001, ηp2 = 0.36}, but no significant change in sleep hygiene {F (1, 32) = 1.08, p = 0.08, ηp2 = 0.15}. All participants in the intervention group rated the programme as good or excellent.ConclusionThis pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region.Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962)

Therapeutic Strategies to Tackle Burnout and Emotional Exhaustion in Frontline Medical Staff: Narrative Review.

Burnout and emotional exhaustion in frontline healthcare workers and their implications for the health of patients, individual clinicians, and organizations are increasingly described among various healthcare settings. Yet therapeutic strategies to address burnout and other work-related conditions are outpaced by innumerable descriptions of burnout prevalence across healthcare disciplines. This review provides a framework that should be helpful in beginning the process of addressing burnout and its related conditions. It begins with an elucidation of key inter-related concepts of work-related conditions that should be considered in the differential diagnosis along with other mental health conditions that are concomitantly elevated in healthcare clinicians (eg, depression and substance abuse) but require a different approach to treatment. Factors that lead to increased resilience, engagement, and thriving in clinical workplaces are considered. While strategies are dichotomized between organizational level interventions and individual or personal interventions to address burnout, the idea of identifying and addressing root causes of burnout and related conditions is highlighted. The efficacy and feasibility of interventions that incorporate mindfulness-based stress reduction, cognitive behavioral strategies, meaning-centered therapy, and compassion training are highlighted as interventions with proven efficacy and durability that should be considered based on work-related stressors and appeal to clinicians.

'We're not gonna have a big quit if loose ones are around': urban, African American smokers' beliefs concerning single cigarette use reduction.

Single cigarette use (i.e. loosies, loose ones, singles) poses risks for smoking continuation among urban, African American smokers. There is, however, limited research to inform health education interventions addressing this behavior. We conducted 25 in-depth interviews with urban, African American users (ages 20-58 years) from Baltimore, MD and the District of Columbia in June and July 2018 to assess their beliefs about reducing single cigarette use. Interviews were guided by the Health Belief Model and its constructs of perceived benefits, perceived barriers, perceived susceptibility, perceived severity and self-efficacy. We analyzed qualitative data using framework analysis. Perceived benefits of reducing single cigarette use involved the avoidance of health risks, including concerns about buying fake cigarettes and exposure to unknown personal hygiene practices from sellers. Perceived barriers were the convenience of buying singles due to their availability, accessibility and low cost. Participants shared they were willing to use cognitive behavioral strategies to reduce their purchasing and use of singles. This study provides insights on potential intervention targets related to beliefs towards reducing single cigarette use. These findings can inform enforcement policies and health education interventions targeting single cigarette use among urban, African American smokers who use singles.

Social anxiety and risky Marijuana use: The role of underutilization of protective behavioral strategies

Social anxiety is a common mental health problem that increases the risk of experiencing cannabis-related problems. In fact, social anxiety more than quadruples the risk of developing cannabis use disorder, yet it is inconsistently related to more cannabis use. Inconsistent findings may be due to lack of attention to protective behavioral strategies (PBS) among socially anxious cannabis users. PBS are cognitive-behavioral strategies to reduce cannabis use and related problems. Yet socially anxious persons may be less likely to use PBS for a variety of reasons (e.g., fear of negative evaluation for engaging in behaviors to reduce use), leading to heavier or more frequent use and related problems. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month cannabis use and related problems among current (past-month) cannabis users (N = 102). Social anxiety was significantly positively related to past-month cannabis problems, but not directly related to cannabis use. Social anxiety was significantly negatively related to PBS. Social anxiety was indirectly (via PBS) related to more frequent use, greater peak use, and more cannabis problems. Serial mediation analyses indicated that social anxiety was indirectly related to more cannabis problems via the serial effects of PBS and cannabis use variables. Findings suggest that socially anxious persons may be vulnerable to heavier cannabis use and more cannabis problems due to PBS underutilization. Treatment implications are discussed.

Working in a prison: Challenges, rewards, and the impact on mental health and well-being

PurposePrisons are uniquely challenging working environments. Staff are often exposed to direct and indirect trauma, impacting negatively on their mental well-being. Due to the limited research into prison staff experience, this paper aims to explore what staff find most challenging, how they cope, what support they would like and rewarding aspects of their work.Design/methodology/approachThis service development project was facilitated through a staff well-being event. A qualitative approach was used and 74 staff members provided anonymised responses. An inductive and data-driven approach was used to analyse the data, and the trustworthiness of the analysis was considered using criteria established by Lincoln and Guba (1985).FindingsThematic analysis identified six themes, namely, the challenging nature of the work, interactions with prisoners, staff interactions, inadequate resources, staff support and development and coping strategies. Key findings include managing distress, self-harm and violence and limited resources presenting challenges. Role variety and opportunities to support prisoners were reported as positive. A variety of coping strategies were identified. Wider availability of supervision and reflective practice was suggested by staff.Practical implicationsRecommendations for increased staff support are made. Suggestions for future research investigating methods to increase rewarding aspects of work within prisons are given.Originality/valueThis analysis adds to the limited body of qualitative research investigating prison staff experiences; in particular, aspects of the work that they find rewarding such as the role variety and opportunities to make positive changes to prisoners’ lives. Novel coping strategies were identified, including cognitive reframing and behavioural strategies for managing stress, which could be encouraged to increase resilience.