Cognitive-behavioral Strategies Research Articles

Banning pre-event rumination in social anxiety: A preliminary randomized trial

Background and ObjectivesPre-event rumination has a clear role in maintaining social anxiety according to cognitive models. However, it is unclear what specific strategies can address pre-event rumination for individuals diagnosed with SAD. The current study aimed to determine the effectiveness of a brief intervention on multiple aspects of pre-event rumination, state anxiety and performance and threat appraisals. Additionally, the trajectory of pre-event rumination was investigated over four days. MethodsParticipants with SAD were informed they would be required to complete a speech task in four days' time and were randomised to an intervention (n = 27) or a non-active control group (n = 25). The intervention group were instructed to “ban” pre-event rumination using a metacognitive therapy technique known as detached mindfulness. All participants completed daily measures of pre-evet rumination that assessed frequency, uncontrollability, engagement and distress associated with pre-event rumination. On the day of the speech task, participants also completed state and cognitive measures before delivering the speech task. ResultsThe intervention group reported reduced frequency, uncontrollability and distress associated with pre-event rumination, compared to the control group. There was no difference between groups for performance and threat appraisals as well as state anxiety. Rumination is a stable and robust process, with an increase in frequency and associated distress 24 hours before a feared social situation. LimitationsThe lack of an active control group precludes comparisons to more traditional cognitive-behavioural therapy strategies for pre-event rumination. ConclusionsPre-event rumination is a durable process but banning pre-event rumination using metacognitive therapy techniques shows promise for specifically addressing this maladaptive process.

The Processes of Cognitive Behavioral Therapy: A Review of Meta-Analyses

Cognitive Behavioral Therapy (CBT) refers to a treatment approach with strong empirical support for its efficacy for various disorders and populations. The goal of the present review was to provide a comprehensive survey of meta-analyses examining the processes of CBT, namely: treatment processes (cognitive reappraisal, behavioral strategies, emotional regulation, motivation strategies, and psychoeducation) and in-session processes (alliance, goal consensus and collaboration, feedback, group cohesion, and homework). We identified 558 meta-analyses of CBT, and 30 meta-analyses met our inclusion criteria as reviews of process-outcome relations. For treatment processes, the strongest support currently exists for cognitive (n = 8 meta-analyses) and behavioral strategies (n = 3 meta-analyses) as change processes in CBT for anxiety disorders and depression. For in-session processes, the strongest support currently exists for the role of the alliance (n = 8 meta-analyses) and homework assignments (n = 6 meta-analyses) as predictors of outcome. Overall, the evidence base for process-outcome relations in CBT is just emerging. Additional research is needed to examine the range of treatment processes in various clinical contexts. Moreover, except for a meta-analysis on collaboration, no meta-analytic studies have been reported on CBT-specific elements of the therapeutic relationship, such as collaborative empiricism and Socratic dialogue.

"It's Just for Us!" Perceived Benefits of Participation in a Group Intervention for Siblings of Children With Cancer.

This qualitative substudy aimed to investigate the outcomes of sibling group interventions from the perspective of siblings of children with cancer and their caregivers. Siblings were randomized to receive the Siblings Coping Together intervention (SibCT) or attention control (CG). In all, 30 participants, 18 siblings (average age = 11.89 years, 9 CG and 9 SibCT) and 12 caregivers (4 CG and 8 SibCT), were interviewed following group participation. SibCT consists of eight 2-hr manualized sessions delivered weekly; in each session, it combines arts and crafts and cognitive-behavioral strategies structured around a specific theme (family or school). The CG is structured only around arts and crafts. Interviews were analyzed using content analysis. Themes common to both groups included the following: having a group just for siblings, improving family relationships, and feeling reassured of parental role. Themes unique to the SibCT group included the following: learning program targets, increasing self-confidence, feeling less different, and connecting caregivers and siblings through homework. Themes unique to the control group included the following: being a good helper and being in the hospital for positive reasons. This study uncovered additional intervention effects not captured in quantitative measures. Whereas benefits were noted in both groups and speak to the importance of support for siblings in general, positive personal and relational changes unique to siblings in the SibCT group and their caregivers support the importance of specific interventions focused on problem-solving siblings' issues.

Group intervention for Chinese elderly adults with insomnia using a cognitive-behavioural approach, and strategies and skills learning and development

ABSTRACTMany elderly people are disturbed by insomnia. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition no longer considers insomnia as merely a symptom, secondary to medical and psychiatric problems, because insomnia has been found to cause depression, heart disease and accidents in older adults. Psychosocial treatment is preferable to pharmacological treatment in handling insomnia because of the lack of side effects. This study aims to examine the impact of group treatment on insomnia-stricken elderly people using cognitive-behavioural therapy (CBT) as well as strategies and skills learning and development (SSLD). These two approaches integrate well with each other. CBT modifies the dysfunctional beliefs and behaviours related to sleep, whilst SSLD enhances insomniacs’ awareness of their underlying needs. A mixed-methods research design revealed positive changes in night-time insomnia symptoms, daytime distress, dysfunctional beliefs about sleep, and depression. The suitability of the intervention model for Chinese elderly people is discussed.

Brief Cognitive-Behavioural Group Counselling Strategy to Improve Resilience Towards Risky Sexual Behaviours in Adolescents

Brief Cognitive-Behavioural Group Counselling Strategy to Improve Resilience Towards Risky Sexual Behaviours in Adolescents

Effects of psycho-education plus basic cognitive behavioural therapy strategies on medication-treated adolescents with depressive disorder in Nigeria

Objective: Limited data exists on psychological interventions for adolescent depression in African countries such as Nigeria. This study therefore investigates the effects of a psychological intervention that includes psycho-education and basic elements of cognitive behavioural therapy (CBT) on depressed medication-treated adolescents in Nigeria.Methodology: This was a pre-post one-group intervention study of 18 adolescents aged 13–18 years with clinically diagnosed depressive disorder, attending a specialist psychiatric hospital. They had been on antidepressants for 3 months or longer. Depressive symptoms, knowledge of depression, hope, and attitudes towards treatment adherence were measured at baseline and repeated at 1 and 4 weeks post-intervention. The adolescents received four sessions of a group-based manualised intervention focused on psycho-education and basic CBT strategies.Results: Statistically significant reductions in depressive symptoms were recorded, as were improvements in the adolescents’ knowledge of depression, hope, and attitude towards treatment adherence one week after the intervention (all p = 0.001). All differences were sustained at 4 weeks post-intervention. Participants’ satisfaction with the intervention was high.Conclusion: This study suggests that adding psycho-education with elements of CBT to antidepressant treatment is feasible, acceptable and can produce further benefits to depressed adolescents in this region.

Investigating the effects of therapist accuracy in cognitive behavioural therapy for depression

ABSTRACTThis study presents a means to address therapist accuracy in CBT as it relates to discussion of cognitive errors and coping strategies. Therapist interventions from CBT therapy sessions of 43 patients with depression were identified using the Comprehensive Psychotherapeutic Interventions Rating Scale, and focus of interventions on negative or positive cognitive errors, or affective, behavioural, or cognitive coping strategies was identified using the Cognitive Errors Rating Scale and Coping Patterns Rating Scale, respectively. Patients’ depression symptoms were assessed using the Beck Depression Inventory. Prior to alpha adjustment, therapist accuracy of cognitive and behavioural coping strategies was found to significantly predict better coping. Tentative conclusions are provided on the value of attuning to patients’ coping strategies.

Module-based comprehensive approach for addressing heterogeneous mental health sequelae of violent loss survivors

ABSTRACTSignificant strides have been made in the trauma and grief fields to address the unique needs of those who have lost a loved one to violent death. Several treatment techniques have been found to be effective for symptoms of trauma and grief that are prevalent among violent loss survivors including restorative retelling and cognitive behavioral strategies. Current interventions either are tailored for a specific mental health problem or are more universal in nature for grief related to violent loss. This paper presents an evidence-based and guided modular approach for responding to the myriad potential mental health needs of violent loss survivors. A comprehensive module-based structured intervention for violent loss survivors, which specifically targets several common mental health difficulties following traumatic loss, may offer clinicians a thorough and flexible approach guided by clinical assessment to address the distinctive and common issues violent loss survivors often face.

Unified protocol for the discontinuation of long-term serotonin reuptake inhibitors in obsessive compulsive disorder: Study protocol and methods

Obsessive-compulsive disorder (OCD) is chronic psychiatric disorder associated with high rates of functional impairment and decreased quality of life. Although serotonin reuptake inhibitors have demonstrated efficacy in the treatment of OCD, little data is available to guide clinicians on how to manage these medications long-term. Cognitive-behavioral approaches provide a promising avenue for helping OCD patients discontinue maintenance SRIs while minimizing the potential for symptom worsening. This manuscript describes the rationale and methods for pilot feasibility study designed to a unified, cognitive-behavioral strategy for discontinuing long-term SRIs in OCD. The aims of the study are (1) to evaluate the feasibility and acceptability of research procedures and interventions, (2) to test the efficacy of this treatment relative to an enhanced control condition and (3) to investigate the role of distress tolerance in both taper completion and clinical outcome. Our central aim is to investigate whether this approach improves discontinue outcomes relative to an enhanced control condition. Identifying optimal long-term treatment strategies for this population is needed to guide clinicians managing this often-chronic disorder.

Effect of Transtheoretical Model Based Intervention Program on Cigarette Smoking Cessation among Technical Secondary School Male Students in Zagazig City

Background: Interventions via cognitive-behavioral strategies are promising in smoking cessation among adolescents, by using the Transtheoretical model (TTM). Objective: To assess the effect of TTM- intervention program on smoking health risk, stages and process of change in smoking cessation, , decisional balance, and self-efficacyamong technical secondary school male students in Zagazig city. Methods: A quasi-experimental study conducted in two randomly selected technical secondary schools in Zagazig city, Sharkia Governorate, Egypt. Male smokers from one school assigned as an experimental group and those from the other school as a control group. The experimental group received interventions based on the stage of behavior change through group counseling followed by individual phone counseling for 10 months. Intervention evaluation was done through self-reported questionnaires assessing knowledge and TTM outcomes. Results: After the intervention, participants in the experimental group (32%) progressed from lower to higher stages of behavior change compared with those in the control group (1.9%). The participants who reached the action/maintenance stage were 13.9% in the experimental group versus 1.9% in the control group. There was a significant difference between two groups in the mean scores of knowledge, processes of change, decisional balance and self-efficacy (P < 0.000). Conclusion: The TTM-based smoking cessation intervention program was effective in inducing a positive movement in the stages of behavior change among adolescent smokers through improving knowledge, experiential and behavioral processes, decisional balance and self-efficacy.

Single session real-time fMRI neurofeedback has a lasting impact on cognitive behavioral therapy strategies.

To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside of session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant's repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the scan session to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive behavioral therapy by personalizing skills and facilitating generalization.

Prevention of Falls - Interventions in the Home Visits to the Elderly: Scoping Review

Background: The prevalence of falls in the elderly population is high, causing mortality, morbidity, and loss of functionality, contributing to an increase in the elderly’s dependence, loss of quality of life and decrease in the average life expectancy. This study aims to identify the interventions performed during the home visit that may have an impact on the reduction of risk, on the prevention of falls, on their recurrence and / or on secondary injuries. Methods and Findings: Scoping review, with the inclusion of primary studies to answer the research question: Which nursing interventions during the home visit prevent the (C) fall in the home (Co) of the Elderly Person? Research conducted in the databases available on the search engines of EBSCO, B-On, ISI; SCOPUS and JBI, inclusion and exclusion criteria were defined. The search time limit has been restricted to the last 5 years. The 10 studies that integrate the sample are heterogeneous, evaluated a total of 32,308 elderly. The use of cognitive-behavioral strategies has a positive effect on reducing mortality, institutionalization, falls and functional decline. The results of our investigation are not conclusive as to the effect of physical exercise performed at home in the prevention of falls. The elderly positively evaluate the performance of home visits to prevent falls. Conclusions: Evidence on the effectiveness of home visits for falls prevention is low. Future studies should explore the effectiveness of different programs to promote physical activity and social participation in reducing the risk and prevalence of falls.

Ansiedad, depresión, afecto negativo y positivo asociados con el consumo de tabaco en universitarias

Introducción: en los últimos años, la prevalencia del consumo de tabaco en mujeres se ha incrementado de manera significativa a nivel nacional e internacional. Esto genera altos costos a nivel económico, familiar y de salud. Un sector de la población en el que resulta particularmente indispensable realizar investigación sobre los factores asociados con el consumo de tabaco es el de mujeres universitarias, a fin de incidir en el desarrollo de estrategias de prevención y en las intervenciones para dejar de fumar. Objetivo: determinar la asociación, entre el consumo de tabaco, la dependencia de la nicotina y enfermedades como ansiedad, depresión y afecto negativo y positivo en universitarias. Método: 72 universitarias fumadoras que asistieron de manera voluntaria a solicitar tratamiento para dejar de fumar al Centro de Atención y Orientación para Estudiantes (CAOPE) de la Facultad de Estudios Superiores Iztacala, de la Universidad Autónoma de México; se aplicaron diferentes instrumentos para conocer el patrón de consumo, el nivel de dependencia, la sintomatología depresiva y de ansiedad, y los afectos positivo y negativo. Resultados: todos los factores emocionales (ansiedad, depresión, afectos positivo y negativo) integrados en un modelo son predictores, tanto del patrón del consumo como del nivel de dependencia en universitarias; la ansiedad, en específico, aumenta el riesgo de consumo de tabaco y de presentar dependencia de la nicotina. Discusión y conclusiones: dichos resultados se deben considerar para diseñar estrategias de prevención y tratamiento para dejar de fumar en mujeres universitarias, en las que se incluyan técnicas cognitivo-conductuales. En cuanto a la prevención, es indispensable incluir estrategias enfocadas al autocontrol de emociones, a la solución de problemas y al afrontamiento para el manejo de la ansiedad.

Self-Guided Online Cognitive Behavioral Strategies for Chemotherapy-Induced Peripheral Neuropathy: A Multicenter, Pilot, Randomized, Wait-List Controlled Trial

The purpose of this pilot, parallel, randomized controlled trial was to examine the efficacy of a self-guided online cognitive and behaviorally-based pain management intervention (Proactive Self-Management Program for Effects of Cancer Treatment [PROSPECT]) to reduce “worst” pain for individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes included “average” pain, nonpainful CIPN symptom severity, impression of change, and pain interference. Sixty patients with chronic painful CIPN were recruited from 5 outpatient academic and community cancer centers. Patients were randomized in a 1:1 ratio to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic “worst” pain intensity diary and standardized measures of pain interference, nonpainful CIPN symptom severity, impression of change, and “average” pain were administered pre/post intervention. Postintervention mean scores were evaluated between groups using analysis of covariance adjusting for baseline. Individuals who received the PROSPECT intervention (n = 19) had significantly greater improvements in “worst pain” compared with individuals receiving usual care (n = 19; P = .046, d = .58). There were no significant differences in mean scores between groups for the secondary outcomes (n = 42). A larger, adequately powered study testing the PROSPECT intervention is needed to determine if improvements in pain may be sustained, evaluate the effect of the intervention on the secondary outcomes, and identify mediators of pain intensity-related improvement. PerspectiveThis study explores the efficacy of an 8-week online cognitive behavioral pain management intervention for chronic painful CIPN. Intervention use resulted in greater improvements in “worst” pain than usual care alone. The findings provide preliminary support for the efficacy of a nonpharmacological intervention for chronic painful CIPN.

Striving Towards Empowerment and Medication Adherence (STEP-AD): A Tailored Cognitive Behavioral Treatment Approach for Black Women Living With HIV

In the U.S. Black women with HIV face numerous psychosocial challenges, particularly trauma, racism, HIV-related discrimination, and gender role expectations, that are associated with negative HIV health outcomes and low medical treatment adherence. Yet many of these factors are unaddressed in traditional cognitive behavioral approaches. This study presents a case series of a tailored cognitive behavioral treatment approach for Black women living with HIV. Striving Towards EmPowerment and Medication Adherence (STEP-AD) is a 10-session treatment aimed at improving medication adherence for Black women with HIV by combining established cognitive behavioral strategies for trauma symptom reduction, strategies for coping with race- and HIV-related discrimination, gender empowerment, problem-solving techniques for medication adherence, and resilient coping. A case series study of five Black women with HIV was conducted to evaluate the preliminary acceptability and feasibility of the treatment and illustrate the approach. Findings support the potential promise of this treatment in helping to improve HIV medication adherence and decrease trauma symptoms. Areas for refinement in the treatment as well as structural barriers (e.g., housing) in the lives of the women that impacted their ability to fully benefit from the treatment are also noted.

High Versus Low Theoretical Fidelity Pedometer Intervention Using Social-Cognitive Theory on Steps and Self-Efficacy

ABSTRACTPurpose: This study was designed to compare a low versus high theoretical fidelity pedometer intervention applying social-cognitive theory on step counts and self-efficacy. Method: Fifty-six public university employees participated in a 10-week randomized controlled trial with 2 conditions that varied in theoretical fidelity. Participants in the high theoretical fidelity condition wore a pedometer and participated in a weekly group walk followed by a meeting to discuss cognitive-behavioral strategies targeting self-efficacy. Participants in the low theoretical fidelity condition met for a group walk and also used a pedometer as a motivational tool and to monitor steps. Step counts were assessed throughout the 10-week intervention and after a no-treatment follow-up (20 weeks and 30 weeks). Self-efficacy was measured preintervention and postintervention. Results: Participants in the high theoretical fidelity condition increased daily steps by 2,283 from preintervention to postintervention, whereas participants in the low fidelity condition demonstrated minimal change during the same time period (p = .002). Individuals attending at least 80% of the sessions in the high theoretical fidelity condition showed an increase of 3,217 daily steps (d = 1.03), whereas low attenders increased by 925 (d = 0.40). Attendance had minimal impact in the low theoretical fidelity condition. Follow-up data revealed that step counts were at least somewhat maintained. For self-efficacy, participants in the high, compared with those in the low, theoretical fidelity condition showed greater improvements. Conclusion: Findings highlight the importance of basing activity promotion efforts on theory. The high theoretical fidelity intervention that included cognitive-behavioral strategies targeting self-efficacy was more effective than the low theoretical fidelity intervention, especially for those with high attendance.

Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong.

Gambling-related cognitions and negative psychological states have been proposed as major factors in the initiation and maintenance of problem gambling (PG). While there are a substantial number of studies supporting the role of cognitive dysfunctions in the initiation and maintenance of PG, very few empirical studies have explored the specific role of negative psychological states in influencing PG behaviours. In addition, very few studies have examined the interaction effects of cognitive dysfunctions and negative psychological states in exerting influence on PG behaviours. Therefore, the present study aims to examine the main and interaction effects of gambling-related cognitions and psychological states on the gambling severity among a group of problem gamblers in Hong Kong. A cross-sectional research design was adopted. A purposive sample of 177 problem gamblers who sought treatment from a social service organization in Hong Kong completed a battery of standardised questionnaires. While gambling-related cognitions were found to exert significant effects on gambling severity, negative psychological states (i.e. stress) significantly moderated the relationship between gambling cognitions and gambling severity. In essence, those participants who reported a higher level of stress had more stable and serious gambling problems than those who reported a lower level of stress irrespective of the level of gambling-related cognitions. The findings of the moderating role of negative emotions in the relationship between cognitive distortions and severity of gambling provide insight towards developing an integrated intervention model which includes both cognitive-behavioural and emotion regulation strategies in helping people with PG.

A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder.

The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n=30) or a novel integrated TSF (iTSF; n=29), with follow-up assessments at 3, 6 and 9 months following treatment entry. Out-patient addiction clinic in the United States. Adolescents [n=59; mean age=16.8 (1.7)years; range=14-21; 27% female; 78% white]. The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. Primary outcome: PDA was not significantly different across treatments [b=0.08, 95% confidence interval (CI)=-0.08 to 0.24, P=0.33; Bayes' factor=0.28). during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b=-0.87; 95% CI=-1.67 to 0.07, P=0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b=-0.42; 95% CI=-0.80 to -0.04, P<0.05; effect size range d=0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r=0.39, P=0.008), and early following (r=0.30, P=0.049), treatment. Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.

Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review

BackgroundOccupational stress and burnout are highly prevalent among medical doctors and can have adverse effects on patient, doctor, and organisational outcomes. The purpose of the current study was to review and evaluate evidence on psychosocial interventions aimed at reducing occupational stress and burnout among medical doctors.MethodA systematic review was conducted for original research articles reporting on psychosocial interventions targeting occupational stress or burnout among medical doctors, published in the English language, and with data collected at a minimum of two time points. Searches were conducted across five electronic databases, as well as by manual search of Google Scholar. Data was extracted relating to study characteristics and outcomes, quality and rigour, as well as modes of delivery and engagement. Studies were appraised using the Strength of Recommendation Taxonomy (SORT) and Critical Appraisal Skills Programme (CASP).ResultsTwenty-three articles were reviewed, which reported on interventions utilising cognitive-behavioural, relaxation, and supportive discussion strategies. Only 12 studies allowed estimation of pre- to post-intervention effects. Cognitive behavioural interventions demonstrated the strongest evidence, particularly for reducing stress. Some evidence was identified to support the efficacy of relaxation-based approaches, but no such evidence was found for the efficacy of discussion-based interventions, such as Balint groups. There was a lack of quality among reviewed studies, with no studies receiving a quality rating of 1, and the overall body of evidence being rated as level B, according to the SORT. Effect sizes were not pooled due to a lack of quality among the study sample.ConclusionThis review found that despite increased scientific attention, the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low. Despite this, interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout. Limitations of the current review include a lack of risk of bias assessment or pooling of analyses. Recommendations for improving the quality of research in this area, as well as implications of the current body of evidence are discussed.Systematic review registrationPROSPERO CRD42016032595

Qualitative Investigation of Exercise Perceptions and Experiences in People With Multiple Sclerosis Before, During, and After Participation in a Personally Tailored Exercise Program

ObjectiveTo undertake a qualitative investigation of exercise perceptions and experiences in people with multiple sclerosis (PwMS) before, during, and after participation in a personally tailored program designed to promote long-term maintenance of self-directed exercise. DesignFocus groups and semistructured telephone interviews. SettingUniversity exercise science department close to the recruiting hospital. ParticipantsPwMS (N=33; mean age ± SD, 47.6±7.9y). InterventionsParticipants were recruited after participation in a randomized controlled exercise trial; all had been allocated to a 12-week exercise program comprising supervised and self-directed exercise sessions. Main Outcome MeasuresExercise perceptions and experiences before, during, and after participation in the program. ResultsFour themes emerged from the analysis: (1) the transition to inactivity; (2) lack of knowledge and confidence; (3) positive exercise experiences; and (4) perspectives on exercise adherence. ConclusionsLack of confidence and exercise knowledge, coupled with negative perceptions about physical capabilities after an MS diagnosis, are clear barriers to exercise participation in PwMS. These issues are not being adequately addressed as part of the health care pathway or in community settings. Perceptions of improved posture, ability to overcome everyday difficulties, acute mood enhancements during and after exercise, and increased opportunities for social interaction were among the reported benefits of exercise participation. Despite the provision of a personally tailored exercise plan and use of cognitive behavioral strategies, self-directed exercise continued to present challenges to PwMS, and the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses.