Resilience-building Intervention Research Articles

Rationale and design of a randomized controlled clinical trial of a resilience-building intervention in adults with congenital heart disease

BackgroundAdults with congenital heart disease (ACHD) are at risk for lower quality of life (QOL) and psychological health. Behavioral interventions to meet their psychosocial needs are lacking. The aim of this study is to evaluate the feasibility of implementing the Promoting Resilience in Stress Management (PRISM) intervention in ACHD and its efficacy in increasing resilience in this population. MethodsWe designed a phase II randomized controlled clinical trial of patients with moderate or complex ACHD, physiological stages C or D. Enrolled participants will be randomized to receive PRISM or usual care. PRISM is a manualized, skills-based behavioral intervention comprised of four one-on-one sessions targeting resilience resources (stress-management, goal-setting, cognitive reframing, meaning making), an optional session on advance care planning, and a facilitated family meeting. Participants in both groups will complete study questionnaires at enrollment and 3-months later. The primary aim is to describe feasibility, namely the proportions of patients who a) enroll in the study among those eligible, and b) complete the PRISM intervention among those randomized to that arm. We will also evaluate PRISM's efficacy by using linear regression models to compare changes in mean resilience scores between assigned groups. In exploratory analyses, we will evaluate effects on QOL, psychological distress, perceived competence for health care management, and comfort with advance care planning. DiscussionThis study will provide rigorous evidence to determine the feasibility and efficacy of a brief intervention to promote resilience and psychosocial health in ACHD. Findings may guide the development of a future multi-site effectiveness study.Clinical Trial Registration: NCT04738474.

Applying the Multiphase Optimization Strategy for Development of a Culturally Tailored Resilience-Building Intervention to Facilitate Advance Care Planning Discussions for Chinese Americans: Protocol for a Feasibility Study (Preprint)

Applying the Multiphase Optimization Strategy for Development of a Culturally Tailored Resilience-Building Intervention to Facilitate Advance Care Planning Discussions for Chinese Americans: Protocol for a Feasibility Study (Preprint)

Resilience processes among Ukrainian youth preparing to build resilience with peers during the Ukraine-Russia war.

The war in Ukraine significantly impacts the mental health and well-being of its youth. Like other communities affected by war, Ukraine's youth are at risk of developing psychopathological symptoms, and there is a shortage of mental health and psychosocial support services to address this. Resilience-building initiatives present an alternative approach to supporting the well-being of young people by promoting protective processes to enhance the likelihood of positive development in the context of adversity. Emerging research findings suggest that young people themselves can serve as powerful facilitators of such initiatives with one another. Yet, evidence about culturally and contextually relevant protective processes is needed to guide such interventions, especially among young people experiencing the war and working to boost resilience within their communities. In this study, we identified key protective processes Ukrainian youth depend on as they adapt to the conflict while also preparing to implement a resilience-building intervention as a facilitator. Through thematic analysis of transcripts of three training sessions with Ukrainian youth (n = 15, 100% female; aged 18-22), we identified the following themes: positive thinking, sense of control, emotion awareness and regulation, close personal relationships, and community support. Findings also highlighted the cultural and contextual nuance of these protective processes, as well as individual differences in the ways they co-occurred and manifested within each youth. Results have implications for developing tailored yet flexible resilience-building interventions that can be delivered by lay people, including youth with their peers, in Ukraine and other cultures and contexts.

Nature for resilience reconfigured: global-to-local translation of frames in Africa

Globally, various frames of urban nature circulate, each emphasising particular challenges and natural solutions in the climate context. Yet which actors and dynamics shape their translation to the African context remains unclear. This paper explores the global-to-local translation process of frames through interventions funded by transnational actors, conceptualised as agents of policy transfer. Critical scholarship has observed that urban adaptation and resilience interventions in Africa are often characterised as technocratic and top-down approaches, hence it is vital to understand whether these are replicated through proliferating nature-based solutions (NBSs). The study of a resilience-building intervention in Lilongwe, Malawi, reveals that transnational actors play important roles by deploying frames of urban nature through funding projects. However, rather than involving a top-down imposition of particular solutions, this sets in motion dynamics: in the competition for resources that frames generate, various actor constellations of transnational actors, subnational governments and local NGOs reconfigure or relabel strategies and associated (nature-based) practices to suit global frames and the resources they generate. This shapes who is included or not, and what kinds of NBS are being developed, for and by whom. There is a risk that priorities of communities get lost in translation. Policy relevance Frames of urban nature shape global agendas but also matter locally in the design of programmes and projects. This study provides key insights of relevance for policymakers. First, external funding for climate and resilience is unpredictable and insufficient to address manifold urgent local priorities. It is important that actors at all levels strive to align resources to holistic strategies of local governments and do not impose certain visions for urban nature. For this to happen, and second, it is key that local governments and communities are empowered to create forms of nature that are built around diverse forms of local knowledge and expertise, to cater to values and priorities of the communities. Third, proponents of NBSs highlight their potential to address interlinked climate-, biodiversity- and society-related challenges. However, unless funding allocation puts emphasis on the interlinkage of goals, the potential for NBSs to reach multiple goals can get lost. Fourth, there is a need to disrupt the persisting scepticism concerning the feasibility of NBSs in informal settlements and forge collaborations that realise interventions closely linked to the priorities of disadvantaged groups in African cities, to leverage the power of nature for more just societies.

The gender dimensions of food security: Ethnographic accounts of agro-pastoralists of the Ittu Oromo, East Africa

Gender is the most important but overlooked aspect of food security analysis. Informed by experiential narrative resilience framework, this paper thus discusses the gender dimensions of food security based on the accounts of Ittu Oromo agro-pastoralists. Ethnographic data were collected through participant observation, focus group discussion and narrative interview, and analyzed thematically. Accordingly, four major themes have emerged: women vis-à-vis food among Ittu Oromo, gender division of labour, consumption decision making, and mutual support (quubii) as food security strategy. The finding thus indicated that women are an important actor in food preservation, preparation and allocation in agro-pastoralists of Ittu Oromo. In division of labour, women are largely engaged in such domestic works as caring and cooking while men engage in farm and other non-domestic activities though there are changes today. Consumption decision-making appears to be collective though men tend to dominate. In household food allocation, women seem powerful though they tend to eat least and last but given precedence – during pregnancy and post-partum period. In the context of dearth, women proved innovative that they put heads together to support each other through such village-based institutions as quubii. Among the agro-pastoralists of Ittu Oromo, quubii plays a pivotal role in building women capacity to deal with food shortage. Women, however, remained to be vulnerable particularly when they are head of the family that culturally sound resilience building intervention such as increased access to resource, enhanced participation in decision making, and strengthening mutual support and cooperation (such as quubii) appears crucial.

Selected Skill Sets as Building Blocks for High School-to-Medical School Bridge: Longitudinal Study Among Undergraduate Medical Students.

The high school-to-medical school education transition is a significant milestone in the students' academic journey, which is characterized by multiple stressors. Although this crucial transition has been repetitively explored, the concept of proactively intervening to support this transition is still novel. In this study, we investigated the efficacy of a web-based multidimensional resilience building intervention in developing selected soft skills that are believed to drive the learner's success in any learning setting. The association between the students' academic performance over time and their proficiency in selected modules addressing skill sets, including Time Management, Memory and Study, Listening and Taking Notes, and College Transition, was also assessed to test the impact of the intervention on the students' learning. A longitudinal study was conducted on 1 cohort of students of a Bachelor of Medicine, Bachelor of Surgery program (MBBS). The medical students were offered a learning intervention around 4 skill sets during the first year of the 6-year program. Quantitative analyses were conducted using deidentified data, relating to the students' proficiency in the 4 skill sets and to the students' academic performance: grade point average (GPA). Descriptive analyses constituted computing an overall score of skill sets' proficiency (of all 4 selected skill sets). The mean and SD (and percentage of the mean) were also calculated for each skill set component, independently, and for the overall score of skill sets' proficiency. Bivariate Pearson correlations were used to assess the extent to which the academic performance of the students can be explained by the corresponding students' level of proficiency in each skill set component and by all 4 sets together. Out of the 63 admitted students, 28 participated in the offered intervention. The means and SDs of the annual GPA of the students for years 1 and 2 (GPA range 1-4) were 2.83 (SD 0.74) and 2.83 (SD 0.99), respectively. The mean and SD of the cumulative GPA toward the end of year 2 was 2.92 (SD 0.70). Correlation analysis showed that the overall score of skill sets proficiency was significantly associated with the annual GPA of year 1 (r=0.44; P=.02) but was not associated with their annual GPA of year 2. The cumulative GPA (toward the end of year 2) appeared to be significantly associated with the overall score (r=0.438; P=.02). Developing purposefully selected skill sets among medical students holds the potential of facilitating the high school-to-medical school education transition and is likely to improve their academic performance. As the medical student progresses, the acquired skills need to be continuously reinforced and effectively built upon.

Assessment of Virtual Mindfulness-Based Training for Health Care Professionals: Improved Self-Reported Respiration Rates, Perceived Stress, and Resilience.

Mindfulness in Motion (MIM) is a workplace resilience-building intervention that has shown reductions in perceived stress and burnout, as well as increased resilience and work engagement in health care workers. To evaluate effects of MIM delivered in a synchronous virtual format on self-reported respiratory rates (RR), as well as perceived stress and resiliency of health care workers. Breath counts were self-reported by 275 participants before and after 8 weekly MIM sessions. MIM was delivered virtually in a group format as a structured, evidence-based workplace intervention including a variety of mindfulness, relaxation, and resilience-building techniques. Participants counted their breaths for 30seconds, which was then multiplied by 2 to report RR. Additionally, participants completed Perceived Stress Scale and Connor-Davidson Resiliency Scale. According to mixed effect analyses there were main effects of MIM Session (P < .001) and Weeks (P < .001), but no Session by Week interaction (P = .489) on RR. On average, RR prior to MIM sessions were reduced from 13.24bpm (95% CI = 12.94, 13.55bpm) to 9.69bpm (95% CI = 9.39, 9.99bpm). When comparing average Pre-MIM and Post-MIM RR throughout the MIM intervention, Week-2 (mean = 12.34; 95% CI = 11.89, 12.79bpm) was not significantly different than Week-1 (mean = 12.78; 95% CI = 12.34, 13.23bpm), but Week-3 through Week-8 demonstrated significantly lower average Pre-MIM and Post-MIM RR compared to Week-1 (average weekly difference range: 1.36 to 2.48bpm, P < .05). Perceived stress was reduced from Week-1 (17.52 ± 6.25) to after Week-8 (13.52 ± 6.04; P < .001), while perceived resiliency was increased from Week-1 (11.30 ± 5.14) to after Week-8 (19.29 ± 2.58); P < .001). Thus far, completion of MIM sessions has shown acute and long-term effects on self-reported RR, but more research is required to determine the extent of improved parasympathetic (relaxed) states. Collectively, this work has shown value for mind-body stress mitigation and resiliency-building in high stress acute health care environments.

Resilience-Building for Mental Health among Early Childhood Educators: A Systematic Review and Pilot-Study towards an EEG-VR Resilience Building Intervention.

Resilience is a key factor that reflects a teacher’s ability to utilize their emotional resources and working skills to provide high-quality teaching to children. Resilience-building interventions aim to promote positive psychological functioning and well-being. However, there is lack of evidence on whether these interventions improve the well-being or mental health of teachers in early childhood education (ECE) settings. This review examined the overall effectiveness of resilience-building interventions conducted on teachers working in the ECE field. A systematic approach is used to identify relevant studies that focus on resilience-building in countering work stress among early childhood educators. Findings from this review observed a preference of group approaches and varying durations of interventions. This review highlights the challenges of the group approach which can lead to lengthy interventions and attrition amongst participants. In addition to the concerns regarding response bias from self-report questionnaires, there is also a lack of physiological measures used to evaluate effects on mental health. The large efforts by 11 studies to integrate multiple centres into their intervention and the centre-based assessment performed by four studies highlight the need for a centre-focused approach to build resilience among teachers from various ECE centres. A pilot study is conducted to evaluate the feasibility of an integrated electroencephalography–virtual reality (EEG-VR) approach in building resilience in teachers, where the frontal brain activity can be monitored during a virtual classroom task. Overall, the findings of this review propose the integration of physiological measures to monitor changes in mental health throughout the resilience-building intervention and the use of VR as a tool to design a unique virtual environment.

Building Resilience and Sense of Control among Adults with Sensory Disabilities as They Grow Older: Examining the Effect of Prayer

This article reports a study of the effect of online prayer lessons in building resilience and sense of personal control among adults with sensory disabilities over a six-year period. Data from intervention and control group participants in select Asian and African cities were collected at baseline (T1) (N1=244) and at three-year intervals T2 (N2=217) and T3 (N3=194). Results indicated that the online prayer lessons were effective (Cohen’s d range = 0.34–1.19, p≤.01) thereby indicating that prayer endowed adults with sensory disabilities a distant perspective on their personal problems and helped make progress on it emotionally. Men, middle class, Hindus, single (never married, widowed, divorced), and living with kin/nuclear families responded better to the online prayer lessons. The ordinary least squares regression and Tobit models indicated that maximum variation in outcomes was attributed to intervention adherence: attending of the online lessons and self-recitation/practice. The longitudinal structural equation model indicated a sustained effect of the said predictors as well as a mutual covariance between resilience and personal control outcomes over a period of time. With certain refinements for women, upper class participants, Christians, currently married, and living with extended family or alone, online prayer lessons are an effective resilience-building intervention for adults with sensory disabilities.

Resilience mediates the association between impulsivity and self-harm in Chinese adolescents

ObjectiveExisting literature is supportive for the positive connection between impulsivity and self-harm (SH), nevertheless, less is known regarding to the role of resilience in this association. This research primarily explored potential mediation of resilience in the association between impulsivity and SH in a large sample of Chinese adolescents. MethodA population-based cross-sectional survey of 4552 adolescents was conducted in southwest China. A self-administered questionnaire was adopted for data collection from all subjects. The Barratt Impulsiveness Scale (BIS), the Modified version of Adolescents Self-Harm Scale (MASHS) and the Resilience Scale for Chinese Adolescents (RSCA) were used to measure impulsivity, SH, and resilience, respectively. The associations between impulsivity, resilience, and SH were estimated by using stepwise multivariate Logistic regression models. Mediation of resilience in impulsivity and SH association was evaluated by using path model. ResultsThe prevalence of SH was 39.1% (95% CI: 34.0%-45.0%) for surveyed adolescents. Impulsivity and resilience were significantly associated with the prevalence of SH. Prominent dose-response association between impulsivity and SH prevalence was further confirmed. Resilience was a salient mediator which accounted for 42.90% of the total impulsivity-SH association. Among all the five dimensions of resilience, goal concentration (23.98%) and emotion regulation (21.94%) showed the strongest mediation. ConclusionsThe findings suggest that resilience building intervention strategies, particularly those focusing on improving goal concentration, emotion regulation, and positive perception, could be effective in reducing impulsivity related SH risk among Chinses adolescents.

Pre-deployment programmes for building resilience in military and frontline emergency service personnel.

Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post-traumatic stress and even post-traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these "pre-deployment resilience-building programmes".The objective of this review was to assess the effectiveness of programmes that seek to build resilience to potentially traumatic events among military and frontline emergency service personnel prior to their deployment. These resilience programmes were compared to other interventions, treatment as usual or no intervention.Studies were identified through searches of electronic databases including Ovid MEDLINE, Embase, PsycINFO, Web of Science and Google Scholar. The initial search took place in January 2019, with an updated search completed at the end of September 2020.Only studies that used a randomised controlled trial (RCT)/cluster-RCT methodology were included. The programmes being evaluated must have sought to build resilience prior to exposure to trauma. Study participants must have been 18 years or older and be military personnel or frontline emergency workers.Studies that met the inclusion criteria were assembled. Data extracted included methods, participants' details, intervention details, comparator details, and information on outcomes. The primary outcomes of interest were resilience, symptoms of post-traumatic stress and PTSD. Secondary outcomes of interest included acute stress disorder, depression, social support, coping skills, emotional flexibility, self-efficacy, social functioning, subjective levels of aggression, quality of sleep, quality of life and stress. Assessment of risk of bias was also completed. A total of 28 studies were included in a narrative synthesis of results.All 28 included studies compared an experimental resilience building intervention versus a control or no intervention. There was a wide range of therapeutic modalities used, including cognitive behavioural therapy (CBT) informed programmes, biofeedback based programmes, stress-management programmes, mindfulness and relaxation programmes, neuropsychological-based programmes, and psychoeducational-informed programmes. The main outcomes are specified here, secondary outcomes such as depression, social support, coping skills, self-efficacy, subjective levels of aggression and stress are reported in text. No studies reported on the following pre-specified outcomes; acute stress disorder, emotional flexibility, social functioning, quality of sleep and quality of life. Resilience Eight studies reported resilience as an outcome. We narratively synthesised the data from these studies and our findings show that five of these interventions had success in building resilience in their respective samples. Two of the studies that reported significant results utilised a CBT approach to build resilience, while the other three successful programmes were mindfulness-based interventions. Symptoms of post-traumatic stress Our narrative synthesis of results included eight studies. Two of the eight studies produced significant reductions in symptoms of post traumatic stress compared to controls. These interventions used neuropsychological and biofeedback intervention models respectively. PTSD caseness Four studies reported PTSD caseness as an outcome. Our narrative synthesis of results suggests that evidence is mixed as to the effectiveness of these interventions in reducing clinical diagnosis of PTSD. One study of a neuropsychology-orientated Attention Bias Modification Training (AMBT) programme had success in reducing both symptoms of post-traumatic stress and numbers of participants receiving a diagnosis of PTSD. A stress-management programme reported that, when baseline differences in rates of pre-deployment mental health issues were controlled for, participants in the control condition were at 6.9 times the risk of a diagnosis of PTSD when compared to the intervention group. Given the diversity of intervention designs and theoretical orientations used (which included stress-management, neuropsychological and psychoeducational programmes), a definitive statement on the efficacy of pre-deployment programmes at reducing symptoms of post-traumatic stress and PTSD cannot be confidently offered.While a number of evaluations of relevant programmes have been published, the quality of these evaluations limits our ability to determine if resilience-building programmes 'work' in terms of preventing negative outcomes such as depression, symptoms of post-traumatic stress and diagnoses of PTSD. Based on our findings we recommend that future research should: a) report pre-/post-means and standard deviation scores for scales used within respective studies, b) take the form of large, RCTs with protocols published in advance, and c) seek to measure defined psychological facets such as resilience, PTSD and stress, and measure these concepts using established psychometric tools. This will provide more certainty in future assessments of the evidence base. From a clinical implications point of view, overall there is mixed evidence that the interventions included in this review are effective at safe guarding military personnel or frontline emergency workers from experiencing negative mental health outcomes, including PTSD, following exposure to potentially traumatic events. Based on this, practitioners seeking to build resilience in their personnel need to be aware of the limitations of the evidence base. Practitioners should have modest expectations in relation to the efficacy of resilience-building programmes as a prophylactic approach to employment-related critical incident traumas.

Use of Mobile Technology Paired with Heart Rate Monitor to Remotely Quantify Behavioral Health Markers among Military Reservists and First Responders.

Heart rate variability (HRV) is a biological marker that reflects an individual's autonomic nervous system regulation. Psychological resilience is an individual's ability to recover from an adverse event and return to physiological homeostasis and mental well-being, indicated by higher resting HRV. The Biofeedback Assisted Resilience Training (BART) study evaluates a resilience-building intervention, with or without HRV biofeedback. This article evaluates the feasibility of remote psychophysiological research by validating the HRV data collected. The BART platform consists of a mobile health application (BART app) paired to a wearable heart rate monitor. The BART app is installed on the participant's personal phone/tablet to track and collect self-report psychological and physiological data. The platform collects raw heart rate data and processes HRV to server as online biofeedback. The raw data is processed offline to derive HRV for statistical analysis. The following HRV parameters are validated: inter-beat interval, respiratory sinus arrhythmia, low-frequency HRV, biofeedback HRV, and heart period. Bland-Altman and scatter plots are used to compare and contrast online and offline HRV measures. Repeated-measures ANOVA are used to compared means across tasks during the stress (rest, stress, and recovery) and training (rest and paced breathing) sessions in order to validate autonomic nervous system changes to physiological challenges. The analyses included 245 participants. Bland-Altman plots showed excellent agreement and minimal bias between online and offline unedited inter-beat interval data during the stress session. RMANOVA during the training session indicated a significant strong effect on biofeedback HRV, F(11,390) = 967.96, P < .01. During the stress session, RMANOVA showed significant strong effect on respiratory sinus arrhythmia and low-frequency HRV, and a significant but weak effect on heart period. The BART digital health platform supports remote behavioral and physiological data collection, intervention delivery, and online HRV biofeedback.

Examining the Acceptability of a Resilience Building Intervention Among Adults Aging With HIV.

Few interventions have targeted resilience resources in people living with HIV (PLWH). We tested the acceptability of an existing resilience intervention in middle-age and older PLWH. Fourteen PLWH attended one 3-hr group session, which included videos, quizzes, and written activities. Participants provided quantitative and qualitative feedback. The mean acceptability rating was 8.71 (1.27) on a 10-point scale. A majority of participants reported that the intervention was an appropriate length; that it improved their resilience, mood, and ability to manage HIV; and that they would likely continue using the tools. Average content retention accuracy was 75% (12.66). Qualitative feedback suggested addressing HIV-specific stressors, including disclosure concerns, stigma, health concerns, and treatment adherence. The resilience intervention was deemed highly acceptable among older PLWH. Uptake may increase by addressing HIV-specific stressors and improving comprehensibility. Future research should further refine and test the efficacy of a modified version of the intervention.

The feasibility of a Comprehensive Resilience-building psychosocial Intervention (CREST) for people with dementia in the community: protocol for a non-randomised feasibility study

BackgroundA dementia diagnosis can prevent people from participating in society, leading to a further decline in cognitive, social and physical health. However, it may be possible for people with dementia to continue to live meaningful lives and continue to participate actively in society if a supportive psychosocial environment exists. Resilience theory, which focuses on strengthening personal attributes and external assets in the face of serious challenges, may provide a scaffold on which an inclusive multifaceted psychosocial supportive environment can be built. This protocol paper describes a study to determine the feasibility of conducting a multifaceted complex resilience building psychosocial intervention for people with dementia and their caregivers living in the community.MethodsThis is a non-randomised feasibility study. Ten participants with dementia and their primary caregivers living in the community will be recruited and receive the CREST intervention. The intervention provides (a) a 7-week cognitive stimulation programme followed by an 8-week physical exercise programme for people with dementia and (b) a 6-week educational programme for caregivers. Members of the wider community will be invited to a dementia awareness programme and GP practices to a dementia training workshop. Trained professionals will deliver all intervention components. Outcomes will assess the feasibility and acceptability of all study processes. The feasibility and acceptability of a range of outcomes to be collected in a future definitive trial, including economic measurements, will also be explored. Finally, social marketing will be used to map a route toward stigma change in dementia for use in a subsequent trial. Quantitative feasibility outcome assessments will be completed at baseline and after completion of the 15-week intervention while qualitative data will be collected at recruitment, baseline, during and post-intervention delivery.ConclusionThis feasibility study will provide evidence regarding the feasibility and acceptability of a comprehensive multifaceted psychosocial intervention programme for people with dementia and their caregivers (CREST). The results will be used to inform the development and implementation of a subsequent RCT, should the findings support feasibility.Trial registrationISRCTN25294519 Retrospectively registered 07.10.2019

A feasibility study of a manualized resilience-based telehealth program for persons with multiple sclerosis and their support partners.

BackgroundResilience is a protective factor that emerges when individuals are faced with challenges and stressors. Multiple sclerosis (MS) is a chronic neurological disease that introduces a great deal of stress for the individual and his/her support partner. We designed a telehealth resilience-building dyadic program for persons with MS (PwMS) and their support partners.ObjectivesTo evaluate the feasibility of the resilience intervention. The secondary objective was to assess the benefits of the intervention.MethodsSixty-two participants (M = 49.5 years, 31 dyads of PwMS) and support partners) were recruited to participate. Out of the 31 dyads, 26 were spouses, 2 were cohabiting partners, and 3 were parent–child dyads.ResultsThe feasibility goals of the intervention were met, as determined by high participant satisfaction and acceptable completion rates. Preliminary outcomes relating to resilience were positive, suggesting that this intervention had a positive impact on participants.ConclusionsTo the best of our knowledge, this is the first resilience-building intervention delivered via telehealth for both PwMS and their support partners. The study showed an increase in resilience-building skills for addressing the challenges faced by PwMS and their support partners. These skills can be promoted and taught, clinically supported by telehealth, an affordable, accessible healthcare solution. Trial Registration at ClinicalTrials.gov (NCT03555253).

Promoting well-being in refugee children: An exploratory controlled trial of a positive psychology intervention delivered in Greek refugee camps.

Rigorously evaluated interventions that target protective factors and positive resources rather than ameliorating negative outcomes in child refugees are rare. To address this, we developed and evaluated a short, group-based resilience-building intervention called Strengths for the Journey (SFJ), which was designed for war-affected children. We conducted a quasi-randomized pilot study of the SFJ intervention with 72 7- to 14-year-old forcibly displaced children (Mage = 10.76, 64.8% female) in three refugee camps in Lesvos, Greece. Intervention effectiveness was assessed by measuring pre-post changes in well-being, self-esteem, optimism, and depressive symptoms from before (T1) to immediately after the intervention/wait-list task (T2). Four focus group interviews were conducted with 31 of the participants to discuss their views on the effects of the intervention and the continued use of the skills that were learned. Using repeated-measures ANOVAs, we found improvements in well-being, F (1, 46) = 42.99, ηp2 = .48, self-esteem, F (1, 56) = 29.11, ηp2 = .40, optimism, F (1, 53) = 27.16, ηp2 = .34, and depressive symptoms, F (1, 31) = 62.14, ηp2 = .67, in the intervention group compared with the wait-listed group (p < .05). Focus group participants highlighted the importance of SFJ in developing a sense of togetherness and building their strengths. Child refugees in low-resource settings may benefit from brief, first-line interventions that target protective factors such as well-being, hope, self-esteem, and belonging.

Forum-theatre technique to foster creative and active problem solving: A resilience-building intervention among in-service teachers

This paper introduces the results of an evaluation of the Forum-theatre workshop method, which was designed within the framework of a resilience-building intervention. About 230 in-service vocational school teachers in Canton of Ticino participated in the study. A mixed-methods research design was applied to investigate potentialities of the Forum-theatre technique in generating a better understanding about interpersonal conflicts at school while fostering active coping strategies. Data were collected by means of participatory observation and a self-reported questionnaire. The findings indicate a perceived positive impact in terms of proactive participation, critical awareness and activated reflectivity. In addition, the interactive drama technique encouraged participants to activate a dialog between multiple perspectives, thus enlarging the perceived spectrum of possible actions during relational conflicts. The paper concludes with implications for creativity and resilience research.

Impact of Palliative Care Interventions on Health-Related Quality of Life (HRQOL): A Secondary Analysis of the Promoting Resilience in Stress Management (PRISM) Randomized Controlled Trial (RCT) (S870)

1.Review the concept of health-related quality of life as a study outcome.2.Evaluate the effectiveness of an intervention using patient-reported health-related quality of life as an outcome. PRISM is a novel resilience-building intervention for adolescents and young adults (AYAs). Primary analysis of the RCT in AYAs with cancer showed PRISM improved HRQOL. Secondary analysis explored changes in HRQOL domains and differences between patient groups. English-speaking AYAs (12-25 years) were randomized to PRISM or usual care (UC) from 1/2015 – 10/2016. Surveys were completed at enrollment and six months later, using the Pediatric Quality of Life Inventory (PedsQL) Generic Short Form (SF-15) and Cancer Module to assess HRQOL. We compared change scores (PRISM vs UC) by domain (PedsQL SF-15: physical, emotional, social, school; Cancer: pain, nausea, procedure anxiety, treatment anxiety, worry, cognition, perceived appearance, communication). Participants were stratified by age (12-17 years vs 18-25 years) and advanced cancer status (yes/no). 74 patients (36 PRISM, 38 UC) completed 6-month assessments. 72% were 12-17 years old. 23% had advanced cancer at enrollment. PRISM improved patient-reported communication (UC: median [interquartile range, IQR] 0 [-17, 8]; PRISM: 8 [0, 25]). Younger patients benefited more, especially in PedsQL SF-15 school (12-17: UC 0 [-8, 0], PRISM 13 [0, 17]; 18-25: UC 0 [-33, 17], PRISM 0 [-25, 17]) and social domains (12-17: UC 0 [-33, 0], PRISM 0 [0, 8]; 18-25: UC 0 [-25, 4], PRISM -17 [-25, 8]), and cancer-specific perceived appearance (12-17: UC -4 [-25, 0], PRISM 8 [-8, 25]; 18-25: UC 0 [-21, 0], PRISM -8 [-25, 17]). Patients with advanced cancer benefited more in cancer-specific domains nausea (no: UC 0 [-10, 15], PRISM 10 [-10, 40]; yes: UC 6 [-15, 25], PRISM 35 [25, 50]) and pain (no: UC 13 [-13, 25], PRISM 6 [-13, 25]; yes: UC -13 [-25, 0], PRISM 6 [-13, 25]). With PRISM, younger AYAs coped better with age-appropriate challenges and AYAs with advanced cancer improved physical symptom HRQOL.

The Primary Prevention of PTSD: A Systematic Review

There has been abundant research targeting the secondary and tertiary prevention and treatment of posttraumatic stress disorder (PTSD), including different forms of debriefing, treatments for acute stress disorder, and targeted intervention strategies (M. T. Feldner, C. M. Monson, & M. J. Friedman, 2007). However, there remains a scarcity of research pertaining to the primary, pretrauma prevention of PTSD. A systematic review was conducted in order to identify and synthesize all programs aimed at the primary prevention of PTSD to date. A broad search strategy was used, yielding 15,014 studies in 4 languages published between 1915 and 2012. Studies in which a resilience-building intervention was delivered prior to a potentially traumatic event, with data collected regarding psychological well-being, were eligible. A total of 7 studies were identified as meeting these criteria. Currently, there is no solid body of research on the primary prevention of PTSD to justify or guide interventions. The limitations and future directions of research in this domain are discussed.