Behavioral Stress Management Research Articles

Digital Coaching to Address Health, Wellness, and Burnout Among Healthcare Workers: Pilot Study Results.

Healthcare worker (HCW) well-being is essential for safe, high-quality patient care, but clinicians and front-line staff continue to experience alarming rates of burnout. This pilot study evaluated a novel 6-week program of remote wellness coaching supported by daily digital messaging to reduce burnout and increase well-being among HCWs. In spring 2023, staff from a large community health center in California were invited to participate in this single-group pretest-posttest study in an academic-practice partnership. Thirty-four participants who were mostly female (91%), Latina (77%), 36 years old on average (range = 20-61), and represented all major job categories provided informed consent and completed the baseline survey. Of these, 17 completed 6 weekly 20-minute coaching sessions; received daily messages about stress management, self-care, workplace well-being, social connections, and lifestyle and health behaviors, and completed follow-up data collection. The Wilcoxon matched pair signed-rank tests assessed changes from baseline to 2-months follow-up. Self-reported burnout decreased from 59% at baseline to 35% at follow-up. Work exhaustion (p < .05), stress (p < .05) and sleep problems (p < .01) reduced significantly, and wellness practices (p < .05), moderate physical activity (p < .01), and healthy daily eating (p < .05) improved. Our pilot study suggests that a brief digital wellness program may address burnout and increase health and well-being among front-line staff and clinicians. Healthcare settings should consider this type of program for their workers, especially given the added burden of COVID-19 on the healthcare system.

Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care

The emergence of incretin-based therapies, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP), as a new class of obesity medications, is dramatically changing obesity care. Use of these medications, known categorically as anti-obesity medications, as part of comprehensive obesity management is associated with significantly greater weight loss and health benefits than found with earlier generation obesity medications. The outcomes reported from medication trials were often achieved in conjunction with lifestyle counseling sessions by a registered dietitian nutritionist (RDN) or other qualified health care professional. Research demonstrates that evidence-based obesity care should incorporate lifestyle interventions. Counseling by a RDN, paired with incretin-based therapies, can play a critical role in supporting adherence to the medication regimen, preventing and managing side effects, adequate nutrient intake, and establishment of lifestyle behaviors for long-term weight and health management. To date, minimal research has been reported on the impact of incretin-based therapies on food and nutrient intake. Until that research is conducted, RDNs and other health professionals can apply knowledge and experience from clients who have undergone other intensive treatments. This article provides considerations for lifestyle interventions, with a focus on medical nutrition therapy (MNT) provided by RDNs, for adults prescribed incretin-based therapies. RDNs have the education and training to provide MNT for people with overweight or obesity, as well as lifestyle counseling on physical activity, stress management, sleep hygiene, goal setting, and other behaviors associated with positive health outcomes. RDNs have a critical role in the integration of incretin-based therapies into obesity management.

Cognitive behavioral digital therapeutic effects on distress and quality of life in patients with cancer: National randomized controlled trial.

Cancer-specific psychological interventions like cognitive behavioral stress management (CBSM) demonstrate distress (e.g., anxiety/depression) and quality of life (QoL) benefits. Digital formats can expand access. Patients (80.6% female; 76.5% White; 25-80 years) with Stage I-III cancer and elevated anxiety within 6 months of treatment (surgery/chemotherapy/radiation/immunotherapy) receipt were randomized 1:1 to a 10-module CBSM or health education control digital app and completed questionnaires at Weeks 0, 4, 8, 12. Primary outcomes of greater group-level anxiety (PROMIS-A) and depression symptom (PROMIS-D) reductions for CBSM were met and published; this secondary report evaluates individual-level response results for these outcomes and outcomes beyond anxiety and depression. Chi-square tests compared responder proportions using PROMIS-A/PROMIS-D symptom categories and two levels (≥5/≥7.5) of T-score point reductions. Changes across conditions over time for stress (Perceived Stress Scale), cancer-specific distress (Impact of Event Scale-Intrusions), and QoL (Functional Assessment of Cancer Therapy-General) were analyzed using repeated measures linear mixed-effects modeling (N = 449). Patient Global Impression of Change-Well-being was also examined. At Week 12, a greater proportion of CBSM (vs. control) participants reported normal-to-mild (vs. moderate-to-severe) PROMIS-A and PROMIS-D, and a greater proportion of CBSM participants at Week 8 or 12 had a ≥7.5 T-score reduction in PROMIS-A and a ≥5 T-score reduction in PROMIS-D (ps < .05). CBSM participants (vs. control) showed significantly greater reductions in Perceived Stress Scale and Impact of Event Scale-Intrusions and increases in Patient Global Impression of Change-Well-being and Functional Assessment of Cancer Therapy emotional and physical well-being (ps < .05), but not functional or social/family well-being. Digitized CBSM benefits distress and QoL. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Application of WeChat-based cognitive behavioural stress management for early-stage cervical cancer patients: a randomised controlled study

Background This randomised controlled study was aimed at investigating the effects of WeChat-based cognitive behavioural stress management (WB-CBSM) on the mental health of patients with early-stage cervical cancer treated with surgical resection. Methods A total of 184 patients with early-stage cervical cancer were randomised to receive either WB-CBSM (n = 92) or normal care (NC) (n = 92) for 8 weeks. Results Compared with the NC group, the WB-CBSM group exhibited reduced Hospital Anxiety and Depression Scale (HADS)–anxiety scores at months (M)1 (t = 2.022, P = 0.045), M3 (t = 2.575, P = 0.011), and M6 (t = 2.709, P = 0.007); anxiety rates at M3 (χ2 = 4.834, P = 0.028) and M6 (χ2 = 5.182, P = 0.023); HADS–depression scores at M3 (t = 2.069, P = 0.040) and M6 (t = 2.449, P = 0.015); and depression rates at M6 (χ2 = 4.268, P = 0.039). Moreover, the WB-CBSM group showed increased Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being scale scores at M1 (t = −2.001, P = 0.047), M3 (t = −2.281, P = 0.024), and M6 (t = −3.501, P = 0.001); the Quality of Life Questionnaire-Core 30 (QLQ-C30) global health score at M3 (t = −2.034, P = 0.043) and M6 (t = −2.426, P = 0.016); and QLQ-C30 function score at M3 (t = −2.009, P = 0.046). However, the groups exhibited decreased EuroQol-5 dimension scores at M3 (t = 2.056, P = 0.041) and M6 ((t = 2.242, P = 0.026) and QLQ-C30 symptom scores at M1 (t = 2.026, P = 0.044) and M3 (t = 2.210, P = 0.028). Conclusion WB-CBSM reduced anxiety and depression and improved the spiritual well-being and quality of life of patients with early-stage cervical cancer treated with surgical resection.

Mujeres Unidas: A Pilot Study to Educate Latina Women.

In the United States, it is estimated that 15% of Latinos will experience a depressive or anxiety disorder during their lifetime. Education, prevention programming, and health interventions around topics such as stress, nutrition, mental health, and health maintenance for Latino immigrants are lacking, inadequate, or nonexistent. This type of programming may be protective against depression and anxiety. A total of 19 Latina women completed a five-week, group-based intervention to learn about stress, stress management, nutrition, mental health, and healthy behaviors in a culturally sensitive environment taught by native Spanish speakers. Program evaluation occurred through in-depth interviews and changes in anxiety and depression scores via the Generalized Anxiety Scale and the Patient Health Questionnaire, respectively. The team saw statistically significant decreases in the GAD-7 scores pre- and post-intervention (8.00 versus 5.08, p<0.05), but no differences in the PSS or the PHQ-2 scores. Group-based intervention and education taught by native Spanish speakers may be an acceptable and feasible approach to addressing anxiety in Latina immigrants.

A quantitative examination of sleep quality, burnout, psychological distress, and social support availability of electrical workers in Ontario, Canada

Electrical workers experience difficult psychosocial working conditions that may expose them to poor mental health outcomes. This study aims to explore the relationships between psychological distress, access to social support, burnout, and sleep quality in Canadian electrical workers. A 30-item cross-sectional survey including the Pittsburgh Sleep Quality Index, Kessler’s Psychological Distress Scale, Copenhagen Burnout Inventory, and social support questions from the WHO-QoL-BREF were completed by 118 electrical workers. Data was analyzed to determine differences between groups, correlations between variables, and to identify predictors of poor sleep quality. No significant differences were found in burnout scores and subjective sleep quality between apprentices, electricians, and contractors. Apprentices reported being more psychologically distressed than electricians (p = 0.005) and contractors (p < 0.001). Electrical workers preferred social support from spouses, family, or friends when things get tough at work. Poor sleep quality was correlated with personal burnout (r = 0.45), work-related burnout (r = 0.37), and psychological distress (r = 0.39); however, these factors did not predict poor sleep quality. The study suggests a need for improved interpersonal communication, stress management, and help-giving behavior among electrician-apprentice and contractor-apprentice relationships in the workplace. Future research should explore the cultural and social dynamics between workers to better understand their impacts on health and wellbeing.

Perioperative/postoperative anxiety and its interventions in gynecological cancers: a comprehensive review of clinical evidence.

Gynecological cancers are prevalent malignancies among females, and surgical intervention is the primary therapeutic approach offering the possibility of a definitive cure. Recent research has highlighted the susceptibility of gynecological cancer patients to experiencing anxiety symptoms during the perioperative and postoperative phases, with this psychological condition being linked to suboptimal recovery following surgery. Nevertheless, certain interventions have shown promise in mitigating perioperative and postoperative anxiety in gynecological cancer patients. In this study, we conducted a comprehensive review to collect the existing evidence on this subject. Through a systematic search across six common databases, we screened and included 28 pertinent studies. The current review emphasizes the elevated occurrence of perioperative and postoperative anxiety among patients with gynecological cancers (i.e., uterine, cervical, ovarian, endometrial, and vulval cancers). Specific nursing interventions (i.e., crisis intervention nursing, multidisciplinary collaborative continuous nursing, psychological nursing, comprehensive psychological nursing, reminiscence therapy involved care, cognitive behavioral stress management, hospital-family integrated continuation nursing, high-quality nursing care, relaxation-focused nursing program, and relaxation/counseling intervention) and psychotropic medications may serve as dependable approaches to mitigate perioperative and postoperative anxiety. This study represents a novel contribution to the literature by providing a characterization of perioperative and postoperative anxiety in the context of gynecological oncology. The findings underscore the significance of addressing perioperative and postoperative anxiety as a critical clinical concern for individuals with gynecological cancers, emphasizing the need for further research to develop effective interventions.

The benefits of an offline to online cognitive behavioral stress management regarding anxiety, depression, spiritual well-being, and quality of life in postoperative intrahepatic cholangiocarcinoma patients.

Cognitive behavioral stress management (CBSM) has been introduced for the postoperative cancer management, but its application in intrahepatic cholangiocarcinoma (ICC) is rare. This current study constructed an offline to online CBSM (OO-CBSM) program and applying multiple assessing scales, aiming at exploring the benefits of OO-CBSM regarding anxiety, depression, spiritual well-being, and quality of life (QoL) in postoperative ICC patients. The study randomly assigned 68 postoperative ICC patients into OO-CBSM (N=34) and normal care (NC) (N=34) groups to undergo 10-week interventions. Hospital anxiety-and-depression scale (HADS), Zung's self-reporting anxiety scale (SAS), and depression scale (SDS), functional-assessment of chronic-illness therapy-spiritual well-being scale (FACIT-Sp), European quality-of-life-5 dimensions (EQ-5D), and quality-of-life questionnaire-core30 (QLQ-C30) were assessed within 6 months (M). HADS-anxiety scores at M3 (P=0.049) and M6 (P=0.009), SAS score at M6 (P=0.028), HADS-depression score at M3 (P=0.043), and SDS scores at M3 (P=0.044) and M6 (P=0.028), were lower in the OO-CBSM group versus the NC group. Meanwhile, FACIT-Sp scores at M1 (P=0.042) and M6 (P=0.003) were higher in the OO-CBSM group over the NC group. Besides, EQ-5D scores at M3 (P=0.067) and M6 (P=0.087) disclosed trends to be lower in the OO-CBSM group versus the NC group, but not statistically significant. QLQ-C30-global-health scores at M3 (P=0.049) and M6 (P=0.033), and QLQ-C30-function score at M6 (P=0.046), were higher in OO-CBSM group over NC group; but QLQ-C30-symptom score was not significantly different at any timepoints between them. OO-CBSM attenuates anxiety and depression, and advances spiritual well-being and QoL in postoperative ICC patients, indicating its potency for the ICC postoperative management.

Management Interventions For Enhancing Emotional Regulation In Children With Autism Spectrum Disorders: Scoping Review

Introduction: Autism Spectrum Disorder (ASD) presents significant challenges in emotional regulation, often leading to behavioral difficulties such as anger outbursts, tantrums, and depression, particularly in early childhood development. Recognizing the need for effective interventions. Objective: To explore management interventions to improve emotion regulation for children with ASD. Methods: We conducted a review of interventions to improve emotion regulation for children with ASD. The search process uses appropriate populations, concepts, and contexts. The search was carried out through the PubMed, Science direct, ProQuest, and SAGE Journal databases published between 2011 - 2021. The selection process was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Critical assessment using The Joanna Briggs Institute checklist. Results: Of 4,157 articles, 7 articles were selected for this review. Several interventions to improve emotional regulation that can be used include Cognitive behavior therapy (CBT), Physical Activity, Stress and Anger Management Program (STAMP), and Stress and Anger Management Program (STAMP). In general, this intervention can be used to improve emotional regulation in children with ASD aged 4-17 years. Conclusion: All interventions can be used to improve emotional regulation in children with ASD

Assessing adherence and competence in delivering telehealth group cognitive behavioral stress management.

Assessing adherence and competence in delivering telehealth group cognitive behavioral stress management.

Aging gracefully: navigating the journey of growing older

Abstract This study aims to explore the concept of aging gracefully, probing beyond just physical appearance to embrace the acceptance of changes that come with age and leading a fulfilled life. This study was conducted through a review of literature from 2018 to 2023 using Google Scholar and other databases and focused on keywords such as “aging gracefully,” “navigating,” and “journey of growing older.” It identified various themes, including the journey of aging, the steps involved in aging gracefully, the significance of embracing aging, and the epigenetic theory of aging, shedding light on how individuals can traverse this path. In conclusion, aging gracefully entails preserving physical health, emotional well-being, and having a good attitude as you age. To accomplish this, we need to stay active with different kinds of workouts, eat a well-balanced diet rich in fruits and vegetables, maintain social connections, and stimulate our brain by engaging in hobbies such as reading and puzzles. Regular check-ups, stress management, skin protection, and healthy behaviors such as getting adequate sleep, reducing alcohol consumption, and quitting smoking are all vital. We should embrace the changes that come with aging and focus on the positive aspects of life to traverse this path gracefully. With this awareness, individuals can face aging with acceptance and vitality, leading life with grace and fulfillment.

Financial Capability, Financial Well-Being, and Life Satisfaction of Women in an Emerging Economy

Life satisfaction depends on several life aspects, such as relationships, achievements, health, and work satisfaction. Theorists and experts contend that domain-specific factors and behaviors predict domain-specific satisfaction. Our study examines life satisfaction from the standpoint of behavior finance indicators by incorporating financial capability factors such as financial literacy, financial management behavior, and financial self-efficacy as antecedents to financial satisfaction and financial stress. Financial satisfaction and financial stress are further assumed to predict life satisfaction. Data are collected from 308 working women using a self-administered questionnaire in three different waves in Pakistan. By examining the fitness of the measurement model, we proceeded toward path analysis of the structural equation model. All the hypothesized relationships are supported except the paths between financial literacy to financial stress and financial management behavior to financial satisfaction. The results and implications are presented based on the findings of the study.

Low Social Well-Being in Advanced and Metastatic Prostate Cancer: Effects of a Randomized Controlled Trial of Cognitive Behavioral Stress Management.

Social well-being impacts cancer patients' health-related quality of life (HRQOL) and coping style. This secondary analysis was conducted to examine whether advanced prostate cancer survivors who had experienced low social well-being would benefit from a web-based cognitive behavioral stress management (CBSM) intervention. APC survivors (N = 192) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) control condition. A subsample of participants (n = 61) with low pre-intervention SWB (measured by social support from and relationship satisfaction with family and friends) was included in the study. Multilevel models compared participants' PC-specific quality of life (sexual, hormonal, urinary), affect-based psychosocial burden (cancer-related anxiety and distress), and coping strategies at baseline, 6months, and 12months. Covariates were included in all models as appropriate. Participants randomized to the CBSM condition showed significantly greater improvements in fear of cancer recurrence and cancer-related intrusive thoughts than those in the HP control condition. A significant condition by time interaction was also found, indicating that CBSM improved participants' PC-related fear in both short- (6months) and long-term (12months). However, the CBSM intervention did not significantly impact APC-related symptom burden. Only for the urinary domain, clinically meaningful changes (CBSM vs HP) were observed. In addition, all participants, regardless of condition, reported less coping (e.g., emotion-, problem- and avoidance-focused) over time. As predicted, the CBSM intervention improved several affect-based psychosocial outcomes for APC survivors with low baseline SWB.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study.

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Videoconference-delivered group cognitive behavioral stress management for ME/CFS patients who present with severe PEM: a randomized controlled trial

ABSTRACT Background In Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), post-exertional malaise (PEM) is associated with greater distress and symptoms. Cognitive Behavioral Stress Management (CBSM) has demonstrated beneficial effects for ME/CFS and may mitigate stress-related triggers of PEM. We tested a virtual CBSM intervention to increase access, and we report on its effects on stress and symptoms in ME/CFS patients with severe PEM. Methods Data were from a randomized controlled trial (NCT01650636) comparing 10-week videoconference-delivered group CBSM (V-CBSM, n = 75) to a 10-week Health Information active control (V-HI, n = 75) in Fukuda criteria ME/CFS patients (71 classified as highPEM, 79 lowPEM). Linear regression explored PEM-by-Treatment interactions on overall symptom frequency and intensity, perceived stress, and fatigue-specific interference and intensity, at 5-month follow-up. Logistic regression tested V-CBSM effects on 5-month PEM status. Analyses controlled for age, gender, race/ethnicity, mode of symptom onset, and time since diagnosis. Results The sample was middle-aged (47.96 ± 10.89 years), mostly women (87%) and non-Hispanic White (65%), with no group differences on these variables or baseline PEM. For highPEM patients, V-CBSM (versus V-HI) demonstrated medium to large effects on follow-up symptom frequency, symptom intensity, fatigue interference, and fatigue intensity (p’s < .05) and trending to significant reductions in perceived stress (p = .07). Differences were not evident for lowPEM patients. Treatment predicted follow-up PEM status at a trend (p = .058), with patients receiving V-CBSM demonstrating half the risk of highPEM classification versus V-HI. Conclusions V-CBSM demonstrates benefits for ME/CFS patients presenting with severe PEM and may reduce the expression of PEM over time. Trial registration: ClinicalTrials.gov identifier: NCT01650636..

Cardiovascular diseases and community mental health

&lt;p class="Default"&gt;Cardiovascular diseases (CVDs) are cited as the deadliest of illnesses. Their incidence and prevalence around the world are steadily rising. CVDs are the cause of approximately one-third of all deaths in the world. It has been stated in empirical studies over the years that poor socioeconomic status, the lack of social support, stress at work and in the family, depression, and psychosocial risk factors such as anxiety and feelings of hostility aggravate the risk of developing coronary heart disease and also worsen the clinical course and prognosis. Additionally, psychobiological, and behavioral mechanisms have been identified in this context. Psychosocial risk factors should be identified in clinical practice and medical results shared with individuals with CVDs, who should also be screened for anxiety, stress, and stress management, as well as for symptoms of depression. Individuals at risk or who are diagnosed as displaying symptoms of anxiety and depression should be referred to psychiatric professionals to ensure that they receive assistance. Cardiac rehabilitation may involve psychosocial interventions that include cognitive behavioral therapy, problem-solving therapy, and stress management programs, applied on their own or together with other interventions. The aim of this review article is to examine CVDs and community mental health, determine which applications may be adopted as standard practice in this context, and raise awareness about this topic among the public and especially among health professionals. &lt;/p&gt;

Evaluating the Efficacy of a Multifaceted Health Behavior Training Program on Psychological Distress

This study aimed to assess the effectiveness of a comprehensive Health Behavior Training Program in reducing psychological distress among adults. The program, integrating cognitive behavioral therapy, mindfulness, stress management, and health education, sought to provide participants with effective tools to manage distress and improve overall well-being. A randomized controlled trial design was employed, involving 50 participants with mild to moderate psychological distress, randomly assigned to either the experimental group receiving the Health Behavior Training Program or a control group receiving no intervention. The intervention consisted of 8 weekly sessions, each lasting 90 minutes. Psychological distress was measured at baseline, post-intervention, and at a three-month follow-up using the Kessler Psychological Distress Scale (K10). The experimental group exhibited a significant reduction in psychological distress scores from pre-test (Mean = 33.81, SD = 4.19) to post-test (Mean = 27.44, SD = 4.42) and maintained these improvements at the three-month follow-up (Mean = 27.39, SD = 4.37). In contrast, the control group showed no significant changes in distress scores over time. Analysis of variance with repeated measurements indicated significant effects of time (F(2) = 6.33, p &lt; 0.01), group (F(1) = 7.10, p &lt; 0.01), and their interaction (F(2) = 6.40, p &lt; 0.01) on psychological distress scores, underscoring the effectiveness of the intervention. The Health Behavior Training Program significantly reduced psychological distress among participants compared to a control group, with sustained effects at a three-month follow-up. These findings support the implementation of multifaceted health behavior interventions as effective tools for managing psychological distress and enhancing mental health outcomes.

Cognitive behavioral stress management effectively facilitates neurologic recovery, alleviates mental distress, and elevates health status in acute ischemic stroke patients.

Cognitive behavioral stress management (CBSM) relieves physical and psychological burdens in patients with some central nervous system diseases, while its utility in acute ischemic stroke (AIS) patients is unclear. This study aimed to explore the effect of CBSM on neurologic recovery and psychosomatic health in AIS patients. Totally, 176 naive AIS patients were randomized into routine care (RC) group (n=88) and CBSM group (n=88) to receive a 3-month corresponding intervention. Modified Rankin scale (mRS) scores at the first month after discharge (M1) (P=0.008) and the third month after discharge (M3) (P=0.016) were lower in the CBSM group than in the RC group. The proportion of AIS patients with mRS score >2 at M3 was reduced in CBSM group vs RC group (P=0.045). Hospital anxiety depression scale (HADS)-anxiety score at M3 (P=0.016), HADS-depression score at M3 (P=0.005), and depression rate at M3 (P=0.021) were decreased in the CBSM group vs the RC group. EuroQol-5 dimension scores at M1 (P=0.024) and M3 (P=0.012) were decreased, while EuroQol-visual analogue scale score at M3 (P=0.026) was increased in the CBSM group vs the RC group. By subgroup analyses, CBSM had favorable outcomes in AIS patients with age ≤65 years. CBSM was beneficial to neurologic recovery and distress relief in AIS patients with an education level of middle school or above, and to health status in those with an education level of primary school or uneducated. In conclusion, CBSM benefitted neurologic recovery and psychosomatic health in AIS patients with minor neurological deficits, however, further studies should verify these results with a larger sample size and longer follow-up.

Supplemental Material for Assessing Adherence and Competence in Delivering Telehealth Group Cognitive Behavioral Stress Management

Supplemental Material for Assessing Adherence and Competence in Delivering Telehealth Group Cognitive Behavioral Stress Management

Impact Anxiety on Quality of Life and Clinical Outcomes of Patients with Acute Coronary Syndrome

Acute coronary syndromes (ACS) are a common ischemic heart disease (IHD) with high morbidity and mortality. Anxiety is common among cardiac patients, has potentially serious consequences if untreated, and is infrequently assessed or managed appropriately. The co-occurrence of anxiety symptoms and ACS is responsible for decreasing the quality of life (QoL) of patients with ACS. Anxiety is a common emotional response among acute coronary syndrome (ACS) patients. Anxiety is frequently encountered in ACS. It is believed that the prevalence of anxiety among cardiac patients is between 15 and 50%. Patients with ACS often experience anxiety due to the sudden onset of symptoms, the potential severity of their condition, and the uncertainty of their prognosis. Anxiety can also be a risk factor for adverse cardiac events and may interfere with treatment adherence and rehabilitation efforts. Therefore, it is important for healthcare providers to recognize and address anxiety in patients with ACS. This can involve a combination of pharmacological interventions, such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs), and non-pharmacological interventions, such as cognitive behavioural therapy, relaxation techniques, and stress management strategies. Additionally, healthcare providers can provide education and support to help patients better understand their condition and manage their symptoms. The importance of increased awareness and treatment of anxiety among patients with cardiac disease is stressed.