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Perceived susceptibility, psychological flexibility and health behaviors (PPE use, social distancing) were measured at two time points spaced 2 months apart during the height of the COVID-19 pandemic and lockdown in the U.S.A (Time 1 April 2020; Time 2 June 2020). Demographic variables were also collected. Data from 151 Mturk workers indicated that Time 1 psychological flexibility significantly predicted PPE use and social distancing. The effect sizes were substantial. Perceived susceptibility was not a significant predictor. Psychological flexibility messaging and interventions could be an important way to increase the likelihood of people performing health protective behaviors to better constrain the continuing COVID-19 outbreak.

The COVID-19 pandemic created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of sociodemographic characteristics, perceived risk for COVID-19, general perceived vulnerability to disease, intolerance of uncertainty, and psychological flexibility. These variables were used to predict COVID-19 preventive health behaviors (PPE use), psychological distress, and physical symptoms. The surveys were completed between April 9, 2020 and April 18, 2020 which is a period that corresponded to the first 2–3 weeks of lockdown for most participants. A demographically diverse sample of participants was recruited. A substantial number of participants reported a reduction employment status and 69% were in self-isolation. Participants reported a high degree of perceived vulnerability to COVID-19. PPE mask wearing was variable: 16% “not at all,” 20% “some of the time,” 42% “a good part of the time,” and 26 “most of the time.” Using clinical cutoff on the post-trauma scale, 70% of the sample would be considered to have symptoms consistent with PTSD. Physical symptom reporting was also high. Intolerance of uncertainty and psychological inflexibility were significant predictors of psychological distress and physical symptoms. Psychological flexibility moderated the relationship between intolerance of uncertainty and psychological distress/physical symptoms. The relationship between intolerance of uncertainty and psychological distress/physical symptoms was stronger among participants with lower levels of psychological flexibility. These findings indicate psychological flexibility can reduce distress associated with COVID-19. Additionally, these results support the workability of the Unified Flexibility and Mindfulness Model as a framework for studying health behavior.

Approximately ten million individuals in the United States self-identify as lesbian, gay, bisexual, and/or queer, and comprise 4% of the work force. There are currently no global protections against discrimination based on sexual identify in the workplace. Therefore, several people who identify as sexual minorities may experience discrimination, incivility, and hostility in the work place leading to burnout, as well as poor mental and physical health. Although global policies and protections against discrimination based on gender and sexual identity are needed, Acceptance and Commitment Therapy (ACT) could provide useful tools at the individual level for sexual minorities experiencing work stress. The current study is a pilot study designed to measure feasibility and acceptability of treatment. Participants were adults (n = 8) who self-identified as sexual minorities, were employed at least half time, and reported experiencing work stress. Participants attended a 4-h ACT session for sexual minorities experiencing work stress. Participants completed process-based measures and symptom-based measures. All measures of feasibility and acceptability indicated that participants found the intervention to be helpful, effective, and insightful. Further, one-tailed paired-samples t-tests indicated significant change for burnout. These results suggest that initial outcomes of the study are promising and encourage further examination of the efficacy of ACT as an intervention for sexual minority employees struggling with work stress. Although it is important to continue to create policy changes against discrimination, ACT may provide skills for sexual minorities to build resilience and increase well-being in an unjust world.

Objectives Health care professionals have elevated rates of burnout and compassion fatigue which are correlated with poorer quality of life and patient care, and inversely correlated with self-compassion. Primary studies have evaluated the extent to which mindfulness-based interventions increase self-compassion with contradictory findings. A meta-analytic review of the literature was conducted to quantitatively synthesize the effects of mindfulness-based interventions on self-compassion among health care professionals. Methods Twenty-eight treatment outcome studies were identified eligible for inclusion. Five cumulative effect sizes were calculated using random-effects models to evaluate differences of changes in self-compassion for treatment and control groups. Within and between group comparisons were evaluated. Sub-group and moderator analyses were conducted to explore potential moderating variables. Results Twenty-seven articles (k = 29, N = 1020) were utilized in the pre-post-treatment meta-analysis. Fifteen samples (52%) included health care professionals and fourteen (48%) professional health care students. Results showed a moderate effect size between pre-post-treatment comparisons (g = .61, 95% CI = .47 to .76) for self-compassion and a strong effect size for pre-treatment to follow-up (g = .76, 95% CI = .41 to 1.12). The effect size comparing post-treatment versus post-control was moderate. One exploratory moderator analysis was significant, with stronger effects for interventions with a retreat component. Conclusions Findings suggest mindfulness-based interventions improve self-compassion in health care professionals. Additionally, a variety of mindfulness-based programs may be useful for employees and trainees. Future studies with rigorous methodology evaluating effects on self-compassion and patient care from mindfulness-based interventions are warranted to extend findings and explore moderators. Electronic supplementary material The online version of this article (10.1007/s12671-020-01342-5) contains supplementary material, which is available to authorized users.

China has become a leading source of international college students for Western countries. Given Chinese students’ increasingly large contribution to the college population in host countries, their specific needs in mental health should be addressed. Studies across different countries indicate that international college students face higher levels of psychological distress compared to domestic students. However, there is little research investigating the effects of culturally sensitive interventions for their stress management. In the current study, we designed a culturally relevant Acceptance and Commitment Therapy (ACT) small group intervention focused on helping these students manage stress relevant to studying abroad. An evaluation of its feasibility, acceptability, and effectiveness using data from eight participants indicated that the ACT intervention was well-received. Statistically significant reductions in depression, stress, anxiety, and symptoms were observed at post evaluation and follow-up evaluation. Cultural implications and practical implications for working with a Chinese population were discussed.

Mindfulness-based interventions (MBIs) have improved psychological outcomes for multiple chronic health conditions, including diabetes. A meta-analytic review of the literature was conducted on all located studies (n = 14) investigating MBIs that targeted diabetes-related distress (DRD) and diabetes-related outcomes among people with Type 1 and Type 2 diabetes. PsychInfo, PubMed, Medline, and Web of Science were searched for MBIs that were designed to improve DRD and other secondary outcomes, including quality of life and measures of metabolic control. A meta-analysis of these outcomes uncovered small-to-moderate effect sizes for intervention studies measuring pretreatment to posttreatment changes in DRD and metabolic control among treatment group participants. However, the pretreatment to follow-up comparisons for DRD and metabolic control were small and unreliable. For control groups, all pre-treatment to post-treatment and pre-treatment to follow-up comparisons were unreliable for all outcomes. A moderate effect size for treatment-control comparisons was found for intervention studies measuring quality of life outcomes at posttreatment, but not at follow-up comparisons. All other effect sizes for treatment-control comparisons were unreliable. Limitations and implications for MBIs among individuals with diabetes are discussed.

Functional Analytic Psychotherapy (FAP) is a contextual behavioral therapy that utilizes behaviorism within the therapeutic relationship to implement in-session changes with the idea that these changes will generalize outside of session. The therapist focuses on reinforcing adaptive behavior and decreasing problematic behavior. Although FAP has existed as a therapy for nearly three decades, there is a limited amount of research examining its efficacy, and the majority of FAP efficacy studies use single-subject data. The current study aims to synthesize data from 20 FAP single-subject design research studies in order to provide a quantitative estimate of its efficacy. The metrics used to synthesize the data in this study include percentage of non-overlapping data (PND), split-middle trend estimation (SMTE), reliable change index (RCI), and Swanson's dsw. For PND and SMTE analyses the overall mean effect sizes fell into the "questionably effective" to "fairly effective" classification. RCIs were consistently classified as "statistically reliable" and swanson's dsw analyses indicated that differences were large and reliable.

We examined the relationship between physical work hazards and employee withdrawal among a sample of health care employees wherein safety compliance was hypothesized to moderate the relationship between physical work hazards and withdrawal. Health care workers (N = 162) completed an online questionnaire assessing physical work hazards, withdrawal, and indicators of workplace safety. Safety compliance moderated the relationship between patient aggression and withdrawal. Interaction plots revealed that for all significant moderations, the relationship between physical work hazards and withdrawal was weaker for those who reported high levels of compliance. Results shed initial light on the benefits of fostering safety compliance in health care contexts, which can contain exposure to physical work hazards.

Behavior therapists must often design treatments for individual patients who present with a wide array of psychophysiological disorders and health problems. The functional analysis and functional analytic causal modeling is a learning-based, empirically focused assessment technique used to systematically gather, integrate, and summarize information about the form and function of a patient’s symptoms. A functional analytic case model can be a critical component of effective treatment design because most interventions attempt to modify relationships between causal factors and symptoms. The objectives of this paper are (a) to present a review of the conceptual foundations and essential procedures in the functional analysis; (b) to outline steps required to generate a functional analytic causal model; (c) to explain simple decisional and statistical procedures that can be used to counter intuitive errors; and (d) to demonstrate how functional analytic case models can be used to guide clinical practice and treatment design for persons presenting with disorders observed in medical settings.

Financial stress is commonly experienced among college students and is associated with adverse academic, mental health, and physical health outcomes. Surprisingly, no validated measures of financial stress have been developed for undergraduate populations. The present study was conducted to generate and evaluate a measure of financial stress for undergraduate students. The newly developed scale and measures of demographics, general stress, and health were completed by 177 undergraduates. The reliability, validity, and factor structure of the new scale were evaluated. Results indicate good reliability and validity, suggesting that the measure can be used in research and in applied settings to assess financial stress. Possible implications are discussed.

Many people undergoing HIV testing experience substantial psychological distress. The psychological distress associated with testing may be influenced by monitoring. Monitoring refers to a strategy wherein a person tends to seek out information concerning threatening events. Furthermore, the ability to achieve cognitive structure (AACS) may influence the relationship between monitoring and psychological distress. The present study examined individuals who were undergoing HIV testing. Specifically, the researchers examined the association among monitoring and AACS on psychological distress during HIV testing. Results indicated that there was no interaction between monitoring and AACS on psychological distress. It was found that AACS was related to participants' level of psychological distress. However, the level of monitoring was not related to participants' psychological distress. Limitations of the study, clinical implications and suggestions for future research are also discussed.

Many people conceal their homosexuality. Concealment of homosexual orientation can be experienced as chronic stress and be associated with increased levels of physical symptoms. Research suggests that disclosure may produce a reduction in perceived stress, physical symptoms, and physiological activation. The cardiovascular activations levels of 27 healthy adult gay males were measured during resting baseline, a disclosure task (i.e. participants were instructed to talk about the difficulties associated with concealing one's sexual orientation), and a recovery phase. Several 2 (high/low concealment) × 2 (high/low disclosure) ANOVAs were conducted to determine if there was an interaction between level of concealment and level of disclosure during the recovery period. Results indicated that participants with a high concealment and high disclosure during the study exhibited significantly greater cardiovascular recovery than participants who engaged in a lower level of disclosure. These findings are discussed in light of Pennebaker's research on inhibition and confession. Copyright © 2006 John Wiley & Sons, Ltd.

In addition to biomedical forms of treatment, many cancer patients have elected to use complementary and alternative medicine (CAM) of a spiritual or religious nature. However, the effectiveness of such spiritual and religious interventions is uncertain. Using a meta-ana-lytic approach, the present study synthesized available treatment-outcome studies on spiritual and religious interventions for cancer patients to determine the efficacy of such interventions. Effect sizes were calculated for three types of outcome measures: biological, psychological, and spiritual. The authors found that nondrug spiritual and religious interventions produced small to moderate effect sizes for treatment versus control comparisons and small effect sizes for pre— versus posttreatment comparisons. Studies that used psychedelic drugs to promote spiritual experiences produced large effect sizes for both treatment versus control and preversus posttreatment comparisons. Finally, they found that, overall, treatment versus...

This study examined the affect of social support intervention on decreasing psychological and physiological stress. Fifty-seven college students, who scored below the median on functional, structural, and satisfaction measures of social support, were recruited. They were randomly assigned to a social support intervention group or a wait-list control group. The social support treatment condition consisted of 1-hour sessions designed to increase levels of structural and functional support. Participants completed self-report inventories measuring daily stress, physical symptoms, depression, anxiety, and social support both prior to and after treatment. After, participants participated in a laboratory-based psychophysiological assessment that measured their cardiovascular reactivity to a social stressor. Results did not suggest the beneficial effects of a social support intervention on physiological and psychological stress. Both groups showed improvement on most measures. The possible reasons for this are length and content of the intervention, the selection criteria of participants, and group process variables.

Many corporations provide employees the option of participating in on-site fitness centers, but utilization rates are low. Perceived barriers to physical activity have been established as important correlates of physical activity, and recent research indicates that barriers may vary across settings. Work-site fitness centers may present unique barriers to participation, but there are currently no standardized measures that assess such barriers. Eighty-eight employees of a midwestern corporation completed a survey designed to identify and evaluate the extent to which barriers influence participation in an on-site corporate fitness center. Regression analyses revealed that external environmental barriers (e.g., inadequate exercise facilities) significantly accounted for not joining the fitness center, and for decreased duration of visits to the facility among members. Internal barriers (e.g., feeling embarrassed to exercise around coworkers) significantly accounted for frequency of fitness center visits among members. This corporate specific measure may lead to more effective interventions aimed to increase use of on-site corporate fitness centers.

Behavioral observation is the systematic recording of behavior by an external observer. The systematic nature of behavioral observation is characterized by carefully detailed procedures that are designed to collect reliable and valid data on client behavior and the factors that control it (Barrios, 1993; Tryon, 1998). For example, nursing staff in a hospital setting might record the number of times that a patient yells or acts aggressively so that the effects of a behavioral management program can be evaluated. Similarly, a clinician may request that the parents of a child with enuresis record the time, date, and location of incontinent occurrences so that the timing of prompts and bathroom trips can more effectively be arranged in an intervention. Finally, observers may be stationed in a classroom to record the extent to which a child with behavioral problems exhibits on-task and off-task behaviors.

An important goal of psychological assessment is to increase the validity of clinical judgments. Judgments about a client’s behavior problems, factors that contribute to those problems, and the best strategies of intervention with a client should be more valid when based on accurate information from psychological assessment.

Behavioral assessment is one of many psychological assessment paradigms. It is composed of a diverse set of assumptions about behavior and its causes and assumptions about the best strategies for understanding persons with behavior problems, planning interventions, and evaluating the effects of those interventions.

In this chapter we discuss the current status, applicability, and utility of behavioral assessment. We examine the status of the paradigm through several indices: (a) the use of behavioral assessment methods in published treatment outcome studies, (b) circulation of behavioral and nonbehavioral journals, (c) membership in professional organizations, (d) the status of behavioral assessment in graduate training programs, and (e) the use of behavioral assessment methods in clinical practice. In the second section of the chapter we discuss the applicability and utility of behavioral assessment.

Research findings have suggested that social support decreases cardiovascular reactivity and reduces the incidence of cardiovascular disease. The authors describe 2 studies evaluating the association between social support and cardiovascular reactivity to a stressor. In both studies, it was predicted that the presence of a supportive person would exert a buffering effect on cardiovascular reactivity. In Study 1, 68 participants were randomly assigned to 1 of 3 conditions: alone, supportive, and nonsupportive. In Study 2, 60 participants were randomly assigned to 1 of 3 conditions: highly supportive, supportive, and nonsupportive. In both studies, a speech was the stressor. Results in both studies showed no significant differences in cardiovascular reactivity between supportive and nonsupportive conditions. The results failed to support the reactivity buffering effects of social support. Findings are explained in terms of evaluation apprehension theory, familiarity of support provider, and level of social support.

Although the Type A behavior pattern has been the subject of extensive research, surprisingly little information is available about the preventive health behavior of this population. Measures of perceived susceptibility, preventive health behavior, current stress, and risk for cardiovascular disease were obtained from 37 Type A and 37 Type B college students. Results indicated that the Type A students generated susceptibility judgments that covaried significantly with perceived stress. Susceptibility judgments for the Type B group, however, covaried significantly with nonbehavioral cardiovascular risk-factor status. Correlations between perceived susceptibility and preventive health behavior also differed between the two groups. For the Type A group, increments in perceived susceptibility were associated with decrements in preventive behavior. For the Type B group, however, increments in perceived susceptibility were associated with increments in preventive behavior. Between-group comparisons of preventive health behavior indicated that Type A participants were less likely to use relaxation and avoidance of overwork but were more likely than those who were Type B to regulate their diets.