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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.

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants’ acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.

Judgments about a client's behavior problems and treatment goals, and the factors that influence them, are elements of most clinical case formulations (CCFs). These judgments are designed to guide clinicians' selection of the most effective intervention foci. Despite their importance, CCFs have undergone infrequent psychometric evaluations. We describe a model to promote and facilitate the psychometric evaluation of CCFs with quantified causal diagrams. This article presents the conceptual foundations, path analyses, benefits, and limitations of quantified causal diagrams. We first present concepts of causality and causal diagrams that are applicable to CCF and psychopathology. We propose that clinical case formulations causal diagrams can strengthen a science-based approach to clinical assessment, facilitate the psychometric evaluation of CCFs, enhance the specificity, precision, and communicability of clinicians' judgments, help the clinician select the most effective intervention foci, predict the effects of changes in causal variables, and emphasize the importance of "uncertainty" in CCFs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Functional Analytic Psychotherapy (FAP) is a contextual behavioral therapy that targets specific ideographic behaviors related to interpersonal functioning and intimacy. There is a scarcity of measures specifically focused on behavioral measurement of intimacy as well as limited studies that examine intimacy in obsessive-compulsive and related disorders (OCRDs). Leonard and colleagues (2014) created the Functional Analytic Psychotherapy Intimacy Scale (FAPIS). The purpose of this study was to investigate the validity of the FAPIS in evaluating those with OCRDs. The FAPIS and other measures of intimacy were administered to 549 nonreferred adults endorsing OCRD symptoms. Several confirmatory factor analyses were conducted to assess the best fitting factor structure, and convergent validity and divergent validity were also assessed. Given the psychometric properties of the FAPIS in this sample, future research may be helpful in assessing if the FAPIS would be beneficial in measuring change related to intimacy when working with people with OCRDs.

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.

The present meta-analysis aims to extend Doris and colleagues' (2015) systematic review and address the comprehensive, quantitative gap in the relation between acculturative stress and eating disorder psychopathology reported by studies in the past 20 years. A total of 14 eligible studies were included in our meta-analysis. Across all study samples, there were 2681 participants. The overall relation between eating disorder psychopathology and acculturative stress measurements was examined. Moderation analyses were run to investigate the substantial heterogeneity detected between studies. Results indicated a small effect size for the relationship between eating pathology behaviors and acculturative stress. These results provide insight for clinicians working with individuals who are experiencing acculturative stress, as well as highlight future research directions.

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.

Objectives: Nurses and nurse aides experience high rates of physical injury, assault, and abuse compared to other occupations. They also frequently have intersectional identities with other groups that experience higher rates of mental and physical health challenges and problems. In addition to belonging to these multiple vulnerable populations, nurses and nurse aides experience high levels of work stress and burnout. These variables are risk factors for injuries associated with lifting and transferring, as well as assault from residents. Given the focus on present moment awareness, commitment to values, and responding flexibly in difficult situations, Acceptance and Commitment Therapy (ACT) may be an effective approach for this population. Design: Participants were randomly assigned to either the ACT group condition or a wait-list control condition. Participants completed baseline and one-month follow-up outcome measures. Setting/Location: The interventions were provided at participant work sites (nursing homes and assisted living facilities) that were located in multiple locations across Northern Ohio. Subjects: Seventy-one nurses and nurse aides participated in the study. Of these, 37 were randomly assigned to the ACT group intervention and 34 were assigned to the wait-list control group. Intervention: A two-session group-based ACT intervention. Each session was 2.5 hours long and spaced one-week apart. The intervention topics included acceptance, mindfulness, psychological flexibility, willingness to experience discomfort, present-moment focus, self-as-context, values identification, and values-congruent committed action. Outcome measures: Days missed due to injury, frequency of work-based injuries, musculoskeletal complaints, mental health symptoms, and overall satisfaction with the intervention. Results: Participants in the ACT group reported significantly fewer days missed due to injury and a significant reduction in mental health symptoms compared to the control group. Participants in the ACT group rated the intervention very favorably. Conclusion: A group-based ACT intervention can promote improvements in well-being for nurses and nurse aides working in long-term care settings. Further research in this area would benefit from conducting group-based ACT interventions at different organizational levels.

The COVID-19 pandemic has prompted a growing recommendation for social distancing and using personal protective equipment (PPE) to help mitigate the virus transmission. Previous studies have shown promising relationships between perceived susceptibility to COVID-19, mindfulness-related variables, and COVID-19 health protective behaviors (social distancing and PPE use). In this longitudinal study, the variables were measured across a two-month interval during the earlier phase of the pandemic in June (Time 1) and August (Time 2), 2020. The results from 151 matched USA MTurk participants indicated that the perceived susceptibility to COVID-19 did not significantly predict the health protective behaviors. For mindfulness, nonreactivity was positively related to PPE use while nonjudgement was negatively related to PPE use. Accordingly, mindfulness promotion messages could be a way to increase the likelihood of people performing health protective behaviors to better constrain the COVID-19 outbreak.

The COVID-19 pandemic created a complex psychological environment for persons in America. A total of 450 USA MTurk workers completed measures of: (a) basic demographic characteristics; (b) health risk factors for COVID-19; (c) perceived susceptibility variables related to COVID-19; (d) COVID-19 preventive health behaviors; and (e) distress, physical symptoms, and quality of life measures. The surveys were completed between April 9, 2020 and April 18, 2020. This recruitment period corresponded to the first 2-3 weeks of lockdown in most of the USA. Follow-up surveys were completed by 151 of the USA participants between June 19, 2020 and July 11, 2020 (approximately 2 months after the first measurement). These data permit evaluation of relationships among demographic variables, COVID-19 stress and coping, COVID-19 preventive health behavior, and the role of mindfulness as a possible moderator of distress as well as a predictor of preventive health behavior. The availability of follow-up data permit longitudinal analyses that provide a stronger basis for causal inference.

The COVID-19 pandemic combined with inconsistent governmental and public health recommendations, media communications emphasizing threat, and widespread lockdowns created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of (a) risk for COVID-19, (b) perceived vulnerability to disease, (c) intolerance of uncertainty, (d) mindfulness, (e) COVID-19 preventive health behaviors, (f) post-Trauma symptoms, and (g) stress related 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 substantial number of participants reported a reduction employment status and 69% were in self-isolation. The participants reported a high degree of perceived vulnerability with 68% indicating they felt there was a 50/50 chance or greater they would contract COVID-19. 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. The mean level of physical symptoms was significantly (p < .001) and substantially higher (d = 1.46) than norms.PPE use was positively associated with level of education and mindfulness nonreactivity and negatively associated with age, having a current medical condition, and mindfulness nonjudgment. Post trauma and physical health symptoms were strongly predicted by susceptibility variables and intolerance of uncertainty.HighlightsCOVID-19 created a complex psychological environment for Americans due to threat exposure combined with contradictory communications from government and media.In a survey of 450 Americans, 68% reported that there was a 50/50 chance of greater they would contract COVID-19 and 70% of participants reported symptoms that met criteria for PTSD.Mask wearing was variable with only 26% reporting use “most of the time.”Participants who reported: older age, having one or mode medical conditions, less educational attainment, and less judgmental attitudes about their own thinking reported lower PPE use.Intolerance of uncertainty and perceived susceptibility were associated with higher PTSD symptoms.Mindfulness awareness and being judgmental attitudes about thinking were associated with lower PTSD symptoms.

Nursing aides working in long-term care settings experience high rates of injury, musculoskeletal symptoms, and exposure to resident aggression. Some of these injuries and exposure to aggression may be related to trait mindfulness. The aim of this study was to examine the relationships between trait mindfulness, job training, injury, sources of injury, and musculoskeletal symptoms among nursing aides working in long-term care residential settings. Nursing aides working in long-term care settings across Ohio, USA (n = 152) were recruited for the study. Measures of sociodemographic characteristics, job tenure, job training, mindfulness, work injuries, sources of injuries, and musculoskeletal symptoms were obtained. Correlational analyses demonstrated that higher levels of mindfulness and training were associated with lower levels of injury and musculoskeletal symptoms. They were also significantly inversely associated with the following injury sources: lifting/repositioning resident, bumping/hitting equipment, and resident aggression. Results of hierarchical linear regressions indicated that mindfulness was a significant and unique predictor of injuries, exposure to the most common sources of injury, and musculoskeletal symptoms. Specifically, nursing aides with higher levels of mindfulness were less likely to report experiencing injuries, exposure to the most common sources of injury, and musculoskeletal symptoms. Given that mindfulness can be trained and modified, adding mindfulness training to nursing aide educational programs could potentially help reduce risk for injury among this vulnerable population of workers. Further research exploring the potential benefit of mindfulness training could address this possibility.

Abstract. Work characteristics such as job satisfaction have been associated with mental and physical health outcomes in several cross-sectional and longitudinal studies. However, meta-analytic reviews indicate that nearly all of the reported relationships between these two sets of constructs rely on self-report measures. Thus, the magnitude of the reported relationships may be inaccurate and inflated due to common method variance (mono-method bias) and negative affectivity. Respiratory sinus arrhythmia (RSA) is an objective measure of risk for adverse mental health and physical health outcomes. To our knowledge, there has been no investigation of the relationship between job satisfaction and respiratory sinus arrhythmia. In this investigation, 29 workers in mental health settings who experience higher than average levels of work stress due to the amount and unpredictability of workload completed sociodemographic measures and a job satisfaction measure. RSA was then collected during a resting baseline, a worry induction stressor condition where they were instructed to think about work stressors, and a post-stress recovery condition. RSA reactivity to the stressor was significantly greater for participants with low job satisfaction. The low job satisfaction participants also demonstrated less RSA recovery after the stressor ended. Alternatively, participants with higher job satisfaction reacted less and recovered more completely from the stressor.

Research links perfectionism, the tendency to hold and pursue unrealistically high standards, to negative mental health outcomes such as eating disorders, anxiety, and depression. Previous research used high frequency heart rate variability (HF-HRV) to measure recovery from stress during a mindfulness meditation in perfectionistic university students and found that only nonperfectionists demonstrated HF-HRV recovery from stress, suggesting that mindfulness was not effective for perfectionists. However, the mindfulness meditation did not incorporate a nonjudgment element, which may be a key component for perfectionists. In the current study, we examined whether mindfulness with a focus on nonjudgment helps university student perfectionists (n = 120) recover from failure (measured by heart rate (HR), HF-HRV, pNN50). Students were randomly assigned to one of four meditation groups: nonjudgment mindfulness, general mindfulness (i.e., attentional awareness without a nonjudgment component), progressive muscle relaxation, and nothing. Cardiac data were recorded during a 5-min baseline, failure task, and 10-min meditation session. HR results suggest that both mindfulness conditions and "nothing" encouraged cardiovascular recovery, but that the mindfulness conditions showed even further recovery during the last five minutes of the meditations. HF-HRV results indicated that participants in the nonjudgment mindfulness condition had marginally higher HF-HRV during the last five minutes of the meditation than at baseline, while participants in the other conditions did not. Therefore, mindfulness with a focus on nonjudgment of emotions may be especially important to help perfectionists improve HF-HRV after failure.

Objectives Research suggests Animal Assisted Interventions (AAI) reduce negative outcomes in medical settings, but quantitative examinations of their effects on medical outcomes such as pain, anxiety, and distress are lacking. Design A comprehensive literature search and meta-analysis were conducted in which 22 studies (13 child, 9 adult) met inclusion criteria. Both intervention versus control and intervention pre-post effect sizes were computed using a random effects model. Results The overall intervention versus control effect size was large and significant (d = 1.65, 95% CI = 0.46–2.832). Similarly, the pre-post effect size was large and significant (d = 2.19, 95% CI = 0.74–3.64). Conclusions The results of this meta-analysis indicate that AAI can yield large effects across a number of medically relevant outcomes. There is, however, substantial methodological variation across studies and more randomized clinical trials with stronger methodological controls are needed to establish the effectiveness of AAI compared to other interventions.

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.

Acceptance and Commitment Therapy (ACT) is a third-wave behavioral therapy that is an empirically supported treatment for various mental health concerns. ACT has been found to be efficacious for treating different types of anxiety disorders. This case study presents the conceptualization (functional analysis), treatment (ACT), and treatment outcomes of a client who presented with emetophobia, a phobia of vomiting, complicated by a metabolic disorder. Measures of emetophobia symptoms, mindfulness, cognitive fusion, thought control strategies, and believability of anxious thoughts and feelings, were collected at pretreatment, posttreatment, 6-month follow-up, and 12-month follow-up. The Reliable Change Index was used to evaluate changes across time. Large and clinically significant decreases on all measures were observed at posttreatment. At 12-month follow-up, improvements were maintained on all measures except the Reappraisal subscale of the Thought Control scale. The implications of this study are discussed, and recommendations are made for clinicians using ACT for the treatment of emetophobia.

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.

The present study examined the different types of stressors experienced by adults of different ages, their coping strategies, and positive/negative affect. A mediation hypothesis of coping strategies was tested on the relationships between age and positive/negative affect. One-hundred and ninety-six community-dwelling adults (age range 18–89 years) reported the most stressful situation they experienced in the past month and coping strategies. Levels of positive and negative affect in the past month were also measured. Content analysis revealed age differences in different types of stressors adults reported. Three types of coping strategies were found: problem-focused, positive emotion-focused, and negative emotion-focused coping. Older adults were less likely than younger adults to use problem-focused coping and reported lower levels of positive affect. Path analysis supported the mediation hypothesis, showing that problem-focused coping mediated the relationship between age and positive affect. Implications are discussed on the importance of promoting problem-focused coping among older adults.

Trait mindfulness has been associated with well-being. A key component of trait mindfulness is intentional attention and awareness which is most commonly measured by the Mindful Attention and Awareness Scale (MAAS). This study investigated the relationship between the MAAS and cardiovascular (HF-HRV, heart rate) reactivity to two laboratory stressors that evoked different patterns of change in heart rate (HR). One stressor (viewing a video of a surgery) evoked HR deceleration while the other stressor (mental arithmetic) evoked HR acceleration. Undergraduate students completed the MAAS and were then exposed to the two stressors while ECG (electrocardiography) was recorded. Findings support the reliability of the stressors to induce expected differential cardiovascular responses and explicate the role of parasympathetic activation. Further, a main effect for MAAS was observed indicating that across laboratory conditions, persons scoring higher on the MAAS had lower HF-HRV relative to persons scoring lower on the MAAS. These findings suggest that higher levels of intentional attention and awareness in a laboratory context might promote parasympathetic withdrawal because these participants were more vigilant, experienced higher cognitive load, and detected more threat cues. Implications for the MAAS and cardiovascular responses to stress are discussed.

Research has demonstrated mixed results regarding the direction of the association between vagal activation and disordered eating. The current meta-analysis examined studies testing the link between resting-state heart rate variability indices of vagal activation (vmHRV), and both clinical and subthreshold disordered eating.A systematic search of the literature resulted in the inclusion of studies that were correlational (associations between HRV and disordered eating symptoms) and that examined group differences (e.g., control group vs. disordered eating group), for a total of 36 samples.Findings indicated a small but reliable association of vmHRV with disordered eating, r = 0.12, indicating greater vagal activation in individuals with disordered eating compared to those with little or no disordered eating behavior. Moderation analyses identified predictors of the vmHRV/disordered eating association. Bulimia nervosa was found to have a large, positive effect size with vmHRV, r = 0.60, which was significantly greater than all other types of disordered eating, QThese insights contribute to an improved understanding of the pathophysiology in disordered eating.La investigación ha demostrado resultados mixtos sobre la dirección de la asociación entre la activación vagal y la conducta alimentaria anormal. El presente metaanálisis examinó los estudios que prueban la relación entre los índices de variabilidad de activación vagal de la frecuencia cardíaca en estado de reposo (vmHRV) y la conducta alimentaria anormal tanto clínica como subclínica. MÉTODO: Una búsqueda sistemática de la literatura resultó en la inclusión de estudios que eran correlacionales (asociaciones entre HRV y síntomas de conductas alimentarias anormales) y que examinaron las diferencias grupales (por ejemplo, grupo control versus grupo de conductas alimentarias anormales), para un total de 36 muestras.Los resultados indican una asociación pequeña pero confiable de vmHRV con conductas alimentarias anormales, r = 0,12, lo que indica una mayor activación vagal en individuos con conductas alimentarias anormales en comparación con aquellos con poca o ninguna conducta alimentaria anormal. Los análisis de moderación identificaron predictores de la asociación vmHRV/conducta alimentaria anormal. Se encontró que la bulimia nervosa (BN) tenía un tamaño de efecto positivo, grande con vmHRV, r = 0.60, que era significativamente mayor que todos los otros tipos de conductas alimentarias anormales, QT = 10.74, p = .047. En comparación con las conductas alimentarias anormales subclínicas, los trastornos de la conducta alimentaria clínicos demostraron una activación vagal aumentada significativa y persistente con un tamaño de efecto medio y confiable, r = 25, QT = 3.94, p = .045. CONCLUSIÓN: Estas ideas contribuyen a una mejor comprensión de la fisiopatología en las conductas alimentarias anormales.

Nursing home settings contain unique environmental factors that may promote the acquisition and maintenance of problematic interpersonal behaviors. Functional Analytic Psychotherapy (FAP) is a contextually-based behavior therapy that can be used to modify problematic interpersonal behaviors via carefully provided and contingent in-session responses of the therapist to client behaviors. Thus, FAP would appear to be a particularly well-suited intervention approach for nursing home residents. To date, the effects of FAP have not been reported for nursing home residents. The current single case study assessed the effects of FAP on three nursing home residents using a single-subject AB design. The AB design consisted of a 2-weeks baseline phase followed by a 4-week FAP treatment phase. The nursing home residents completed pre-treatment and post-treatment measures of interpersonal relating. Client interpersonal behaviors were also recorded during each session and coded into two categories: Maladaptive in-session behaviors and adaptive in-session behaviors. Using the reliable change index and Swanson’s dsw to evaluate questionnaire outcomes, results indicated that all three participants reported a significant change in interpersonal functioning. Analysis of in-session behavior indicated that there were significant decreases in maladaptive behaviors and an increase in adaptive behaviors for two clients. Finally, observed in-session behavior changes were congruent with self-reported changes in interpersonal behavior. These results indicate that FAP was an effective intervention for these nursing home residents.

The goals of this chapter are to describe and advocate for psychological assessment strategies that: (1) use the best available evidence-based measurement and clinical judgment strategies; (2) reflect the context dependent, conditional, and multimodal nature of behavior; (3) attend to the functional relations associated with behavior change; (4) are sensitive to diversity and individual differences among clients; (5) capture to the dynamic nature of behavior and functional relations; and (6) promote direct and minimally inferential approaches to measurement. We emphasize the conceptual foundations of behavioral assessment and their influence on behavioral assessment strategies and methods, particularly the dynamic, conditional, multimodal, and idiographic aspects of behavioral problems, goals, and causal relations. We also highlight the utility of integrating a functional analysis approach to assessment and clinical case formulations. We conclude the chapter with a set of recommendations for conducting psychological assessment in clinical contexts.

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.

Individuals who are HIV-positive may experience various types of stressors. Research shows that negative appraisals and avoidance coping in response to stress are associated with less adaptive functioning. As an alternative, acceptance may be related to better well-being. Several investigators have shown that acceptance is associated with healthier outcomes for various medical populations. However, acceptance has not been empirically examined within HIV-positive individuals. The aim of the present study was to evaluate the relationships among acceptance, avoidance coping, and multiple aspects of psychological functioning in military veterans receiving HIV-related care at a veterans affairs (VA) healthcare system. Seventy-six military veterans who were HIV-positive and receiving care at a local VA healthcare system completed a battery of questionnaires assessing the variables of interest. Results indicated that acceptance was related to better mental health variables. To continue this line of research, fut...

According to Cognitive Interference Theory, evaluation anxiety leads to increased negative off-task self-dialogue which then results in diminished cognitive performance. Given that negative off-task self-dialogue is primarily verbal, the phonological loop and central executive components of the working memory system should be most affected by evaluation anxiety. Eighty-eight participants were randomly assigned to receive evaluation anxiety inducing instructions or supportive instructions prior to administration of three tests (Digit Span, Visual Memory Span, and StroopColour-Word) that measured the phonological loop, visuospatial sketchpad, and central executive components of working memory. Measures of evaluation anxiety and negative off-task self-dialogue were obtained during and after testing. Results showed that participants receiving anxiety inducing instructions reported significantly more evaluation anxiety and off-task self-dialogue. They also had significantly lower performance on the Digit Span Test and the StroopColour-Word Test. Negative off-task self-dialogue also mediated the relationship between evaluation anxiety and performance on the Digit Span Test. Copyright © 2011 John Wiley & Sons, Ltd.

Acceptance and chronic pain is an emerging topic both for research and intervention. Initial studies have demonstrated that acceptance is correlated with higher quality of daily emotional, social, and physical functioning in chronic pain populations. The purpose of the present study was to clarify the nature of the relationship between acceptance, appraisals that are relevant to chronic pain (i.e., control and catastrophizing), and coping among migraine headache sufferers. Seventy four participants with migraine headaches completed self report measures assessing appraisal, coping strategies, acceptance, and pain related disability. Sixty three participants also completed a 28-day daily dairy assessing headache activity, catastrophizing, control, acceptance, and coping strategies. Hierarchical regression and multilevel modeling were used to examine the relations between these variables. Results indicated that higher levels of pain-related acceptance were associated with lower levels of catastrophizing and pain-related interference, and increased perceived control. Participants who endorsed higher levels of pain-related acceptance also reported engaging in a higher level of activity and indicated they used fewer coping strategies on a daily basis. Acceptance continues to show promise as a way of viewing pain that lessens the detrimental impact of certain types of thoughts (i.e., catastrophizing), and leads to increased participation in daily life.

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.

Abstract. Although band and spot electrodes have been compared in prior research, they have not been evaluated (a) at identical anatomical locations, (b) during a single laboratory session, (c) with measures taken in close temporal proximity, (d) using a single impedance cardiograph unit, or (e) using sufficiently powerful statistical tests. Thirty-one healthy young adults completed a psychophysiological assessment which consisted of baseline, mental arithmetic stressor, and recovery conditions. Data from spot and band electrodes were collected by alternating between electrode types every minute of the experiment. Correlations between spot and band electrodes at absolute levels of all cardiovascular measures (cardiac output, impedance derivative, basal impedance level, Heather index, heart rate, left ventricular ejection time, pre-ejection period, stroke volume) were of high magnitude (ravg = .78), while the correlations for difference scores were lower (ravg = .50). Analyses of mean levels indicated spot electrodes yielded significantly lower values for the impedance derivative, Heather index, and basal impedance, and higher values for cardiac output and stroke volume, than band electrodes. The advantages and disadvantages associated with spot and band electrode configurations, as well as their use in ambulatory recording, are discussed.

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...

Objective Heart failure (HF) markedly diminishes an individual's quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis. Methods Fifty-eight HF patients completed daily diaries that evaluated mood, social support, coping, and physical symptoms for 2 weeks. Results After being prewhitened for serial dependencies, the data were entered into regression analyses to determine the concurrent and lagged relationships among them. Significant concurrent relationships were obtained between physical symptoms and depression, social conflict, positive and negative mood, and symptom-focused coping. Furthermore, negative mood and distraction coping predicted greater physical symptoms the next day, while action/acceptance coping predicted fewer physical symptoms the next day. Conclusion Our data provide evidence for an association between daily psychosocial functioning and HF physical symptoms. Implications for research and clinical work with HF patients are discussed.

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.

The pathogenic processes responsible for cardiovascular disease have their origins in childhood. Although children’s measures of heart rate and blood pressure have been found to be reliable, the reliability of impedance cardiography derived measures have not been evaluated. Thirty-three children, ages 8‐11 participated in two sessions. Stressors included serial subtraction, isometric handgrip, and mirror-image tracing. Results indicated the impedance measures showed moderately high temporal stability ~average scores ravg 5 .74; difference scores ravg 5 .53! and intertask consistency ~average scores ravg 5 .78; difference scores ravg 5 .53!. Blood pressure demonstrated the lowest reliability; Heather index, preejection period, and stroke volume demonstrated the highest. These findings suggest children’s cardiovascular reactivity to laboratory stressors can be reliably and consistently assessed using impedance cardiography.

The words managed care , regardless of whether preceded by a descriptive adjective, seem to have sufficient power to send many seasoned behavioral health clinicians running for the greener pastures of cash-only, pay-as-you-go service settings. For some clinicians, this exodus has served them and their patients quite well, particularly patients with financial means and with mental health issues that are treatable with standard and time-limited forms of outpatient interventions. Individuals with more severe mental illness and those who may have limited means, however, probably do less well in the cash-only, nonmanaged care environment. When the cost for ongoing care goes up, the clinician invariably needs to tap the managed care, insurance revenue stream to support the patient's expanded treatment needs. If a physician or clinician chooses not to understand and be part of managed care networks, they could severely decrease their ability to advocate for their patients in any arena apart from within their own offices. This article is designed to give a fundamental overview of managed care with hope of demystifying and maybe even devillianizing the concept of managed care if not the practice of managed care. What are simple ways to understand managed care, and how and why should you practice in it? Many psychiatrists view managed care as an obvious plot designed to create insult and injury. The insult is the amount of paperwork and seemingly unnecessary clinical oversight required in treating a patient within a behavioral health managed care organization (BHMCO). The injury is the potential constraint on practice and the limitations on the care that a patient may be able to receive. Many clinicians believe that the act of bringing the BHMCO into the patient–doctor relationship is a clear violation of that relationship, which increases the potential for negative treatment outcomes.

Objective.—The purpose of this study was to investigate how migrainous subjects and controls differ in their cardiovascular reactivity and recovery to a cognitive and an acute pain laboratory stressor. Background.—Prior research suggests that individuals subject to migraine may respond physiologically to pain and stress differently than controls. Methods.—Fifty-two women (26 with migraine and 26 controls) participated in a single laboratory session. Multiple cardiovascular responses to a cognitive (mental arithmetic) and an acute pain (cold pressor task) stressor were recorded with cardiac impedance methods. The cardiovascular responses measured included systolic and diastolic blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance. Results.—Results indicated that the migrainous participants displayed different cardiovascular recovery patterns for total peripheral resistance, cardiac output, and stroke volume following the termination of the mental arithmetic task. Conclusions.—These results support the hypothesis that individuals with migraine respond physiologically to stress differently than control individuals.

Objective: The authors evaluated relationships among group process and treatment outcomes in a stress management intervention. Method: A group-based stress management intervention was provided to a sample of self-referred adults. After each therapy session, group members completed a process measure. Before and after the intervention, group members underwent a psychophysiological assessment of negative moods, daily stress, physical symptoms, and cardiovascular reactivity to stress. Results: Group process was comprised of three dimensions: positive process, satisfaction, and negative process. Ratings of positive process and satisfaction significantly increased across sessions. In addition, satisfaction ratings were inversely correlated with cardiovascular reactivity, whereas negative process ratings were positively correlated with cardiovascular reactivity. Conclusion: The finding of increasing positive process and satisfaction may be related to the structure of the intervention, which allowed for more frequent and diverse interaction during later sessions. Correlations between negative process and cardiovascular reactivity may reflect the influence of hostile traits.