Unraveling the complexity of cardiac distress : a study of prevalence and severity
- Jackson, Alun, Rogerson, Michelle, Amerena, John, Smith, Julian, Hoover, Valerie, Alvarenga, Marlies, Higgins, Rosemary, Grande, Michael, Ski, Chantal, Thompson, David, Murphy, Barbara
- Authors: Jackson, Alun , Rogerson, Michelle , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Grande, Michael , Ski, Chantal , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
- Full Text:
- Reviewed:
- Description: Introduction: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. Method: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. Results: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. Conclusion and Implications: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery. Copyright © 2022 Jackson, Rogerson, Amerena, Smith, Hoover, Alvarenga, Higgins, Grande, Ski, Thompson and Murphy.
- Authors: Jackson, Alun , Rogerson, Michelle , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Grande, Michael , Ski, Chantal , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 13, no. (2022), p.
- Full Text:
- Reviewed:
- Description: Introduction: While much research attention has been paid to anxiety and depression in people who have had a recent cardiac event, relatively little has focused on the broader concept of cardiac distress. Cardiac distress is a multidimensional construct that incorporates but extends beyond common mood disorders such as anxiety and depression. In the present study we assessed the prevalence, severity and predictors of a broad range of physical, affective, cognitive, behavioral and social symptoms of cardiac distress. This is the first study to investigate cardiac distress in this comprehensive way. Method: A sample of 194 patients was recruited from two hospitals in Australia. Eligible participants were those who had recently been hospitalized for an acute cardiac event. Data were collected at patients' outpatient clinic appointment ~8 weeks after their hospital discharge. Using a questionnaire developed through a protocol-driven 3-step process, participants reported on whether they had experienced each of 74 issues and concerns in the past 4 weeks, and the associated level of distress. They also provided sociodemographic and medical information. Regression analyses were used to identify risk factors for elevated distress. Results: Across the 74 issues and concerns, prevalence ratings ranged from a high of 66% to a low of 6%. The most commonly endorsed items were within the domains of dealing with symptoms, fear of the future, negative affect, and social isolation. Common experiences were “being physically restricted” (66%), “lacking energy” (60%), “being short of breath” (60%), “thinking I will never be the same again” (57%), and “not sleeping well” (51%). While less prevalent, “not having access to the health care I need,” “being concerned about my capacity for sexual activity,” and “being unsupported by family and friends” were reported as highly distressing (74, 64, and 62%) for those experiencing these issues. Having a mental health history and current financial strain were key risk factors for elevated distress. Conclusion and Implications: Specific experiences of distress appear to be highly prevalent in people who have had a recent cardiac event. Understanding these specific fears, worries and stressors has important implications for the identification and management of post-event mental health and, in turn, for supporting patients in their post-event cardiac recovery. Copyright © 2022 Jackson, Rogerson, Amerena, Smith, Hoover, Alvarenga, Higgins, Grande, Ski, Thompson and Murphy.
Type D personality, stress, coping and performance on a novel sport task
- Borkoles, Erika, Kaiseler, Mariana, Evans, Andrew, Ski, Chantal, Thompson, David, Polman, Remco
- Authors: Borkoles, Erika , Kaiseler, Mariana , Evans, Andrew , Ski, Chantal , Thompson, David , Polman, Remco
- Date: 2018
- Type: Text , Journal article
- Relation: PLoS One Vol. 13, no. 4 (2018), p. e0196692-e0196692
- Full Text:
- Reviewed:
- Description: We investigated (1) the relationship between Type D personality, stress intensity appraisal of a self-selected stressor, coping, and perceived coping effectiveness and (2) the relationship between Type D personality and performance. In study one, 482 athletes completed the Type D personality questionnaire (DS14), stress thermometer and MCOPE in relation to a recently experienced sport stressor. Type D was associated with increased levels of perceived stress and selection of coping strategies (more emotion and avoidance coping) as well as perceptions of their effectiveness. In study two, 32 participants completed a rugby league circuit task and were assessed on pre-performance anxiety, post-performance affect and coping. Type D was associated with poorer performance (reduced distance more errors), decreases in pre-performance self-confidence and more use of maladaptive resignation/withdrawal coping. Findings suggest that Type D is associated with maladaptive coping and reduced performance. Type D individuals would benefit from interventions related to mood modification or enhancing interpersonal functioning.
- Authors: Borkoles, Erika , Kaiseler, Mariana , Evans, Andrew , Ski, Chantal , Thompson, David , Polman, Remco
- Date: 2018
- Type: Text , Journal article
- Relation: PLoS One Vol. 13, no. 4 (2018), p. e0196692-e0196692
- Full Text:
- Reviewed:
- Description: We investigated (1) the relationship between Type D personality, stress intensity appraisal of a self-selected stressor, coping, and perceived coping effectiveness and (2) the relationship between Type D personality and performance. In study one, 482 athletes completed the Type D personality questionnaire (DS14), stress thermometer and MCOPE in relation to a recently experienced sport stressor. Type D was associated with increased levels of perceived stress and selection of coping strategies (more emotion and avoidance coping) as well as perceptions of their effectiveness. In study two, 32 participants completed a rugby league circuit task and were assessed on pre-performance anxiety, post-performance affect and coping. Type D was associated with poorer performance (reduced distance more errors), decreases in pre-performance self-confidence and more use of maladaptive resignation/withdrawal coping. Findings suggest that Type D is associated with maladaptive coping and reduced performance. Type D individuals would benefit from interventions related to mood modification or enhancing interpersonal functioning.
Therapist-Assisted, Internet-Based Treatment for Panic Disorder: Can General Practitioners achieve comparable patient outcomes to Psychologists?
- Shandley, Kerrie, Austin, David, Klein, Britt, Pier, Ciaran, Schattner, Peter, Pierce, David, Wade, Victoria
- Authors: Shandley, Kerrie , Austin, David , Klein, Britt , Pier, Ciaran , Schattner, Peter , Pierce, David , Wade, Victoria
- Date: 2008
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 10, no. 2 (2008), p. 1-15
- Full Text:
- Reviewed:
- Description: Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F1,82 = 9.13, P = .00) and environmental (F1,82 = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (χ 2 1 = 4.40, P = .02, N = 96). Conclusions: This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.
- Description: Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F1,82 = 9.13, P = .00) and environmental (F1,82 = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (
- Authors: Shandley, Kerrie , Austin, David , Klein, Britt , Pier, Ciaran , Schattner, Peter , Pierce, David , Wade, Victoria
- Date: 2008
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 10, no. 2 (2008), p. 1-15
- Full Text:
- Reviewed:
- Description: Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F1,82 = 9.13, P = .00) and environmental (F1,82 = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (χ 2 1 = 4.40, P = .02, N = 96). Conclusions: This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.
- Description: Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F1,82 = 9.13, P = .00) and environmental (F1,82 = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (
The longitudinal association between anxiety and Internet addiction in adolescence : The moderating effect of classroom extraversion
- Stavropoulos, Vasileios, Gomez, Rapson, Steen, Eloisa, Beard, Charlotte, Liew, Lucas, Griffiths, Mark
- Authors: Stavropoulos, Vasileios , Gomez, Rapson , Steen, Eloisa , Beard, Charlotte , Liew, Lucas , Griffiths, Mark
- Date: 2017
- Type: Text , Journal article
- Relation: Journal of Behavioral Addictions Vol. 6, no. 2 (2017), p. 237-247
- Full Text:
- Reviewed:
- Description: Background and aims The risk effect of anxiety on addictive behaviors, including Internet addiction (IA), has repeatedly been highlighted in the international literature. However, there is a lack of longitudinal studies examining this association in relation to proximal context effects, particularly in adolescence. Such findings would shed light on potential age- and proximal context-related variations in the anxiety-IA association that could better inform IA prevention and intervention initiatives. Methods In this study, 648 adolescents, embedded in 34 classrooms, were assessed at the age of 16 and again at the age of 18 to examine the effect of anxiety on IA behaviors in relation to the average level of classroom extraversion. IA was assessed with the Internet Addiction Test (Young, 1998), anxiety with the relevant subscale of the Symptom Checklist 90 - Revised (Derogatis & Savitz, 1999) and classroom extraversion with the synonymous subscale of the Five Factor Questionnaire (Asendorpf & van Aken, 2003). A three-level hierarchical linear model was calculated. Results The present findings demonstrated that: (a) higher levels of anxiety were significantly associated with higher IA behaviors, (b) the strength of this association did not vary over time (between 16 and 18 years old), and (c) however, it tended to weaken within classrooms higher in extraversion. Discussion This study indicated that the contribution of individual IA risk factors might differently unfold within different contexts.
- Authors: Stavropoulos, Vasileios , Gomez, Rapson , Steen, Eloisa , Beard, Charlotte , Liew, Lucas , Griffiths, Mark
- Date: 2017
- Type: Text , Journal article
- Relation: Journal of Behavioral Addictions Vol. 6, no. 2 (2017), p. 237-247
- Full Text:
- Reviewed:
- Description: Background and aims The risk effect of anxiety on addictive behaviors, including Internet addiction (IA), has repeatedly been highlighted in the international literature. However, there is a lack of longitudinal studies examining this association in relation to proximal context effects, particularly in adolescence. Such findings would shed light on potential age- and proximal context-related variations in the anxiety-IA association that could better inform IA prevention and intervention initiatives. Methods In this study, 648 adolescents, embedded in 34 classrooms, were assessed at the age of 16 and again at the age of 18 to examine the effect of anxiety on IA behaviors in relation to the average level of classroom extraversion. IA was assessed with the Internet Addiction Test (Young, 1998), anxiety with the relevant subscale of the Symptom Checklist 90 - Revised (Derogatis & Savitz, 1999) and classroom extraversion with the synonymous subscale of the Five Factor Questionnaire (Asendorpf & van Aken, 2003). A three-level hierarchical linear model was calculated. Results The present findings demonstrated that: (a) higher levels of anxiety were significantly associated with higher IA behaviors, (b) the strength of this association did not vary over time (between 16 and 18 years old), and (c) however, it tended to weaken within classrooms higher in extraversion. Discussion This study indicated that the contribution of individual IA risk factors might differently unfold within different contexts.
The diagnostic validity and reliability of an internet-based clinical assessment program for mental disorders
- Nguyen, David, Klein, Britt, Meyer, Denny, Austin, David, Abbott, Jo-Anne
- Authors: Nguyen, David , Klein, Britt , Meyer, Denny , Austin, David , Abbott, Jo-Anne
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 17, no. 9 (2015), p.
- Full Text:
- Reviewed:
- Description: Background: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. Objective: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. Methods: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. Results: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder:kappa=.37) to strong (eg, panic disorder:kappa=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia:kappa=.54) to substantial (eg, bulimia nervosa:kappa=.87). Conclusions: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders.
- Authors: Nguyen, David , Klein, Britt , Meyer, Denny , Austin, David , Abbott, Jo-Anne
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 17, no. 9 (2015), p.
- Full Text:
- Reviewed:
- Description: Background: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. Objective: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. Methods: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. Results: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder:kappa=.37) to strong (eg, panic disorder:kappa=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia:kappa=.54) to substantial (eg, bulimia nervosa:kappa=.87). Conclusions: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders.
The association of avoidance coping style, and perceived mother and father support with anxiety/depression among late adolescents : Applicability of resiliency models
- Gomez, Rapson, McLaren, Suzanne
- Authors: Gomez, Rapson , McLaren, Suzanne
- Date: 2006
- Type: Text , Journal article
- Relation: Personality and Individual Differences Vol. 40, no. 6 (2006), p. 1165-1176
- Full Text:
- Reviewed:
- Description: This study examined the applicability of the compensatory, the risk-protective, the challenge, and the protective-protective models of resiliency for the prediction of anxiety/depression from avoidance coping style (the risk factor) and perceived mother and father support (the protective factors). A total of 331 participants, with age ranging from 18 to 20 years, completed self-rating questionnaires covering perceived mother support, perceived father support, avoidance coping style, and anxiety/depression. Results showed that for perceived mother support as the protective factor, there was support for the compensatory, the risk-protective, and the challenge models. With perceived father support as the protective factor, there was support for the compensatory and challenge models. When both perceived mother and father support were considered together, there was support for the protective-protective model. © 2005 Published by Elsevier Ltd.
- Description: C1
- Description: 2003002027
- Authors: Gomez, Rapson , McLaren, Suzanne
- Date: 2006
- Type: Text , Journal article
- Relation: Personality and Individual Differences Vol. 40, no. 6 (2006), p. 1165-1176
- Full Text:
- Reviewed:
- Description: This study examined the applicability of the compensatory, the risk-protective, the challenge, and the protective-protective models of resiliency for the prediction of anxiety/depression from avoidance coping style (the risk factor) and perceived mother and father support (the protective factors). A total of 331 participants, with age ranging from 18 to 20 years, completed self-rating questionnaires covering perceived mother support, perceived father support, avoidance coping style, and anxiety/depression. Results showed that for perceived mother support as the protective factor, there was support for the compensatory, the risk-protective, and the challenge models. With perceived father support as the protective factor, there was support for the compensatory and challenge models. When both perceived mother and father support were considered together, there was support for the protective-protective model. © 2005 Published by Elsevier Ltd.
- Description: C1
- Description: 2003002027
Research projects reports and professional and ethical issues report
- Authors: Molloy, Mari
- Date: 2004
- Type: Text , Thesis , PhD
- Full Text:
- Description: "The thematic link within each of the individual reports arising from three of these placements is that of anxiety and depression"
- Description: Doctor of Psychology (Clinical)
- Authors: Molloy, Mari
- Date: 2004
- Type: Text , Thesis , PhD
- Full Text:
- Description: "The thematic link within each of the individual reports arising from three of these placements is that of anxiety and depression"
- Description: Doctor of Psychology (Clinical)
Perceived barriers and enablers to physical activity participation in people with alopecia areata : a constructivist grounded theory study
- Rajoo, Yamuna, Wong, J., Raj, I., Kennedy, Gerard
- Authors: Rajoo, Yamuna , Wong, J. , Raj, I. , Kennedy, Gerard
- Date: 2020
- Type: Text , Journal article
- Relation: BMC Psychology Vol. 8, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: Background: Alopecia Areata (AA) is an autoimmune disease that is characterised by hair loss. Individuals diagnosed with it often describe feelings of trauma and social rejection due to cosmetic repercussions and are at high risk of experiencing psychological distress. Physical activity (PA) participation has been associated with better mental health outcomes in diverse populations. A preliminary study of individuals with AA indicated that severe hair loss is associated with symptomatic depression, anxiety and stress, which negatively impacted PA participation. While strategies to increase PA participation in the general population have been established, little is known about PA participation in people with AA. This study aimed to understand barriers and enablers to PA participation in people with AA to inform the development of evidence-based interventions. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, theory development, and data comparisons to explore the perceived barriers and enablers to PA. Data were collected through a focus group (8 participants [33.38 ± 10.81 years]) and individual telephone interviews (8 participants [33.89 ± 11.87 years]). The study was conducted in Melbourne, Australia. Interview data were recorded digitally, transcribed verbatim and analysed. Recruitment continued until theoretical saturation was achieved. Results: The constructivist grounded theory method used has assisted to develop an explanatory model which is used to explain the themes for barriers and enablers to PA participation. The four phases in the explanatory model are as follows (1) onset of AA; (2) reaction towards the condition; (3) adjustment; and (4) acceptance. Conclusion: The findings highlighted perceived barriers and enablers to PA participation in people with AA. Future interventions could consider addressing these barriers specifically to maximise effectiveness and to improve mental health status based on the phases of the explanatory model. © 2020, The Author(s).
- Authors: Rajoo, Yamuna , Wong, J. , Raj, I. , Kennedy, Gerard
- Date: 2020
- Type: Text , Journal article
- Relation: BMC Psychology Vol. 8, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: Background: Alopecia Areata (AA) is an autoimmune disease that is characterised by hair loss. Individuals diagnosed with it often describe feelings of trauma and social rejection due to cosmetic repercussions and are at high risk of experiencing psychological distress. Physical activity (PA) participation has been associated with better mental health outcomes in diverse populations. A preliminary study of individuals with AA indicated that severe hair loss is associated with symptomatic depression, anxiety and stress, which negatively impacted PA participation. While strategies to increase PA participation in the general population have been established, little is known about PA participation in people with AA. This study aimed to understand barriers and enablers to PA participation in people with AA to inform the development of evidence-based interventions. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, theory development, and data comparisons to explore the perceived barriers and enablers to PA. Data were collected through a focus group (8 participants [33.38 ± 10.81 years]) and individual telephone interviews (8 participants [33.89 ± 11.87 years]). The study was conducted in Melbourne, Australia. Interview data were recorded digitally, transcribed verbatim and analysed. Recruitment continued until theoretical saturation was achieved. Results: The constructivist grounded theory method used has assisted to develop an explanatory model which is used to explain the themes for barriers and enablers to PA participation. The four phases in the explanatory model are as follows (1) onset of AA; (2) reaction towards the condition; (3) adjustment; and (4) acceptance. Conclusion: The findings highlighted perceived barriers and enablers to PA participation in people with AA. Future interventions could consider addressing these barriers specifically to maximise effectiveness and to improve mental health status based on the phases of the explanatory model. © 2020, The Author(s).
Investigating cumulative effects of preperformance routine interventions in beach volleyball serving
- Wergin, Vanessa, Beckmann, Jurgen, Gröpel, Peter, Mesagno, Christopher
- Authors: Wergin, Vanessa , Beckmann, Jurgen , Gröpel, Peter , Mesagno, Christopher
- Date: 2020
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 15, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: Pre-performance routines (PPRs) can be used in certain sports to minimize the effects of choking under pressure. This study aimed to investigate the cumulative effectiveness of PPR interventions on the accuracy of beach volleyball serves. Fifty-four beach volleyball players were randomly assigned to one of three PPR intervention groups or a control group. Participants performed 10 serves at a target on the opposite side of the beach volleyball court (pretest), were educated on a PPR intervention, and then completed 10 serves at the target under pressure that was induced through videotaping and ego-relevant instructions (posttest). The results indicated no difference in post-test serving accuracy among the intervention groups and the wait-list control group and no difference in effectiveness between cumulative and isolated PPR use. A possible explanation may be the inefficiency of the pressure manipulation. However, the null results related to isolated and cumulative PPR use under general (i.e., no pressure) conditions are still an important research finding. Future research should investigate the effectiveness of cumulative and other PPRs in other sports in general and under pressure. © 2020 Wergin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Investigating cumulative effects of preperformance routine interventions in beach volleyball serving
- Authors: Wergin, Vanessa , Beckmann, Jurgen , Gröpel, Peter , Mesagno, Christopher
- Date: 2020
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 15, no. 1 (2020), p.
- Full Text:
- Reviewed:
- Description: Pre-performance routines (PPRs) can be used in certain sports to minimize the effects of choking under pressure. This study aimed to investigate the cumulative effectiveness of PPR interventions on the accuracy of beach volleyball serves. Fifty-four beach volleyball players were randomly assigned to one of three PPR intervention groups or a control group. Participants performed 10 serves at a target on the opposite side of the beach volleyball court (pretest), were educated on a PPR intervention, and then completed 10 serves at the target under pressure that was induced through videotaping and ego-relevant instructions (posttest). The results indicated no difference in post-test serving accuracy among the intervention groups and the wait-list control group and no difference in effectiveness between cumulative and isolated PPR use. A possible explanation may be the inefficiency of the pressure manipulation. However, the null results related to isolated and cumulative PPR use under general (i.e., no pressure) conditions are still an important research finding. Future research should investigate the effectiveness of cumulative and other PPRs in other sports in general and under pressure. © 2020 Wergin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Identifying complementary and alternative medicine recommendations for anxiety treatment and care : a systematic review and critical assessment of comprehensive clinical practice guidelines
- Zhao, Fei-Yi, Kennedy, Gerard, Xu, Peijie, Conduit, Russell, Wang, Yan-Mei, Zhang, Wen-Jing, Wang, Hui-Ru, Yue, Li-Ping, Huang, Yu-Ling, Wang, Yin, Xu, Yan, Fu, Qiang-Qiang, Zheng, Zhen
- Authors: Zhao, Fei-Yi , Kennedy, Gerard , Xu, Peijie , Conduit, Russell , Wang, Yan-Mei , Zhang, Wen-Jing , Wang, Hui-Ru , Yue, Li-Ping , Huang, Yu-Ling , Wang, Yin , Xu, Yan , Fu, Qiang-Qiang , Zheng, Zhen
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Frontiers in Psychiatry Vol. 14, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs. Methods: Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively. Results: Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind–body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John’s wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as “unclear, unambiguous, or uncertain”. No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism. Conclusion: Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694. Copyright © 2023 Zhao, Kennedy, Xu, Conduit, Wang, Zhang, Wang, Yue, Huang, Wang, Xu, Fu and Zheng.
- Authors: Zhao, Fei-Yi , Kennedy, Gerard , Xu, Peijie , Conduit, Russell , Wang, Yan-Mei , Zhang, Wen-Jing , Wang, Hui-Ru , Yue, Li-Ping , Huang, Yu-Ling , Wang, Yin , Xu, Yan , Fu, Qiang-Qiang , Zheng, Zhen
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Frontiers in Psychiatry Vol. 14, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs. Methods: Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively. Results: Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind–body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John’s wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as “unclear, unambiguous, or uncertain”. No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism. Conclusion: Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694. Copyright © 2023 Zhao, Kennedy, Xu, Conduit, Wang, Zhang, Wang, Yue, Huang, Wang, Xu, Fu and Zheng.
General practice nurse-led screening for anxiety in later life in Australian primary care settings
- Hills, Sharon, Robinson, Tracy, Northam, Holly, Hungerford, Catherine
- Authors: Hills, Sharon , Robinson, Tracy , Northam, Holly , Hungerford, Catherine
- Date: 2019
- Type: Text , Journal article
- Relation: Australasian Journal on Ageing Vol. 38, no. 4 (Dec 2019), p. E121-E126
- Full Text:
- Reviewed:
- Description: Objective To test the feasibility of general practice nurse (GPN)-led screening for clinically significant symptoms of anxiety (CSSA) in older people and to estimate the prevalence of CSSA. Methods General practice nurse-led screening for CSSA was undertaken in eight general practices by integrating the five-item Geriatric Anxiety Inventory-Short Form (GAI-SF) into the annual 75 years and older health assessment (75+ HA). Prevalence rates were calculated, and field notes were analysed. Results Over 30 months, 736 patients were screened for CSSA, with a detected prevalence rate of 20.1%. The application of the GAI-SF into the 75+ HA was feasible and readily accepted by patients. Conclusions The five-item GAI-SF is an age-appropriate screening tool for CSSA in general practice settings. Further research is warranted, particularly in relation to the development and implementation of evidence-informed, general practice-based interventions for CSSA that can be effectively delivered to meet the needs of older people.
- Authors: Hills, Sharon , Robinson, Tracy , Northam, Holly , Hungerford, Catherine
- Date: 2019
- Type: Text , Journal article
- Relation: Australasian Journal on Ageing Vol. 38, no. 4 (Dec 2019), p. E121-E126
- Full Text:
- Reviewed:
- Description: Objective To test the feasibility of general practice nurse (GPN)-led screening for clinically significant symptoms of anxiety (CSSA) in older people and to estimate the prevalence of CSSA. Methods General practice nurse-led screening for CSSA was undertaken in eight general practices by integrating the five-item Geriatric Anxiety Inventory-Short Form (GAI-SF) into the annual 75 years and older health assessment (75+ HA). Prevalence rates were calculated, and field notes were analysed. Results Over 30 months, 736 patients were screened for CSSA, with a detected prevalence rate of 20.1%. The application of the GAI-SF into the 75+ HA was feasible and readily accepted by patients. Conclusions The five-item GAI-SF is an age-appropriate screening tool for CSSA in general practice settings. Further research is warranted, particularly in relation to the development and implementation of evidence-informed, general practice-based interventions for CSSA that can be effectively delivered to meet the needs of older people.
Evaluation of various support intensities of digital mental health treatment for reducing anxiety and depression in adults : protocol for a mixed methods, adaptive, randomized clinical trial
- Andrews, Brooke, Klein, Britt, McLaren, Suzanne, Watson, Shaun, Corboy, Denise
- Authors: Andrews, Brooke , Klein, Britt , McLaren, Suzanne , Watson, Shaun , Corboy, Denise
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 12, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. © Brooke Andrews, Britt Klein, Suzanne McLaren, Shaun Watson, Denise Corboy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.04.2023.
- Authors: Andrews, Brooke , Klein, Britt , McLaren, Suzanne , Watson, Shaun , Corboy, Denise
- Date: 2023
- Type: Text , Journal article
- Relation: JMIR Research Protocols Vol. 12, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. © Brooke Andrews, Britt Klein, Suzanne McLaren, Shaun Watson, Denise Corboy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.04.2023.
Efficacy of a digital mental health biopsychosocial transdiagnostic intervention with or without therapist assistance for adults with anxiety and depression : adaptive randomized controlled trial
- Andrews, Brooke, Klein, Britt, Nguyen, Huy, Corboy, Denise, McLaren, Suzanne, Watson, Shaun
- Authors: Andrews, Brooke , Klein, Britt , Nguyen, Huy , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. ©Brooke Andrews, Britt Klein, Huy Van Nguyen, Denise Corboy, Suzanne McLaren, Shaun Watson.
- Authors: Andrews, Brooke , Klein, Britt , Nguyen, Huy , Corboy, Denise , McLaren, Suzanne , Watson, Shaun
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 25, no. (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. ©Brooke Andrews, Britt Klein, Huy Van Nguyen, Denise Corboy, Suzanne McLaren, Shaun Watson.
Definition of choking in sport: Re-conceptualization and debate
- Mesagno, Christopher, Hill, Denise
- Authors: Mesagno, Christopher , Hill, Denise
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Sport Psychology Vol. 44, no. 4 (July-August 2013 2013), p. 267-277
- Full Text:
- Reviewed:
- Description: In sport, choking under pressure is a negative athletic experience that may have psychologically damaging effects. The media recognizes that choking is a dramatic drop in performance, whereas researchers have labeled choking as any decrease in performance under pressure. This discrepancy between the media's and researchers' perception of choking leads to ambiguity among terms and confusion among researchers, applied practitioners, and the general public. Thus, the current position paper will: critically analyze current choking definitions and explore why they are not appropriate operational definitions; explain the current underperformance and choking terminology debate; offer an alternative choking definition that should be debated; and also identify ways that researchers can improve the robustness of choking investigations. It is hoped that this paper will stimulate debate and improve the quality of future choking research.
- Authors: Mesagno, Christopher , Hill, Denise
- Date: 2013
- Type: Text , Journal article
- Relation: International Journal of Sport Psychology Vol. 44, no. 4 (July-August 2013 2013), p. 267-277
- Full Text:
- Reviewed:
- Description: In sport, choking under pressure is a negative athletic experience that may have psychologically damaging effects. The media recognizes that choking is a dramatic drop in performance, whereas researchers have labeled choking as any decrease in performance under pressure. This discrepancy between the media's and researchers' perception of choking leads to ambiguity among terms and confusion among researchers, applied practitioners, and the general public. Thus, the current position paper will: critically analyze current choking definitions and explore why they are not appropriate operational definitions; explain the current underperformance and choking terminology debate; offer an alternative choking definition that should be debated; and also identify ways that researchers can improve the robustness of choking investigations. It is hoped that this paper will stimulate debate and improve the quality of future choking research.
Compassion satisfaction and compassion fatigue in Australian emergency nurses : a descriptive cross-sectional study
- O'Callaghan, Erin, Lam, Louisa, Cant, Robyn, Moss, Cheryle
- Authors: O'Callaghan, Erin , Lam, Louisa , Cant, Robyn , Moss, Cheryle
- Date: 2020
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 48, no. (Jan 2020), p. 8
- Full Text:
- Reviewed:
- Description: Introduction: Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual's personal wellbeing and reduce work efficiency. Methods: A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. Results: The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses' stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. Conclusion/s: Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses' levels of stress and help limit staff burnout.
- Authors: O'Callaghan, Erin , Lam, Louisa , Cant, Robyn , Moss, Cheryle
- Date: 2020
- Type: Text , Journal article
- Relation: International Emergency Nursing Vol. 48, no. (Jan 2020), p. 8
- Full Text:
- Reviewed:
- Description: Introduction: Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual's personal wellbeing and reduce work efficiency. Methods: A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. Results: The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses' stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. Conclusion/s: Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses' levels of stress and help limit staff burnout.
Cognitive behaviour therapy for older adults experiencing insomnia and depression in a community mental health setting: Study protocol for a randomised controlled trial
- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Jenkins, Megan, Harvey, Jack
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
- Date: 2015
- Type: Text , Journal article
- Relation: Trials Vol. 16, no. 1 (2015), p.1-12
- Full Text:
- Reviewed:
- Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
- Date: 2015
- Type: Text , Journal article
- Relation: Trials Vol. 16, no. 1 (2015), p.1-12
- Full Text:
- Reviewed:
- Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.
Clinical significance of individual GAD symptoms in later life
- Miloyan, Beyon, Pachana, Nancy
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Geriatric Psychiatry and Neurology Vol. 29, no. 2 (2016), p. 92-98
- Full Text:
- Reviewed:
- Description: Background: There are age-related differences in the manifestation of generalized anxiety disorder (GAD) symptoms and their associated impact on psychosocial and functional status. However, it remains unclear whether specific symptoms (or symptom patterns) are of comparable clinical significance across different functional domains. Methods: A sample of 865 self-reported worriers (aged 60 years and older) who endorsed GAD screening questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results: Being easily fatigued was significantly associated with occupational disability and a functional disability variable (restricting usual activity in any way). Irritability was significantly associated with social friction (arguments with friends, family, or colleagues) and a functional disability variable (found was unable to do something wanted to do), and poor self-perceived health was also associated with the same functional disability variable. Excessive worry, despite being among the least reported symptoms, was significantly associated with distress. Conclusions: These findings suggest that individual GAD symptoms are differentially associated with aspects of clinical significance relevant to daily life, such as social, occupational, and functional ability. The differential impact of individual symptoms on functional status may be diluted when using symptom sum scores. A nuanced approach to assessing the clinical significance of individual GAD symptoms in older adults may be fruitful for efforts aimed at early detection and treatment. © 2015 SAGE Publications.
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Geriatric Psychiatry and Neurology Vol. 29, no. 2 (2016), p. 92-98
- Full Text:
- Reviewed:
- Description: Background: There are age-related differences in the manifestation of generalized anxiety disorder (GAD) symptoms and their associated impact on psychosocial and functional status. However, it remains unclear whether specific symptoms (or symptom patterns) are of comparable clinical significance across different functional domains. Methods: A sample of 865 self-reported worriers (aged 60 years and older) who endorsed GAD screening questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results: Being easily fatigued was significantly associated with occupational disability and a functional disability variable (restricting usual activity in any way). Irritability was significantly associated with social friction (arguments with friends, family, or colleagues) and a functional disability variable (found was unable to do something wanted to do), and poor self-perceived health was also associated with the same functional disability variable. Excessive worry, despite being among the least reported symptoms, was significantly associated with distress. Conclusions: These findings suggest that individual GAD symptoms are differentially associated with aspects of clinical significance relevant to daily life, such as social, occupational, and functional ability. The differential impact of individual symptoms on functional status may be diluted when using symptom sum scores. A nuanced approach to assessing the clinical significance of individual GAD symptoms in older adults may be fruitful for efforts aimed at early detection and treatment. © 2015 SAGE Publications.
Choking under pressure : The role of fear of negative evaluation
- Mesagno, Christopher, Harvey, Jack, Janelle, Christopher
- Authors: Mesagno, Christopher , Harvey, Jack , Janelle, Christopher
- Date: 2011
- Type: Text , Journal article
- Relation: Psychology of Sport and Exercise Vol.13 , no.1 (2012), p.60-68
- Full Text:
- Reviewed:
- Description: Objective: Conceptual models and predictors of choking under pressure (i.e., choking) have been proposed, but the role of fear of negative evaluation remains largely unknown. The purpose of the current study was to determine the degree to which fear of negative evaluation (FNE) may predispose athletes to choking. Design and method: 138 Experienced basketball players participated in a pre-selection stage, which involved completing a set of questionnaires that included the Brief Fear of Negative Evaluation-II (BFNE-II) questionnaire. Based on the scores from the BFNE-II, 34 athletes, categorized as either low- or high-FNE, were selected to perform basketball shots from five different areas of the court under low- and high-pressure phases. Shooting performance was evaluated based on the total number of successful shots out of 50 attempts. Results: Results indicated that the high-FNE athletes displayed a significant increase in anxiety and a significant decrease in performance from low- to high-pressure phases. The low-FNE group exhibited only minimal changes in anxiety throughout the study and was able to maintain performance under pressure. Further mediation analysis investigating significant difference in performance between FNE groups within the high-pressure phase indicated that that cognitive anxiety was a partial mediator between FNE group and performance, but somatic anxiety was not. Conclusions: Findings extend the existing choking literature by providing empirical support for the role of FNE in the context of the self-presentation model of choking. © 2011 Elsevier Ltd.
- Authors: Mesagno, Christopher , Harvey, Jack , Janelle, Christopher
- Date: 2011
- Type: Text , Journal article
- Relation: Psychology of Sport and Exercise Vol.13 , no.1 (2012), p.60-68
- Full Text:
- Reviewed:
- Description: Objective: Conceptual models and predictors of choking under pressure (i.e., choking) have been proposed, but the role of fear of negative evaluation remains largely unknown. The purpose of the current study was to determine the degree to which fear of negative evaluation (FNE) may predispose athletes to choking. Design and method: 138 Experienced basketball players participated in a pre-selection stage, which involved completing a set of questionnaires that included the Brief Fear of Negative Evaluation-II (BFNE-II) questionnaire. Based on the scores from the BFNE-II, 34 athletes, categorized as either low- or high-FNE, were selected to perform basketball shots from five different areas of the court under low- and high-pressure phases. Shooting performance was evaluated based on the total number of successful shots out of 50 attempts. Results: Results indicated that the high-FNE athletes displayed a significant increase in anxiety and a significant decrease in performance from low- to high-pressure phases. The low-FNE group exhibited only minimal changes in anxiety throughout the study and was able to maintain performance under pressure. Further mediation analysis investigating significant difference in performance between FNE groups within the high-pressure phase indicated that that cognitive anxiety was a partial mediator between FNE group and performance, but somatic anxiety was not. Conclusions: Findings extend the existing choking literature by providing empirical support for the role of FNE in the context of the self-presentation model of choking. © 2011 Elsevier Ltd.
Cannabis use and anxiety : Is stress the missing piece of the puzzle?
- Temple, Elizabeth, Driver, Matthew, Brown, Rhonda
- Authors: Temple, Elizabeth , Driver, Matthew , Brown, Rhonda
- Date: 2014
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 5, no. (2014), p. 1-13
- Full Text:
- Reviewed:
- Description: Objective: Comorbidity between anxiety and cannabis use is common yet the nature of the association between these conditions is not clear. Four theories were assessed, and a fifth hypothesis tested to determine if the misattribution of stress symptomology plays a role in the association between state-anxiety and cannabis. Methods: Three-hundred-sixteen participants ranging in age from 18 to 71 years completed a short online questionnaire asking about their history of cannabis use and symptoms of stress and anxiety. Results: Past and current cannabis users reported higher incidence of lifetime anxiety than participants who had never used cannabis; however, these groups did not differ in state-anxiety, stress, or age of onset of anxiety. State-anxiety and stress were not associated with frequency of cannabis use, but reported use to self-medicate for anxiety was positively associated with all three. Path analyses indicated two different associations between anxiety and cannabis use, pre-existing and high state-anxiety was associated with (i) higher average levels of intoxication and, in turn, acute anxiety responses to cannabis use; (ii) frequency of cannabis use via the mediating effects of stress and self-medication. Conclusion: None of the theories was fully supported by the findings. However, as cannabis users reporting self-medication for anxiety were found to be self-medicating stress symptomology, there was some support for the stress-misattribution hypothesis. With reported self-medication for anxiety being the strongest predictor of frequency of use, it is suggested that researchers, clinicians, and cannabis users pay greater attention to the overlap between stress and anxiety symptomology and the possible misinterpretation of these related but distinct conditions. © 2014 Temple, Driver and Brown.
- Authors: Temple, Elizabeth , Driver, Matthew , Brown, Rhonda
- Date: 2014
- Type: Text , Journal article
- Relation: Frontiers in Psychiatry Vol. 5, no. (2014), p. 1-13
- Full Text:
- Reviewed:
- Description: Objective: Comorbidity between anxiety and cannabis use is common yet the nature of the association between these conditions is not clear. Four theories were assessed, and a fifth hypothesis tested to determine if the misattribution of stress symptomology plays a role in the association between state-anxiety and cannabis. Methods: Three-hundred-sixteen participants ranging in age from 18 to 71 years completed a short online questionnaire asking about their history of cannabis use and symptoms of stress and anxiety. Results: Past and current cannabis users reported higher incidence of lifetime anxiety than participants who had never used cannabis; however, these groups did not differ in state-anxiety, stress, or age of onset of anxiety. State-anxiety and stress were not associated with frequency of cannabis use, but reported use to self-medicate for anxiety was positively associated with all three. Path analyses indicated two different associations between anxiety and cannabis use, pre-existing and high state-anxiety was associated with (i) higher average levels of intoxication and, in turn, acute anxiety responses to cannabis use; (ii) frequency of cannabis use via the mediating effects of stress and self-medication. Conclusion: None of the theories was fully supported by the findings. However, as cannabis users reporting self-medication for anxiety were found to be self-medicating stress symptomology, there was some support for the stress-misattribution hypothesis. With reported self-medication for anxiety being the strongest predictor of frequency of use, it is suggested that researchers, clinicians, and cannabis users pay greater attention to the overlap between stress and anxiety symptomology and the possible misinterpretation of these related but distinct conditions. © 2014 Temple, Driver and Brown.
Blood-injection-injury phobia in older adults
- Miloyan, Beyon, Eaton, William
- Authors: Miloyan, Beyon , Eaton, William
- Date: 2016
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 28, no. 6 (2016), p. 897-902
- Full Text:
- Reviewed:
- Description: Background: This study aims to (i) estimate the prevalence of blood-injection-injury phobia (BIIP) diagnosed as present at any time during the life prior to the interview, with or without another Specific Phobia diagnosed as present during the 12 months prior to the interview, (ii) characterize types and frequencies of co-occurring fears, (iii) evaluate the association with chronic medical conditions and lifetime psychiatric comorbidity, and (iv) explore medical service use associations in a nationally representative sample of older adults. Methods: A sample of 8,205 older adults, aged 65 years or older, was derived from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Results: The weighted lifetime prevalence of BIIP with and without 12-month Specific Phobia was 0.6% (95% CI: 0.4-0.8) and 4.2% (95% CI: 3.7-4.8), respectively, and these two groups ranked similarly in terms of sociodemographic, health, and psychiatric characteristics. BIIP most frequently co-occurred with other lifetime fears, and was positively associated with hypertension and lifetime history of anxiety and personality disorders after controlling for sociodemographic and psychiatric confounders. Conclusions: Our findings suggest that lifetime BIIP may bear mental and physical health significance in older adults. © 2016 International Psychogeriatric Association.
- Authors: Miloyan, Beyon , Eaton, William
- Date: 2016
- Type: Text , Journal article
- Relation: International Psychogeriatrics Vol. 28, no. 6 (2016), p. 897-902
- Full Text:
- Reviewed:
- Description: Background: This study aims to (i) estimate the prevalence of blood-injection-injury phobia (BIIP) diagnosed as present at any time during the life prior to the interview, with or without another Specific Phobia diagnosed as present during the 12 months prior to the interview, (ii) characterize types and frequencies of co-occurring fears, (iii) evaluate the association with chronic medical conditions and lifetime psychiatric comorbidity, and (iv) explore medical service use associations in a nationally representative sample of older adults. Methods: A sample of 8,205 older adults, aged 65 years or older, was derived from Wave 1 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Results: The weighted lifetime prevalence of BIIP with and without 12-month Specific Phobia was 0.6% (95% CI: 0.4-0.8) and 4.2% (95% CI: 3.7-4.8), respectively, and these two groups ranked similarly in terms of sociodemographic, health, and psychiatric characteristics. BIIP most frequently co-occurred with other lifetime fears, and was positively associated with hypertension and lifetime history of anxiety and personality disorders after controlling for sociodemographic and psychiatric confounders. Conclusions: Our findings suggest that lifetime BIIP may bear mental and physical health significance in older adults. © 2016 International Psychogeriatric Association.