Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to reduce the incidence of posttraumatic stress after acute myocardial infarction through trauma-focused psychological counseling: study protocol for a randomized controlled trial

BACKGROUND Posttraumatic Stress Disorder (PTSD) may occur in patients after exposure to a life-threatening illness. About one out of six patients develop clinically relevant levels of PTSD symptoms after acute myocardial infarction (MI). Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events. The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI. METHODS/DESIGN The study is a single-center, randomized controlled psychological trial with two active intervention arms. The sample consists of 426 patients aged 18 years or older who are at 'high risk' to develop clinically relevant posttraumatic stress symptoms. 'High risk' patients are identified with three single-item questions with a numeric rating scale (0 to 10) asking about 'pain during MI', 'fear of dying until admission' and/or 'worrying and feeling helpless when being told about having MI'. Exclusion criteria are emergency heart surgery, severe comorbidities, current severe depression, disorientation, cognitive impairment and suicidal ideation. Patients will be randomly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions (that is, the verum intervention) or the general role of psychosocial stress in coronary heart disease (that is, the control intervention). The session will take place in the coronary care unit within 48 hours, by the bedside, after patients have reached stable circulatory conditions. Each patient will additionally receive an illustrated information booklet as study material. Sociodemographic factors, psychosocial and medical data, and cardiometabolic risk factors will be assessed during hospitalization. The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up, which is hypothesized to be at least 20% lower in the verum group than in the control group using the t-test. Secondary outcomes are posttraumatic stress levels at 12-month follow-up, and psychosocial functioning and cardiometabolic risk factors at both follow-up assessments. DISCUSSION If the verum intervention proves to be effective, the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT01781247.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist

Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.

Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.

Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.

Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.

Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.

Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

Better access to mental health : mapping the evidence supporting participation in meaningful occupations

Introduction: The purpose of this scoping and mapping project is to assess evidence for the use of focused psychological strategies (FPS) under the Better Access to Mental Health (BAMH) scheme to enable people with mental health problems to increase their functional performance and to participate in meaningful occupations. In particular, it aims to provide an accessible summary of evidence for practitioners who use FPS with their clients.

Methods: Evidence scoping and mapping is a relatively new technique, used to provide an overview of key findings in an area of practice. A five stage process of scoping and mapping was used in this project.

Results: A total of 81 studies which addressed the use of focused psychological strategies to promote functional performance and participation in meaningful occupations were found. Surprisingly, only three were published in occupational therapy journals with one further article being authored by occupational therapists. Three maps are provided showing this evidence by diagnosis, intervention and level of evidence.

Conclusion: Clinicians can say with some confidence that cognitive behavioural therapies are effective functional tools, particularly when working with people with depression or schizophrenia. They can also be confident that good quality evidence exists across a range of diagnoses, although there are many gaps where little to no research has been conducted. Suggestions for further research are provided which take into account the findings of these maps.

Coping strategies used by ballet dancers : effects of individual differences in competitive trait anxiety

The world of classical ballet exerts considerable physical and psychological stress upon those who participate, and yet the process of coping with such stressors is not well understood. The purpose of the present investigation was to examine relationships between coping strategies and competitive trait anxiety among ballet dancers. Participants were 104 classical dancers (81 females and 23 males) ranging in age from 15 to 35 years (M = 19.4 yr., SD = 3.8 yr.) from three professional ballet companies, two private dance schools, and two full-time, university dance courses in Australia. Participants had a mean of 11.5 years of classical dance training (SD = 5.2 yr.), having started dance training at 6.6 years of age (SD = 3.4 yr.). Coping strategies were assessed using the Modified COPE scale (MCOPE: Crocker & Graham, 1995), a 48-item measure comprising 12 coping subscales (Seeking Social Support for Instrumental Reasons, Seeking Social Support for Emotional Reasons, Behavioral Disengagement, Planning, Suppression of Competing Activities, Venting of Emotions, Humor, Active Coping, Denial, Self-Blame, Effort, and Wishful Thinking). Competitive trait anxiety was assessed using the Sport Anxiety Scale (SAS: Smith, Smoll, & Schutz, 1990), a 21-item measure comprising three anxiety subscales (Somatic Anxiety, Worry, Concentration Disruption). Standard multiple regression analyses showed that trait anxiety scores, in particular for Somatic Anxiety and Worry, were significant predictors of seven of the 12 coping strategies (Suppression of Competing Activities: R2 = 27.1%; Venting of Emotions: R2 = 23.2%; Active Coping: R2 = 14.3%; Denial: R2 = 17.7%; Self-Blame: R2 = 35.7%; Effort: R2 = 16.6%; Wishful Thinking: R2 = 42.3%). High trait anxious dancers reported more frequent use of all categories of coping strategies. A separate two-way MANOVA showed no significant main effect for gender nor status (professional versus students) and no significant interaction effect. The present findings are generally consistent with previous research in the sport psychology domain (Crocker & Graham, 1995; Giacobbi & Weinberg, 2000) which has shown that high trait anxious athletes tend, in particular, to use more maladaptive, emotion-focused coping strategies when compared to low trait anxious athletes; a tendency which has been proposed to lead to negative performance effects. The present results emphasize the need for the effectiveness of specific coping strategies to be considered during the process of preparing young classical dancers for a career in professional ballet. In particular, the results suggest that dancers who are, by nature, anxious about performance may need special attention to help them to learn to cope with performance-related stress. Given the absence of differences in coping strategies between student and professional dancers and between males and females, it appears that such educational efforts should begin at an early career stage for all dancers.

Dyslexia in higher education: Implications for maths anxiety, statistics anxiety and psychological well-being

This study examined levels of mathematics and statistics anxiety, as well as general mental health amongst undergraduate students with dyslexia (n = 28) and those without dyslexia (n = 71). Students with dyslexia had higher levels of mathematics anxiety relative to those without dyslexia, while statistics anxiety and general mental health were comparable for both reading ability groups. In terms of coping strategies, undergraduates with dyslexia tended to use planning-based strategies and seek instrumental support more frequently than those without dyslexia. Higher mathematics anxiety was associated with having a dyslexia diagnosis, as well as greater levels of worrying, denial, seeking instrumental support and less use of the positive reinterpretation coping strategy. By contrast, statistics anxiety was not predicted by dyslexia diagnosis, but was instead predicted by overall worrying and the use of denial and emotion focused coping strategies. The results suggest that disability practitioners should be aware that university students with dyslexia are at risk of high mathematics anxiety. Additionally, effective anxiety reduction strategies such as positive reframing and thought challenging would form a useful addition to the support package delivered to many students with dyslexia.

Coping and psychological adjustment among people with multiple sclerosis

Objective
This study was concerned with examining the coping and psychological adjustment of people with multiple sclerosis (MS) and determining how they were different in these dimensions from people from the general population. The role of severity and duration of illness as well as levels of social support on coping style and adjustment were also evaluated.

Method
The participants were 381 (144 men, 237 women) people with MS and 291 (101 men, 190 women) people from the general population.

Results
The results demonstrated that people with MS (particularly men) were less likely to adopt coping styles related to problem solving and seeking support and demonstrated poorer levels of adjustment on all dimensions. Adopting a wishful thinking coping style, as well as a lack of problem-focused coping or failure to seek social support, was also more likely to be associated with poorer psychological adjustment for both men and women with MS. Levels of health impairment were only minimally related to psychological adjustment, particularly for men.

Discussion
These findings highlight the importance of developing educational programs that include strategies to adopt more problem-focused coping strategies, so that people with MS can more readily adjust to their illness.

Trait anxiety and coping strategies among ballet dancers

This study examined relationships between competitive trait anxiety and coping strategies among ballet dancers. Participants were 104 classical dancers (81 females and 23 males) ranging in age from 15 to 35 years (mean 19.4 years; SD 3.8 years) from three professional ballet companies, two private dance schools, and two university dance courses in Australia. Participants completed the Modified COPE scale and the Sport Anxiety Scale. Trait anxiety scores, in particular for somatic anxiety and worry, were significant predictors of 7 of the 12 coping strategies (wishful thinking, r2 = 42.3%; selfblame, r2 = 35.7%; suppression of competing activities, r2 = 27.1%; venting of emotions, r2 = 23.2%; denial, r2 = 17.7%; effort, r2 = 16.6%; active coping, r2 = 14.3%). Approximately 96% of dancers could be classified correctly as high or low trait-anxious from their reported coping style. No significant effects of gender or status (professional versus students) were found. Findings showed that high trait-anxious athletes tend to use more maladaptive, emotion-focused coping strategies compared with low trait-anxious athletes; a tendency that has been proposed to lead to negative performance effects. Dancers who are by nature anxious about performance may need special attention to help them to learn to cope with performance-related stress. Med Probl Perform Art 18:59–64, 2003.

Coping resources, coping strategies and adaptation to organisational change : direct or buffering effects?

This study examined the effects of personal and social resources, coping strategies and appraised stress on employees' levels of anxiety and depression. In relation to the effects of resources and coping strategies, two different models were tested. The main effects model proposes that, irrespective of the level of stress, coping resources and coping strategies have direct effects on well-being. In contrast, the buffering model predicts that the buffering effects of coping resources and strategies are only evident at high levels of stress. One hundred lawyers completed a structured self-administered questionnaire that measured their personal and social resources, use of problem-focused and emotion-focused coping strategies, and appraisals of the stressfulness of the situation. Results revealed generally strong support for the main effects model in the prediction of employee levels of anxiety and depression. Lower levels of anxiety were linked to judgements of lower levels of organizational change, greater self-confidence, greater internality of control beliefs and less use of emotion-focused coping strategies. Lower levels of depression in employees were also linked to judgements of lower levels of organizational change, greater use of resources and less appraised stress. There was only limited support for the buffering effects model. Due to the small size of the sample, the findings need to be explored further in other contexts.

Novice teachers' perceptions of the extent to which the Brock University teacher education program focused on methods of promoting responsibility in students

The purpose of this study was to determine novice t~ache~s' perceptions of th~ extent to which the Brock University teacher education program focused on strategies for promoting responsibility in students. Individual interviews were conducted with ten randomly selected teachers who were graduates of this teacher education program between the years of 1989 and 1992, and a follow-up group discussion activity, with the same teachers, was also held. Findings revealed that the topic of personal responsibility was discussed within various components of the program, including counselling group sessions, but that these discussions were often brief, indirect and inconsistent. Some of the strategies which the teachers used in their own classrooms to promote responsibility in students were ones which they had acquired from those counselling group °sessions or from associate teachers. Various strategies included: setting ~lear expectations of students with positive and negative consequences for behaviour (e.g., material rewards and detentions, respectively), cemmunic?ting'with other teachers an~ parents, and -. suspending students from school. A teacher's choice of any particular strategy seemed to be affected by his or her personality, teaching sUbject and region of employment, as well as certain aspects of the teacher education program. It was concluded that many of the teachers appeared to be controlling rude and vio~ent- behaviour, as opposed to promoting responsible behaviour. Recommendations were made for the pre-service program, as well as induction and inservice programs, to increase teacher preparedness for promoting responsible student behaviour. One of these recommendations addressed the need to help teachers learn how to effectively communicate with their students.

An evaluation of the effect of an educational intervention for Australian social workers on competence in delivering brief cognitive behavioural strategies : a randomised controlled trial

Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below. Conclusions Social workers can attain significant improvements in competency in delivering cognitive behavioural strategies from undertaking brief face to face training. This is relevant in the context of health reforms that involve social worker delivery of evidence based psychological care. Further research is required to assess how these improvements in competence translate into performance in practice and clinical outcomes for patients.

The propaganda strategies adopted by the Colonial British during the Malayan Emergency, 1948-1960 as applied in newspaper coverage: A case study

The ongoing discussions on the fluid boundaries between ‘propaganda’ and ‘persuasion’ have emerged in numerous studies, the most prominent being Jowett and O’Donnell (2006). Sharing their views, Herman and Chomsky (1988) argued on the repercussions of only using elite sources in media reports due to their capacity to mobilise the masses for a single cause and shape elite opinions, due to the absence of alternative or opposing viewpoints. This case study examined the nature of propaganda strategies adopted by the colonial British during the Malayan Emergency that proved to be highly effective. This study consisted of two separate elements. First, it extends the discussion on propaganda by examining the significance of ‘race’ used as a crucial element within the discourses of anti-communism, as a legitimate rationale to mobilise forces, primarily within a Malayan context. Second, it investigated how propaganda strategies such as the forced resettlement of the ethnic Chinese, strategies used in framing the insurgents, and psychological warfare operated as powerful mechanisms to shape propaganda communication. A comparative content analysis of two mainstream English newspapers – namely The Times (London) and Straits Times (Singapore) – was conducted to identify trends in reporting used. Juxtaposing this method was the administration of in-depth interviews with ex-service personnel who had actively served in Malaya during the Malayan Emergency. The findings of this research reveal a significant correlation between ‘race’ and the constructs of communism. The results also indicate that psychological strategies adopted by the British in the form of deeds and news production proved to be highly effective.

Attributions, cognitions, and coping styles:teleworkers' reactions to work-related problems

Based on the attributional reformulation of learned helplessness theory (Abramson, Seligman, & Teasdale, 1978) and Lazarus and Launier's (1978) primary-secondary appraisal theory of stress, the present study sought to examine teleworkers' reactions to their work-related problems. The role of attributions about the sources, and cognitions about the consesquences, of these problems in promoting positive adaptation was addressed. In particular, it was predicted that teleworkers who made optimistic attributions and cognitions would be more likely to employ problem-focused coping strategies and, as a result, report more positive psychological and job-related outcomes. Based on a survey sample of 192 teleworkers, the results indicated that a tendency to engage in self-blame was related to the use of emotion-focused coping strategies. In turn, there was evidence linking emotion-focused coping strategies to negative outcomes and problem-focused coping strategies to positive outcomes. The results are discussed in relation to attributional approaches to stress which highlight the importance of cognitions about the consequences of negative events. Finally, implications for the training of teleworkers are presented.

The relationship between coping strategies and level of depression among spousal caregivers of elders with dementia

Caregivers are often under a great deal of stress while caring for their spouses with dementia. It is when the stress builds up and becomes overwhelming that the caregiver is at risk for developing depression. The primary objective of this study was to determine which cognitive and behavioral coping strategies are associated with lower levels of depression; once these strategies are identified, interventions can be established to educate these caregivers. Thirty-two spousal caregivers participated in this study. They each filled out a questionnaire, which contained three sections. The first section asked them for demographic information about themselves and their spouses; the second section consisted of a coping strategies scale; and, the third section contained a depression scale. Results of this study indicate that problem-focused coping strategies were associated with a lesser degree of depressive symptomatology, whereas most of the emotion-focused strategies were associated with a greater degree of depressive symptomatology among the present sample of spousal caregivers. In addition, no relationship was found between the length of time providing care to their spouses and their level of depression.

Self-management of cancer treatment-related fatigue, nausea, vomiting and oral mucositis in Chinese cancer patients

Background: Treatment-related symptoms continue to place a significant burden on many cancer patients. Many side effects require patients to engage in a range of self-management actions. While some studies have explored self-management of treatment-related side effects in Western settings, very few studies were identified that described the self-management practices of cancer patients in China. Objective: The purposes of this study are to: (1) Investigate Chinese cancer patients. self-management behaviours in dealing with the fatigue, nausea/vomiting and oral mucositis that result from treatment, as well as the perceived effectiveness of these behaviours and related self-efficacy in performing them. (2) Explore factors influencing symptom self-management behaviours using the Cancer Symptom Self-management Framework based on Grey, Knafl and McCorkle.s (2006) self-management framework as a guide. Methods: This study was divided into two phases. Phase One consisted of the translation and modification of two instruments. The adaptation of these instruments to ensure applicability in the Chinese context was achieved through semi-structured interviews with six cancer patients, and content evaluation with eight experienced oncology nurses. A pilot study was conducted with nine cancer patients to trial the questionnaire set in the Chinese context. Based on the results of Phase One, Phase Two involved a cross-sectional survey of Chinese cancer patients undergoing cancer treatment using these instruments. A total of 277 chemotherapy patients with fatigue and/or nausea and vomiting, and 100 radiotherapy patients with oral mucositis were surveyed. Results: Participants in this study reported a variety of self-management behaviours to cope with fatigue, nausea, vomiting and oral mucositis. There are some consistencies as well disparities between strategies that are frequently used and those rated as effective. For fatigue self-management, participants were more likely to use strategies related to rest and sleep, while activity enhancement strategies were rated as achieving higher relief. For nausea and vomiting self-management, dietary modification and taking medication were most frequently used and rated as moderately effective. Psychological strategies were used by more than a third of participants and were rated as mildly effective. Some other infrequently used strategies, such as distraction by keeping busy and acupressure, were rated as moderately effective. For oral mucositis self-management, having soft, bland food and keeping the mouth moisturised were most frequently reported and they were rated as achieving moderate relief. A prescribed mouthwash was used by most but not all participants and brought moderate relief. In general, patients had low-to-moderate self-efficacy in nausea and vomiting self-management behaviours, moderate self-efficacy in fatigue self-management behaviours, and low-to-moderate self-efficacy in oral mucositis self-management behaviours. In terms of the factors influencing symptom self-management, different predictors were identified affecting engagement in fatigue, nausea/vomiting and oral mucositis self-management behaviours. Self-efficacy scores of different behaviours were consistently found to be a positive predictor of the relief level from corresponding behaviours, after controlling for other variables. Perceived social support from health care professionals was identified as an important factor influencing nausea and vomiting self-management behaviours, while neighbourhood support was important for fatigue self-management. In addition, symptom distress was identified as an important factor influencing nausea and vomiting self-management. Conclusion: Similar to reports from overseas, Chinese cancer patients initiate a wide range of self-management behaviours in response to treatment-related side effects. While some behaviours were reported to provide relief, many did not. Given these results, this study has a number of practical implications for health care professionals, particularly in relation to developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis. Additionally, this study suggests a number of theoretical implications and directions for future research. It is envisaged that these recommendations may pave the way for further studies understanding and promoting cancer symptom self-management in Chinese people affected by cancer.

Self-management of chemotherapy-related nausea and vomiting : a cross-sectional survey of Chinese cancer patients

BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) remain prevalent among cancer patients despite pharmacological advances in CINV therapy. Patients can initiate nonpharmacologic strategies, which potentially play an important role as adjuncts to pharmacological agents in alleviating CINV. Some studies have explored nausea and vomiting self-management (NVSM) behaviors among patients in Western settings; however, little is known about the NVSM behaviors of patients in China. OBJECTIVES This study examines NVSM behaviors of Chinese cancer patients. METHODS A cross-sectional survey was conducted in a specialist cancer hospital in southeast China. RESULTS A sample of 255 cancer patients was recruited. A mean of 8.56 (±3.15) NVSM behaviors was reported. Most NVSM behaviors were rated as moderately effective and were implemented with moderate self-efficacy. Higher distress levels, better functional status, previous similar symptom experiences, receiving chemotherapy as an inpatient, and greater support from multiple levels were related to greater engagement in NVSM; higher self-efficacy levels pertaining to NVSM behaviors were associated with reports of more relief from specific NVSM behaviors. CONCLUSIONS A range of NVSM strategies was initiated by Chinese cancer patients and provided some relief. A range of individual, health status, and environmental factors influenced engagement with and relief from NVSM behaviors. IMPLICATIONS FOR PRACTICE To enhance Chinese patients' NVSM, patients should be supported to engage in behaviors including taking antiemetics, modifying their diet, using psychological strategies, and creating a pleasant environment. The findings highlight the importance of enhancing patients' self-efficacy in NVSM, alleviating symptom distress, and improving social support to achieve better outcomes.