Emotional Freedom Techniques for Postpartum Depression, Perceived Stress, and Anxiety.

OBJECTIVE: To examine the effect of an Emotional Freedom Techniques (EFT) group intervention on perceived stress, depression, and anxiety symptoms in women in the postpartum period. DESIGN: A one-group pre- and posttest quasi-experimental design. SETTING/LOCAL PROBLEM: Postpartum depression (PPD) and anxiety affect nearly one in five women in the first 12 months after childbirth. The COVID-19 pandemic was associated with a significant worsening of symptoms of PPD, stress, and anxiety in this population. Mental health screening is the standard of care in perinatal settings. This practice has led to an increased rate of PPD and anxiety diagnoses and the need for evidence-based nonpharmacologic interventions to support mothers with PPD and anxiety. PARTICIPANTS: Eleven mothers seeking care for lactation concerns who screened positive for PPD and anxiety symptoms. INTERVENTION/MEASUREMENTS: A total of eight 1-hour group EFT sessions were offered to participants over a period of 4 weeks. During the group sessions, participants were taught how to perform the steps of EFT and apply it in a supportive group format. Measurement tools included the Subjective Unit of Distress Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. The preintervention and postintervention scores of these tools were compared using a paired-samples t test. RESULTS: After implementing EFT as a group intervention, we observed a reduction in mental health burden experienced by women in the postpartum period. There was a statistically significant decrease in depression (p = .003), anxiety (p <.001), and perceived stress (p <.001) scores 1 month after the EFT intervention. CONCLUSION: These findings suggest that EFT may be a viable adjunctive intervention for managing depression, anxiety, and stress in the postpartum period. Further research with larger and more diverse samples is needed to confirm these findings.

An international survey of Psychiatric-Mental-Health Nurses on the content validity of the International Classification of Functioning, Disability and Health Core Sets for Schizophrenia.

The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia describe the key problems in functioning that are experienced by individuals with this disorder. This study examines the content validity of these Core Sets and aims to identify the most frequent problems faced by people with schizophrenia, considering for this analysis the perspective of Psychiatric-Mental-Health Nurses. The study complied with the COREQ checklist for qualitative studies. A total of 101 nurses from 30 countries covering all six World Health Organization regions participated in a Delphi study. Their responses in Round 1 were linked to ICF categories, retaining those reported by at least 5% of participants. In Round 2, they were asked to rate the relevance of each of these categories to the nursing care of patients with schizophrenia. This process was repeated in Round 3. A total of 2327 concepts were extracted in Round 1 and linked to ICF categories. Following the analysis, 125 categories and 31 personal factors were presented to the experts in rounds 2 and 3. Consensus (defined as agreement ≥75%) was reached for 97 of these categories and 29 personal factors. These categories corresponded to all those (N = 25) in the Brief Core Set and 87 of the 97 categories of the Comprehensive Core Set for schizophrenia. Ten new categories emerged. The Delphi process identified the problems in functioning that nurses encounter when treating individuals with schizophrenia, and the results supported the content validity of the Core Sets. We conclude that these Core Sets offer a comprehensive framework for structuring clinical information and guiding the treatment process.

Implications of hypothalamic-pituitary-adrenal axis functioning in posttraumatic stress disorder.

BACKGROUND: Cortisol secretions serve as the barometer of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates and controls responses to stress. Studies of cortisol secretions in patients with posttraumatic stress disorder (PTSD) reveal inconsistent results. PURPOSE: Current research on HPA axis functioning in PTSD is examined to elucidate the neuroendocrine contributions in the disorder, identify current treatment's impact on the HPA axis, and consider implications for nursing care and areas for future research. FINDINGS: There is evidence for HPA dysregulation in PTSD, which contributes to widespread impairment in functions such as memory and stress reactivity and to physical morbidity via processes such as allostatic load. There is limited, but building, evidence that dehydroepiandrosterone (DHEA), which is released simultaneously with cortisol, may provide anti-glucocorticoid and neuroprotective effects. CONCLUSION: Current treatments such as selective serotonin reuptake inhibitors and psychotherapy may have a beneficial impact on the HPA axis in PTSD populations. Somatic approaches to treating PTSD have not yet been studied in relation to their impact on HPA axis parameters in PTSD patients. Treatment studies of DHEA or glucocorticoids have not yet used HPA axis endpoints. PTSD treatment studies that include measures of HPA axis target mechanisms and consider HPA axis regulation as an additional treatment outcome are warranted.

Psychophenomenology of the postpsychotic adjustment process.

A clinical phenomenological study with nine adults with schizophrenia explored the postpsychotic adjustment stage of recovery from a psychotic episode to map a psychological recovery trajectory. Participants (ages 21-37 years) were actively involved in an early psychosis outpatient treatment program. Psychophenomenological analysis of interview data resulted in 458 descriptive expressions reflecting four structural elements. Cognitive dissonance involved achieving pharmacological efficacy and cognitive efforts to "sort out" the experience. Insight was distinguished by mastery of autonomous performance of reality checks. Cognitive constancy was marked by resuming interpersonal relationships and age-appropriate activities. Ordinariness involved consistent engagement in daily activities reflective of prepsychosis functioning.

Clinicians on the front line: active management of depression and anxiety in primary care.

Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we always recognize these patients in practice? What are the barriers to diagnosis and treatment, and how can they overcome? What are the treatment options of these sometimes life-altering conditions, and how do we choose from among the many that exist?

Wellness outcomes of trauma psychoeducation.

A program evaluation study was conducted to determine if a group psychoeducation course would improve wellness scores in subjects with trauma-related disorders. The sample consisted of 10 men age 20-65 years and 44 women age 20-66 years. Levels of wellness were evaluated using the Wellness Assessment Tool [International Journal of Psychiatric Nursing Research, 3(1) (1996), 308-317] that evaluates 10 wellness items in each of the four domains: health, attitudes/behavior, environment/relationship, and spirituality. Paired sample correlations showed statistically significant correlations among 37 of the 50 pairs, ranging from .524 in the health scores to .830 in spirituality. The paired t tests also showed significant differences at P = .05 in each of the wellness domains. Subjects felt an improvement in overall health, a decrease in interpersonal conflict, a stronger sense of spirituality, and improvement in environmental control and interpersonal relationships.

The BE SMART trauma reframing psychoeducation program.

Despite the human capacity to survive and adapt, traumatic experiences can cause alterations in health, attitudes and behaviors, environmental and interpersonal functioning, and spiritual balance such that the memory of an event or a set of events taints all other experiences. The BE SMART (Become Empowered: Symptom Management for Abuse and Recovery from Trauma) group psychoeducation program is a 12-week course designed for both men and women to learn wellness coping principles in recovering from the aftermaths of trauma and abuse. The course is based on the Murphy-Moller Wellness Model [Murphy, M. F., & Moller, M. D. (1996). The Three R's Program: A Wellness Approach to Rehabilitation of Neurobiological Disorders. The International Journal of Psychiatric Nursing Research, 3(1), 308-317] and the Trauma Reframing Therapy [Rice, M. J., & Moller, M. D. (2003). Wellness Outcomes of Trauma Psychoeducation. Podium presentation at the 2003 Meeting of the American Psychiatric Nurses Association. Atlanta, Georgia. October].