Long-term effects of a tailored mindfulness-based program for Chinese intensive care unit nurses: A randomized parallel-group trial.

AIM: This study investigated the direct and long-term improvements that mindfulness-based interventions exert on intensive care unit nurses. We assessed an abbreviated four-week, twice-weekly mindfulness-based intervention program's effect on work-related mental health variables and examined whether the intervention impact was maintained at two- and six-month follow-up assessments. We also examined the training program's effects on work and life. BACKGROUND: Previous research has shown that mindfulness interventions exert positive effects immediately after treatment. However, few studies have examined whether treatment effects are maintained over time or under different circumstances. Moreover, treatment effects among Chinese intensive care unit nurses have rarely been examined. DESIGN: We conducted a randomized, non-blinded, parallel-group trial. METHODS: Participants included 90 intensive care unit nurses, divided into two cohorts, who participated in the program in October 2016 and April 2017. They completed validated measures of mindfulness, burnout syndromes, anxiety and depressive symptoms and well-being at baseline (T1), immediately after intervention (T2), two months after (T3) and six months after (T4) the intervention. RESULTS: We observed a significant group effect (1) immediately post-intervention and two months after intervention for mindfulness; (2) at two months after intervention for anxiety, depression and subjective well-being and (3) at post-intervention, two months after and six months after for emotional exhaustion. CONCLUSIONS: These findings suggest that the tailored four-week mindfulness-based intervention program improved intensive care unit nurses' mental health, although further research is needed to verify its feasibility in a clinical working environment.

Perceived stress from interpersonal relations predicts suicidal ideation in Chinese university students: Roles of meaning in life and coping humor.

Existing studies emphasize that interpersonal relationships are closely associated with the increased risk of suicidal ideation (SI). However, the mechanism underlying this association remains poorly understood. In this study, we investigated how and under what conditions the perceived stress from interpersonal relations links to SI. Also we explored the possible important roles of meaning in life and coping humor. A total of 1472 Chinese freshmen completed self-reported questionnaires of thwarted belongingness (TB), fear of negative evaluation (FNE), meaning in life, coping humor, and SI. Our results showed that SI was associated with more TB and FNE, and it was linked to less meaning in life and coping humor. Importantly, two dimensions of meaning in life mediated the associations between TB, FNE, and SI. Specifically, TB increased SI by destroying both presence of meaning and search for meaning while FNE increased SI by destroying presence of meaning, but not by search for meaning. Additionally, coping humor attenuated the effect of FNE on SI. Our findings highlight the protective roles of meaning in life and coping humor in the link between perceived stress from interpersonal relations and SI among Chinese university students. These results provide feasible advices for practitioners to carry out suicide prevention and intervention.

Factors contributing to coparenting quality: characteristics at the individual level and the relational level.

This study aimed to explore how characteristics of parents at the individual level (i.e. anxiety, depression, and psychological resilience) and the relational level (i.e. family functioning) are associated with their coparenting quality in Chinese context. A total of 432 parents whose first child aged 1-18 were recruited to complete online self-measures of anxiety, depression, psychological resilience, family functioning, and coparenting quality. The findings indicated that parents with more anxiety and depression tended to have worse resilience and family functioning, as well as poorer coparenting quality. There were strong correlations between resilience, family functioning, and coparenting quality. Mediation analysis showed that resilience and family functioning partially mediated the link between anxiety and coparenting and fully mediated the link between depression and coparenting. Moreover, family functioning fully carried the impact of resilience on coparenting. These results extended our understanding by demonstrating that resilience and family functioning serve as mediators between negative emotions and coparenting quality. The significant implications for parental practice and research were also discussed.

Increased Intra-Individual Variability as a Marker of Executive Dysfunction in Generalized Anxiety Disorder.

Recent studies suggest that individual difference in intra-individual variability (IIV) of reaction times is an important indicator of attentional executive control. However, there are few existing studies on the executive control of high trait-anxious individuals assessed by using reaction time variability. This study assessed whether executive functions are impaired among clinical and non-clinical trait-anxious individuals indicated by IIV. The cross-reliability and discriminative power of three IIV parameters (raw intra-individual standard deviation, SD; reaction time coefficient of variation, RTCV; and mean absolute deviation, MAD) were compared. Twenty-five non-clinical individuals with low trait anxiety (LTA), 31 non-clinical individuals with high trait anxiety (HTA), and 19 clinical patients diagnosed with generalized anxiety disorder (GAD) finished self-reported measures, an emotional spatial-cuing task, and a non-emotional arrow flanker task. In the emotional task, GAD patients had significantly slower response speed, lower accuracy, and greater IIV parameters than the LTA and HTA groups. In the non-emotional task, the GAD group exhibited poorer processing efficiency, greater SD and RTCV, and intact performance effectiveness. RTCV is suggested to be a better marker of executive dysfunction than SD and MAD due to its good discriminative power and reliability as well as less affected by reaction times.

Thwarted Belongingness Hindered Successful Aging in Chinese Older Adults: Roles of Positive Mental Health and Meaning in Life.

Aging of population has brought great challenges to many regions throughout the world. It has been demonstrated that interpersonal relationship is closely related to the experiences of aging for older adults. However, it still remains unknown how and under what conditions thwarted belongingness links to successful aging. This study examined the relationship between thwarted belongingness and successful aging and tested the mediating role of positive mental health and the moderating role of meaning in life. Community-dwelling older adults (n = 339) aged 60-75 years recruited in Chongqing, China completed self-measures of thwarted belongingness, successful aging, meaning in life, and positive mental health. Correlation analyses showed that successful aging was associated with less thwarted belongingness, better positive mental health, and higher levels of meaning in life. Positive mental health was found to totally mediate the negative effect of thwarted belongingness on successful aging. Moderated mediation analyses further revealed that two components of meaning in life (present of meaning and search for meaning) attenuated the indirect effect of thwarted belongingness on successful aging via positive mental health. This study highlights the protective roles of positive mental health and meaning in life and addressed cultural aspects in the process of successful aging among Chinese older adults.

COVID-19 among Chinese high school graduates: Psychological distress, growth, meaning in life and resilience.

This study examined perceived impact of COVID-19 (PIC) on mental health outcomes (anxiety, depression, and posttraumatic growth) and roles of resilience and meaning in life. In October 2020, 430 Chinese high school graduates completed self-report measures. Results showed that 4.4% and 5.8% participants had anxiety and depression symptoms (⩾10), respectively, while 13.3% developed posttraumatic growth (⩾37.5). Resilience and meaning in life mediated the relationships between PIC and mental health outcomes. These findings underline psychological distress and growth coexisted in COVID-19, while resilience and meaning in life served as important protective factors of mental health.

Individual risky and protective factors influencing university new graduates' career adaptability during COVID-19: A moderated mediation model.

This study examined the characteristics of university new graduates' career adaptability and the effects of individual internal factors during COVID-19. In January 2021, 1160 Chinese university new graduates completed self-report measures. Career adaptability was related to less intolerance of uncertainty and anxiety sensitivity and higher levels of proactive personality and resilience. Resilience mediated the relationships between intolerance of uncertainty, anxiety sensitivity, and career adaptability. Proactive personality buffered the negative effect of anxiety sensitivity on career adaptability. Implications for promoting career adaptability and alleviating the effects of intolerance of uncertainty and anxiety sensitivity in the COVID-19 epidemic and beyond are discussed.

Coparenting Alleviated the Effect of Psychological Distress on Parental Psychological Flexibility.

Parenting is full of challenges and responsibilities. It is particularly important for parents to be open to parental difficult experiences and adopt behaviors consistent with self-chosen values, which termed as parental psychological flexibility (PPF). However, few studies have focused on the effect of psychological distress (anxiety and depression) on different components of PPF. This study examined the effect of psychological distress on the three components of PPF (cognitive defusion, committed action, and acceptance) as well as the role of coparenting quality in Chinese parents. A total of 462 parents of children aged 1-18 years completed self-report measures of anxiety, depression, coparenting, and PPF. Our results revealed that higher level of PPF went along with less anxiety and depression, while it was also associated with better coparenting quality. Coparenting partially mediated the effect of anxiety on cognitive defusion and acceptance and fully mediated the effect of depression on cognitive defusion and acceptance. Moderation analyses showed that the link between anxiety and cognitive defusion, as well as the link between anxiety and acceptance were moderated by coparenting. We discussed the implications of coparenting as a protective factor in alleviating the negative effect of psychological distress on PPF.

Positive functioning at work during COVID-19: Posttraumatic growth, resilience, and emotional exhaustion in Chinese frontline healthcare workers.

Research on traumatic events often emphasizes the importance of posttraumatic growth (PTG) and resilience, yet few studies have explored their trends and their relationship throughout the progression of traumatic events. This paper explores the longitudinal relationship between resilience and PTG, as well as the role of job burnout in this relationship, among frontline healthcare workers during the COVID-19 pandemic, who have been exposed to high-risk work environments over extraordinarily long workdays. In Study 1, 134 Chinese frontline healthcare workers completed a three-wave survey (Time 1, Time 2, and Time 3) in February-May 2020. In Study 2, 401 frontline healthcare workers completed a cross-sectional survey. The cross-lagged analysis suggested that resilience at Time 1 positively predicted PTG at Time 2, which in turn positively predicted resilience at Time 3. PTG at Time 1 also positively predicted resilience at Time 2 (Study 1). However, job burnout was negatively related to both resilience and PTG; in particular, emotional exhaustion moderated the link between PTG and resilience (Study 2). Our findings support a cycle of reinforcement between resilience and PTG over time. The positive effect of PTG on resilience, however, is undermined by emotional exhaustion. Implications for future intervention research and workplace support are discussed.

Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases.

Over the past half-century, medical research on cardiovascular disease (CVD) has achieved a great deal; however, medication adherence is unsatisfactory. Nearly 50% of patients do not follow prescriptions when taking medications, which limits the ability to maximize their therapeutic effects and results in adverse clinical outcomes and high healthcare costs. Furthermore, the effects of medication adherence interventions are disappointing, and tailored interventions have been proposed as an appropriate way to improve medication adherence. To rethink and reconstruct methods of improving medication adherence for CVD, the literature on tailored interventions for medication adherence focusing on CVD within the last 5 years is retrieved and reviewed. Focusing on identifying nonadherent patients, detecting barriers to medication adherence, delivering clinical interventions, and constructing theories, this article reviews the present state of tailored interventions for medication adherence in CVD and also rethinks the present difficulties and suggests avenues for future development.

Military Career Adaptability Questionnaire in China: Development and Validation.

OBJECTIVE: To develop the Military Career Adaptability Questionnaire (MCAQ) in China and to test its reliability and validity. METHODS: In study 1, an open-ended questionnaire survey was conducted among 200 military personnel. Based on the empirical construction by military personnel of various branches, the dimensions of the MCAQ were constructed, and a preliminary questionnaire was prepared. In study 2, the questionnaire survey was conducted in 1,578 participants enrolled through stratified cluster sampling. They were randomly divided into two groups (n = 789). Sample 1 was used for item analysis and exploratory factor analysis, and sample 2 was used for confirmatory factor analysis and internal consistency testing. In sample 1, the participants were selected to test the test-retest reliability of the questionnaire at a 4 weeks interval. In sample 2, participants were selected to test criterion validity using the Psychological Capital Questionnaire and the Job Satisfaction Questionnaire. RESULTS: According to study 1, we obtained an initial 23-item MCAQ containing five dimensions (organization and fusion ability, communication ability, learning development ability, emotion regulation ability, and career transformation ability). After the exploratory factor analysis in study 2, 21 items contributing 72.17% of the total variance remained. Via the subsequent confirmatory factor analysis, the model was confirmed to have good fit indices [chi-square/degree of freedom (X 2/df) = 3.11, goodness of fit index (GFI) = 0.90, normed fit index (NFI) = 0.91, incremental fit index (IFI) = 0.94, tucker lewis index (TLI) = 0.93, comparative fit index (CFI) = 0.94, standardized root mean square residual (SRMR) = 0.07]. These five factors were significantly correlated with the total score of the MCAQ (r = 0.73-0.79, p < 0.01). The Cronbach α coefficient of the questionnaire was 0.92; the Cronbach α coefficients of the five factors were 0.89, 0.83, 0.88, 0.84, and 0.79, respectively, the test-retest reliability of the questionnaire was 0.93. CONCLUSION: The MCAQ developed in this study has a clear five-factor structure and good reliability and validity. It can be used to assess the career adaptability of military personnel to provide a theoretical basis for military vocational psychological education.

Anxiety and depression aggravate impulsiveness: the mediating and moderating role of cognitive flexibility.

Empirical research suggested that individuals with anxiety and/or depression exhibited action on the spur of the moment, with little consideration for the consequences of their actions. However, it remains unclear whether the precise mechanisms underlying the impacts of anxiety and depression on impulsivity. The present study examined how anxiety and depression influence impulsivity, as well as the mediating and moderating role of cognitive flexibility. A sample of 477 Chinese university students was recruited. All participants finished self-report measures of anxiety, depression, impulsivity, and cognitive flexibility. No significant gender difference was found in anxiety, depression, cognitive flexibility, and three subscale scores of impulsivity. Greater scores of anxiety and depression were associated with lower scores of cognitive flexibility and higher levels of impulsivity. Depression and cognitive flexibility could predict attention impulsivity and nonplanning impulsivity, while anxiety and cognitive flexibility could predict motor impulsivity. Cognitive flexibility served as a mediator in the links of anxiety and three subscales of impulsivity. Furthermore, cognitive flexibility moderated the impact of anxiety on motor impulsivity.

A randomized controlled trial of well-being therapy to promote adaptation and alleviate emotional distress among medical freshmen.

BACKGROUND: Maladjustment and emotional distress are extremely prevalent among first-year medical students in college and are associated with numerous negative consequences for medical freshmen, their families and universities. The current research aimed to detect the efficacy of a well-being therapy in promoting adaptation to college life and alleviating emotional distress among medical freshmen. METHODS: One hundred one participants who met the inclusion criteria were enrolled in a single-blind randomized controlled trial. Well-being therapy was given to the intervention group weekly for 5 weeks (WBT, n = 50). At the same time, students in the placebo control condition (CC, n = 51) were required to record early memory for 5 weeks and at weekly meetings it would be shared voluntarily. Psychological well-being, adaptation, anxiety and depression were recorded at pretest, posttest, and at three-month follow-up. Data from 87 first-year students with complete follow-ups (WBT, n = 39; CC, n = 48) were analyzed over three time periods. RESULTS: Compared with the control group, students undergoing the 5-week well-being therapy reported larger improvements in psychological well-being and adaptation, and greater alleviation in symptoms of anxiety and depression from pretest to posttest to follow-up. CONCLUSIONS: Well-being intervention may provide first-year medical students with skills to efficiently manage maladjustment and emotional distress. It seems that medical freshmen would benefit a lot when such an intervention programme could be incorporated into the general medical education. TRIAL REGISTRATION NUMBER: ChiCTR-ROC-17012636. Registered 11 September 2017 (Retrospectively registered) at Chinese Clinical Trial Registry.

Moderating Effect of Mindfulness on the Relationships Between Perceived Stress and Mental Health Outcomes Among Chinese Intensive Care Nurses.

This study aimed to explore the potential moderating effect of mindfulness and its facets on the relationships among perceived stress and mental health outcomes (burnout, depression, anxiety, and subjective well-being) among Chinese intensive care nurses. A total of 500 Chinese intensive care nurses completed self-report measures of mindfulness, burnout syndromes, perceived stress, depression, anxiety, and subjective well-being. Correlation and hierarchical multiple regressions were applied for data analysis. Mindfulness moderated the effects of perceived stress on emotional exhaustion (the core component of burnout syndrome), depression, anxiety, positive affect, and negative affect but not on the other two dimensions of burnout and life satisfaction. Further analyses indicated that the ability to act with awareness was particularly crucial in improving the effects of perceived stress on depression. These results further broaden our understanding of the relationships between perceived stress and burnout, depression, anxiety, and subjective well-being by demonstrating that mindfulness may serve as a protective factor that alleviates or eliminates the negative effects of perceived stress on depression, anxiety, burnout syndrome, and subjective well-being and may instigate further research into targeted mindfulness interventions for Chinese intensive care nurses.

Frontal Alpha EEG Asymmetry Before and After Positive Psychological Interventions for Medical Students.

Subjective well-being (SWB) refers to traits concerned with happiness, fulfillment and enrichment and is a substantial predictor of a flourishing life. Interest in the promotion of well-being has blossomed in recent years, and it is widely reported that positive psychological interventions (PPIs) can effectively improve SWB. However, to date, the neural correlates of PPIs remain elusive. Since previous research has suggested that emotion regulation might be the theoretical foundation for potential working mechanisms, here we used electroencephalography (EEG) techniques to identify whether the intentional increase of subjective well-being through PPIs was associated with greater tonic left frontal activation. Fifty-five students met the inclusion criteria and were allocated to a randomized controlled trial that was single blinded. The intervention group received PPIs once a week for 10 weeks (n = 28). Meanwhile, students in a placebo control group (CG, n = 27) were asked to write down early memories every day for 10 weeks and were invited to share voluntarily at the weekly meeting. Measures of subjective well-being, depression and anxiety were assessed at pre-test and post-test. Forty-eight students completed the post-test, and the collected data were analyzed across time (PPIs, n = 25; CG, n = 23). It was found that students undergoing the 10-week PPIs reported larger improvement in SWB, and greater relief in self-rated depression and anxiety from pre-intervention to post-intervention than did those in the control group. As expected, in conjunction with the promotion of subjective well-being and the amelioration of emotional distress from pre- to post-treatment in the intervention group, a significantly increased coefficient of frontal alpha EEG asymmetry was found. In summary, these findings suggest that adaptive emotion regulation, which is characteristic of greater tonic left frontal activation, reflects the efficiency of PPIs and highlights the frontal alpha EEG asymmetry as a neural substrate linking PPIs and mental health. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR-ROC-17012636.

Transcriptional Regulation Involved in Fear Memory Reconsolidation.

Memory reconsolidation has been demonstrated to offer a potential target period during which the fear memories underlying fear disorders can be disrupted. Reconsolidation is a labile stage that consolidated memories re-enter after memories are reactivated. Reactivated memories, induced by cues related to traumatic events, are susceptible to strengthening and weakening. Gene transcription regulation and protein synthesis have been suggested to be required for fear memory reconsolidation. Investigating the transcriptional regulation mechanisms underlying reconsolidation may provide a therapeutic method for the treatment of fear disorders such as post-traumatic stress disorder (PTSD). However, the therapeutic effect of treating a fear disorder through interfering with reconsolidation is still contradictory. In this review, we summarize several transcription factors that have been linked to fear memory reconsolidation and propose that transcription factors, as well as related signaling pathways can serve as targets for fear memory interventions. Then, we discuss the application of pharmacological and behavioral interventions during reconsolidation that may or not efficiently treat fear disorders.

Impaired Cognitive Control of Emotional Conflict in Trait Anxiety: A Preliminary Study Based on Clinical and Non-Clinical Individuals.

BACKGROUND: It has been observed that trait anxiety easily leads to conflict maladaptation under conflict circumstances. However, it remains unclear whether the precise neural mechanisms underlying the effects of high trait anxiety (HTA) on cognitive control are consistent in high trait anxious individuals, with and without anxiety disorders. METHODS: The present study recruited 29 healthy volunteers with low trait anxiety (LTA), 37 healthy volunteers with HTA, and 23 patients with generalized anxiety disorder (GAD). All participants completed demographic information and self-report measures of trait anxiety and depression. Then, they performed the emotional flanker task with event-related potentials (ERPs) recorded. RESULTS: Behavioral data manifested that, relative to LTA individuals, GAD patients displayed prolonged response times and increased error rates, while HTA individuals showed intact response times and accuracies. Event-related potential (ERP) data revealed that HTA individuals exhibited a trend toward more negative N2 amplitudes for conflict detection. By contrast, both HTA and GAD individuals displayed decreased P3 amplitudes for conflict resolution. ERP results indicated that both HTA and GAD individuals exhibited conflict maladaptation on the N2 amplitude. Correlation analyses also showed that the increased anxiety symptoms were associated with longer reaction times, more error rates, lower P3 amplitudes, and more perturbations in conflict adaptation on reaction times and N2 amplitudes. CONCLUSION: Our results demonstrated a severely impaired cognitive control in GAD patients while a moderately impaired cognitive control in HTA individuals. Trait anxiety can indeed serve as a predominant factor at the onset and in the maintenance of GAD. Therefore, the trait anxiety reducing strategies may provide significant therapeutic gains.

Resilience and Cognitive Bias in Chinese Male Medical Freshmen.

BACKGROUND: Psychological resilience has become a hot issue in positive psychology research. However, little is known about cognitive bias difference of individuals with different resilience levels. This study aimed to explore the characteristics of cognitive bias and its role in Chinese medical freshmen with different resilience levels. METHODS: 312 Chinese medical freshmen were surveyed by the Chinese version of Connor-Davidson Resilience Scale, 92 of whom were, respectively, allocated into high (n = 46) and low (n = 46) resilient group to complete computerized tests using an attentional shifting task and an emotional picture recognition task. RESULTS: All participants had the highest recognition accuracy toward negative pictures compared to neutral and positive ones. By comparison, it was found that the high-resilient group had a longer recognition response time toward positive emotional pictures, but a shorter response time toward negative emotional pictures, while the low-resilient group had a longer response time toward negative emotional pictures. CONCLUSION: This study pointed to the association between resilience and cognitive bias. Medical freshmen with different resilience levels showed significant differences in the cognitive bias toward emotional pictures, suggesting that reducing negative cognitive bias and promoting positive cognitive bias could be important targets to increase resilience.