Emotion, stress, and cardiovascular response: an experimental test of models of positive and negative affect.

BACKGROUND: The nature of the relationship between positive affect (PA) and negative affect (NA) has been a topic of debate for some time. In particular, there are gaps in our knowledge of the independent effects of PA and NA on health under stress. PURPOSE: The study examined the effects of a laboratory-induced stressor on the experience of PA and NA, and the effects of affect on cardiovascular (CV) reactivity and recovery. METHOD: A sample of 56 female college students was randomly assigned to a public speaking (stress) task or a silent reading (control) task. Pre- and posttask PA and NA were measured using the Positive and Negative Affect Schedule (PANAS Watson J Pers Soc Psychol 54:1,063-1,070, 1988). Baseline, task, and posttask cardiovascular measures were also recorded. RESULTS: The results indicated that PA and NA responded differently to the stressor and contributed independently to the prediction of both CV reactivity and recovery. Of particular interest was the finding that higher levels of both PA and NA predicted greater CV recovery. CONCLUSION: Results are discussed in light of the debate concerning the (in)dependence of positive and negative emotions and the importance of understanding the dynamics of emotions, stress, and health.

Psychosocial care in mental health nursing: a think aloud study.

AIM: This paper is a report of a study identifying psychosocial interventions relevant to routine care and exploring their content critically and analysing patterns in the use of these interventions. BACKGROUND: People experiencing enduring and serious mental disorders value psychosocial engagement as a means of achieving recovery and rehabilitation. However, mental health nurses' use of person-centred and directive psychosocial engagement in routine care is unclear, with the potential arising for benevolence and paternalism. METHOD: A think aloud study was carried out with 37 mental health nurses responding to a simulated case depicting a person with an enduring mental health problem. Participants were recruited from community and acute hospital facilities across Ireland and responded to two tasks: identifying the nature of the person's problems and recommending what to do next. Transcripts were coded using judgement and intervention themes designed for the purpose. Patterns in the use of psychosocial intervention themes were described and further analysed by level of experience (highly experienced or not) and practice setting (acute/community setting). FINDINGS: A task-oriented psychosocial intervention labelled structured engagement was used extensively, followed by reassurance and encouragement based on pragmatic communication. A minority of nurses used dialogue, representing person-centred care. Highly experienced community mental health nurses were the most likely to talk in terms of intensive psychosocial engagement. CONCLUSION: Relying on pragmatic problem-solving is problematic in terms of decision-making transparency and service user involvement. The use of informal knowledge in practice should be negotiated through more open discussion by nurses, including adoption of a consensus on the components of psychosocial care.

Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation: A Randomized Controlled Study.

BACKGROUND: This study tested the effectiveness of a computerized mindfulness-based cognitive therapy intervention compared with computerized pain management psychoeducation in a randomized study. METHODS: Using an intention-to-treat approach, 124 adult participants who reported experiencing pain that was unrelated to cancer and of at least 6 months duration were randomly assigned to computerized mindfulness-based cognitive therapy ("Mindfulness in Action" [MIA]) or pain management psychoeducation programs. Data were collected before and after the intervention and at 6-month follow-up. RESULTS: Participants in both groups showed equivalent change and significant improvements on measures of pain interference, pain acceptance, and catastrophizing from pretreatment to posttreatment and the improvements were maintained at follow-up. Average pain intensity also reduced from baseline to posttreatment for both groups, but was not maintained at follow-up. Participants in both groups reported increases in subjective well-being, these were more pronounced in the MIA than the pain management psychoeducation group. Participants in the MIA group also reported a greater reduction in pain "right now," and increases in their ability to manage emotions, manage stress, and enjoy pleasant events on completion of the intervention. The changes in ability to manage emotions and stressful events were maintained at follow-up. CONCLUSIONS: The results of the study provide evidence that although there were equivalent changes across outcomes of interest for participants in both conditions over time, the MIA program showed a number of unique benefits. However, the level of participant attrition in the study highlighted a need for further attention to participant engagement with online chronic pain programs.

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial.

INTRODUCTION: Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive-behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. METHODS AND ANALYSIS: Participants with non-malignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. ETHICS AND DISSEMINATION: The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN18166896.