The Relationship of Mentorship to Career Outcomes in Academic Psychiatry and Psychology: a Needs Assessment.

OBJECTIVE: Faculty development is designed to facilitate career advancement of junior faculty but there is limited empirical evidence on how to design an effective program. METHODS: As a first step in the design of an effective program, a needs assessment was conducted. Participants were faculty members of an academic psychiatry department. Participants completed a quantitative and qualitative survey assessing their experience with mentors, academic self-efficacy, career burnout and satisfaction, academic productivity, and perceived barriers to scholarship. RESULTS: Eighty percent (N = 104) of eligible faculty members completed the study survey (54% female; 81% White, 10% underrepresented in medicine). Less than half of the respondents (44%) reported having a current mentor. Number of mentors (r = .33; p < .01), mentorship meetings (r = .35; p < .01), and mentorship quality (r = .33; p < .01) were significantly correlated to a standardized measure of academic self-efficacy. Self-efficacy was significantly associated with academic productivity (r = .44; p < .001) and career satisfaction (r = .29; p < .05). The top barriers to scholarship productivity were time and lack of access to resources. Faculty members without a mentor endorsed more barriers to scholarship (p < .001) than those with a mentor. Themes that emerged from the qualitative data suggest that mentorship supports career advancement through coaching and professional development, invitations to collaborate and resource share, networking, and active teaching. CONCLUSION: Based on the relationship of mentoring to career outcomes, a robust faculty development program needs a formal academic mentorship program to improve career satisfaction and academic productivity.

Medical students describe their wellness and how to preserve it.

BACKGROUND: Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students. METHODS: Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018-2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters. RESULTS: Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn't address the medical culture met with skepticism. CONCLUSIONS: Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students' identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

Expanding Access to Social Support in Primary Care via Telemedicine: A Pilot Study.

The coronavirus pandemic quickly exposed the need for efficient and widespread implementation of telehealth services. Additionally, it further unveiled the impact of social and environmental barriers to healthcare in underserved, rural populations. This in-practice pilot study tested the utility of a geographically centralized social worker providing services between a patient and a primary care provider via telecommunication at two high volume rural outpatient family practice clinics. Outcome measures included patient and provider satisfaction. Twenty-two telehealth social work encounters occurred spanning both adult and pediatric patients. Data collected from patients, primary care providers, and social work staff revealed positive feedback. The data from our small pilot study demonstrated that social work triage delivered via a tablet was an acceptable and valued resource in busy primary care practices.

Engaging primary care providers in managing pediatric eating disorders: a mixed methods study.

BACKGROUND: The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers' perspective of challenges to identifying and managing eating disorders in the primary care setting. METHODS: This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. RESULTS: Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. CONCLUSIONS: Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

The importance of bereavement cognitions on grief symptoms: Applications of cognitive processing therapy.

The experience of bereavement and trauma share some overlapping features, such as changes in the cognitive processing of information. This article explored the extent to which cognitive processes during bereavement influence coping outcomes in relation to grief in a sample of university students who had been previously bereaved (N = 104). First, we examined differences in bereavement outcomes based on whether cognitive processes associated with the bereavement were accommodated (n = 55), over-accommodated (n = 25), or assimilated (n = 24). Results indicate that grief-related outcomes significantly differed as a result of cognitive processes. We then compared the degree to which these cognitive processes accounted for grief outcomes in individuals with high and low grief symptoms. In individuals with low grief levels, both depressive symptoms and grief cognitions significantly accounted for grief levels. However, in individuals with high grief levels, only cognitive processes significantly accounted for levels of grief. Results from this study underscore the importance of examining cognitive processes during bereavement. Future research should further examine the underlying mechanisms that contextualize both the bereavement and cognitive processes surrounding the loss. Finally, results from this study highlight the associated cognitive processing of information as a potential topic for targeted treatment in bereavement.

Comprehensive meta-analysis of resilience interventions.

BACKGROUND/RATIONALE: There is no current consensus on operational definitions of resilience. Instead, researchers often debate the optimal approach to understanding resilience, while continuing to explore ways to enhance and/or promote its qualities in various populations. The goal of the current meta-analysis is to substantiate existing evidence examining the promotion of resilience through various interventions. Particular emphasis was placed upon the factors that contribute to variability across interventions, such as age, gender, duration of intervention, intervention approaches and risk exposure of targeted population. METHOD: The literature search was conducted on May 28, 2019. Search terms included "resilience intervention" OR "promoting resilience" OR "promoting resiliency" OR "resilience-based intervention". A total of 268 studies, with 1584 independent samples, were included in the meta-analysis. In addition to overall efficacy, outcome-based analyses were conducted for intervention outcomes based on action, biophysical, coping, emotion, resilience, symptoms, and well-being. Finally, moderators of age, gender, length of intervention, intervention approach, intervention target, and the level of risk exposure of the sampled population were examined as moderators. RESULTS: The multi-level meta-analysis indicated that resilience-promoting interventions yielded a small, but statistically significant overall effect, Hedges's g = 0.48 (SE = 0.04, 95% CI = [0.40, 0.56]. The variability in study effect sizes within and between studies was significant, p < .001, with many falling short of the threshold for practical significance. DISCUSSION: Findings lend some support for the overall efficacy of resilience interventions. However, empirical results should be cautiously interpreted in tandem with their theoretical relevance and potential advancements to the construct of resilience. Variabilities across findings reflect the current ambiguities surrounding the conceptualization and operationalization of resilience. Directions for future research on resilience as well as practical considerations are discussed.

The feasibility of verbal and virtual reality exposure for youth with academic performance worry.

With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.

Investigating the therapeutic potential of cognitive bias modification for high anxiety sensitivity.

BACKGROUND AND OBJECTIVES: Individuals with high anxiety sensitivity (AS) display negative interpretive biases in response to uncomfortable but nondangerous physical sensations. Research suggests that modifying interpretation biases associated with AS leads to changes in AS. The present study sought to replicate and extend this research by addressing limitations of previous studies, increasing the amount of training and adding a follow-up period. METHOD: Participants high in AS were randomly assigned to four sessions of computerized interpretation bias modification (CBM-I) training or four sessions of computerized "sham" training (control condition) over a 2-week period. The outcomes were AS, interpretive biases, and reactions to induced physical sensations. Assessments occurred at baseline, during training, immediately after the final training session, and 2 weeks after the final training; number of re-assessments varied by outcome. RESULTS: The CBM-I condition did not outperform the control condition. At the end of the training period, the CBM-I condition displayed limited reductions in AS and interpretation biases. There were no changes in reactions to induced physical sensations. Similar results were found in the control condition for all outcomes. LIMITATIONS: The control task and the dose of training may have obscured potential effects of CBM-I. CONCLUSIONS: When considered within the context of previous research, the experimental effects and therapeutic potential of CBM-I for high AS appear to be minimal. However, methodological questions need to be resolved before such a conclusion can be considered definitive.

Stress Management and Resiliency Training in a Nurse Residency Program: Findings From Participant Focus Groups.

Stress is a well-recognized phenomenon in the nursing profession, particularly for new nurses. This study (a) assessed nurse residents' experience with a stress management program and (b) informed adjustments to the program. Analysis of qualitative data revealed three themes: (a) enhanced personal and professional development, (b) sensitivity to learner needs, and (c) fostering the principles of mindfulness. A stress management program has the potential to positively enhance the new nurse's transition to work.

Reframing the individual stress response: Balancing our knowledge of stress to improve responsivity to stressors.

Although responses to stressors have both adverse and positive consequences on health, many believe that stress is entirely negative. Research revealed that negative beliefs about stress can hinder well-being and result in the avoidance of stressors. Stress-optimizing interventions that target various stress appraisal processes may be a useful tool to reframe how individuals understand and respond to stressors. The current study extends previous findings on stress reframing and sought to examine the extent to which the presentation of information about stress outcomes may influence the individual to respond to subsequent stressors. Seventy-seven undergraduate students (96% female) were randomized into one of four reframing conditions (balanced stress outcomes, negative stress outcomes, positive stress outcomes, and control) and underwent a psychosocial stressor. Results highlight similarities between balanced and positive framings of stress across measures of heart rate and blood pressure, whereas subjective ratings of stress and electrodermal activity suggest balanced framing may be efficacious in attenuating stress. Findings are discussed in the context of differing stress-optimizing interventions and consider the complexities of the individual stress response.

The efficacy of stress reappraisal interventions on stress responsivity: A meta-analysis and systematic review of existing evidence.

BACKGROUND: The beliefs we hold about stress play an important role in coping with stressors. Various theoretical frameworks of stress point to the efficacy of reframing stress-related information through brief reappraisal interventions in order to promote adaptive coping. PURPOSE: The goal of the current meta-analysis and systematic review is to substantiate the efficacy of reappraisal interventions on stress responsivity compared to control conditions. Differences in experimental methodologies (e.g., type of stressor used, timing of reappraisal intervention, and content of intervention instructions) will be examined to further delineate their effects on intervention outcomes. METHODS: The literature searches were conducted on May 16, 2018 using PsycINFO, ProQuest Dissertations and Theses, and PILOTS databases with no date restriction. The search terms included stress, reframing, reappraisal, mindset and reconceptualising. A total of 14 articles with 36 independent samples were included in the meta-analysis, while 22 articles with 46 independent samples were included in the systematic review. Random-effects model was used to test the null hypothesis using two-tailed significance testing. Fisher's Z value was reported for each corresponding test. Heterogeneity tests are reported via Cochran's Q-statistics. RESULTS: Findings from both the meta-analysis and systematic review revealed that overall, reappraisal interventions are effective in attenuating subjective responsivity to stress. Standard differences in means across groups are 0.429 (SE = 0.185, 95% CI = 0.067 to 0.791; z = 2.320, p = .020). However, reappraisal intervention groups did not outperform control groups on measures of physiological stress, with standard differences of -0.084 (SE = 0.135, 95% CI = -0.349 to 0.180; z = -0.627, p = .531). Moderator analysis revealed heterogeneous effects suggesting large variability in findings. CONCLUSIONS: On one hand, findings may suggest a promising avenue for the effective management of self-reported stress and optimization of stress responses. However, more research is needed to better elucidate the effects, if any, of reappraisal interventions on stress physiology. Implications for the use of reappraisal interventions on stress optimization are discussed in the context of theoretical frameworks and considerations for future studies.

Subjective and physiological responses to the 35% carbon dioxide challenge in healthy and non-clinical control populations: a meta-analysis and systematic review.

BACKGROUND/RATIONALE: The carbon dioxide (CO2) challenge has been reliably used in laboratory settings as a panicogen in clinical populations. However, the magnitude of these effects on healthy and non-clinical control populations are not clear. The aim of this meta-analysis and systematic review is to provide quantitative estimates of those effects. Specifically, the current paper will evaluate the relative efficacy of the CO2 challenge in eliciting both subjective and physiological arousal in healthy and non-clinical control populations. METHOD: A total of 16 articles with 35 independent samples were included in the meta-analysis, while 37 studies with 74 independent samples were included in the systematic review. RESULTS: Both the meta-analysis and systematic review found the CO2 challenge to elicit an increase in subjective distress via self-reported anxiety and fear. Physiological responses via blood pressure and heart rate were heterogeneous in studies sampled, with no significant changes observed across studies. Moderator analyses revealed the variations in findings may be attributed to participant screening and invasive sampling. DISCUSSION: Findings highlight the CO2 challenge as a useful tool in the provocation of subjective distress. Implications for both the use of the CO2 challenge and its anticipated effects in healthy and non-clinical control populations are discussed.

An Online- and Mobile-Based Application to Facilitate Exposure for Childhood Anxiety Disorders.

In the current paper, we describe an integrated online- and mobile-based application for the treatment of childhood anxiety disorders, Anxiety Coach. The technology is designed to increase the use of exposure therapy by therapists and patients. We begin by outlining the clinical content and design of the application, and then review the clinical administration and theoretical basis for the program. Next, using results from an implementation feasibility study, we illustrate how data collected during application use can inform therapists, supervisors, and researchers about process variables (i.e., use of exposure) and outcomes (i.e., symptom improvement). Implications of the potential for Anxiety Coach to increase access to evidence-based treatment and directions for further research are discussed.

The effect of a very low calorie diet on subjective depressive symptoms and anxiety: meta-analysis and systematic review.

There are conflicting findings regarding the effect very low calorie diets (VLCDs) have on self-reported depressive symptoms and anxiety levels. Some studies have reported decreased subjective depressive symptoms and anxiety post-diet, whereas other studies have not. Further complicating matters, the protocol for VLCDs vary substantially across studies, which could account for the mixed findings. The primary goal of this meta-analysis and systematic review was to determine the effect VLCDs have on subjective depressive symptoms and anxiety pre- to post-diet. In addition, potential moderators (the presence/absence of behavioral therapy, duration of diet, inclusion/exclusion of low intensity exercise, and amount of weight lost) were examined to assess the effect of procedural deviations across VLCD studies on depressive symptoms and anxiety. A random-effects model was used for the meta-analysis and included nine studies with 16 independent samples. To further explain the results, study rigor was examined in the systematic review, which included 11 studies with 20 independent samples. Depressive symptoms significantly decreased pre- to post-diet when behavioral therapy was implemented during the diet, the duration of the diet was relatively long (8-16 weeks), low intensity exercise was included, and the dieters lost 14.1 kg or more post-diet. However, no difference in depressive symptoms were observed pre- to post-diet when behavioral therapy was not included, the diet was shorter (1-7 weeks), no exercise was implemented and dieters lost <14 kg of weight post-diet. There was no change in anxiety pre- to post-diet. Health care providers involved in supervising VLCDs should consider using a VLCD of at least 8 weeks that includes behavioral therapy and low intensity exercise in order to enhance the potential benefits of VLCDs on depressive symptoms. More research is required to examine the effect of VLCDs on anxiety.

Feasibility trial of an unsupervised, facility-based exercise programme for depressed outpatients.

This pilot study examined feasibility of an unsupervised, facility-based exercise programme for promoting exercise adherence among depressed adult outpatients. The potential effect of adding physical activity counselling on depressive symptoms and physical activity was also explored. Participants were randomly assigned to a 12-week programme comprising an orientation and access to fitness centre resources (control, n = 18) or that programme plus 6 physical activity counselling sessions (intervention, n = 18). Outcome measures were feasibility (fitness centre attendance over 12 weeks); Beck Depression Inventory (BDI-II) and International Physical Activity Questionnaire (IPAQ) completed at baseline and week 12; and qualitative programme feedback. Fitness centre attendance averaged only 12 days (14% of all possible days) with no differences between study groups. No group differences were found on IPAQ or BDI-II scores at week 12. Increases from baseline in IPAQ moderate/vigorous activity minutes were associated with decreases in BDI-II scores at week 12 (p < 0.001). The most helpful programme aspect reported was connecting participants to fitness centre resources. In this pilot study of depressed outpatients, an unsupervised fitness centre based program was not feasible for promoting exercise adherence and adding physical activity counselling was not useful for increasing physical activity levels or reducing depression.

The effect of pet therapy on the physiological and subjective stress response: A meta-analysis.

Studies have reported that exposure to pet therapy (PT) can reduce physiological and subjective stress and anxiety levels. The aim of this meta-analysis is to examine the efficacy of PT as a method for reducing physiological stress levels (blood pressure and heart rate) and subjective stress and anxiety scores (self-reported stress/anxiety). Further, we examined the effects of sample characteristics and modifications to the PT (different age groups and health status of participants across samples, whether a stressor was present, and individual versus group PT) as potential moderators of the relationship between PT and stress reactivity. Our searches incorporated articles published from May 2017 and earlier in PsycINFO, MEDLINE, and PubMed. This meta-analysis included 28 articles with 34 independent samples and contained a total of 1,310 participants. Using a random effects model, we determined that significant differences occurred in heart rate, self-reported anxiety, and self-reported stress after PT exposure compared with before PT. However, we did not detect significant differences in blood pressure after PT. Sample characteristics and modifications to the PT significantly moderated the effect of PT on stress responses. Our results suggest that PT can be an effective program for reducing stress reactivity.

Health Coaching in Severe COPD After a Hospitalization: A Qualitative Analysis of a Large Randomized Study.

BACKGROUND: We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore the health-coaching intervention as seen from the perspective of the participants who received the intervention and the coaches who delivered it. METHODS: Semistructured participant interviews (n = 24) and a focus group of all health coaches (n = 3) who participated in this study were conducted. Interviews and focus group were recorded and transcribed verbatim. Transcripts were analyzed using coding and categorizing techniques and thematic analysis. Mixed-method triangulation was used to merge quantitative and qualitative data. RESULTS: Content analysis revealed 4 predominant themes of the coaching intervention: health-coaching relationship, higher participant confidence and reassurance (most related to improvement in physical quality of life), improved health-care system access (most related to decreased hospital readmissions), and increased awareness of COPD symptoms (most related to improvement in emotional quality of life). The strongest theme was the relationship with the health coach, including coach style and motivational interviewing approach. Health coaches' focus group also noted the importance of the coaching relationship as the most significant theme. CONCLUSIONS: This study provided themes to further inform the delivery and implementation of health-coaching interventions in patients with COPD after hospital discharge. Health coaching forged partnerships and created a platform for patient engagement, which was confirmed by both participants and health coaches.

Sex differences in salivary cortisol reactivity to the Trier Social Stress Test (TSST): A meta-analysis.

Some, but not all studies using the Trier Social Stress Test (TSST) have demonstrated evidence in support of sex differences in salivary cortisol. The aim of the current meta-analysis is to examine sex differences in salivary cortisol following exposure to the TSST. We further explored the effects of modifications to the TSST protocol and procedural variations as potential moderators. We searched articles published from January, 1993 to February, 2016 in MedLine, PsychINFO, and ProQuest Theses and Dissertations. This meta-analysis is based on 34 studies, with a total sample size of 1350 individuals (640 women and 710 men). Using a random effects model, we found significant heterogeneity in salivary cortisol output across sexes, such that men were observed to have higher cortisol values at peak and recovery following the TSST compared to women. Modifications to the sampling trajectory of cortisol (i.e., duration of acclimation, peak sampling time, and duration of recovery) significantly moderated the heterogeneity across both sexes. Further, there are observed sex differences at various time points of the reactive cortisol following the TSST. Lastly, current results suggest that these sex differences can be, at least in part, attributed to variations in methodological considerations across studies. Future research could advance this line of inquiry by using other methods of analyses (e.g., area under the curve; AUC), in order to better understand the effects of methodological variations and their implications for research design.

Re-conceptualizing stress: Shifting views on the consequences of stress and its effects on stress reactivity.

BACKGROUND: The consequences of stress are typically regarded from a deficit-oriented approach, conceptualizing stress to be entirely negative in its outcomes. This approach is unbalanced, and may further hinder individuals from engaging in adaptive coping. In the current study, we explored whether negative views and beliefs regarding stress interacted with a stress framing manipulation (positive, neutral and negative) on measures of stress reactivity for both psychosocial and physiological stressors. METHOD: Ninety participants were randomized into one of three framing conditions that conceptualized the experience of stress in balanced, unbalanced-negative or unbalanced-positive ways. After watching a video on stress, participants underwent a psychosocial (Trier Social Stress Test), or a physiological (CO2 challenge) method of stress-induction. Subjective and objective markers of stress were assessed. RESULTS: Most of the sampled population regarded stress as negative prior to framing. Further, subjective and objective reactivity were greater to the TSST compared to the CO2 challenge. Additionally, significant cubic trends were observed in the interactions of stress framing and stress-induction methodologies on heart rate and blood pressure. Balanced framing conditions in the TSST group had a significantly larger decrease in heart rate and diastolic blood pressure following stress compared to the positive and negative framing conditions. CONCLUSION: Findings confirmed a deficit-orientation of stress within the sampled population. In addition, results highlighted the relative efficacy of the TSST compared to CO2 as a method of stress provocation. Finally, individuals in framing conditions that posited stress outcomes in unbalanced manners responded to stressors less efficiently. This suggests that unbalanced framing of stress may have set forth unrealistic expectations regarding stress that later hindered individuals from adaptive responses to stress. Potential benefits of alternative conceptualizations of stress on stress reactivity are discussed, and suggestions for future research are made.