Search inside yourself: investigating the effects of a widely adopted mindfulness-at-work development program.

Purpose ­: Workplace mindfulness training has many benefits, but designing programs to reach a wide audience effectively and efficiently remains a challenge. The purpose of this study is to assess the effects of a widely adopted workplace mindfulness program on the mindfulness, active listening skill, emotional intelligence, and burnout of employees in a large, multinational internet company. Design/methodology/approach ­: The study sample included 123 employees across three company offices who completed the two-day Search Inside Yourself (SIY) program. Data were collected using self-report measures pre-, post-, and four-weeks post-intervention and were analyzed using paired samples t-tests. Findings ­: Significant increases were detected in mindfulness and the "awareness of emotion" components of emotional intelligence four weeks post-course. No significant changes were found in participants' self-reported levels of burnout, active listening skill or the "management of emotion" components of emotional intelligence. Practical implications ­: Teaching workplace mindfulness and emotional intelligence skills through a highly applied, condensed course format may be effective for increasing mindfulness and the "awareness" components of emotional intelligence. Longer courses with more applied practice may be necessary to help participants build emotional management and listening skills and to reduce burnout. Originality/value ­: The present study is, to the authors' knowledge, the first academic, peer-reviewed assessment of SIY, a workplace mindfulness training program that has been taught to over 50,000 people worldwide.

The Psychology of Shoplifting: Development of a New Typology for Repeated Shoplifting.

Despite the damaging effects of shoplifting on individuals, the current literature offers little guidance for changing shoplifting behavior. One limitation in this area of research has been the failure to use empirically and theoretically sound methodologies to identify individuals' diverse characteristics and motivations. The present study addressed these limitations by developing an empirically and theoretically supported typology of the varied individuals who shoplift. Participants included 202 community individuals who reported repeated shoplifting and provided information about their shoplifting behavior, motivations, mental health, ethical attitudes, personal histories, and life circumstances. Cluster analyses revealed that the sample could be divided into six discrete groups. These clusters comprise a typology of shoplifting, including Loss-Reactive (28% of the sample), Impulsive (20%), Depressed (18%), Hobbyist (18%), Addictive-Compulsive (9%), and Economically Disadvantaged (7%) types. Each type comprises a unique pattern of shoplifting with unique needs. This research establishes a promising foundation for treating the diverse individuals who shoplift.

Precursors to Heterophobia: An Examination of Temporal Sequence Among a Sample of Gay Men.

Heterophobia, defined as gay men's fear and avoidance of heterosexual men, has been linked to behavioral health outcomes and could contribute to social disconnectedness and intergroup conflict. The Gay Male Heterophobia Scale assesses 3 meaningful aspects of gay male heterophobia: disconnectedness, expected rejection, and unease/avoidance. The current study sought to assess the development of heterophobia among gay men over 2 weeks using a longitudinal cross-lagged panel design. Using data gathered from 253 gay-identified men collected on MTurk, the results indicated that disconnectedness is an important mediator in the relationship between minority stress and unease/avoidance of heterosexual men but does not mediate the relationship between minority stress and expectations of rejection. Implications for future research and clinical applications are provided, in addition to a discussion of study limitations.

Development of the Gay Male Heterophobia Scale.

The current study presents the initial validation of a new 20-item measure of heterophobia, a construct frequently discussed but inadequately researched in the literature on gay men's lives. This process included initial focus groups, exploratory and confirmatory national samples of gay men. The sample included measures of homophobia, rejection sensitivity, discrimination history, gay identity development, and social desirability to address convergent and discriminant validity. Results of an exploratory factor analysis yielded three meaningful factors: Disconnectedness, Expected Rejection, and Unease/ Avoidance. These factors had significant positive associations with constructs such as rejection sensitivity, homonegativity, and previous experiences of gay-related discrimination, but were only weakly associated with gay identity development. Heterophobia factors had insignificant or negative correlations with social desirability. This factor structure was supported by the results of confirmatory factor analyses. Implications for future research and clinical practice, along with limitations, are provided.

An academic-marketing collaborative to promote depression care: a tale of two cultures.

OBJECTIVES: Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. METHODS: An interdisciplinary group of academic researchers contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. RESULTS: There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients' struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: (a) educating the patient to consider and investigate the possibility of depression; (b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and (c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, "Faces," involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the academic team was present and consulted closely during production. Challenges included reconciling the marketing tradition of audience segmentation with the overall project goal of reaching as broad an audience as possible; integrating research findings across dimensions of words, images, music, and tone; and dealing with misunderstandings related to project scope and budget. CONCLUSION: Mixed methods research can usefully inform PSAs that incorporate patient perspectives and are produced to professional standards. However, tensions between the academic and commercial worlds exist and must be addressed. PRACTICE IMPLICATIONS: While rewarding, academic-marketing collaborations introduce tensions which must be addressed.

Role of the gender-linked norm of toughness in the decision to engage in treatment for depression.

OBJECTIVE: Given their prevalence and persuasive power in our culture, gender norms--commonly described as socially reinforced, learned expectations of what it means to be a man or a woman--likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment ("wait-and-see" approach). METHODS: Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions. RESULTS: Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=-.70, p<.01). Men's greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.03). CONCLUSIONS: Men's greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women's treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.

Relational barriers to depression help-seeking in primary care.

OBJECTIVE: To identify attitudinal and interpersonal barriers to depression care-seeking and disclosure in primary care and in so doing, evaluate the primary care paradigm for depression care in the United States. METHODS: Fifteen qualitative focus group interviews in three cities. Study participants were English-speaking men and women aged 25-64 with first-hand knowledge of depression. Transcripts were analyzed iteratively for recurring themes. RESULTS: Participants expressed reservations about the ability of primary care physicians (PCPs) to meet their mental health needs. Specific barriers included problems with PCP competence and openness as well as patient-physician trust. While many reflected positively on their primary care experiences, some doubted PCPs' knowledge of mental health disorders and believed mental health concerns fell outside the bounds of primary care. Low-income participants in particular shared stories about the essentiality, and ultimate fragility, of patient-PCP trust. CONCLUSION: Patients with depression may be deterred from care-seeking or disclosure by relational barriers including perceptions of PCPs' mental health-related capabilities and interests. PRACTICE IMPLICATIONS: PCPs should continue to develop their depression management skills while supporting vigorous efforts to inform the public that primary care is a safe and appropriate venue for treatment of common mental health conditions.

"I didn't know what was wrong:" how people with undiagnosed depression recognize, name and explain their distress.

BACKGROUND: Diagnostic and treatment delay in depression are due to physician and patient factors. Patients vary in awareness of their depressive symptoms and ability to bring depression-related concerns to medical attention. OBJECTIVE: To inform interventions to improve recognition and management of depression in primary care by understanding patients' inner experiences prior to and during the process of seeking treatment. DESIGN: Focus groups, analyzed qualitatively. PARTICIPANTS: One hundred and sixteen adults (79% response) with personal or vicarious history of depression in Rochester NY, Austin TX and Sacramento CA. Neighborhood recruitment strategies achieved sociodemographic diversity. APPROACH: Open-ended questions developed by a multidisciplinary team and refined in three pilot focus groups explored participants' "lived experiences" of depression, depression-related beliefs, influences of significant others, and facilitators and barriers to care-seeking. Then, 12 focus groups stratified by gender and income were conducted, audio-recorded, and analyzed qualitatively using coding/editing methods. MAIN RESULTS: Participants described three stages leading to engaging in care for depression - "knowing" (recognizing that something was wrong), "naming" (finding words to describe their distress) and "explaining" (seeking meaningful attributions). "Knowing" is influenced by patient personality and social attitudes. "Naming" is affected by incongruity between the personal experience of depression and its narrow clinical conceptualizations, colloquial use of the word depression, and stigma. "Explaining" is influenced by the media, socialization processes and social relations. Physical/medical explanations can appear to facilitate care-seeking, but may also have detrimental consequences. Other explanations (characterological, situational) are common, and can serve to either enhance or reduce blame of oneself or others. CONCLUSIONS: To improve recognition of depression, primary care physicians should be alert to patients' ill-defined distress and heterogeneous symptoms, help patients name their distress, and promote explanations that comport with patients' lived experience, reduce blame and stigma, and facilitate care-seeking.

Barriers in diagnosing and treating men with depression: a focus group report.

This study reports on the experiences of 45 male focus group participants with a history of depression. Men responded to questions addressing the interaction between the male role, masculinity, depression, and experiences with treatment for depression. Using a qualitative, thematic-based coding strategy, three primary themes emerged. First, participants described aspects of the male gender as being in conflict or incongruent with their experiences of depression and beliefs about appropriate help-seeking behaviors. Second, men outlined alternative symptom profiles that could interfere with the recognition of depression and willingness to seek help. Finally, men expressed a range of positive and negative reactions toward depression treatment and treatment providers. Implications for health care providers are provided.

Encouraging patients with depressive symptoms to seek care: a mixed methods approach to message development.

OBJECTIVE: To assess the message preferences of individuals affected by depression as part of a project that will evaluate interventions to encourage at-risk patients to talk to their physicians about depression. METHODS: Adaptive Conjoint Analysis (ACA) of 32 messages defined by 10 message attributes. Messages were developed based on input from three focus groups comprised of individuals with a personal and/or family history of depression, then tested using volunteers from an Internet health community. In an online conjoint survey, 249 respondents with depression rated their liking of the messages constructed for each attribute. They were then presented with two message sets and rated their preferences. Preference utilities were generated using hierarchical Bayes estimation. RESULTS: The optimal communication approach described both psychological and physical symptoms of depression, recognized multiple treatment options, offered lifetime prevalence data, noted that depression can affect anyone, and acknowledged that finding an effective treatment can take time. CONCLUSION: Individuals with depression respond differently to depression care messages, underscoring the need for careful message development and evaluation. PRACTICE IMPLICATIONS: ACA, used in conjunction with focus groups, is a promising approach for developing and testing messages in the formative research stage of intervention development.

Health educators' perceptions of a sexual health intervention for homeless adolescents.

OBJECTIVE: The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents. METHOD: Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques. RESULTS: Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population. CONCLUSIONS: The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population. PRACTICE IMPLICATIONS: Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible.

Marketing mental health to men: theoretical and practical considerations.

The current paper addresses the importance of and relevant challenges pertaining to the marketing of mental health to men. Included are pertinent definitions, a review of related research, and a discussion of recent large-scale gender-specific mental health campaigns. In addition, central aspects of the social marketing framework considered to be particularly useful for addressing men's resistance to help seeking are reviewed. Suggestions for future research topics are also provided.

Men in (and out of) therapy: central concepts, emerging directions, and remaining challenges.

This article introduces the special issue on recent conceptual, practical, and research developments relevant to men and therapy. The paper reviews the considerable shifts that have emerged in our understanding and measurement of masculinity as it pertains to men's health and therapy. In addition, this introduction outlines the primary focus of each article in this special issue and describes the general guidelines offered to the contributors. Collectively, these special-issue articles describe promising paradigms, provide useful examples, and stress the need for further research on men, masculinity, and the therapeutic process.

Online therapy: review of relevant definitions, debates, and current empirical support.

The current article reviews the most recent literature addressing the definitions, ethical considerations, and potential strengths and limitations of online therapy. In addition, a framework is provided for how to conceptualize and categorize different aspects of online therapy for research purposes. Relevant studies of both online and face-to-face therapy as well as suggestions for future research are outlined.