Fostering Cultures of Sustainability in a Multi-Unit Office Building: A Theory of Change.

Psychological approaches to fostering sustainability are heavily focused on individual behaviors and often insufficiently address the physical and social contexts individuals are embedded in. This limits the ability to create meaningful, long-lasting change, as many of day-to-day behaviors are social practices embedded in broader cultural norms and systems. This is particularly true in the work context, where organizational cultures heavily condition both the actions of individual employees and the collective actions of organizations. Thus, we argue cultures, not behaviors, must become the focus of sustainability change efforts. In this paper, we present a theory of change aimed at fostering strong organizational cultures of sustainability (COS) within a high-performance multi-tenant office building. Our theory takes a systems perspective that incorporates the social and physical aspects of the work environment, and views culture change as a co-creative exercise involving engagement of multiple stakeholders. The paper concludes with implications for practice and research.

Anxiety Reduction Among Breast-Cancer Survivors Receiving Hypnotic Relaxation Therapy for Hot Flashes.

Anxiety is common among breast-cancer survivors. This analysis examined the effect of a hypnotic relaxation therapy, developed to reduce hot flashes, on anxiety levels of female breast-cancer survivors. Anxiety was assessed using a numeric analog scale and the Hospital Anxiety and Depression Scale-Anxiety subscale. Significant reductions in anxiety were found from pre- to postintervention for each weekly session and were predictive of overall reductions in anxiety from baseline to after the last intervention. In this analysis, hypnotizability did not significantly predict for anxiety reductions measured before and after each session or from baseline to exit. These data provide initial support for the use of hypnotic relaxation therapy to reduce anxiety among breast-cancer survivors.

Difficult conversations: from diagnosis to death.

BACKGROUND: Communication is the cornerstone of good multidisciplinary medical care, and the impact of conversations about diagnosis, treatment, and prognosis is indisputable. Healthcare providers must be able to have difficult conversations that accurately describe diagnostic procedures, treatment goals, and the benefits and/or risks involved. METHODS: This paper reviews the literature about the importance of communication in delivering bad news, the status of communication training, communication strategies, and psychosocial interventions. RESULTS: Although many published guidelines address difficult communication, communication training is lacking. Consequently, many clinicians may have difficulties with, or in the worst-case scenario, avoid delivering bad news and discussing end-of-life treatment. Clinicians also struggle with how to have the last conversation with a patient and how to support patient autonomy when they disagree with a patient's choices. CONCLUSION: There is a clinical imperative to educate physicians and other healthcare workers on how to effectively deliver information about a patient's health status, diagnostic avenues to be explored, and decisions to be made at critical health junctions. Knowing how to implement the most rudimentary techniques of motivational interviewing, solution-focused brief therapy, and cognitive behavioral therapy can help physicians facilitate conversations of the most difficult type to generate positive change in patients and families and to help them make decisions that minimize end-of-life distress.

Psychosocial issues in pediatric oncology.

Psychosocial oncology, a relatively new discipline, is a multidisciplinary application of the behavioral and social sciences, and pediatric psychosocial oncology is an emerging subspecialty within the domain of psychosocial oncology. This review presents a brief overview of some of the major clinical issues surrounding pediatric psychosocial oncology.

MODERATING EFFECT OF HYPNOTIZABILITY ON HYPNOSIS FOR HOT FLASHES IN BREAST CANCER SURVIVORS.

The objective of this study was to examine the potential role of hypnotizability as a moderator of effectiveness of a hypnosis intervention for reducing hot flashes in breast cancer survivors. Sixty women were randomized into either five weekly sessions of hypnosis or a wait list control condition. Nine of the participants dropped out of the study and 24 were randomized to the control condition. There were 27 participants who completed the hypnosis intervention and for whom hypnotizability was assessed. The frequency and severity of hot flashes were measured by daily diaries completed for one week at baseline and at the end of treatment. Hypnotizability was assessed by the Stanford Hypnotic Clinical Scale. Hot flash scores were reduced by 68% on average at the end of treatment. Sequential multiple regression was used to test whether hypnotizability moderated the effect of initial hot flash scores on post-test hot flash scores. The results suggest that the hypnosis intervention was more effective for participants who scored higher on measured hypnotizability. The moderating role of hypnotizability may be useful to consider in treatment of hot flashes with the hypnosis intervention. While this study was limited to breast cancer survivors it may clarify some of the complexity of the response to hypnosis.

Perceived stress among nursing and administration staff related to accreditation.

BACKGROUND: Nurses in hospital administration and management positions may experience workplace stress, which can have important consequences on the health and well-being. PURPOSE: The aim of this study was to examine the effects of perceived stress on nursing hospital management and administrative employees of a large health care organization before and after a review by The Joint Commission on the Accreditation of Healthcare Organizations. METHODS: A total of 100 hospital employees were randomly selected to complete questionnaires assessing their perception of stress and its effect on their well-being before and after the site review. They were also asked to rate their subjective experience of sleep, anxiety, depression, and job satisfaction. RESULTS: Perceived stress was significantly related to employees' increased health concerns, symptoms of depression and anxiety, interpersonal relationships, and job satisfaction (p = .003). CONCLUSIONS: Hospital accreditation reviews may increase perceived stress and appears to be related to emotional and physical well-being. APPLICATION: The implications include evidence there is a need for organizations to initiate corrective action to help nurses in administrative roles to cope with increased levels of job strain, minimize potential psychological and physiological consequences, and preserve job satisfaction.

Preferences for hypnotic imagery for hot-flash reduction: a brief communication.

The purpose of this brief report is to identify imagery preferences of women receiving hypnotherapy to alleviate hot flashes. As part of a larger study, 51 breast cancer survivors were asked to identify their own personal preferences for imagery for reducing hot flashes. Most of the participants identified personal imagery associated with coolness; none of the participants selected imagery for warmth or heat. The most widely used was imagery involving water associated with coolness (27.0%). It is recommended that clinicians using hypnosis for reduction of hot flashes attend to patients' preferences as specific imagery may moderate the effectiveness of hypnosis for hot flashes.

Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors.

PURPOSE: Hot flashes are a significant problem for many breast cancer survivors. Hot flashes can cause discomfort, disrupted sleep, anxiety, and decreased quality of life. A well-tolerated and effective mind-body treatment for hot flashes would be of great value. On the basis of previous case studies, this study was developed to evaluate the effect of a hypnosis intervention for hot flashes. PATIENTS AND METHODS: Sixty female breast cancer survivors with hot flashes were randomly assigned to receive hypnosis intervention (five weekly sessions) or no treatment. Eligible patients had to have a history of primary breast cancer without evidence of detectable disease and 14 or more weekly hot flashes for at least 1 month. The major outcome measure was a bivariate construct that represented hot flash frequency and hot flash score, which was analyzed by a classic sums and differences comparison. Secondary outcome measures were self-reports of interference of hot flashes on daily activities. RESULTS: Fifty-one randomly assigned women completed the study. By the end of the treatment period, hot flash scores (frequency x average severity) decreased 68% from baseline to end point in the hypnosis arm (P < .001). Significant improvements in self-reported anxiety, depression, interference of hot flashes on daily activities, and sleep were observed for patients who received the hypnosis intervention (P < .005) in comparison to the no treatment control group. CONCLUSION: Hypnosis appears to reduce perceived hot flashes in breast cancer survivors and may have additional benefits such as reduced anxiety and depression, and improved sleep.

Pilot evaluation of hypnosis for the treatment of hot flashes in breast cancer survivors.

This single arm, pilot study investigated the use of hypnosis to reduce hot flashes in 16 breast cancer survivors. Each patient provided baseline data and received 4 weekly sessions of hypnosis that followed a standardized transcript. Patients were also instructed in self-hypnosis. Throughout the clinical care, patients completed daily diaries of the frequency and severity of their hot flashes. Patients also completed baseline and post-treatment ratings of the degree to which hot flashes interfered with daily activities and quality of life. Results indicated a 59% decrease in total daily hot flashes and a 70% decrease in weekly hot flash scores from their baselines. There was also a significant decrease in the degree to which hot flashes interfered with daily activities for all measures including work, social activities, leisure activities, sleep, mood, concentration, relations with others, sexuality, enjoyment of life, and overall quality of life. This pilot study suggests that clinical hypnosis may be an effective non-hormonal and non-pharmacological treatment for hot flashes. A randomized, controlled clinical trial is planned to more definitively elucidate the efficacy and applicability of hypnosis for reducing hot flashes.

Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: Case studies and possible benefits.

This study explored using hypnosis for pain and anxiety management in 6 colonoscopy patients (5 men, 1 woman), who received a hypnotic induction and instruction in self-hypnosis on the day of their colonoscopy. Patients' levels of anxiety were obtained before and after the hypnotic induction using Visual Analogue Scales (VAS). Following colonoscopy, VASs were used to assess anxiety and pain during colonoscopy, perceived effectiveness of hypnosis, and patient satisfaction with medical care. Hypnotizability was assessed at a separate appointment. The authors also obtained data (time for procedure, number of vasovagal events, and recovery time) for 10 consecutive patients who received standard care. Results suggest that hypnosis appears to be a feasible method to manage anxiety and pain associated with colonoscopy, reduces the need for sedation, and may have other benefits such as reduced vasovagal events and recovery time.

Intensive hypnotherapy for smoking cessation: a prospective study.

This study reports on a prospective pilot trial of intensive hypnotherapy for smoking cessation. The hypnotherapy involved multiple individual sessions (8 visits) over approximately 2 months, individualization of hypnotic suggestions, and a supportive therapeutic relationship. Twenty subjects were randomly assigned to either an intensive hypnotherapy condition or to a wait-list control condition. The target quitting date was 1 week after beginning treatment. Patients were evaluated for smoking cessation at the end of treatment and at Weeks 12 and 26. Self-reported abstinence was confirmed by a carbon-monoxide concentration in expired air of 8 ppm or less. The rates of point prevalence smoking cessation, as confirmed by carbon-monoxide measurements for the intensive hypnotherapy group, was 40% at the end of treatment; 60% at 12 weeks, and 40% at 26 weeks (p < .05).

Noncompliance with behavioral recommendations following bariatric surgery.

BACKGROUND: Bariatric surgery has been increasingly utilized for treatment of severe obesity. Although initial weight loss following surgery is almost completely assured, little is known about long-term out-come and patient compliance with post-surgical behavioral recommendations for diet and exercise that would improve outcome. The purpose of this study was to examine the rate of noncompliance with behavioral recommendations and to identify the incidence of psychological concerns following bariatric surgery. METHOD: Subjects were identified from an active clinical data-base of prospective clinical follow-up of all bariatric surgery patients. 100 consecutive patients who underwent Roux-en-Y gastric bypass were identified, and a chart review was conducted at 6 and 12 months postoperatively to gather demographic data and identify the prevalence of noncompliance identified in monthly follow-up visits. Also, patients were asked about depression, relationship/sexual concerns, and medical complications. RESULTS: 81 women and 19 men were followed for 1 year. The majority of patients reported noncompliance in at least one area, with lack of exercise and snacking being most frequently cited (41%, 37% respectively overall). Most patients were compliant with eating protein first and avoiding sodas. At 12 months follow-up, 12% reported depression, 4% reported sexual concerns and 2% reported relationship problems. Also, 9% reported having experienced some medical complication related to their surgery. CONCLUSION: Noncompliance with behavioral recommendations is pervasive following bariatric surgery, with lack of exercise being the most likely area of noncompliance. Because of the importance of compliance with behavioral recommendations for the successful outcome of bariatric surgery, further research is warranted to further clarify the factors that impact long-term outcome and to design interventions to improve compliance.

Complementary and alternative medicine use by psychiatric inpatients.

82 psychiatric inpatients hospitalized for acute care were interviewed about their use of complementary and alternative medicine (CAM) modalities. The clinical diagnoses of respondents included Depressive Disorder (61%), Substance Abuse (26%), Schizophrenia (9%), and Anxiety Disorders (5%). Analysis indicated that 63% used at least one CAM modality within the previous 12 mo. The most frequently used modality was herbal therapies (44%), followed by mind-body therapies such as relaxation or mental imagery, hypnosis, meditation, biofeedback (30%), and spiritual healing by another (30%). Physical modalities such as massage, chiropractic treatment, acupuncture, and yoga were used by 21% of respondents. CAM therapies were used for a variety of reasons ranging from treatment of anxiety and depression to weight loss. However, most respondents indicated they did not discuss such use with their psychiatrist or psychotherapist.

Prevalence of anxiety among patients undergoing colorectal surgery.

To assess prevalence of anxiety 36 consecutive patients undergoing colorectal surgery with general anesthesia were interviewed on the day of surgery and completed the State-Trait Anxiety Inventory. Postsurgical ratings of pain and anxiety were obtained within 24 hours after surgery. Analysis indicated that 29 scored moderate or higher on the State Anxiety scale prior to surgery. The correlations for scores on presurgical Trait Anxiety with postsurgical pain and Trait Anxiety scores were significant (p<.01) but not that for pre- and postsurgical State Anxiety

Can hypnosis reduce hot flashes in breast cancer survivors? A literature review.

Hot flashes are a significant problem for many breast cancer survivors and can cause discomfort, insomnia, anxiety, and decreased quality of life. In the past, the standard treatment for hot flashes has been hormone replacement therapy. However, recent research has found an increased risk of breast cancer in women receiving hormone replacement therapy. As a result, many menopausal women and breast cancer survivors reject hormone replacement therapy and many women want non-pharmacological treatment. In this critical review we assess the potential use of hypnosis in reducing the frequency and intensity of hot flashes. We conclude that hypnosis is a mind-body intervention that may be of significant benefit in treatment of hot flashes and other benefits may include reduced anxiety and improved sleep. Further, hypnosis may be a preferred treatment because of the few side-effects and the preference of many women for a non-hormonal therapy. Two case studies are included to illustrate hypnosis for hot flashes. However this intervention has not been adequately studied. We discuss an NIH-funded randomized clinical trial of hypnosis for hot flashes in breast cancer survivors that is presently being conducted.

Use of a numeric visual analog anxiety scale among patients undergoing colorectal surgery.

The aim of this study was to evaluate the utility of a Numeric Visual Analog Anxiety Scale (NVAAS) as a potentially accurate and efficient way to determine presurgery anxiety among patients undergoing colorectal surgery. A secondary aim was to determine the relationship between NVAAS ratings of anxiety and postsurgery pain. Thirty-six patients scheduled for colorectal surgery were asked to rate their state anxiety on the NVAAS and to complete the State-Trait Anxiety Inventory (STAI). The NVAAS correlated significantly with STAI-state anxiety (0.64, p <.0001). The NVAAS measure of presurgery anxiety also correlated significantly with STAI-trait anxiety (0.46, p <.005) and postsurgery Visual Analog Scale pain ratings (0.35, p <.038). The NVAAS appears to be a valid and sensitive measure of anxiety among patients undergoing colorectal surgery. The NVAAS also has the advantage of being convenient and easy to use at bedside, increasing its clinical utility in medical nursing care.

Development of a model for a structured support group for patients following bariatric surgery.

Bariatric surgery is performed to alleviate the major health problems associated with morbid obesity. However, after surgery, patients must learn to deal with new self-images and old behavior patterns that may precipitate a return to the pre-surgery status. Thus, long-term follow-up and continued emotional support are essential ingredients for a successful bariatric surgery outcome. Patients who attend group meetings regularly, tend to lose more weight. Patients are encouraged to participate in a structured support group both before and after bariatric surgery. The current model of the group incorporates self-responsibility, aspects of the "relapse prevention" model, and group therapy processes. Additionally the group is flexible, to adapt to the needs of the evolving group membership.

A model of hypnotic intervention for palliative care.

The World Health Organization defines palliative care as "the active total care of patients whose disease is not responsive to curative treatment." One of the primary issues of palliative care for patients with advanced cancer is symptom control and quality-of-life issues. The purpose of the hypnotic model presented here is to improve the patient's total psychological, social, and spiritual well-being. There exists a need for a broad and inclusive model of mind-body interventions for palliative care. This is supported by the observation that symptoms related to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The following model integrates naturalistic, solution-oriented hypnosis within the framework of a situational 4-stage crisis matrix. The four stages of the matrix are: (1) The Initial Crisis, (2) Transition, (3) Acceptance, and (4) Preparation for Death. Hypnotic interventions are tailored to each stage in the crisis matrix.

The integration of hypnosis into a model of palliative care.

There exists a need for a broad and inclusive model of integration of mind-body interventions for palliative care. Symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The hypnotic model's purpose is to improve the patient's total psychological, social, and spiritual well-being. A 4-stage model of interventions is offered to assist the clinician in developing and implementing appropriate hypnotherapeutic treatment for noncurative patients. The focus of the hypnotherapy is to ameliorate the effects of pain and dyspnea to restore a level of psychological and physical wellbeing. Within this model of therapy for patients with active, progressive, far-advanced disease and a short life expectancy, the goals of the hypnotic intervention are to provide relief from pain and shortness of breath. Other focuses include assisting the patient with the psychological adjustment to their noncurative and ultimately final state.