Does increasing biodiversity in an urban woodland setting promote positive emotional responses in humans? A stress recovery experiment using 360-degree videos of an urban woodland.

Green spaces can support human stress reduction and foster positive emotional well-being. Previous research has suggested that biodiversity (i.e. the variety of species of plants and animals in a given location) can enhance recovery from stress even further. However, there is limited experimental evidence testing this hypothesis and results, to date, have been mixed. This study aimed to provide further understanding of the role of biodiversity (actual or perceived) on human well-being by experimentally manipulating species richness and stress. Participants (372 in total) took part in an online experiment, where they received an episode of mild stress before watching a 360-degree video to recover. The video showed the same location, an urban woodland, but at one of four artificially manipulated levels of biodiversity. The participants reported their Positive and Negative Affect before and after the stress induction and after watching the video, providing a measure of their stress and well-being throughout the experiment. Participants also reported their perceptions of biodiversity (i.e. how diverse they thought the location was) and elaborated on their responses with brief comments. Repeated Measure Analysis of Variance revealed that exposure to all levels of biodiversity reduced the participants' Negative Affect, but with no significant difference between the conditions. However, the analysis showed higher Positive Affect in those participants who perceived the environment as more biodiverse. Comments from participants indicated that those who reported noticing flowers and trees in the environment also showed higher Positive Affect. This suggests that perceiving biodiversity promotes more positive emotions, but critically one needs to actually notice (engage with) the components of biodiversity to elicit these extra benefits.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Defining compassion: A Delphi study of compassion therapists' experiences when introducing patients to the term 'compassion'.

OBJECTIVES: Compassion-focused therapy (CFT) is shown to be an effective psychological intervention; however, patients can experience resistance to CFT due to preconceptions regarding the term 'compassion'. This study aims to obtain guidance from therapists in how to overcome these resistances DESIGN: This is the first study using the Delphi methodology to ask CFT therapists about how their patients understanding of the term compassion might act as a barrier to engaging with an otherwise beneficial therapy. METHODS: Two rounds of interview questions were posed to 15 expert CFT therapists. RESULTS: The results provide verification that there is resistance to CFT due to preconceptions around 'compassion', specifically its association with 'pity', 'weakness' and low-rank social positions. Further, this appears to be pronounced in patients who value competitiveness. CONCLUSIONS: The results have practical implications such as the need for therapists to acknowledge the potential for resistance and the need for experiential strategies and illustrative examples of compassion to facilitate successful engagement with CFT.

'This Is What the Colour Green Smells Like!': Urban Forest Bathing Improved Adolescent Nature Connection and Wellbeing.

BACKGROUND: Research suggests that an early connection with nature can benefit wellbeing into adulthood. However, there is less research assessing whether adolescents benefit from formal nature connection interventions such as forest bathing (slow mindful nature walks). This research aimed to assess whether an urban nature connection intervention (called ParkBathe) could improve adolescents' nature connection and wellbeing. METHOD: In an experimental repeated measures design, 44 adolescents sampled opportunistically from Scouts groups, completed surveys and interviews before and after experiencing an urban nature connection intervention. RESULTS: Paired-samples t-tests between baseline and post-intervention survey scores revealed statistically significant improvements in anxiety (13% reduction); rumination (44% reduction); scepticism (17% reduction); nature connection (25% increase); and social connection (12% increase). The largest effect size was found for nature connection. Interviews revealed that before the session, participants had a mixed understanding and expectations of the intervention. CONCLUSIONS: After the session, the participants expressed enjoying the social aspects of being part of a group and being present in the moment by noticing nature. They expressed the effects of this as immediately calming and relaxing. Urban forest bathing improved nature connection and wellbeing in adolescents and could be implemented and/or signposted by schools and youth charities.

The Feasibility and Impact of Practising Online Forest Bathing to Improve Anxiety, Rumination, Social Connection and Long-COVID Symptoms: A Pilot Study.

BACKGROUND: Long-COVID affects over 144 million people globally. In the absence of treatments, there is a need to establish the efficacy of therapies that improve patient outcomes. Forest bathing has been demonstrated to improve physical and mental outcomes but there is no evidence in Long-COVID patients. Accordingly, this pilot study sought to determine the feasibility and effectiveness of online forest bathing in adults with Long-COVID. METHODS: Feasibility was assessed by monitoring retention rates and participant feedback. In a waitlist controlled, repeated measures design, 22 Long-COVID patients completed weekly online surveys during a four-week waitlist control period, before engaging in four weekly online forest bathing sessions, completing post-intervention surveys following each session. RESULTS: In terms of retention, 27% did not provide post-intervention data, reasons for non-adherence were: feeling too ill, having medical appointments, or having career responsibilities. Compared with the waitlist control period, there were statistically significant improvements in Anxiety (49% decrease), Rumination (48% decrease), Social Connection (78% increase), and Long-COVID symptoms (22% decrease). Written qualitative comments indicated that participants experienced feelings of calm and joy, felt more connected socially and with nature, and experienced a break from the pain and rumination surrounding their illness. CONCLUSIONS: Online Forest bathing resulted in significant improvements in well-being and symptom severity and could be considered an accessible and inexpensive adjunct therapy for Long-COVID patients. Where people have limited access to in-person nature, virtual nature may offer an alternative to improve health and well-being outcomes.

Compassion Focused Group Therapy for People With a Diagnosis of Bipolar Affective Disorder: A Feasibility Study.

Background: Compassion focused therapy (CFT) is an evolutionary informed, biopsychosocial approach to mental health problems and therapy. It suggests that evolved motives (e.g., for caring, cooperating, competing) are major sources for the organisation of psychophysiological processes which underpin mental health problems. Hence, evolved motives can be targets for psychotherapy. People with certain types of depression are psychophysiologically orientated towards social competition and concerned with social status and social rank. These can give rise to down rank-focused forms of social comparison, sense of inferiority, worthlessness, lowered confidence, submissive behaviour, shame proneness and self-criticism. People with bipolar disorders also experience elevated aspects of competitiveness and up rank status evaluation. These shift processing to a sense of superiority, elevated confidence, energised behaviour, positive affect and social dominance. This is the first study to explore the feasibility of a 12 module CFT group, tailored to helping people with a diagnosis of bipolar disorder understand the impact of evolved competitive, status-regulating motivation on their mental states and the value of cultivating caring and compassion motives and their psychophysiological regulators. Methods: Six participants with a history of bipolar disorder took part in a CFT group consisting of 12 modules (over 25 sessions) as co-collaborators to explore their personal experiences of CFT and potential processes of change. Assessment of change was measured via self-report, heart rate variability (HRV) and focus groups over three time points. Results: Although changes in self-report scales between participants and across time were uneven, four of the six participants consistently showed improvements across the majority of self-report measures. Heart rate variability measures revealed significant improvement over the course of the therapy. Qualitative data from three focus groups revealed participants found CFT gave them helpful insight into: how evolution has given rise to a number of difficult problems for emotion regulation (called tricky brain) which is not one's fault; an evolutionary understanding of the nature of bipolar disorders; development of a compassionate mind and practices of compassion focused visualisations, styles of thinking and behaviours; addressing issues of self-criticism; and building a sense of a compassionate identity as a means of coping with life difficulties. These impacted their emotional regulation and social relationships. Conclusion: Although small, the study provides evidence of feasibility, acceptability and engagement with CFT. Focus group analysis revealed that participants were able to switch from competitive focused to compassion focused processing with consequent improvements in mental states and social behaviour. Participants indicated a journey over time from 'intellectually' understanding the process of building a compassionate mind to experiencing a more embodied sense of compassion that had significant impacts on their orientation to (and working with) the psychophysiological processes of bipolar disorder.

Nurturing compassion in schools: A randomized controlled trial of the effectiveness of a Compassionate Mind Training program for teachers.

OBJECTIVES: Schools are experiencing an unprecedented mental health crisis, with teachers reporting high levels of stress and burnout, which has adverse consequences to their mental and physical health. Addressing mental and physical health problems and promoting wellbeing in educational settings is thus a global priority. This study investigated the feasibility and effectiveness of an 8-week Compassionate Mind Training program for Teachers (CMT-T) on indicators of psychological and physiological wellbeing. METHODS: A pragmatic randomized controlled study with a stepped-wedge design was conducted in a sample of 155 public school teachers, who were randomized to CMT-T (n = 80) or a waitlist control group (WLC; n = 75). Participants completed self-report measures of psychological distress, burnout, overall and professional wellbeing, compassion and self-criticism at baseline, post-intervention, and 3-months follow-up. In a sub-sample (CMT-T, n = 51; WLC n = 36) resting heart-rate variability (HRV) was measured at baseline and post-intervention. RESULTS: CMT-T was feasible and effective. Compared to the WLC, the CMT-T group showed improvements in self-compassion, compassion to others, positive affect, and HRV as well as reductions in fears of compassion, anxiety and depression. WLC participants who received CMT-T revealed additional improvements in compassion for others and from others, and satisfaction with professional life, along with decreases in burnout and stress. Teachers scoring higher in self-criticism at baseline revealed greater improvements post CMT-T. At 3-month follow-up improvements were retained. CONCLUSIONS: CMT-T shows promise as a compassion-focused intervention for enhancing compassion, wellbeing and reducing psychophysiological distress in teachers, contributing to nurturing compassionate, prosocial and resilient educational environments. Given its favourable and sustainable effects on wellbeing and psychophysiological distress, and low cost to deliver, broader implementation and dissemination of CMT-T is encouraged.

Compassion Protects Mental Health and Social Safeness During the COVID-19 Pandemic Across 21 Countries.

Objectives: The COVID-19 pandemic is having an unprecedented detrimental impact on mental health in people around the world. It is important therefore to explore factors that may buffer or accentuate the risk of mental health problems in this context. Given that compassion has numerous benefits for mental health, emotion regulation, and social relationships, this study examines the buffering effects of different flows of compassion (for self, for others, from others) against the impact of perceived threat of COVID-19 on depression, anxiety, and stress, and social safeness. Methods: The study was conducted in a sample of 4057 adult participants from the general community population, collected across 21 countries from Europe, Middle East, North America, South America, Asia, and Oceania. Participants completed self-report measures of perceived threat of COVID-19, compassion (for self, for others, from others), depression, anxiety, stress, and social safeness. Results: Perceived threat of COVID-19 was associated with higher scores in depression, anxiety, and stress, and lower scores in social safeness. Self-compassion and compassion from others were associated with lower psychological distress and higher social safeness. Compassion for others was associated with lower depressive symptoms. Self-compassion moderated the relationship between perceived threat of COVID-19 on depression, anxiety, and stress, whereas compassion from others moderated the effects of fears of contracting COVID-19 on social safeness. These effects were consistent across all countries. Conclusions: Our findings highlight the universal protective role of compassion, in particular self-compassion and compassion from others, in promoting resilience by buffering against the harmful effects of the COVID-19 pandemic on mental health and social safeness. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-021-01822-2.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress.

BACKGROUND: Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress. METHODS: Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress. RESULTS: Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries. CONCLUSIONS: Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries.

BACKGROUND: The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. METHODS: Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. RESULTS: Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. CONCLUSIONS: Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

Developing a whole-school mental health and wellbeing intervention through pragmatic formative process evaluation: a case-study of innovative local practice within The School Health Research network.

BACKGROUND: The evidence-base for whole school approaches aimed at improving student mental health and wellbeing remains limited. This may be due to a focus on developing and evaluating de-novo, research-led interventions, while neglecting the potential of local, contextually-relevant innovation that has demonstrated acceptability and feasibility. This study reports a novel approach to modelling and refining the programme theory of a whole-school restorative approach, alongside plans to scale up through a national educational infrastructure in order to support robust scientific evaluation. METHODS: A pragmatic formative process evaluation was conducted of a routinized whole-school restorative approach aimed at improving student mental health and wellbeing in Wales. RESULTS: The study reports the six phases of the pragmatic formative process evaluation. These are: 1) identification of innovative local practice; 2) scoping review of evidence-base to identify potential programme theory; outcomes; and contextual characteristics that influence implementation; 3) establishment of a Transdisciplinary Action Research (TDAR) group; 4) co-production and confirmation of an initial programme theory with stakeholders; 5) planning to optimise intervention delivery in local contexts; and 6) planning for feasibility and outcome evaluation. The phases of this model may be iterative and not necessarily sequential. CONCLUSIONS: Formative, pragmatic process evaluations can support researchers, policy-makers and practitioners in developing robust scientific evidence-bases for acceptable and feasible local innovations that do not already have a clear evidence base. The case of a whole-school restorative approach provides a case example of how such an evaluation may be undertaken.

Crisis management for people with dementia at home: Mixed-methods case study research to identify critical factors for successful home treatment.

Best practice in dementia care is support in the home. Yet, crisis is common and can often result in hospital admission with adverse consequences. The objective of this mixed-methods case study research was to identify the critical factors for resolving crisis for a person with dementia living at home. The research was an in-depth investigation of what happens during crisis for people with dementia and how it is managed by a Home Treatment Crisis Team to resolution and outcome at 6 weeks and 6 months. The methods were; observation of crisis management for 15 patients with dementia (max three observations per patient, total 41), interviews with patients with dementia (n = 5), carers (n = 13) and professionals (n = 14, range one to six interviews per person, total 29), focus group (nine professionals), and extraction of demographics and medical history from medical records. Analysis focused on the identification of factors important for crisis resolution and avoidance of hospital admission. Critical factors for the Home Treatment Crisis Team to enable successful crisis resolution were: immediate action to reduce risk of harm, expertise in dementia care and carer education, communication skills to establish trust and promote benefits of home treatment, shared decision-making, medication management, addressing the needs of carers independently of the person with dementia and, local availability of respite and other community services. The Home Treatment Crisis Team integrated the seven factors to deploy a biopsychosocial systems approach with embedded respect for personhood. This approach enabled crisis resolution for a person with dementia by creating a system of services, treatments, resources and relationships, 'Safe Dementia Space', in the community with avoidance of hospital admission in more than 80% of referrals. The identified critical factors for crisis resolution are important considerations in the design and delivery of home treatment services for people with dementia.

The Schwartz Centre Rounds: Supporting mental health workers with the emotional impact of their work.

In healthcare settings, there is an emotional cost to caring which can result in compassion fatigue, burnout, secondary trauma, and compromised patient care. Innovative workplace interventions such as the Schwartz Rounds offer a group reflective practice forum for clinical and non-clinical professionals to reflect on the emotional aspects of working in health care. Whilst the Rounds are established in medical health practice, this study presents an evaluation of the Rounds offered to mental health services. The Rounds were piloted amongst 150 mental health professionals for 6 months and evaluated using a mixed-methods approach with standardized evaluation forms completed after each Round and a focus group (n = 9) at one-month follow-up. This paper also offers a unique six-year follow-up of the evaluation of the Rounds. Rounds were rated as helpful, insightful, and relevant, and at six years follow-up, Rounds were still rated as valuable and viewed as embedded. Focus groups indicated that Rounds were valued because of the opportunity to express emotions (in particular negative emotions towards patients that conflict with the professional care-role), share experiences, and feel validated and supported by colleagues. The findings indicate that Schwartz Rounds offer a positive application in mental healthcare settings. The study supports the use of interventions which provide an ongoing forum in which to discuss emotions, develop emotional literacy, provide peer support and set an intention for becoming a more compassionate organization in which to work.

Engaging with distress: Training in the compassionate approach.

WHAT IS KNOWN ON THE SUBJECT?: Mental health nurses provide care within an environment that is often threatening. The environment is often threatening because: (a) patients' needs are complex and highly emotional, (b) nurses often do not have the time and resources they would wish for and (c) caring for patients can be emotionally exhausting and distressing. Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there is no study evaluating compassion interventions for the high-threat profession of mental health nursing and no study qualitatively evaluating compassion training and implementation. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study looked at what happens if compassion training delivered by the originator of Gilbert's model of compassion is given to mental health nurses. Nurses were interviewed 1 year later to see how relevant and useful the training was, and whether they had been able to use it in their daily work. Consistent with previous studies, the study found a reduction in professionals' self-criticism and an increase in self-compassion, which in this study extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying the training directly to reduce patient self-criticism. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses felt that more training and supervision was needed to build the confidence to use the training regularly at work. They felt it had been difficult to use the training because of the threatening environment in which they worked. Nurses recommended that the whole organization would need the training to make it part of their everyday work. ABSTRACT: Introduction Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there has not been a study evaluating compassion interventions for the high-threat profession of mental health nursing. Neither has there been a study providing an in-depth qualitative evaluation of training and implementation. The current study aims to address these gaps in the literature. Aim The aims were to evaluate Compassionate Mind Training-CMT for mental health nurses and to assess implementation. Method Focus groups were conducted (N = 28) 1 year later to evaluate CMT and implementation. Results Content analysis revealed four training themes: (a) Useful framework; (b) Thought-provoking and exciting; (c) Appreciation of person-centred approach; and (d) Need for ongoing training and supervision. Three implementation themes emerged: (a) Applied approach with patients and staff themselves; (b) Environmental challenges to implementation; and (c) Attitudinal challenges to implementation. Discussion Consistent with previous studies, professionals experienced reduced self-criticism and an increased self-compassion, which extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying training directly to reduce patient self-criticism. Implications For successful implementation, formal adoption of compassion approaches is needed with strategic integration at all levels.

Shmapped: development of an app to record and promote the well-being benefits of noticing urban nature.

The majority of research to date on the links between well-being and green spaces comes from cross-sectional studies. Shmapped is an app that allows for the collection of well-being and location data live in the field and acts as a novel dual data collection tool and well-being intervention, which prompts users to notice the good things about their surroundings. We describe the process of developing Shmapped from storyboarding, budgeting, and timescales; selecting a developer; drawing up data protection plans; and collaborating with developers and end-user testers to ultimately publishing Shmapped. The development process and end-user testing resulted in a highly functional app. Limitations and future uses of such novel dual data collection and intervention apps are discussed and recommendations are made for prospective developers and researchers.

Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Behavior.

CONTEXT & OBJECTIVES: The Controlled Antenatal Thyroid Screening (CATS) study was the first randomized controlled trial to investigate effects of treating suboptimal gestational thyroid function (SGTF) on child cognition. Since observational studies indicated that SGTF may also increase symptoms of autism and attention-deficit/hyperactivity disorder (ADHD), the CATS cohort was used to investigate whether treatment of mothers affected their children's behavior. DESIGN & PARTICIPANTS: Mothers (N = 475) completed 3 questionnaires: the Strengths and Difficulties Questionnaire (SDQ), the Child ADHD Questionnaire, and the Social Communication Questionnaire (SCQ, used as a screen for autism spectrum disorder [ASD]), about their children (mean age 9.5 years). Group comparisons of total scores, numbers of children above clinical thresholds, and association between high maternal free thyroxine (FT4) (> 97.5th percentile of the UK cohort, "overtreated") and child neurodevelopment were reported. RESULTS: There were no differences in total scores between normal gestational thyroid function (GTF) (n = 246), treated (n = 125), and untreated (n = 104) SGTF groups. More children of treated mothers scored above clinical thresholds, particularly the overtreated. Scores were above thresholds in SDQ conduct (22% vs 7%), SCQ total scores (7% vs 1%), and ADHD hyperactivity (17% vs 5%) when comparing overtreated (n = 40) and untreated (N = 100), respectively. We identified significantly higher mean scores for SDQ conduct (adjusted mean difference [AMD] 0.74; 95% confidence interval [CI], 0.021-1.431; P = 0.040, effect size 0.018) and ADHD hyperactivity (AMD 1.60, 95% CI, 0.361-2.633; P = 0.003, effect size 0.028) comparing overtreated with normal-GTF children. CONCLUSIONS: There was no overall association between SGTF and offspring ADHD, ASD, or behavior questionnaire scores. However, children of "overtreated" mothers displayed significantly more ADHD symptoms and behavioral difficulties than those of normal-GTF mothers. Thyroxine supplementation during pregnancy requires monitoring to avoid overtreatment.

A Smartphone App for Improving Mental Health through Connecting with Urban Nature.

In an increasingly urbanised world where mental health is currently in crisis, interventions to increase human engagement and connection with the natural environment are one of the fastest growing, most widely accessible, and cost-effective ways of improving human wellbeing. This study aimed to provide an evaluation of a smartphone app-based wellbeing intervention. In a randomised controlled trial study design, the app prompted 582 adults, including a subgroup of adults classified by baseline scores on the Recovering Quality of Life scale as having a common mental health problem (n = 148), to notice the good things about urban nature (intervention condition) or built spaces (active control). There were statistically significant and sustained improvements in wellbeing at one-month follow-up. Importantly, in the noticing urban nature condition, compared to a built space control, improvements in quality of life reached statistical significance for all adults and clinical significance for those classified as having a mental health difficulty. This improvement in wellbeing was partly explained by significant increases in nature connectedness and positive affect. This study provides the first controlled experimental evidence that noticing the good things about urban nature has strong clinical potential as a wellbeing intervention and social prescription.

30 Days Wild and the Relationships Between Engagement With Nature's Beauty, Nature Connectedness and Well-Being.

Recent research suggests that engagement with natural beauty (EWNB) is key to the well-being benefits of nature connectedness. The Wildlife Trust's 30 Days Wild campaign provides a large-scale intervention for improving public engagement with nature and its beauty. The effect of 30 Days Wild participation on levels of EWNB and the relationship between EWNB, nature connectedness and happiness was evaluated during the 2017 campaign. Of the 49,000 people who signed up to the campaign, 308 people fully completed measures of EWNB, nature connection, health, happiness, and conservation behaviors at baseline, post-30 days and post-2 months. There were sustained and significant increases for scores in nature connection, health, happiness, and conservation behaviors. In addition, 30 Days Wild was the first intervention found to increase EWNB. Further, the significant increase in EWNB mediated the relationship between the increases in nature connectedness and happiness. In a supplementary study to understand the well-being benefits further (n = 153), emotional regulation was found to mediate the relationship between nature connectedness and happiness, but EWNB and emotional regulation were not related. The links between nature's beauty, nature connectedness and well-being are discussed within an account of affect-regulation.

Pragmatic RAndomised controlled trial of a trauma-focused guided self-help Programme versus InDividual trauma-focused cognitive Behavioural therapy for post-traumatic stress disorder (RAPID): trial protocol.

BACKGROUND: There is good evidence that trauma-focused therapies for Post-Traumatic Stress Disorder are effective. However, they are not always feasible to deliver due a shortage of trained therapists and demands on the patient. An online trauma-focused Guided Self-Help (GSH) programme which could overcome these barriers has shown promise in a pilot study. This study will be the first to evaluate GSH against standard face-to-face therapy to assess its suitability for use in the NHS. METHODS: The study is a large-scale multi-centre pragmatic randomised controlled non-inferiority trial, with assessors masked to treatment allocation. One hundred and ninety-two participants will be randomly allocated to receive either face-to-face trauma-focused cognitive behaviour therapy (TFCBT) or trauma-focused online guided self-help (GSH). The primary outcome will be the severity of symptoms of PTSD over the previous week as measured by the Clinician Administered PTSD Scale for DSM5 (CAPS-5) at 16 weeks post-randomisation. Secondary outcome measures include PTSD symptoms over the previous month as measured by the CAPS-5 at 52 weeks plus the Impact of Event Scale - revised (IES-R), Work and Social Adjustment Scale (WSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Test (AUDIT-O), Multidimensional Scale for Perceived Social Support (MSPSS), short Post-Traumatic Cognitions Inventory (PTCI), Insomnia Severity Index (ISI) and General Self Efficacy Scale (GSES) measured at 16 and 52 weeks post-randomisation. Changes in health-related quality of life will be measured by the EQ-5D and the level of healthcare resource utilisation for health economic analysis will be determined by an amended version of the Client Socio-Demographic and Service Receipt Inventory European Version. The Client Satisfaction Questionnaire (CSQ) will be collected at 16 weeks post-randomisation to evaluate treatment satisfaction. DISCUSSION: This study will be the first to compare online GSH with usual face-to-face therapy for PTSD. The strengths are that it will test a rigorously developed intervention in a real world setting to inform NHS commissioning. The potential challenges of delivering such a pragmatic study may include participant recruitment, retention and adherence, therapist retention, and fidelity of intervention delivery. TRIAL REGISTRATION: ISRCTN13697710 registered on 20/12/2016.

Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Cognition.

Context and Objective: The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment of suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in intelligence quotient (IQ) at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5 years and included children from normal gestational thyroid function (normal-GTF) mothers. Design, Setting, and Participants: One examiner, blinded to participant group, assessed children's IQ (Wechsler Intelligence Scale for Children, Fourth Edition UK), long-term memory, and motor function (Developmental Neuropsychological Assessment II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of an IQ < 85 in the groups. Results: There was no difference in IQ < 85 between children of mothers with normal-GTF and combined SGTF, i.e., treated and untreated (fully adjusted odds ratio [OR] = 1.15 [95% confidence interval (CI) 0.52, 2.51]; P = 0.731). Furthermore, there was no significant effect of treatment [untreated OR = 1.33 (95% CI 0.53, 3.34); treated OR = 0.75 (95% CI 0.27, 2.06) P = 0.576]. IQ < 85 was 6.03% in normal-GTF, 7.56% in treated, and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with free thyroxine > 97.5th percentile of the entire CATS-I cohort revealed no significant effect on a child's IQ < 85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (P < 0.0001) and accounted for 45% of the variation. Conclusions: Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be a result of the similar proportion of IQ < 85 in children of women with normal-GTF and SGTF.