Increasing Resilience to Traumatic Stress: Understanding the Protective Role of Well-Being.

The brain maintains homeostasis in part through a network of feedback and feed-forward mechanisms, where neurochemicals and immune markers act as mediators. Using a previously constructed model of biobehavioral feedback, we found that in addition to healthy equilibrium another stable regulatory program supported chronic depression and anxiety. Exploring mechanisms that might underlie the contributions of subjective well-being to improved therapeutic outcomes in depression, we iteratively screened 288 candidate feedback patterns linking well-being to molecular signaling networks for those that maintained the original homeostatic regimes. Simulating stressful trigger events on each candidate network while maintaining high levels of subjective well-being isolated a specific feedback network where well-being was promoted by dopamine and acetylcholine, and itself promoted norepinephrine while inhibiting cortisol expression. This biobehavioral feedback mechanism was especially effective in reproducing well-being's clinically documented ability to promote resilience and protect against onset of depression and anxiety.

Breaking Away: The Role of Homeostatic Drive in Perpetuating Depression.

We propose that the complexity of regulatory interactions modulating brain neurochemistry and behavior is such that multiple stable responses may be supported, and that some of these alternate regulatory programs may play a role in perpetuating persistent psychological dysfunction. To explore this, we constructed a model network representing major neurotransmission and behavioral mechanisms reported in literature as discrete logic circuits. Connectivity and information flow through this biobehavioral circuitry supported two distinct and stable regulatory programs. One such program perpetuated a depressive state with a characteristic neurochemical signature including low serotonin. Further analysis suggested that small irregularities in glutamate levels may render this pathology more directly accessible. Computer simulations mimicking selective serotonin reuptake inhibitor (SSRI) therapy in the presence of everyday stressors predicted recidivism rates similar to those reported clinically and highlighted the potentially significant benefit of concurrent behavioral stress management therapy.

Diabetes Camp Counselors: An Exploration of Counselor Characteristics and Quality of Life Outcomes.

Purpose The purpose of this study is to investigate the effect of volunteering at a diabetes camp on emerging adults with and without type 1 diabetes mellitus (T1DM). Methods Thirty counselors with and 22 without T1DM (19.07 ± 2.71 years old) volunteered at a 1-week T1DM camp in the northeastern United States. Counselors with T1DM had a range of self-reported A1C scores (5.8% or 39.9 mmol/mol to 14.0% or 129.5 mmol/mol). Self-report measures of quality of life, hope, and well-being were completed pre- and postcamp at 4 time points: 1 month before camp, arrival at camp, final day of camp, and 2 months postcamp. Open-ended questions regarding counselor experiences were analyzed to understand camp effect. Results There were significant differences between counselors' levels of trait hope in comparison to published norms. There were few clear differences in psychosocial outcomes pre- and postcamp; however, some increases in well-being were revealed in anticipation of camp. Major reasons for volunteering included assisting others and reciprocating or continuing a perceived positive experience as a camper. Conclusion No changes in psychosocial outcomes pre- to postcamp were observed. However, measures used in this study may be poorly defined for a counselor population. Further research on the characteristics of emerging adults who choose to be camp counselors is needed. By understanding the demographics of this population, health professionals can help target individuals to become camp counselors as well as enhance the camp experience to fit their developmental needs.

Application of well-being therapy to people with disability and chronic illness.

PURPOSE/OBJECTIVE: Research data clearly indicate most people living with a disability return to premorbid levels of psychological functioning. However, some individuals living with a disability are vulnerable for the development of psychological disorders including depression, anxiety, and posttraumatic stress disorder. Rather than understanding this phenomenon of vulnerability solely as the presence of psychopathology, it can be understood from a positive psychology standpoint as a deficit of well-being. We extend this approach by demonstrating the links between the historic foundational principles of rehabilitation psychology and the relevant current research on psychology of well-being. The article then explores the implications of providing meaningful interventions that could improve the lives of persons living with disability and chronic illness. RESULTS: Based on this view, well-being therapy is proposed as an intervention because it has proven efficacy in acting as a buffer against the development of some negative affective states. The assumptions and dimensions underlying this approach are shown to be relevant to both persons living with disability and to the foundational principles of rehabilitation psychology. A model for assisting people with disability in improving their well-being and decreasing negative aspects of their life by balancing factors relevant to well-being is discussed. CONCLUSIONS/IMPLICATIONS: The authors conclude by exploring the benefits of engendering positive well-being versus the traditional focus on solely alleviating negative affective states.

Supervision in rehabilitation psychology: Application of Beatrice Wright's value-laden beliefs and principles.

Clinical supervision is of critical importance for training subsequent generations of psychologists. Specialty training in rehabilitation psychology requires exposure to specific knowledge, skills, and attitudes related to disability and specialized supervision and mentorship. In the literature to date, minimal guidance exists regarding supervision training and methods specifically for rehabilitation psychologists. This article aims to provoke discussion regarding supervision practice and dissemination of the values fundamental to our specialty. The foundational wisdom of Dr. Beatrice Wright (1983) is applied for the purposes of this endeavor. Examples of clinical supervision scenarios are presented as teaching vignettes to demonstrate ways in which supervisors and mentors can incorporate this content, promote discussion, and apply it to real-world practice.

Attitudes toward psychological telehealth: current and future clinical psychologists' opinions of internet-based interventions.

OBJECTIVES: The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed. METHOD: An online survey assessed 717 participants comprising 409 licensed psychologists (40.8% female, mean age = 56.57, standard deviation [SD] = 11.01) and 308 doctoral-level students (78.9% female, mean age = 27.66, SD = 5.9) across domains of endorsement and rejection. RESULTS: Binary logistic regression indicated no significant difference between currently licensed and future psychologists in their endorsement of telehealth modalities. Cognitive-behavioral, cognitive, behavioral, and systems psychologists were significantly more accepting of telehealth interventions than were dynamic/analytic or existential therapists. CONCLUSIONS: Increasing exposure to telehealth through education as well as continued research on efficacy for specific diagnoses may help psychologists to more effectively determine whether telehealth is the "best fit" for both clinician and client.

Controversy clarified: an updated review of clinical psychology and tele-health.

One of the most controversial topics in the field of clinical psychology, online tele-health, or the integration of computers and the internet with therapeutic techniques, remains at the forefront of many debates. Despite potential interest, there are numerous factors that a psychologist must consider before integrating an online tele-health intervention into their own practice. This article outlines literature pertinent to the debate. The article begins with a brief history of the use of non-face-to-face interventions as well as the earliest recorded use of "tele-health" before discussing the modern benefits and risks associated with usage. Considerations for the psychologist as well as the client are detailed; incorporating ethical implications. The authors conclude that the utilization of tele-health interventions is an exponentially expanding field that should continue to be explored. Despite many well-conceived studies, a psychologist should educate themselves in all aspects of the new modes of intervention (e.g., ethical, legal, evidence-based treatments) before attempting to implement them into everyday practice. The article ends with a discussion on the acceptance among psychologists, as well as the outlook for the future.

A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation.

Healthy People 2010 made it a priority to eliminate health disparities. We used a rapid assessment response and evaluation (RARE) to launch a program of participatory action research focused on health disparities in an urban, disadvantaged Black community serviced by a major south Florida health center. We formed partnerships with community members, identified local health disparities, and guided interventions targeting health disparities. We describe the RARE structure used to triangulate data sources and guide intervention plans as well as findings and conclusions drawn from scientific literature and epidemiological, historic, planning, clinical, and ethnographic data. Disenfranchisement and socioeconomic deprivation emerged as the principal determinants of local health disparities and the most appropriate targets for intervention.

Family medicine physicians' advice about use of nonconventional modalities for menopausal symptom management.

AIMS: This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management. METHODS: Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief. RESULTS: Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed. CONCLUSIONS: These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.

Treatment of menopausal symptoms in family medicine settings following the Women's Health Initiative findings.

PURPOSE: This study explores trends in treatment of menopausal symptoms and use of hormone replacement therapy (HRT) in family medicine settings subsequent to the release of the Women's Health Initiative (WHI) findings. METHODS: Anonymous self-administered questionnaires were distributed to family medicine residents and faculty from 8 participating family medicine residency programs in the state of Florida. The survey asked physicians how they typically treated common menopausal symptoms in otherwise healthy menopausal women, and how their practice patterns had changed since the release of the WHI findings. We analyzed survey responses from 62 faculty and 148 residents (66% of eligible respondents). RESULTS: HRT is still prominent for treating irregular menses, vaginal dryness, vasomotor symptoms, and decreased libido. Faculty physicians were significantly more likely than residents to use HRT for menopausal symptoms. Female physicians were more likely than male physicians to say their treatment patterns had changed as a result of the WHI. CONCLUSIONS: After weighing the evidence of potential risks of HRT from the WHI study, family medicine physicians altered and broadened their strategies for treating common menopausal symptoms. Although HRT remains a prominent treatment approach, there is now more physician-patient discussion of individual risks and benefits than occurred before the WHI's release of findings.