Effectiveness of cognitive behavior therapy on occupational stress management among administrative, language, science and vocational education staff within open and distance learning centers: A randomized controlled trial evaluation.

BACKGROUND: The administrative, language, science and vocational staff in Nigerian open and distance learning centers handle a wide range of responsibilities, including teaching, supervising exams, managing projects for distant learners, conducting research, and attending conferences. However, no research in southeast Nigeria has looked into how the administrative, language, science and vocational staff at open-distance learning centers manage occupational stress. Therefore, the purpose of this study was to investigate how administrative, language, science and vocational education staff at open distance learning facilities in southeast Nigeria manage their work-related stress in relation to cognitive behavior therapy intervention. METHODS: The study used a randomized control group trial design with 63 administrative, language, science and vocational staff members as the sample size. Data were gathered using the Occupational Stress Index and the Perceived Stress Scale. The instruments' respective internal consistency reliability indices are.87 and.77. The 12-week intervention of cognitive behavior therapy was conducted. A postintervention exam was given to participants in both the intervention group and the nonintervention group after the conclusion of the intervention, and a follow-up assessment was given 2 months later. The paired samples t-test and the independent samples t-test were used to evaluate the data for the within-groups and between-groups effects, respectively. RESULTS: In open and distance learning facilities in southeast Nigeria, it was discovered that cognitive behavior therapy significantly improved the administrative, language, science and vocational education staff's ability to manage occupational stress. CONCLUSION: Administrative, language, science and vocational education staff at open distance learning facilities in southeast Nigeria can effectively manage their occupational stress through the use of cognitive behavior therapy.

Cognitive and behavioral approaches to occupational stress management: The case of adult education administrative workers in Nigeria.

BACKGROUND: Those in administrative positions in adult education are more likely to suffer from stress because of the hard work they do, long hours in the office, a lack of adequate medical and welfare packages, and a lack of financial aid. In this study, adult education workers in Nigeria were assessed on the effectiveness of a cognitive and behavioral approach to managing occupational stress in public administration. METHOD: This study was a group-randomized trial in which 94 adult education workers occupy public administrative positions within Enugu State, Nigeria, participated. Data were collected using 2 instruments, the Perceived Stress Scale, and the Workplace Stress Scale, which were validated by cognitive and behavioral psychologists at the University of Nigeria, Nsukka. The instruments contained internal construct and content validity as determined by Cronbach alpha. ANCOVA was employed to test for hypotheses and answer research questions. RESULTS: This study demonstrates that cognitive and behavioral approaches are significantly effective in managing occupational stress among adult education workers who work for public agencies. CONCLUSION: To improve stress management capacity among adults in public administration positions, researchers recommend frequent exposure to cognitive and behavioral approaches.

Occupational stress, respect, and the need for psychological counselling in Chinese nurses: a nationwide cross-sectional study.

OBJECTIVES: This study aimed to explore occupational stress, perceived respect, and the need for psychological counselling among nurses in China. STUDY DESIGN: This was a nationwide cross-sectional study. METHODS: Chinese nurses from 311 cities were randomly selected through a simple random sampling method. Occupational stress, perceived respect, and psychological counselling need were assessed using an online questionnaire validated by experts. The underlying associated factors were analysed using multiple logistic regression analyses. RESULTS: We collected and analysed 51,406 valid online questionnaires. Family factors and low income were the most commonly cited sources of occupational stress, and 91.9% and 80.0% of nurses, respectively, perceived that individuals in society and patients did not give adequate respect. Furthermore, 75.5% and 79.7%, respectively, believed they were not respected by clinical managers and doctors. As a result, 64.7% nurses believed they had a moderate or high need for psychological counselling. However, 80.7% indicated that receiving adequate respect could decrease the need for stress-related psychological counselling. Indeed, multiple logistic regression analyses showed that lower respect perceived by nurses was associated with higher need for psychological counselling, particularly regarding criticism that nurses perceived from nursing managers (a little: odds ratio [OR], 1.597; 95% confidence interval [CI], 1.176-2.170; P = 0.003; moderately: OR, 1.433; 95% CI, 1.180-1.741; P < 0.001) and the difficulty of receiving respect from patients and their families (a little: OR, 1.389; 95% CI, 1.044-1.850; P = 0.024). CONCLUSIONS: Nurses in China perceive high levels of occupational stress and low levels of respect and often seek psychological counselling.

The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial.

BACKGROUND: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. OBJECTIVE: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. METHODS: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. RESULTS: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM -0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. CONCLUSIONS: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407.

Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory.

OBJECTIVES: Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. DESIGN: Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. SETTING: Three Resilience Hubs in the North of England. PARTICIPANTS: Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). RESULTS: Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. CONCLUSIONS: Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.

Coping strategy for work-family conflict and burnout in construction industrial adult workers: A philosophical highlight.

BACKGROUND: The work environment in Nigeria is demanding and could lead to psychological disturbances. Evidentially, construction workers have confirmed the horrible job stress and work-family conflict they experience in the workplace. This has led to work-related burnout. As a matter of importance, this study was conducted. METHODS: A pure experimental design was used, which helped to randomly assigned recruited 98 construction industry adult workers to 2 arms (treatment and waitlisted control groups). Two dependent measures were distributed before, immediately after, and 4 weeks after completion of intervention with 12 sessions that were given to the treatment group. RESULTS: This study found that cognitive behavior therapy is beneficial in the management of work-family conflict and work burnout among construction industry workers. Therefore, there is a need for advancement and adequate implementation of cognitive behavior therapy in industries for psychological functioning of workers.

Comparison between Standard Expository Cognitive Behavioral Therapy (CBT-E) and Immersive Virtual Reality CBT (CBT-VR) for Rehabilitation of Patients Affected by Occupational Stress Disorders: Study Protocol.

Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms that can lead to occupational stress diseases, namely Adjustment Disorder and Post-Traumatic Stress Disorder. The literature has evidenced that "exposure therapy" of cognitive-behavioral training (CBT-E) seems to be the most effective technique to manage stress symptoms, including work stress diseases, and several studies have considered Virtual Reality (VR) as an adjuvant tool to exposure-based psychotherapy (CBT-VR) for the treatment of multiple psychiatric disorders. The aim of this study is to evaluate the effectiveness of CBT with exposure to stressful work scenarios in imaginative (CBT-E) and in immersive virtual reality (CBT-VR) scenarios in a group of workers affected by work-related stress disorders and compare the clinical and physiological outcomes between the two exposure techniques. A long-term goal would be to develop an evidence-based rehabilitation program as a treatment for the reintegration into work of patients affected by these psychiatric disorders.

Evaluation of a Stress Management Course for Shipboard Sailors.

BACKGROUND: As part of their day-to-day operational mission, shipboard sailors experience unique stressors that can affect their health and readiness. The San Diego Fleet and Family Support Center (FFSC) conducts in-person classes to teach stress management principles to sailors. The FFSC stress management course covers the causes and consequences of stress, reviews the Navy Operational Stress Control model, and provides information on basic stress management skills. This course has not been rigorously evaluated to determine its impact on the sailors' ability to manage stress. The purpose of this study was to evaluate the short-term impact of the FFSC stress management class on the (1) sailors' stress management knowledge, (2) sailors' intention to share knowledge from the class with others, and (3) sailors' satisfaction with the class. METHOD: Shipboard sailors (n = 95) who attended a stress management course completed pretest and posttest assessments that measured workplace stress, current stress management behaviors, stress management knowledge, intention to share course information, and participant satisfaction with the course. Most ratings were made on a 5-point scale, where higher scores indicated more positive outcomes. RESULTS: In the aggregate, participants gave high marks for the class (M = 3.81, SD = 0.66), gave positive ratings for the class instructors (M = 3.84, SD = 0.67), and were satisfied with the class (M = 4.05, SD = 0.63). Sailors also reported that the class was relevant to their work (M = 3.64, SD = 0.81). Overall, 80% of class participants intended to share information learned in the class with family members and military friends, potentially extending the reach and impact of the FFSC class. Finally, sailors did not show increased stress management knowledge as a result of taking the FFSC stress management class (P = .31). CONCLUSION: This study was the first evaluation of the short-term impact of the FFSC stress management course on the stress management knowledge of shipboard crews. Study limitations prevented the study team from assessing the long-term impact of the stress management course on future stress levels and stress abatement behaviors. Recommendations are made to enhance future evaluations of FFSC classes for service members.

The Effectiveness of a Four-Week Online Mindfulness Training Course on Individual Mindfulness Skills and Personal Perception of Stress in Company Employees Working from Home.

Working from home comes with many benefits. However, employees are often exposed to various stressors when working outside of the traditional workplace environment. The subjective experience of these stressors is related to one's perception of the situation and the perceived resources available. As working from home has become the new normal for many during the COVID-19 pandemic, it is in the interest of companies to provide employees with tools to cope with these stressors. One such tool is online mindfulness training. This study investigates how a four-week online mindfulness training influences an individual's mindfulness skills, subjective perception, and processing of stressors. Forty participants working from home at the time of the study were examined in a pre-test using a pre-post design in which the experimental group participated in a four-week online training course in mindfulness. Since the results showed a significantly reduced subjective perception of stress in the experimental group after mindfulness training, a long-term study was conducted including 40 additional participants. The study revealed a training success of at least three months. It thus introduces new possibilities for effective stress management in all workplace settings.

The effect of the demonstration-based progressive muscle relaxation technique on stress and anxiety in nurses caring for COVID-19 patients: a randomized clinical trial.

BACKGROUND: Caring for patients with coronavirus disease 2019 (COVID-19) challenges nurses and causes them to experience stress and anxiety. From this perspective, it is of utmost importance to develop quick and effective intervention strategies to prevent numerous complications. This study aimed to investigate the effect of the progressive muscle relaxation technique, using the demonstration method on the stress and anxiety of nurses who care for COVID-19 patients. METHODS: This randomized clinical trial was conducted in 2021. Forty-six nurses working in two referral hospitals with wards for COVID-19 patients in Tehran, Iran recruited by convenience sampling method and then randomly assigned to experimental or control groups. The nurses in the experimental group educated the progressive muscle relaxation by the demonstration method, and they were encouraged to practice it. The Depression Anxiety Stress Scale-21 was utilized to measure the stress and anxiety levels in the nurses. RESULTS: Before the intervention, the levels of stress in the experimental and control groups were 13.91 ± 2.41 vs. 14.34 ± 2.74 (p = 0.571), and their anxiety was 13.34 ± 3.41 vs. 12.78 ± 2.21 (p = 0.510), respectively. After the intervention, the levels of stress in the experimental and control groups were 10.95 ± 2.01 vs. 14.17 ± 2.34 (p < 0.001), and their anxiety was 9.47 ± 2.37 vs. 12.91 ± 1.85 (p < 0.001), respectively. Moreover, the levels of stress and anxiety in the experimental group significantly diminished after intervention (p < 0.001), but no significant changes were observed in the control group (p > 0.05). CONCLUSION: Concerning the effectiveness of the progressive muscle relaxation technique in relieving the stress and anxiety of the nurses caring for COVID-19 patients, it is suggested to include this relaxation technique in nursing courses.

[Chronic Occupational Stress: Psychotherapeutic Treatment Approaches]. / Chronischer beruflicher Stress: Behandlungsansätze mit Psychotherapie.

Mental illness is a central risk factor for occupational incapacity and premature retirement. One of the contributors for mental illness as well as somatic diseases is chronic stress at work. Therefore, it is essential for affected individuals to get professional help in order to identify and ease mental stress at work as well as to regain their working ability and prevent relapses. Job-related stress models facilitate the identification of health-relevant stress factors on an individual and organizational level. This enables therapists to use job-related treatment approaches. These should comprise the following elements: motivational support, cognitive coping strategies, provision of knowledge and exercises for the competence to act and strategies for recovery, and social counseling. Promising results in the growing field of internet-based occupational e-mental health allow us to expect good effects in prevention and psychotherapeutic treatment of occupational stress.

The Efficacy of a Web-Based Stress Management Intervention for Employees Experiencing Adverse Working Conditions and Occupational Self-efficacy as a Mediator: Randomized Controlled Trial.

BACKGROUND: Work stress is highly prevalent and puts employees at risk for adverse health consequences. Web-based stress management interventions (SMIs) promoting occupational self-efficacy might be a feasible approach to aid employees to alleviate this burden and to enable them to improve an unbalanced situation between efforts and rewards at work. OBJECTIVE: The first aim of this randomized controlled trial was to investigate the efficacy of a web-based SMI for employees perceiving elevated stress levels and an effort-reward imbalance in comparison to a waitlist control (WLC) group. Second, we investigated whether the efficacy of an SMI could be explained by an increase in occupational self-efficacy and whether this personal resource enables employees to change adverse working conditions. METHODS: A total of 262 employees reporting effort-reward imbalance scores over 0.715 and elevated stress levels (10-item Perceived Stress Scale [PSS-10] score ≥22) were randomly assigned to either the intervention group (IG; SMI) or the WLC group. The primary outcome was perceived stress measured using the PSS-10. The secondary outcomes included mental and work-related health measures. Four different mediation analyses were conducted with occupational self-efficacy, efforts, and rewards as mediators. After eligibility screening, data were collected web based at baseline (T1), 7 weeks (T2) and 6 months (T3). RESULTS: Study participation was completed by 80% (105/130, 80.8%) in the IG and 90% (119/132, 90.2%) in the WLC group. Analyses of covariance revealed that stress reduction was significantly higher for the SMI group compared with the WLC group at T2 (d=0.87, 95% CI 0.61-1.12, P<.001) and T3 (d=0.65, 95% CI 0.41-0.90, P<.001). Mediation analyses indicated that occupational self-efficacy mediated the beneficial effect of the SMI on stress directly. Furthermore, the analyses revealed a significant indirect effect of occupational self-efficacy via rewards (b=0.18, t259=4.52, P<.001), but not via efforts (b=0.01, t259=0.27, P>.05) while efforts still had a negative impact on stress (b=0.46, t257=2.32, P<.05). CONCLUSIONS: The SMI was effective in reducing stress and improving occupational self-efficacy in employees despite them experiencing an effort-reward imbalance at work. Results from mediation analyses suggest that fostering personal resources such as occupational self-efficacy contributes to the efficacy of the SMI and enables employees to achieve positive changes regarding the rewarding aspects of the workplace. However, the SMI seemed to neither directly nor indirectly impact efforts, suggesting that person-focused interventions might not be sufficient and need to be complemented by organizational-focused interventions to comprehensively improve mental health in employees facing adverse working conditions. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005990; https://tinyurl.com/23fmzfu3.

Changes in Salivary Immunoglobulin A, Stress, and Burnout in a Workplace Mindfulness Intervention: A Pilot Study.

The purpose of this pilot study was to examine the effectiveness of a 6-week workplace mindfulness- and self-compassion-based intervention (MSCBI) on perceived stress, burnout, immune functioning (assessed with the biomarker Immunoglobulin A), self-compassion, and experiential avoidance compared to a Workplace Stress Management Intervention. Both interventions were contextual, i.e., they were carried out in the workplace setting and during working hours. We followed a randomised controlled trial study design. The total sample was composed of 24 employees of an automotive company. One-way analyses of covariance between groups revealed significant differences in post-intervention levels of perceived stress, salivary Immunoglobulin A (sIgA), emotional exhaustion, self-compassion, and experiential avoidance, after adjusting for pre-test scores. The results of this study have several implications. Firstly, it confirms that MSCBIs might be more effective than regular psychoeducational interventions for work-related stress and burnout treatment. Secondly, sIgA can be used to assess immune function state changes when MSCBIs are carried out. Furthermore, these results indicate that it is feasible to carry out MSCBIs within companies and during working hours, and that these interventions can help effectively manage stress and burnout associated with the work environment.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial.

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.

Decreasing On-shift Stress With a Crisis Intervention Cart.

Because of the pandemic's impact on morbidity and mortality, nursing leaders have witnessed a marked increase in the number of staff who experience crisis and extreme stress during their shift. This hospital's Engagement and Resilience Council aimed to mediate this stress by implementing resilience-building interventions during moments of peaked stress. Preliminary data show these interventions may markedly improve stress levels in frontline caregivers by up to 52% in some clinical settings.

Self-Reported Coping Strategies for Managing Work-Related Stress among Public Safety Personnel.

Public safety personnel (PSP) experience a disproportionately high number of on-the-job stressors compared to the general population. PSP develop self-initiated actions, or coping strategies, that either confront the situation (approach strategies) or avoid the situation (avoidance strategies) to reduce the impact of stressors on their well-being. Understanding how PSP cope with stress is critical to ensuring their safety and that of the public. In the current study, we examined the coping strategies of PSP (n = 828 in the total sample). Participants managed their experiences of occupational stress or distress using three primary approach coping strategies: education (learning about mental illness and their causes), self-reliance (processes of self-reflection), and treatment (pharmaceutical, psychotherapy) that were considered adaptive. Results demonstrate PSP used multiple coping strategies simultaneously to deal with occupational stress. PSP who reported doing better tended to attribute their success to treatment, specifically psychotherapy, either alone or in combination with other interventions, and almost always emphasizing important supports from co-workers, families, and friends. Changing workplace culture could help to de-pathologize the effects of stress reactions being perceived as individual "failings".

Effects of flower essences on nursing students' stress symptoms: a randomized clinical trial.

OBJECTIVE: To analyze the effects of flower essence bouquets on the signs and symptoms of stress in nursing students. METHOD: Randomized clinical trial, triple blind, with two groups, flower essence group and placebo group, carried out with 101 nursing students. The groups used the formula for 60 days at a dosage of 4 drops 4 times a day. The outcome was evaluated using the Baccaro Test and the Perceived Stress Scale applied at the beginning and at the end of the intervention. The outcome analysis was performed using the mixed effects model, with 〈 = 5% and the effect size verified by the Cohen's d test. RESULTS: There was no significant difference between the groups in stress reduction (p > 0.05). Both groups showed a reduction in scale scores (p < 0.001) with large effect size. There was an influence of the COVID-19 pandemic in the reduction of Baccaro Test scores. CONCLUSION: The intervention with flower essence therapy was not more effective than placebo in reducing stress signs and symptoms. Brazilian Registry of Clinical Trials: UTN U1111-1257-5715.

The experiences of palliative care professionals and their responses to work-related stress: A qualitative study.

OBJECTIVES: Previous qualitative research has demonstrated that palliative care professionals (PCPs) deal with a wide array of emotionally challenging issues associated with the care they provide. Although previous research has identified self-care strategies PCPs engage in, there is a lack of focus on what responses are helpful and/or unhelpful. The aim of the current study is to understand and describe the experiences of PCPs and to explore the helpful and unhelpful responses to work-related stress they employ. DESIGN: This was a qualitative study of the experiences of working PCPs in a hospice setting. METHODS: Nine semi-structured interviews were conducted and subsequently analysed using the framework method. RESULTS: The current study revealed five overarching themes: (1) Sources of Meaning and Purpose (making a difference, personal growth), (2) Sources of Stress (emotional challenges, patient family dynamics, work environment factors, public perception, uncontrollability of symptoms), (3) Personal Impact (life engagement, perceptions of death), (4) Unhelpful Responses (self-doubt, emotional suppression, rumination, overidentifying, lack of self-care), and (5) Helpful Responses (acceptance, being present, perspective taking, being able to switch off, social support, active self-care). CONCLUSIONS: The experiences of PCPs can be interpreted from or directly mapped onto the psychological (in)flexibility model in Acceptance and Commitment Therapy (ACT). It is suggested that ACT training for professionals may encourage more reliable and explicit helpful responses and reduce the impact of unhelpful responses. Thus, an ACT training intervention may enhance wellbeing and effectiveness in PCPs.

Economic Precarity, Financial Strain, and Job-Related Stress Among Philadelphia's Public Mental Health Clinicians.

OBJECTIVE: Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths. METHODS: In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic. RESULTS: Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001). CONCLUSIONS: The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.

Effectiveness of auriculotherapy on stress reduction in health workers: a controlled randomized clinical trial / Efetividade da auriculoterapia na redução de estresse em trabalhadores de saúde: ensaio clínico controlado randomizado / Efectividad de la auriculoterapia para la reducción del estrés de trabajadores de la salud: ensayo clínico controlado aleatorizado

Abstract Objective: to assess the effectiveness of auriculotherapy in reducing occupational stress among Family Health Strategy workers during the COVID-19 pandemic. Method: a controlled randomized clinical trial divided into two groups, namely: auriculotherapy for stress group and placebo group. The Shapiro-Wilk test was used to assess data normality. The ANOVA test for repeated measures and the Tukey post-hoc test were applied to the group with normal samples. In turn, the Friedman and Durbin-Conover tests were employed in the group with non-normal distribution. Cohen's d index was calculated for the therapy effect size. A 95% significance level and p<0.05 were considered. Results: the auriculotherapy group presented 16.3% and 23.7% reductions in occupational stress after the third and sixth auriculotherapy sessions, with Cohen's d indices of 1.12 (large effect) and 1.82 (very large effect), respectively. Conclusion: auriculotherapy proved to be effective in reducing occupational stress among Family Health Strategy workers during the COVID-19 pandemic. It is suggested that new studies are developed both during and after the pandemic in order to improve health workers' Quality of Life. ReBEC registration: RBR - 38hjyt3.

Resumo Objetivo: avaliar a efetividade da auriculoterapia na redução do estresse ocupacional em trabalhadores de saúde da Estratégia de Saúde da Família durante a pandemia da COVID-19. Método: ensaio clínico controlado randomizado em dois grupos: grupo auriculoterapia para o estresse e grupo placebo. Foi utilizado o teste de Shapiro-Wilk para avaliar a normalidade dos dados. O teste ANOVA de medidas repetidas e o teste post-hoc Tukey foram aplicados para o grupo com amostras normais. Já o teste de Friedman e de Durbin-Conover foram utilizados no grupo com distribuição não normal. Para o tamanho do efeito da terapia, foi calculado o índice d de Cohen. Considerou-se o nível de significância de 95% e valor p<0,05. Resultados: o grupo auriculoterapia apresentou redução do estresse ocupacional de 16,3 e 23,7% após a terceira e sexta sessões de auriculoterapia, com índices d de Cohen de 1,12 (grande efeito) e 1,82 (efeito muito grande), respectivamente. Conclusão: a auriculoterapia mostrou-se efetiva na redução do estresse ocupacional em trabalhadores de saúde da Estratégia Saúde da Família durante a pandemia da COVID-19. Sugere-se que novos estudos sejam desenvolvidos durante e após a pandemia de maneira a melhorar a qualidade de vida dos trabalhadores de saúde. Registro ReBEC: RBR - 38hjyt3.

Resumen Objetivo: evaluar la efectividad de la auriculoterapia para la reducción del estrés laboral en trabajadores de salud de la Estrategia Salud de la Familia durante la pandemia de COVID-19. Método: ensayo clínico controlado aleatorizado en dos grupos: grupo auriculoterapia para el estrés y grupo placebo. Se utilizó la prueba de Shapiro-Wilk para evaluar la normalidad de los datos. Al grupo con muestras normales se les aplicó la prueba ANOVA de medidas repetidas y la prueba post-hoc de Tukey. Se utilizaron las pruebas de Friedman y Durbin-Conover en el grupo con distribución no normal. Para el tamaño del efecto de la terapia se calculó el índice d de Cohen. Se consideró un nivel de significación del 95% y un valor de p <0,05. Resultados: el grupo auriculoterapia mostró una reducción del estrés laboral de 16,3 y 23,7% después de la tercera y sexta sesión de auriculoterapia, con índices d de Cohen de 1,12 (efecto grande) y 1,82 (efecto muy grande), respectivamente. Conclusión: la auriculoterapia demostró ser eficaz para la reducción del estrés laboral en trabajadores de la salud de la Estrategia Salud de la Familia durante la pandemia de COVID-19. Se sugiere desarrollar nuevos estudios durante y después de la pandemia con el fin de mejorar la calidad de vida de los trabajadores de la salud. Registro ReBEC: RBR - 38hjyt3.