RESUMO
Empathy is a multifaceted skill and asset for health care providers. This paper uses current neuroscience literature of empathy to generate nuanced theory of how empathy can be blocked by personal stress and aversion among health care professionals. Current training approaches for educating sustainable empathy are reviewed in depth. The final part of the paper provides suggestions on how to spread empathy education farther and wider across medical education.
Assuntos
Educação Médica/organização & administração , Empatia , Modelos Psicológicos , Relações Médico-Paciente , Estresse Psicológico/psicologia , Comunicação , Emoções , Humanos , Atenção Plena , Neurociências , AutoeficáciaRESUMO
For human service care providers working in hospitals, balancing the motivation for interpersonal engagement with patients alongside self-protective emotional boundaries is a familiar struggle. Empathy is a critical, although not thoroughly understood, aspect of patient care as well as an important ingredient for feeling work satisfaction and meaning. However, empathy can lead to feelings of sympathetic emotional distress and even burnout. This article uses an illustrative case study from a medical social worker in the emergency room to explore these themes of empathy, burnout, and the search for meaning in work. The discussion examines areas for further empirical study and intervention to support care-provider empathy and avoid burnout.
Assuntos
Esgotamento Profissional/psicologia , Empatia , Hospitais , Assistentes Sociais/psicologia , Emoções , Humanos , Atenção Plena , Modelos Psicológicos , Saúde OcupacionalRESUMO
Social workers in Emergency Departments (ED) provide counseling, community resource linkage, and discharge planning. The ED is a critical intervention point for patients with multiple unmet medical, psychological, and social needs, and little or no other contact with service providers. In part because of its role as a medical safety net for underserved populations, use of the ED has steadily increased over time. There is limited research examining the utility of social services in the ED. This article provides a brief history of hospital social work and a literature review of ED social work research with the goal of advancing current research and practice agendas.
Assuntos
Serviço Hospitalar de Emergência , Papel Profissional , Pesquisa , Serviço Social , Acessibilidade aos Serviços de Saúde , Humanos , Patient Protection and Affordable Care ActRESUMO
Introduction: Considering the relevance of the emotional state, it is necessary to understand how daily stimuli can modulate the emotions. Animated short films are common stimuli, but it is unknown how they can modulate the emotional state. The study aimed to evaluate: how participants' emotional state changed after watching animated short films with positive or negative emotional valence in an online experiment; the relationship between participants' baseline score on an Emotional Intensity Scale and their potential change in the main emotion after watching the films; and the association between the initial main emotion valence and the potential change in this emotion with participants' sociodemographic information. Methods: A sample of 2,269 participants recruited during COVID-19 pandemic were randomly assigned to either watch a negative or positive animated short film. Results: The results showed that, after watching a film with negative valence, participants were in a more negative emotional state than at baseline and compared with those who watched the film with positive valence. Also, individuals who had a negative baseline emotion and maintained the same emotion after the film had presented higher baseline emotional state scores (more negative emotion) than those who changed their emotions. In addition, the individuals who kept the baseline emotion had an association with age, marital status, level of education and psychiatric disorders, use of medication, and emotional awareness, while the individuals who changed the baseline emotion had an association with age, gender, and following or not social distancing recommendations. Conclusion: Baseline emotional state may influence the response to animated short films and sociodemographic characteristics are associated with the initial main emotion valence and its potential change in this emotion.
RESUMO
BACKGROUND: Human flourishing is a long sought-after aspiration historically considered and espoused through religious, philosophical, and creative avenues. Only recently has western science began to investigate the meaning, underlying foundations of, and effective strategies for promoting flourishing in life. OBJECTIVE: Here, we present a framework for teaching the science and practice of human flourishing grounded in connection, positivity, and resilience (CPR) based on a synthesis of theoretical frameworks and observations and input from a global sample of learners enrolled in an online course. METHODS: The CPR framework is distilled from empirical research in psychology and neuroscience and an applied pedagogy of flourishing delivered through a massive open online course (MOOC) that has reached over 650,000 people worldwide. RESULTS: Building knowledge and skills tied to three pillars of CPR: connection, positivity, and resilience intrinsically and measurably reinforces the experiences and behaviors that foster flourishing, mainly through prosocial human connection. CONCLUSION: Human flourishing is malleable and the CPR framework is a promising method for teaching people the key ideas, spaces of opportunity for change, and behaviors, activities, exercises, and practices that strengthen flourishing in life.
RESUMO
PURPOSE: A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers, which may be alleviated by mindfulness interventions. Research on scalable, tailored, online mindfulness training programs is needed. We sought to test the feasibility and acceptability of a remotely delivered 8-week mindfulness-based intervention, Being Present 2.0 (BP2.0). METHODS: We performed a single-arm feasibility study of BP2.0 among patients with any metastatic gastrointestinal cancer receiving chemotherapy, with or without an informal caregiver. Participants were instructed to practice mindfulness using pre-recorded guided meditations 5 times per week using a study-specific website and to attend a weekly live, interactive virtual meeting facilitated by a trained instructor. The web-based platform enabled direct measurement of adherence. RESULTS: The study enrolled 46 of 74 (62%) patients contacted, together with 23 caregivers (69 participants total), from May to October 2018. Median patient age was 52 (range 20-70 years), 39% were male, 67% non-Hispanic white, 65% had colorectal cancer, and 78% lived outside of San Francisco. The top reasons cited for participation were to reduce stress/anxiety and learn how to meditate. Mean baseline National Comprehensive Cancer Network Distress Thermometer (NCCN DT) scores were 4.7 (patients) and 5.8 (caregivers). The study discontinuation rate was 20% (eight patients and six caregivers). Among the remaining 55 participants, 43 (78%) listened to at least one audio recording and/or attended at least one virtual meeting, although adherence data was incomplete. The retention rate was 71%, with 39 participants completing at least one follow-up assessment. In post-intervention qualitative interviews, 88% of respondents reported a positive experience. Compared to baseline, participants reported significantly reduced post-intervention NCCN DT scores (mean 3.1; P = .012). CONCLUSION: The BP2.0 online mindfulness-based program is feasible and acceptable for patients with metastatic gastrointestinal cancer and caregivers. These results will guide plans for a follow-up efficacy study. ClinicalTrials.gov Identifier: NCT03528863.
RESUMO
BACKGROUND: Psilocybin therapy has shown promise as a rapid-acting treatment for depression, anxiety, and demoralization in patients with serious medical illness (e.g., cancer) when paired with individual psychotherapy. This study assessed the safety and feasibility of psilocybin-assisted group therapy for demoralization in older long-term AIDS survivor (OLTAS) men, a population with a high degree of demoralization and traumatic loss. METHODS: Self-identified gay men OLTAS with moderate-to-severe demoralization (Demoralization Scale-II ≥8) were recruited from the community of a major US city for a single-site open-label study of psilocybin-assisted group therapy comprising 8-10 group therapy visits and one psilocybin administration visit (0·3-0·36â¯mg/kg po). Primary outcomes were rate and severity of adverse events, and participant recruitment and retention. The primary clinical outcome was change in mean demoralization from baseline to end-of-treatment and to 3-month follow-up assessed with a two-way repeated measures ANOVA. Trial registration: Clinicaltrials.gov (NCT02950467). FINDINGS: From 17 July 2017 to 16 January 2019, 18 participants (mean age 59·2 years (SD 4·4)) were enrolled, administered group therapy and psilocybin, and included in intent-to-treat analyses. We detected zero serious adverse reactions and two unexpected adverse reactions to psilocybin; seven participants experienced self-limited, severe expected adverse reactions. We detected a clinically meaningful change in demoralization from baseline to 3-month follow-up (mean difference -5·78 [SD 6·01], ηp 2â¯=â¯0·47, 90% CI 0·21-0·60). INTERPRETATION: We demonstrated the feasibility, relative safety, and potential efficacy of psilocybin-assisted group therapy for demoralization in OLTAS. Groups may be an effective and efficient means of delivering psychotherapy pre- and post-psilocybin to patients with complex medical and psychiatric needs. FUNDING: Carey Turnbull, Heffter Research Institute, NIMH R25 MH060482, NIH UL1 TR001872, River Styx Foundation, Saisei Foundation, Sarlo Foundation, Stupski Foundation, Usona Institute, US Department of Veterans Affairs (Advanced Neurosciences Fellowship and IK2CX001495).