A document by Wendy Huerta. Click on the document to view its contents.

Background: Post-traumatic stress disorder (PTSD) is one of the most prevalent mental health issues among emergency nurses, particularly in the aftermath of the COVID-19 pandemic. However, there is a scarcity of empirical studies on improving PTSD and related symptoms. Objective: To investigate the effectiveness of the mindfulness-based stress reduction (MBSR) program in reducing PTSD symptoms, emotional exhaustion, and coping styles among emergency nurses. Methods: A randomized clinical trial was conducted with 74 emergency nurses experiencing symptoms of PTSD who were recruited from two hospitals. Participants were randomly assigned to either the intervention group (n=38) or the comparison group (n=36) using a random number calculation procedure. The intervention group received an 8-week MBSR program, while the comparison group had the option to receive the same training upon completion of the study. Self-reported data on mindfulness, PTSD symptoms, emotional exhaustion, and coping styles were evaluated at baseline, after treatment, and 1-month of follow-up. Results: Participants in the MBSR group showed a significant improvement in PTSD symptoms (M(I-J)=-7.789, P<0.001, 95% CI=3.642~11.937), emotional exhaustion (M(I-J)=4.763, P=0.004, 95%CI=1.274~8.253) and mindfulness (M(I-J)=-7.421, P<0.001, 95%CI=-12.349~2.493) after treatment. These effects were sustained up to 1-month follow-up. No significant improvement in coping style was observed in any of the subjects. Conclusion: MBSR is feasible and effective in reducing symptoms of PTSD and emotional exhaustion among emergency nurses. However, it has a lesser effect on coping styles. MBSR has the potential to alleviate the psychological impact of occupational stress on nurses.

Objective: The present study assessed initial evidence of program feasibility, satisfaction, and pre-to post-intervention changes in moral injury symptoms among recent-era veterans who participated in Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based 7-week mindfulness-based program targeting moral injury among veterans. Method: Of 56 recent-era veterans who met study criteria and were randomized, 40 (71.4%) completed the pre- and post-intervention survey and attended at least one treatment session. Of these 40, 21 completed MMMI and 19 completed an equally intensive educational support (ES) control intervention. Among the analytic sample ( n = 40), most participants identified as White (77.5%), were men (62.5%), and reported a service-connected disability (82.5%). Results: Participants attended on average 6.11 sessions. Program satisfaction was moderately high across both conditions. Several significant condition x time interactions were found, with those in the MMMI condition reporting greater pre- to post-intervention decreases in moral injury (η2=.121), impaired functioning due to moral injury (η2=.129), shame-related experiences due to moral injury (η2=.105), and other-directed moral injury (e.g., betrayal, difficulty forgiving others; η2=.129) as compared to the ES condition. Conclusions: These preliminary findings suggest MMMI appears feasible and acceptable and may be able to reach veterans who may not seek traditional Veterans Affairs Medical Center care or who prefer a web-based program. Given its promise for the treatment of moral injury among veterans, MMMI warrants additional large-scale clinical-trial testing.

Objective: This study aims to evaluate the effectiveness and patient satisfaction of Group Schema Therapy-Day Treatment (GST-d) in treating individuals with cluster B/C personality disorders. Method: The study utilized a naturalistic design with 39 patients undergoing 34 weeks of combined group and individual schema therapy. This included weekly full-day GST-d sessions, 15 individual sessions, and two group follow-ups. Results: Significant reductions were observed in psychological symptoms, personality issues, and dysfunctional schemas, with effect sizes (Cohen d’s) ranging from .77 to .87. Healthy modes showed a smaller effect size of .24. The dropout rate was 17.9%, but overall patient satisfaction remained high. Conclusions: The findings suggest the potential effectiveness of GST-d in treating personality disorders. Despite some limitations, the study recommends further research with a larger sample and randomized control trials to better understand the relationship between patient satisfaction and treatment outcome, as well as cost-effectiveness.

Purpose: This study aimed to probe the psychological problems in the parents of children with strabismus. Methods: Cross-sectional study. A total of 220 parents of children with strabismus were enrolled. Demographic and clinical characteristics of strabismus children were collected and analyzed. The HADS and SAS/SDS were used to evaluate anxiety and depression in parents of children with strabismus. Results: There were significant differences in the rate of both anxiety and depression between HADS-A and SAS (21.82 vs. 12.73%, P = 0.012) and between HADS-D and SDS (16.82 vs. 31.82%, P<0.001). Additionally, the HADS-D score was positively correlated with strabismus deviation ( P= 0.018), parents’ educational level ( P = 0.001), and family habitation ( P = 0.034). SDS score presented less correlation with clinical features of children with strabismus, which illuminated that only SDS score was positively associated with educational level ( P = 0.040). No correlation between both HADS-A and SAS scores was found with patients’ clinical features. Meantime consumption of HADS was 2.54±1.45 minutes, which was shorter than that of SAS/SDS(7.25±4.13minutes)( P <0.001). Conclusion: Parents of children with strabismus who are experiencing psychosocial distress should be identified. HADS seems to be a better option for emotional assessment than SAS/SDS in parents of children with strabismus.

Objective: Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety and depression disorders. Nonetheless, nearly 50% of all patients do not respond. Besides other factors, this seems to be linked to the experience of traumatic life events. This study aims to assess the effects of trauma history on the choice of therapy interventions and treatment outcomes. Methods: We analyzed data from 340 CBT outpatients diagnosed with a depression or anxiety disorder and possibly a trauma history treated under naturalistic conditions. Based on their written therapy files, we collected information on trauma history, psychiatric diagnoses, duration of therapy, applied interventions, and severity of depression and anxiety symptoms at the start and end of therapy. The influence of trauma, diagnoses, and intervention use on the development of depression and anxiety symptoms were analyzed. Results: Patients with a trauma history reported higher overall depression and anxiety symptoms than those without trauma. No differences in the duration of therapy, applied interventions, or decrease in symptom severity were found between patients with and without a trauma history. Trauma-specific interventions failed to boost treatment success; however, they were also seldom applied. Conclusion: Although no differences between traumatized and non-traumatized patients were found for naturalistic CBT, traumatized patients maintained higher levels of symptom severity irrespective of diagnoses. These results indicate a need for more trauma-specific and personalized interventions. Therapists may need evidence-based guidelines to personalize CBT for patients with a trauma history and high symptom severity.

Objective: Emotion intolerance and perfectionism are two maintaining mechanisms to eating disorder psychopathology. However, it is unclear how these mechanisms relate to one another. This study explored whether perfectionism is a vulnerability factor for facets of restrictive eating in the context of body-related emotions. Methods: Female undergraduate students ( N=148) completed questionnaires assessing baseline levels of self-critical perfectionism and personal standards perfectionism. Participants then engaged in an ecological momentary assessment protocol where body-related emotion intolerance and restrictive eating facets (cognitive restraint and behavioural restriction) were assessed over 10 consecutive days. Multi-level modeling and simple slopes analysis were used to explore these moderated relationships. Results: Based on the analyses, both self-critical and personal standards perfectionism dimensions interacted with body-related emotion intolerance to predict increases in restrictive eating facets. Conclusion: These findings indicate that personal standards perfectionism, though conceptualized as the less maladaptive dimension of perfectionism, should not be ignored in eating disorder conceptualizations and treatments. Recommendations are provided on how to refine treatment targets to be more attuned with situations that elicit body-related emotion intolerance.

This study aims to investigate the potential of a modified Cognitive-Behavioral Group Therapy (CBGT) intervention in promoting social adjustment and reducing parental stress among children exhibiting symptoms of attention deficit hyperactivity disorder (ADHD). The research also highlights the mechanisms and advantages of employing modified CBGT counseling to address negative symptoms associated with ADHD in children. The study was conducted at Fuzhou Children’s Hospital of Fujian Province, involving two CBGT counseling sessions held in 2021 and 2022, with a total of 20 pairs of parents and children with ADHD participating. The assessment utilized measures such as SNAP, Barratt Impulsivity, and Conners to evaluate changes in the children’s social adjustment abilities and core/associated ADHD symptoms before and after CBGT intervention. Additionally, the Parental Stress Index was employed to gauge the level of stress experienced by the parents. The results demonstrated that modified CBGT interventions effectively alleviate ADHD symptoms, enhance parent-child relationships, and reduce parental stress levels. Consequently, CBGT interventions have shown substantial improvements in children’s social adjustment abilities and have proven to be a significant source of relief for parents. The study also addresses the limitations associated with existing ADHD treatments and CBGT interventions.

Transference-focused psychotherapy (TFP) is an evidence-based, psychodynamic psychotherapy empirically validated for patients with borderline personality disorder (BPD) and successfully adapted for the treatment of narcissistic personality disorder (NPD). Personality disorders are characterized by the behavioral and affective dysregulation associated with pathological identity formation. Based on contemporary object relations theory (ORT), the goal of TFP is symptom relief through improvement in self and interpersonal functioning. The TFP treatment frame, established through an initial contracting phase and combined with the therapist’s technical neutrality, facilitates activation, identification and containment of affectively charged perceptions of self and other. These perceptions, or object relations dyads, are repeatedly identified, labeled and explored through the interpretative process. Over the course of treatment, the patient’s capacity for affect containment and reflection improves and a better integrated, realistic sense of self develops consistent with healthier personality functioning. Utilizing a compilation of several patients, the treatment of NPD with TPF is described and the evidence for the efficacy of TFP for NPD is summarized.

Background: Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes towards the body and the impact this might have for the development of psychopathology is however less well elucidated. Method: 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders or OPD and 63 comprising a healthy control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror Results: The AAIs from the BPD group were predominantly insecure-preoccupied and unresolved. Adolescents with PD but particularly BPD had significantly greater issues with negative body representations (NBR) than the control group. Insecure attachment and unresolved attachment status were significantly linked to NBR. Regression results revealed a low loving relationship with fathers, high involving anger with father, low coherence of mind & passive speech uniquely predicted 61% of variance in NBR. Conclusion: Unfavorable attachment experiences may give rise to negative body images and influence the development of psychopathology, especially BPD.

Introduction: The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople’s intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. Methods: Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. Results: The result found the significant effect of emotional suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. Conclusions: The results showed that emotional suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as emotional suppression in developing suicide prevention strategies.

Objectives: Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. Method: Participants ( N =246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: Distress (composed of depression, generalized anxiety, irritability, and panic symptoms); Fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and Bipolar (mania and obsessive-compulsive). Results: During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed Distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed Fear. Conclusion: It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Objective: Interpersonal difficulties are salient among those with a history of NSSI and precede NSSI urges and behaviors. Yet, limited research has focused on identifying which aspects of interpersonal stress may confer risk for NSSI. Method: The current study aimed to leverage data from two samples (combined n=206; n=114 with NSSI history) of participant-driven interviews regarding a recent interpersonal stressor to enhance the field’s knowledge of interpersonal difficulties in relation to NSSI risk. Results: Using topic modeling to extract thematic information, analyses identified four main topics: daily difficulties; family members; adjectives/verbal fillers; and friendship/romantic relationships. Relationships between the topics and three predictors (i.e., NSSI history, emotion dysregulation, sample) were examined. In one sample, the proportion of ‘adjectives/verbal fillers’ was greater for participants with a NSSI history and at higher levels of emotion dysregulation. Across samples, for participants with a NSSI history, ‘adjectives/verbal fillers’ and ‘friendship/romantic partners’ increased with levels of emotion dysregulation. Conclusion: Findings highlight a greater use of adjectives and verbal fillers among individuals with a history of NSSI and higher levels of emotion dysregulation. This pattern of language may serve as an indicator of a specific aspect of emotion regulation difficulties that confers risk for NSSI.

Objective: Although life stress and adversity have emerged as risk factors for mental health problems and cognitive impairment among older adults, prior studies on this topic have been cross-sectional and based on relatively homogeneous samples. To address these issues, we examined prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the U.S. Method: We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3,496 individuals (59.9% female), aged ≥64 years old (M age=76.0 ±7.6 years). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities and later-life depression, anxiety, and cognitive impairment. Results: Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Second, experiencing a childhood adversity was associated with a 17.4% increased risk of experiencing an adulthood adversity. Finally, childhood and adulthood adversities both prospectively predicted more symptoms of late-life depression, anxiety, and cognitive impairment. Discussion: These findings are among the first to demonstrate prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help health care professionals and policymakers identify individuals who could benefit from interventions designed to reduce stress and enhance resilience.