RESUMEN
BACKGROUND: The impact of the COVID-19 pandemic on the mental health of healthcare workers throughout the world has been reported, but most studies have been cross-sectional and excluded the Midwestern U.S. healthcare workforce. OBJECTIVE: This study aimed to longitudinally assess the psychological wellbeing and wellness strategies used by a Midwestern academic health system's workforce at multiple points throughout waves of the COVID-19 pandemic to inform ongoing implementation of appropriate wellness activities. METHODS: An anonymous REDCap survey linked within our team-developed wellness education was posted in the employee online newsletter in April (T1), July (T2), October 2020 (T3), and May 2021 (T4). Surveys were open to all employees (approx. 9000) for approximately 12 days at each time point. Anxiety, depressive symptoms, stress, self-efficacy, and self-care activities were assessed. Following each data collection, team members discussed findings and planned wellness education implementation. RESULTS: Response ranged from n = 731 (T1) to n = 172 (T4). Moderate to severe stress was reported by 29.5% (n = 203) of respondents at T1 and 34.0% (n = 108) at T2. At T3, all psychological symptoms significantly increased (p < .001) as COVID-19 surged, with 48.5% (n = 141) of respondents reporting moderate to severe stress. At T4, stress significantly declined (p < .001). Exercise was the most frequently reported coping strategy. CONCLUSIONS: Mental health symptoms reported by a Midwestern healthcare workforce increased during surges of COVID-19 hospitalizations. Individuals in non-patient contact roles experienced symptom levels similar to and at times with greater severity than healthcare personnel with patient contact roles.
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COVID-19 , Humanos , Estudios Transversales , Pandemias , Personal de Salud , AnsiedadRESUMEN
PURPOSE: Significant cancer-related distress affects 30-60% of women diagnosed with breast cancer. Fewer than 30% of distressed patients receive psychosocial care. Unaddressed distress is associated with poor treatment adherence, reduced quality of life, and increased healthcare costs. This study aimed to evaluate the preliminary efficacy of a new web-based, psychoeducational distress self-management program, CaringGuidance™ After Breast Cancer Diagnosis, on newly diagnosed women's reported distress. METHODS: One-hundred women, in five states, diagnosed with breast cancer within the prior 3 months, were randomized to 12 weeks of independent use of CaringGuidance™ plus usual care or usual care alone. The primary multidimensional outcome, distress, was measured with the Distress Thermometer (DT), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Impact of Events Scale (IES) at baseline and months 1, 2, and 3. Intervention usage was continually monitored by the data analytic system imbedded within CaringGuidance™. RESULTS: Although multilevel models showed no significant overall effects, post hoc analysis showed significant group differences in slopes occurring between study months 2 and 3 on distress (F(1,70) = 4.91, p = .03, η2 = .065) measured by the DT, and depressive symptoms (F(1, 76) = 4.25, p = .043, η2 = .053) favoring the intervention. CONCLUSIONS: Results provide preliminary support for the potential efficacy of CaringGuidance™ plus usual care over usual care alone on distress in women newly diagnosed with breast cancer. This analysis supports and informs future study of this self-management program aimed at filling gaps in clinical distress management.
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Neoplasias de la Mama/terapia , Depresión/terapia , Psicoterapia/métodos , Estrés Psicológico/terapia , Telemedicina/métodos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/psicología , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Persona de Mediana Edad , Calidad de Vida/psicología , Automanejo , Estrés Psicológico/etiología , Estrés Psicológico/psicologíaRESUMEN
Recent research suggests atypical error-monitoring is important to understanding pathological anxiety. Because uncertainty is a transdiagnostic factor associated with anxiety and related disorders, recent research has begun to examine the influence of uncertainty in error-monitoring. Moreover, task irrelevant threat has been shown to influence cognitive performance in individuals with maladaptive anxiety. The current study aims to merge these literatures by examining the influence of task-irrelevant uncertain evaluative threat on error-monitoring using an event-related brain potential, the error-related negativity (ERN). Considering extensive literature indicating a relationship between worry and the ERN, worry was included as a continuous predictor in the analyses. Participants were randomly assigned to either a condition of negative or uncertain evaluative threat to determine their influence on error-monitoring in a Flankers task. Results for the ERN suggest that the ERN was significantly reduced only for the uncertain evaluative threat condition. The current study suggests that uncertain evaluative threat distractors result in a subsequent reduction in error-monitoring. This is consistent with literature suggesting that anxiety impairs inhibition of attentional processing of task irrelevant threatening information. This study adds to the burgeoning literature on the malleability of the ERN. Future research is needed to determine the mechanisms underlying this effect.
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Ansiedad/psicología , Encéfalo/fisiología , Desempeño Psicomotor/fisiología , Tiempo de Reacción/fisiología , Incertidumbre , Adolescente , Adulto , Ansiedad/fisiopatología , Atención/fisiología , Electroencefalografía/métodos , Potenciales Evocados/fisiología , Femenino , Humanos , Masculino , Distribución Aleatoria , Adulto JovenRESUMEN
Efforts to improve the efficiency of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) have demonstrated that reducing the length of imaginal exposures does not negatively affect treatment outcome. A recent adaptation of PE, called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE], integrates substance use disorder treatment with PE in the same timeframe (twelve 90-minute sessions, 8 of which include imaginal exposure). The current study, which represents a subanalysis of a larger randomized controlled trial, examined how the length of imaginal exposures (nonrandomized and measured continually) related to PTSD, substance use, and depression in a sample of military veterans (N = 31) who completed the COPE treatment. Participants completed an average of 11.5 of the 12 therapy sessions and 7.2 of the 8 imaginal exposures during treatment. Results of 3 linear mixed models indicate that PTSD, substance use, and depressive symptoms all improved over the course of treatment (ps < .001; η2 ranged between .17 and .40), and that the length of imaginal exposures did not significantly interact with any outcome. Although preliminary, the findings suggest that it may be feasible to shorten imaginal exposures without mitigating treatment gains. Implications for treatment are discussed.
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Depresión/terapia , Terapia Implosiva/métodos , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/terapia , Veteranos/psicología , Adulto , Depresión/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Worry and anticipatory processing are forms of repetitive negative thinking (RNT) that are associated with maladaptive characteristics and negative consequences. One key maladaptive characteristic of worry is its abstract nature (Goldwin & Behar, 2012; Stöber & Borkovec, 2002). Several investigations have relied on inductions of worry that are social-evaluative in nature, which precludes distinctions between worry and RNT about social-evaluative situations. The present study examined similarities and distinctions between worry and anticipatory processing on potentially important maladaptive characteristics. METHODS: Participants (N = 279) engaged in idiographic periods of uninstructed mentation, worry, and anticipatory processing and provided thought samples during each minute of each induction. Thought samples were assessed for concreteness, degree of verbal-linguistic activity, and degree of imagery-based activity. RESULTS: Both worry and anticipatory processing were characterized by reduced concreteness, increased abstraction of thought over time, and a predominance of verbal-linguistic activity. However, worry was more abstract, more verbal-linguistic, and less imagery-based relative to anticipatory processing. Finally, worry demonstrated reductions in verbal-linguistic activity over time, whereas anticipatory processing demonstrated reductions in imagery-based activity over time. LIMITATIONS: Worry was limited to non-social topics to distinguish worry from anticipatory processing, and may not represent worry that is social in nature. Generalizability may also be limited by use of an undergraduate sample. CONCLUSIONS: Results from the present study provide support for Stöber's theory regarding the reduced concreteness of worry, and suggest that although worry and anticipatory processing share some features, they also contain characteristics unique to each process.
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Ansiedad/psicología , Formación de Concepto/fisiología , Imaginación/fisiología , Pensamiento/fisiología , Adolescente , Análisis de Varianza , Femenino , Humanos , Relaciones Interpersonales , Lingüística , Masculino , Autoinforme , Encuestas y Cuestionarios , Conducta Verbal , Adulto JovenRESUMEN
Social support plays a significant role in the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). However, there has been little investigation of social support with PTSD and its frequent comorbid conditions and related symptoms. Substance use disorders (SUDs) are 1 set of conditions that have yet to be investigated in combination with PTSD and social support. As compared with civilians, veterans are at increased risk for developing both PTSD and SUD. In this study, veterans (N = 171) with symptoms of PTSD (76% met diagnostic criteria) and SUD (83% met diagnostic criteria for any dependence) were recruited and completed clinician-rated and self-report measures of PTSD, SUD, and social support. Overall, low social support was reported in the sample. When controlled for the other disorder's symptoms, PTSD symptoms demonstrated a significant negative relation and SUD symptoms demonstrated a significant positive relation to social support. The PTSD findings are consistent with previous studies on PTSD and social support without SUD comorbidity. However, the SUD findings are inconsistent with previous studies, which focused primarily on older veterans. Together, these findings highlight the significance of social support in individuals with PTSD and SUD and promote future research within comorbid presentations. (PsycINFO Database Record
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Apoyo Social , Trastornos por Estrés Postraumático/complicaciones , Trastornos Relacionados con Sustancias/complicaciones , Veteranos/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Repetitive negative thinking (RNT) has been implicated in several disorders (e.g., Clark (2005)). However, little research has examined how RNT influences other risk factors of psychopathology, such as attentional control. This study used prospective methodology to determine if relationships among various RNT styles and symptoms of psychological disorders are indirectly influenced by facets of attentional control. The sample included 376 participants who completed measures of RNT (worry, rumination, anticipatory processing, obsessions, intrusive thoughts and panic cognitions), psychopathology (generalized anxiety disorder, depression, social anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder), and attentional control at two time points. Several relationships between RNT forms and symptom levels were indirectly predicted by the focusing subscale of attentional control; however, the patterns of these relationships differed based on the disorder. The shifting subscale did not indirectly predict any relationship. Therefore, it appears that low focusing may be a particular risk factor for the development of later RNT and/or psychopathology symptoms.
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Trastornos de Ansiedad/psicología , Atención , Depresión/psicología , Pesimismo , Psicopatología , Pensamiento , Adulto , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/psicología , Depresión/epidemiología , Depresión/etiología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/psicología , Pánico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Trastornos de Estrés Traumático Agudo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Self-focused attention is thought to be a key feature of social anxiety disorder. Yet few studies have used event-related potentials (ERPs) to examine whether socially anxious individuals display greater monitoring of their performance and attention to their errors. Similarly, only a few studies have used ERPs to examine how social anxiety is related to processing of performance feedback. Individuals with high (n=26) and low (n=28) levels of social anxiety completed a trial-and-error learning task. Self-focus was manipulated using false heart-rate feedback during a random subset of trials. Performance feedback was given using emotional and neutral faces in a positive context (correct=happy face; incorrect=neutral face) and negative context (correct=neutral face; incorrect=disgust face) in order to investigate biased interpretation and attention to feedback. Socially anxious subjects displayed enhanced amplitude of the ERN and CRN, suggesting greater response monitoring, and enhanced Pe amplitude, suggesting greater processing of errors relative to the low social anxiety group. No group differences were observed with respect to feedback processing. Before learning stimulus-response mappings in the negative context, the FRN was larger for self-focus compared to standard trials and marginally larger for socially anxious subjects compared to controls. These findings support cognitive models and suggest avenues for future research.
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Trastornos de Ansiedad/psicología , Ansiedad/psicología , Atención/fisiología , Autoimagen , Ajuste Social , Adulto , Electroencefalografía , Emociones , Potenciales Evocados , Femenino , Humanos , Masculino , Trastornos Fóbicos/psicologíaRESUMEN
Overgeneralization of fear to safety cues is increasingly being studied in order to further our understanding of the maintenance of anxiety disorders. The current study used event-related potentials (ERPs) to evaluate whether worry affects anticipation and processing of threat and neutral pictures during a conditioning task. Fifty-two high (n=24) and low (n=28) worriers completed a paradigm in which a neutral stimulus indicated the valence of a second stimulus, either a threat or neutral picture. Results found that worriers displayed reduced anticipatory responses to both stimulus types as indexed by the stimulus preceding negativity, although they displayed an increased stimulus preceding negativity to threatening images during the second half of the task. In addition, high and low worriers differed in processing of threat and neutral images as indexed by the late positive potential. These findings support the overgeneralization of fear literature, suggesting that worriers display difficulty discriminating safety cues from threat cues, and this affects the attentional resources devoted to subsequent stimuli. Implications of these results are discussed.
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Ansiedad/psicología , Señales (Psicología) , Miedo/psicología , Adolescente , Trastornos de Ansiedad , Atención , Condicionamiento Clásico , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Currently, electronic cigarettes (e-cigarettes) are studied as though they are a homogeneous category. However, there are several noteworthy differences in the products that fall under this name, including potential differences in the efficacy of these products as smoking cessation aids. The current study examined the comparative efficacy of first- and second-generation e-cigarettes in reducing nicotine withdrawal symptoms in a sample of current smokers with little or no experience of using e-cigarettes. DESIGN: Twenty-two mildly to moderately nicotine-dependent individuals were randomized to a cross-over design in which they used first- and second-generation e-cigarettes on separate days with assessment of withdrawal symptoms directly prior to and after product use. SETTING AND PARTICIPANTS: A community-based sample recruited in the Midwest region of the United States reported a mean age of 28.6 [standard deviation (SD) = 12.9]. The majority were male (56.5%), Caucasian (91.3%), reported smoking an average of 15.2 (SD = 9.6) tobacco cigarettes per day, and a mean baseline carbon monoxide (CO) level of 18.7 parts per million (p.p.m.). MEASUREMENTS: Symptoms of withdrawal from nicotine were measured via the Mood and Physical Symptoms Scale. FINDINGS: Analysis of changes in withdrawal symptoms revealed a significant time × product interaction F(1, 21) = 5.057, P = 0.036, n(2) P = 0.202. Participants experienced a larger reduction in symptoms of nicotine withdrawal after using second-generation compared with first-generation e-cigarettes. CONCLUSIONS: Second-generation e-cigarettes seem to be more effective in reducing symptoms of nicotine withdrawal than do first-generation e-cigarettes.
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Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Nicotina/efectos adversos , Cese del Hábito de Fumar/métodos , Síndrome de Abstinencia a Sustancias/prevención & control , Tabaquismo/terapia , Adulto , Análisis de Varianza , Estudios Cruzados , Sistemas Electrónicos de Liberación de Nicotina/instrumentación , Sistemas Electrónicos de Liberación de Nicotina/métodos , Femenino , Humanos , Masculino , Cese del Hábito de Fumar/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Recent research suggesting that nicotine cues are appetitive in nature promotes the affective modulation of the startle reflex (AMSR) paradigm as a potentially valuable psychophysiological tool for elucidating mechanisms involved in nicotine addiction. Despite numerous studies indicating stress as a key factor in nicotine dependence, specific behavioral mechanisms linking stress and smoking have yet to be explicated. The current study aimed to determine the effects of stress, a negative affective state intimately linked with nicotine use, on the psychophysiological responding of nicotine dependent individuals during smoking cues. Twenty-nine nicotine dependent individuals were randomly assigned to the trier social stress test or control condition directly prior to administration of the AMSR paradigm, which examined their physiological responses to appetitive, neutral, aversive, and nicotine cue images. Both groups evinced significantly decreased startle magnitudes in response to nicotine cues as compared to aversive images. However, exposure to stress did not significantly modulate the startle reflex while viewing nicotine cues. Stress induction does not appear to modulate the AMSR paradigm when evaluating responses to nicotine images. These findings suggest that AMSR is robust to effects of acute stress induction in nicotine dependent individuals which may increase its viability as a clinical tool for assessing success in smoking cessation interventions.
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Reflejo de Sobresalto/fisiología , Fumar/fisiopatología , Estrés Psicológico/fisiopatología , Tabaquismo/fisiopatología , Adulto , Señales (Psicología) , Femenino , Humanos , Masculino , Distribución Aleatoria , Adulto JovenRESUMEN
Research on cognitive theories of social anxiety disorder (SAD) has identified individual processes that influence this condition (e.g., cognitive biases, repetitive negative thinking), but few studies have attempted to examine the interaction between these processes. For example, attentional biases and anticipatory processing are theoretically related and have been found to influence symptoms of SAD, but they rarely have been studied together (i.e., Clark & Wells, 1995). Therefore, the goal of the current study was to examine the effect of anticipatory processing on attentional bias for internal (i.e., heart rate feedback) and external (i.e., emotional faces) threat information. A sample of 59 participants high (HSA) and low (LSA) in social anxiety symptoms engaged in a modified dot-probe task prior to (Time 1) and after (Time 2) an anticipatory processing or distraction task. HSAs who anticipated experienced an increase in attentional bias for internal information from Time 1 to Time 2, whereas HSAs in the distraction condition and LSAs in either condition experienced no changes. No changes in biases were found for HSAs for external biases, but LSAs who engaged in the distraction task became less avoidant of emotional faces from Time 1 to Time 2. This suggests that anticipatory processing results in an activation of attentional biases for physiological information as suggested by Clark and Wells.
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Ansiedad/terapia , Atención/fisiología , Cognición , Terapia Cognitivo-Conductual/métodos , Emociones/fisiología , Adolescente , Adulto , Anticipación Psicológica , Ansiedad/psicología , Femenino , Humanos , Masculino , Pruebas Psicológicas , Encuestas y CuestionariosRESUMEN
The Attentional Control Scale (ACS; Derryberry & Reed, 2002) has been used to assess executive control over attention in numerous studies, but no published data have examined the factor structure of the English version. The current studies addressed this need and tested the predictive and convergent validity of the ACS subscales. In Study 1, exploratory factor analysis yielded a two-factor model with Focusing and Shifting subscales. In Study 2, confirmatory factor analysis supported this model and suggested superior fit compared to the factor structure of the Icelandic version (Ólafsson et al., 2011). Study 3 examined correlations between the ACS subscales and measures of working memory, anxiety, and cognitive control. Study 4 examined correlations between the subscales and reaction times on a mixed-antisaccade task, revealing positive correlations for antisaccade performance and prosaccade latency with Focusing scores and between switch trial performance and Shifting scores. Additionally, the findings partially supported unique relationships between Focusing and trait anxiety and between Shifting and depression that have been noted in recent research. Although the results generally support the validity of the ACS, additional research using performance-based tasks is needed.
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Atención , Encuestas y Cuestionarios , Ansiedad/psicología , Depresión/psicología , Función Ejecutiva , Análisis Factorial , Femenino , Humanos , Masculino , Memoria a Corto Plazo , Psicometría , Tiempo de Reacción , Movimientos Sacádicos , Adulto JovenRESUMEN
Anticipatory processing is an anxious style of repetitive negative thought associated with social anxiety (SA) that was proposed by Clark and Wells. Considerable research has examined factors of Clark and Wells' cognitive model of SA (e.g. attention, interpretation), but few studies have examined anticipatory processing, which is hypothesized to interact with other components in the model. In the current study, individuals high in social anxiety symptoms (HSA; N = 56) and control participants [Normal Control (NC); N = 52] engaged in an anticipation or distraction task prior to a threatened social interaction. HSAs who anticipated had higher self-focused attention than NCs who anticipated and HSAs in the distraction condition, suggesting an important relationship between anticipation and self-focus that is specific to HSAs. Those who anticipated endorsed more negative interpretations than those who engaged in distraction, regardless of SA status. However, this relationship was mediated by self-focus. Implications in the context of Clark and Wells' model and future directions are discussed.
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Anticipación Psicológica , Cognición , Trastornos Fóbicos/psicología , Atención , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Modelos Psicológicos , Pruebas Psicológicas , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Cognitive models of social anxiety disorder posit that maladaptive thought processes play an etiological role in symptoms. The current study tested whether socially anxious individuals (HSAs) demonstrated impaired processing efficiency at the neural and behavioral level, and whether this was exacerbated by self-focused attention. Thirty-two (16 socially anxious, 16 nonanxious controls) subjects completed a mixed-antisaccade task with an oddball instructional cue. To manipulate self-focus, participants were told that the oddball cue indicated elevated heart rate. The HSA group demonstrated delayed saccade onset compared with controls, but made fewer errors. HSAs also had lower P3b amplitude compared with controls, suggesting reduced availability of resources for discriminating cues, and later P3b latency during self-focus trials, suggesting delayed cue categorization. Additionally, HSAs had greater CNV negativity compared with controls, suggesting greater effort in response preparation, and this negativity was reduced during self-focus trials, supporting the hypothesis that self-focused attention preoccupies executive resources. The current study supports and expands cognitive theories by documenting impaired neural and behavioral functioning in social anxiety and the role of self-focused attention in these deficits.
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Ansiedad/fisiopatología , Ansiedad/psicología , Atención/fisiología , Inhibición Psicológica , Trastornos Fóbicos/fisiopatología , Trastornos Fóbicos/psicología , Conducta Social , Estudios de Casos y Controles , Señales (Psicología) , Femenino , Humanos , Masculino , Movimientos Sacádicos/fisiología , Adulto JovenRESUMEN
The vigilance-avoidance hypothesis suggests that socially anxious individuals attempt to detect signs that they are being evaluated (vigilance) and subsequently direct attention away from such stimuli (avoidance). Although extensive evidence supports vigilance, data concerning subsequent avoidance is equivocal. Drawing from models of attention, the current study hypothesised that working memory load moderates late attentional bias in social anxiety such that avoidance occurs if working memory load is low, and difficulty disengaging attention occurs if working memory load is high. Forty-one undergraduates (19 socially anxious; 22 non-anxious controls) completed a dot-probe task with emotional (happy and disgust) and neutral facial expressions and a concurrent n-back task. Results supported the hypothesis such that socially anxious subjects demonstrated avoidance of disgust faces when working memory load was absent, but had difficulty disengaging attention during high working memory load. Theoretical implications and directions for future research are discussed.