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Objective: Medical school presents a time of psychological distress for many students, who are less likely than the general population to seek mental health treatment due to multiple treatment barriers. Internet-based cognitive behavioral therapy (iCBT) programs may be an acceptable option for medical students. This study aims to assess acceptability and usability of ThinkFeelDo, an iCBT program, and to examine the impact of the program on perceived stress, quality of life, and the development of cognitive and behavioral coping skills., Method: Fourteen medical students (M age = 25.4 years, 50% female) participated in the 6-week ThinkFeelDo program and completed baseline and end of treatment assessments., Results: ThinkFeelDo was used (login M = 11.9, SD = 9.8) and was rated as somewhat useful. Participants requested further refinement of lessons to better fit the typical narrative of a medical student and endorsed interest in the program being offered at the beginning of medical school. At end of program, participants increased the frequency with which they used cognitive and behavioral coping skills, t(10) = -3.400, p = .007., Conclusions: Results of this study indicate that medical students are willing to utilize online mental health programs and may receive benefit. However, the sample was small, self-selected, and without a comparison group. Feedback collected through this study provides insight on how to effectively integrate iCBT programs into the medical school experience.

The Cognitive and Behavioral Response to Stress Scale (CB-RSS) is a self-report measure of the use and helpfulness of several cognitive and behavioral skills. Unlike other measures that focus on language specific to terms used in therapy, the CB-RSS was intended to tap the strategies in ways that might be understandable to those who had not undergone therapy. The measure was included in a clinical trial of cognitive-behavioral therapy for depression and completed by 325 participants at baseline and end of treatment (18 weeks). Psychometric properties of the scale were assessed through iterative exploratory and confirmatory factor analyses. These analyses identified two subscales, cognitive and behavioral skills, each with high reliability. Validity was addressed by investigating relationships with depression symptoms, positive affect, perceived stress, and coping self-efficacy. End of treatment scores predicted changes in all outcomes, with the largest relationships between baseline CB-RSS scales and coping self-efficacy. These findings suggest that the CB-RSS is a useful tool to measure cognitive and behavioral skills both at baseline (prior to treatment) as well as during the course of treatment., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Chronic Fatigue Syndrome (CFS) is characterized in part by debilitating fatigue typically exacerbated by cognitive and/or physical exertion, referred to as post-exertional malaise (PEM). In a variety of populations, the cortisol awakening response (CAR) has stood out as a marker of endocrine dysregulation relevant to the experience of fatigue, and may therefore be particularly relevant in CFS. This is the first study to examine PEM and the CAR in a sample of individuals with CFS. The CAR has also been established as a stress-sensitive measure of HPA axis functioning. It follows that better management of stress could modulate the CAR, and in turn PEM. In this cross-sectional study, we hypothesized that greater Perceived Stress Management Skills (PSMS) would relate to lower reports of PEM, via the impact of PSMS on the CAR. A total of 117 adults (72% female) with a CFS diagnosis completed self-report measures of PSMS and PEM symptomatology and a two-day protocol of saliva collection. Cortisol values from awakening and 30 min post-awakening were used to compute the CAR. Regression analyses revealed that greater PSMS related to greater CAR and greater CAR related to less PEM severity. Bootstrapped analyses revealed an indirect effect of PSMS on PEM via the CAR, such that greater PSMS related to less PEM, via a greater CAR. Future research should examine these trends longitudinally and whether interventions directed at improving stress management skills are accompanied by improved cortisol regulation and less PEM in individuals with CFS., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Psychosocial and personality factors are known to contribute to the maintenance of and recovery from chronic pain conditions but less is known about their influence on the efficacy of pain treatment programs. The purpose of the present study is to examine the ability of the Millon Behavioral Medicine Diagnostic (MBMD), a broadband measure of personality and psychosocial characteristics, to predict response to multidisciplinary pain treatment. 93 patients completed the MBMD, and ratings of current pain and average pain on an 11 point scale, prior to a multidisciplinary pain management program. Ratings of current and average pain were completed upon program completion. Participants were classified as "successful" or "unsuccessful" program completers based on pain reductions of ≥2 points. After program completion, 47 % of participants evidenced successful pain reductions. These successful participants had lower scores on depression and on coping style scales measuring introversive, inhibited, and dejected tendencies at baseline. Additionally, lower pre-treatment depression scores and lower scores on each of these coping style scales predicted lower pain ratings at discharge independent of educational level and pre-treatment pain ratings. The MBMD may be a useful tool to delineate patients who are likely to make significant treatment gains in intense, multidisciplinary pain treatment programs.

Prostate cancer treatment presents multiple challenges that can negatively affect health-related quality of life (HrQoL), and that can be further compromised by maladaptive personality styles and psychological adjustment difficulties. This study examined the utility of a comprehensive psychosocial screening tool to identify psychosocial traits that prospectively predict HrQoL status among men treated for localized prostate cancer. The Millon Behavioral Medicine Diagnostic (MBMD) was administered to 66 men (M age = 68 years, 59% White) treated by either radical prostatectomy or radiotherapy along with standard measures of general and prostate-cancer-specific quality of life assessed at a 12-month follow-up. Higher scores on both summary MBMD Management Guides (Adjustment Difficulties and Psych Referral) and higher scores on personality styles characterized by avoidance, dependency, depression, passive aggressiveness, and self-denigration predicted lower HrQoL (β range = -.21 to -.50). Additionally, higher scores on the MBMD Depression, Tension-Anxiety, and Future Pessimism scales predicted lower HrQoL. Finally, higher scores on the MBMD Intervention Fragility and Utilization Excess scale also consistently predicted poorer mental and physical health functioning over time. These results point to the utility of the MBMD to help screen for potential impairments in mental and physical health functioning in men undergoing treatment for prostate cancer.