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Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations.We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time.Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark.Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping.ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.

Objectives Since 2016, Canada has allowed for euthanasia based on strict criteria under federal medical assistance in dying legislation. The purpose of this study was to determine how Canadian intensivists perceive medical assistance in dying and whether they believe their approach to withdrawal of life-sustaining therapies has changed following introduction of medical assistance in dying. Design Electronic survey. Setting Participants were recruited from 11 PICU programs and 14 adult ICU programs across Canada. All program leaders for whom contact information was available were approached for participation. Participants We invited intensivists and critical care trainees employed between December 2019 and May 2020 to participate using a snowball sampling technique in which department leaders distributed study information. All responses were anonymous. Quantitative data were analyzed using descriptive statistics. Categorical variables were analyzed using Pearson chi-square test. Interventions Not applicable. Measurements and main results We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. Most were from academic centers (81%, n = 121). Of respondents, 86% (n = 130) were familiar with medical assistance in dying legislation, 71% in favor, 14% conflicted, and 11% opposed. Only 5% (n = 8) thought it had influenced their approach to withdrawal of life-sustaining therapies. Half of participants had no standardized protocol for withdrawal of life-sustaining therapies in their unit, and 41% (n = 62) had observed medications given in disproportionately high doses during withdrawal of life-sustaining therapies, with 13% having personally administered such doses. Most (80%, n = 120) had experienced explicit requests from families to hasten death, and almost half (47%, n = 70) believed it was ethically permissible to intentionally hasten death following withdrawal of life-sustaining therapies. Conclusions Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected.

Due to high rates of potentially traumatic exposure (PTE) within the firefighting profession, a large body of literature concerning firefighters’ mental health has developed over recent decades. However, given variable prevalence outcomes and the largely descriptive nature of most studies, it is unclear whether the prevalence of trauma-related mental disorders in firefighters is elevated in comparison with the general population. The present systematic review examined literature on prevalence of posttraumatic stress disorder, depression, and anxiety in firefighters exposed to routine, duty-related PTEs to synthesize prevalence outcomes across the literature. Systematic search of 6 databases was conducted to review eligible articles published between 1980 and 2017 in any language. In all, 40 articles concerned firefighters exposed to routine work-related PTE. We report that strong evidence exists to suggest that the prevalence of posttraumatic stress disorder and depression is elevated in firefighters compared with the general population of Canada, whereas moderate evidence exists for the elevated prevalence of anxiety disorders. However, measurement tool is a substantial source of variability in prevalence estimates across the literature, and few predictive factors bear consistent relationships to posttraumatic stress disorder across samples. Future work should focus on measurement variance and examine possible interactions between commonly assessed predictive factors for disorder risk in firefighters.

Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes.The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection.The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences.Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD.

Public transportation workers are exposed to higher levels of stress related to accidents, injuries, and person-under-train events when compared to other workers. This systematic review integrates the existing literature on mental health among high-risk public transportation workers to estimate the prevalence of post-traumatic stress disorder (PTSD), major depressive and anxiety symptoms following critical incidents while on duty. This systematic review is part of a larger systematic review which examines mental health and work outcomes of individuals working in professions at high risk of critical incident exposure, i.e., high-risk professions. Articles were included if they measured the prevalence of PTSD, Major Depressive Disorder (MDD) and Anxiety Disorder (AD) in a transportation population following exposure to a major incident, for example, a person-under-a-train. Among the ten articles, all reported prevalence of PTSD which ranged from 0.73 to 29.9%. Four articles reported prevalence of depression among transportation workers exposed to a critical incident and prevalence outcomes ranged from 0.05 to 16.3%. Only two reported prevalence of anxiety from 1.3 to 13.9%. This literature reports that transportation workers are prone to involvement in traumatic accidents leading to higher rates of PTSD compared to the general population. Strategies to reduce transportation accidents and to provide transportation workers follow-up mental health support is needed for this vulnerable population.

Ambulance personnel, including paramedics, emergency medical technicians, and others, are exposed to potentially distressing situations frequently as a function of their duties. The present systematic review evaluated the prevalence of trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and anxiety in ambulance personnel with best-evidence narrative synthesis across an international dataset of 24 eligible studies to determine whether prevalence is elevated in this occupational group relative to the general population. In addition, we integrate and synthesize findings related to predictive factors for the prevalence of these disorders across the literature, broadly grouping predictive factors into three categories: individual-difference factors (e.g., sociodemographics), exposure-related factors (e.g., frequency), and organizational factors (e.g., support from supervisors). The relationship between exposure-related factors and depression/anxiety symptoms is of special interest because both disorders may occur outside the context of traumatic stress but are also highly comorbid with PTSD. We report strong evidence that prevalence rates of probable PTSD, depression, and anxiety disorder are elevated in ambulance personnel. The strongest predictive associations for PTSD symptoms concerned exposure-related and organizational factors, whereas individual-difference factors bore weak or inconsistent associations with symptoms. Importantly, there is a concerning lack of data regarding the impact of workplace traumatic exposure on depression and anxiety in ambulance personnel, and as such it is not possible at present to differentiate between manifestation of symptoms following exposure compared with ongoing symptoms unrelated to the workplace. Addressing this gap in the literature is of critical importance for guiding organizational response to these disorders in ambulance service. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

Background The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset. Methods We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison. Results PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk. Conclusions PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.

We conducted a systematic review of the empirical literature examining the effectiveness of psychological interventions for post-traumatic symptomatology in police, firefighters, and paramedic pers...

We conducted two studies to examine the relationship between social anxiety ( n = 134) and social anxiety disorder (SAD; n = 126), social exclusion, and empathic accuracy. Participants were randomly assigned to either a control or an exclusion condition and then observed four videos of targets discussing high school experiences in which they were socially excluded. Participants’ ratings of targets’ emotions while discussing those experiences were compared with targets’ self-ratings. Results of both studies indicated that individuals with social anxiety and SAD displayed greater empathic accuracy than control subjects and that exclusion did not affect that relationship. State measures of participants’ emotional and cognitive reactions to targets mediated the association between SAD and accuracy. When asked to provide advice to targets, SAD participants provided fewer responses overall and fewer suggestions that promoted relationship repair. Thus, they were less able to translate their empathic responses for social pain into prosocial action.

Individuals with social anxiety are sensitive to social hierarchies and tend to compare themselves unfavorably with others, perceiving themselves as inferior or lower in social rank. The current study explores patterns of change in these negative perceptions, and their associated emotional outcomes, in an online social context. Undergraduate students (N = 291) browsed the profiles of eight Instagram influencers and completed a measure of social comparison after viewing each profile, yielding multiple ratings of their own perceived social rank. Participants completed measures of affect and state self-esteem before and after the profile browsing task. Higher social anxiety predicted lower, and greater declines in, social rank self-perceptions during browsing. Higher social anxiety also predicted greater decreases in positive affect, increases in negative affect, and decreases in state self-esteem from the beginning to the end of the browsing task. Low baseline rank perceptions contributed to change in all three emotional variables. Decreases in rank perceptions contributed further to decreases in positive affect and appearance-related self-esteem. This study elaborates on cognitive-evolutionary theory, suggesting that the inferiority self-perceptions of socially anxious individuals translate to online social contexts, may be strengthened with increased exposure to such contexts, and may have a detrimental emotional impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In addition to high-risk and high-stress events that police officers routinely encounter, many are also exposed to extreme traumatic exposures or disasters caused by nature (eg. Hurricanes) and hum...

Purpose The purpose of this systematic review is to evaluate the extant literature on depression and anxiety disorders in police using a multinational data set to determine whether the prevalence of these trauma-related disorders (TRMDs) is elevated in comparison to the general population. Design/methodology/approach Systematic review was employed in combination with best-evidence narrative synthesis to evaluate these hypotheses. Findings Despite wide variability in prevalence outcomes across the literature, strong evidence supports the hypothesis that the prevalence of depression is elevated in police, whereas moderate evidence supports the same hypothesis regarding anxiety. Preliminary evaluation of commonly examined predictive factors for each disorder demonstrated weak and inconsistent associations between these TRMDs and sociodemographic factors. No studies evaluated the relationship between incident-related factors (e.g. severity or frequency of exposure) and TRMDs, thus, at present, the literature on police is almost entirely unable to address the question of whether the prevalence of these disorders in police is influenced by exposure to work-related trauma. Research limitations/implications The findings highlight a critical need for future work to address incident-related factors in predicting symptoms of depression and anxiety in police samples to determine whether these disorders bear a unique relationship to work-related traumatic exposure. Such work will significantly benefit the design and implementation of successful prevention and intervention strategies in the workplace. Originality/value The present review provides a comprehensive synthesis of a highly variable literature, highlighting critical gaps in our current knowledge of TRMDs in police and suggesting numerous avenues for future study.

In addition to the daily stressors of the job, correctional officers are exposed to violence, direct threat to themselves, and ultimately workplace injury at rates considerably higher than that of ...

Safety behaviors display some similarities to coping behaviors, raising questions about whether the two sets of behaviors display distinct associations with anxiety symptoms.To examine this issue, we conducted two cross-sectional studies in which participants (Both studies indicated that the safety behavior measures displayed strong positive associations with their respective symptoms, as did several dysfunctional coping strategies, most notably wishful thinking.These findings provide preliminary empirical support for the conceptual distinction between safety behaviors and coping, and suggest that assessing both concepts provide a nuanced understanding of responding to anxiety-evoking situations.

The current studies examined whether self-attributes can come to elicit anxiety after being paired with negative evaluation. Results from Study 1 suggested that appearing unintelligent and appearing nervous were partially distinct attributes of concern related to social anxiety and validated stimuli used in the subsequent study. In Study 2, participants completed a differential associative learning task in which either words related low intelligence or appearing nervous were paired with negative evaluation. Results suggested that participant anxiety and expectancy ratings increased for words belonging to the attribute category paired with negative evaluation but not the other. Participant social anxiety was not associated with the effects.

Clinical researchers suggest that post-event thinking functions to negatively bias event recall for socially anxious participants. We used a repeated retrieval paradigm to examine the effects of post-event retrieval on memory for social information. Undergraduate participants (

Introduction Paramedics and dispatchers are exposed to high levels of stress and consequent psychological injury. Resilience training enhances the capacity to cope with stress and be resilient. It is widely recommended that resilience training be customised to specific occupational groups, but there is no established method for achieving such customisation. Exploratory factor analysis was used to identify dimensions underlying resilient coping in paramedics and dispatchers. The objective was to provide a basis for customised resilience training in this population. Methods The Resilient Coping Survey (RCS) was developed on the basis of interviews with paramedics and dispatchers as well as scoping review to identify coping items relevant to this occupational group. The RCS included scales of coping (Resilience at Work and the Self-Compassion Scale – Short Form), a scale of self-perceived resilience (the Brief Resilience Scale) and a set of items reflecting coping skills specific to paramedic service work. The survey was administered to paramedics and dispatchers in British Columbia, Canada. Results 703 paramedics and dispatchers responded to the survey. Analysis of the survey data identified five resilient coping factors: balance, self-acceptance, trusted social support, meaningful work and physical self-care. Each of these factors predicted resilience. No difference was found overall in resilience across gender; but only for male workers did resilience fall steadily with years of service. Conclusion Resilience training for paramedics and dispatchers would appropriately target the five resilient coping factors and be delivered throughout the paramedic service career.

Social anxiety and loneliness are traits that have been studied extensively and independently. This is surprising given that the two lines of empirical research have produced almost identical findings, particularly those related to underlying mechanisms. Given the growing interest in both constructs, foundational research is needed to examine the tacit, untested assumption that the traits are distinct from each other, as well as from depression, another trait with established social correlates. Accordingly, an exploratory factor analysis and subsequent confirmatory factor analysis were conducted on two samples of 493 participants to evaluate one- (social anxiety-loneliness-depression), two- (social anxiety-loneliness, and depression), and three-factor models (social anxiety, loneliness, and depression) of these constructs. Results supported the three-factor model, indicating the three traits are best conceptualized as related, but distinct. These findings raise questions about the degree of overlapping fi...

Purpose The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs. Materials and methods We used focus groups and coding of transcripts into themes and subthemes in 2 tertiary care ICUs and 1 community ICU. Results Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported causes of moral distress were concerns about the care provided by other health care workers, the amount of care provided (especially too much care at end of life), poor communication, inconsistent care plans, and issues around end of life decision making. Conclusions Causes of moral distress vary among ICU professional groups, but all are amenable to improvement.

Clinical theorists postulate that individuals with social anxiety disorder (SAD) display memory biases such that recall of social events becomes more negative with time; however, alternative memory models have also been proposed. Research has focused predominantly on selective recall of negative information with inconsistent findings. The goal of the current study was to examine potential biases in recall of positive social feedback. Individuals with SAD (n = 59) and nonanxious community controls (n = 63) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their speech. Participants were asked to recall the feedback after 5 minutes and after 1 week. Results indicated that at delayed recall, individuals with SAD recalled positive feedback as less positive than it had been. The findings support cognitive models of SAD and extend the model to positive social information. Research is needed to understand the mechanisms that underlie fading positivity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective Despite the social impairment associated with social anxiety disorder (SAD), little research has examined the impact of treatment on positive relational functioning. Accordingly, the authors conducted a treatment outcome study to evaluate a cognitive behavior therapy (CBT) regimen augmented by a relational focus (CBT-R) relative to a graduated exposure-applied relaxation (GEAR) regimen and wait list (WL) control. To examine the mechanism(s) that underlies treatment effects, they used structural equation modeling (SEM) to evaluate two potential mediators, change in judgment biases and in safety behaviors. Method Treatment-seeking adults who met SAD diagnostic criteria (n = 100; 50% women; mean age = 32.9 years.; 36% ethnic minority) were randomly assigned to CBT-R, GEAR, or WL. CBT-R and GEAR participants received 14 group treatment sessions. Social initiation, relationship satisfaction, and a SAD symptom composite were assessed at pre- and postassessment, and 6- and 12-month follow-ups. Results Intent-to-treat multilevel modeling analyses indicated that the CBT-R regimen resulted in significantly greater improvement relative to GEAR on relationship satisfaction and SAD symptoms. SEM results revealed that change in safety behaviors partially mediated the superior performance of CBT-R on both variables with confidence intervals set at .90. Conclusions These findings indicate that CBT-based regimens can improve social approach processes in individuals with SAD and that safety behavior reduction contributes to positive outcomes. (PsycINFO Database Record

Purpose To determine which demographic characteristics are associated with moral distress in intensive care unit (ICU) professionals. Methods We distributed a self-administered, validated survey to measure moral distress to all clinical personnel in 13 ICUs in British Columbia, Canada. Each respondent to the survey also reported their age, sex, and years of experience in the ICU where they were working. We used multivariate, hierarchical regression to analyze relationships between demographic characteristics and moral distress scores, and to analyze the relationship between moral distress and tendency to leave the workplace. Results Response rates to the surveys were the following: nurses—428/870 (49%); other health professionals (not nurses or physicians)—211/452 (47%); physicians—30/68 (44%). Nurses and other health professionals had higher moral distress scores than physicians. Highest ranked items associated with moral distress were related to cost constraints and end-of-life controversies. Multivariate analyses showed that age is inversely associated with moral distress, but only in other health professionals (rate ratio [95% confidence interval]: −7.3 [−13.4, −1.2]); years of experience is directly associated with moral distress, but only in nurses (rate ratio (95% confidence interval):10.8 [2.6, 18.9]). The moral distress score is directly related to the tendency to leave the ICU job, in both the past and present, but only for nurses and other non-physician health professionals. Conclusion Moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is lower with older age for other non-physician professionals but greater with more years of experience in nurses, and is associated with tendency to leave the job.

We examined whether dispositional social anxiety influenced empathy for individuals who experience aversive social events. Participants (N = 121) were randomly assigned to an experimental condition designed to increase state anxiety via social threat or to a control condition. They then observed videos of target individuals discussing high school events in which they were either socially included or excluded. Both participants and targets rated the emotions the targets felt when discussing those situations. Hierarchical linear modeling revealed that social anxiety was associated with greater accuracy for targets’ negative social emotions but only under conditions of social threat. These results suggest that individual differences in social anxiety may influence empathic accuracy for others’ social pain.

First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms. A factor analysis revealed that distressing events were characterized by chaos and resource limitations. Consistent with contemporary models, two mediational analyses revealed that each event characteristic predicted peritraumatic dissociation and posttraumatic cognitions, which in turn predicted PTSD symptoms. Moreover, the effect of each event characteristic on PTSD symptoms was partially mediated by these cognitive processes.

Background Moral distress is common among personnel in the intensive care unit, but the consequences of this distress are not well characterized. Objective To examine the consequences of moral distress in personnel in community and tertiary intensive care units in Vancouver, Canada. Methods Data for this study were obtained from focus groups and analysis of transcripts by themes and sub-themes in 2 tertiary care intensive care units and 1 community intensive care unit. Results According to input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported emotion associated with moral distress was frustration. Negative impact on patient care due to moral distress was reported 26 times, whereas positive impact on patient care was reported 11 times and no impact on patient care was reported 10 times. Having thoughts about quitting working in the ICU was reported 16 times, and having no thoughts about quitting was reported 14 times. Conclusion In response to moral distress, health care providers experience negative emotional consequences, patient care is perceived to be negatively affected, and nurses and other health care professionals are prone to consider quitting working in the intensive care unit.

Following initial interactions, some people are less willing to pursue ongoing contact with socially anxious individuals than with those who are not socially anxious. To better understand this process, we conducted two studies that examined peers’ first impressions of target individuals. Unacquainted individuals ( N = 104 and 114) participated in round robin, unstructured interactions in groups of 3 to 10 and then rated each partner and themselves on items reflecting the Big Five personality dimensions. The ratings were analyzed according to Biesanz’s (2010) social accuracy model of interpersonal perception, which distinguishes the positivity from the accuracy of social judgments. Study 1 revealed that perceivers did not view socially anxious targets more negatively or as less likable than non-socially anxious targets but were less able to recognize their unique personality features. Study 2 replicated those findings and indicated that perceivers’ difficulties recognizing socially anxious targets’ unique features were not due to negative biases in the socially anxious targets’ self-ratings or to general psychological maladjustment. The findings are consistent with cognitive models, which underscore the role of self-concealment in social anxiety disorder.

In 2011, the Board of Directors of the Canadian Psychological Association (CPA) launched the Task Force on Evidence-Based Practice of Psychological Treatments to support and guide practice as well as to inform stakeholders. This article describes the work of this task force, outlining its raison d'etre, providing a comprehensive definition of evidence-based practice (EBP), and advancing a hierarchy of evidence that is respectful of diverse research methodologies, palatable to different groups, and yet comprehensive and compelling. The primary objective was to present an overarching methodology or approach to thinking about EBP so that psychologists can provide and implement the best possible psychological treatments. To this end, our intention for this document was to provide a set of guidelines and standards that will foster interest, encourage development, and promote effectiveness in EBP.Keywords: evidence-based practice, evidence-based treatment, empirically supported treatment, psychotherapy, psychological treatmentAs part of the 2011-2012 Canadian Psychological Association (CPA) President's mandate (see Dozois, 2012, 2013), the Board of Directors voted in favor of a motion (March 2011) that the CPA establish a task force on the evidence-based practice (EBP) of psychological treatments that would generate a set of criteria and develop a position statement regarding the optimal integration of research evidence into practice. The board members believed that it was important for the CPA to develop a position on EBP in psychology to support and guide practice as well as to inform stakeholders. Psychological health and psychological disorders are clearly a priority for many of Canada's stakeholder groups (e.g., the Mental Health Commission of Canada, Treasury Board, Public Health Agency of Canada), and effective psychological treatment is also an important priority for CPA.BackgroundImportant objectives in professional psychology include the generation of treatment-relevant scientific knowledge and the ap- plication of this knowledge to the development of efficacious and effective interventions for mental and behavioral health problems (Baker, McFall, & Shoham, 2009; Kazdin, 2008; Lilienfeld, 2010; Treat, Bootzin, & Baker, 2012). Such objectives arise from a growing recognition in the field that the practice of psychological treatments should be based on valid evidence regarding which approaches to intervention are most likely to be successful. Al- though there is controversy regarding what constitutes "evidence," most psychologists believe in the utility of research for informing clinical practice and view EBP positively (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013).In 1995, the American Psychological Association's (APA) So- ciety of Clinical Psychology Task Force on Promotion and Dis- semination of Psychological Procedures published its initial report, which listed treatments considered to be well-established or prob- ably efficacious according to a standard set of criteria (e.g., Chambless & Ollendick, 2001; Chambless et al., 1996). These criteria were subsequently adopted by the CPA Section on Clinical Psychology in their task force report, Empirically Supported Treat- ments in Psychology: Implications for Canadian Professional Psy- chology (Hunsley, Dobson, Johnston, & Mikail, 1999a, 1999b).Although many researchers and practitioners were enthusiastic about these efforts to promote empirically supported treatments, the criteria used to designate such treatments elicited considerable controversy. Concerns with the focus on empirically supported treatments have done little to narrow the gap between research and practice and to alter many clinicians' utilization of scientific liter- ature (see Hunsley, 2007a; Kazdin, 2008; Lilienfeld et al., 2013, for reviews of some of the challenges and solutions). For example, some psychologists have argued that the type of research deemed necessary to produce supportive evidence for a treatment is in- compatible with schools of psychotherapy outside of the cognitive behavioral therapy (CBT) framework (e. …

A primary tenet of Pryor and Bright’s Chaos Theory of Careers is that our world is full of change and unpredictability. When it comes to career development, rather than relying solely on good planning, one should accept and embrace unexpected changes and think creatively about possibilities. Although the Chaos Theory of Careers approach to counselling is logical and relevant to the real world, it may not be applied easily to clients with high levels of anxiety and low tolerance of uncertainty. The current paper explores the challenges of providing chaos career counselling to highly anxious clients. Borrowing concepts from a cognitive behavioural theory model for generalized anxiety disorder, this paper suggests several techniques from the cognitive behavioural theory literature that may facilitate chaos career counselling for anxious clients.

Much acculturation research has investigated links with depression or with general psychological adjustment. Social adjustment, although critical to the acculturation process, has been relatively neglected. The association between acculturation and interpersonal problems was assessed in two samples of Chinese-Canadian university students using the Vancouver Index of Acculturation (VIA) and the circumplex version of the Inventory of Interpersonal Problems (IIP-C). Sample 1 participants ( N = 185) completed the standard IIP-C, yielding a single effect: Mainstream acculturation predicted fewer problems with nonassertiveness. Sample 2 ( N = 187) completed a short-form of the IIP-C twice – once referring specifically to problems they experienced in interacting with Chinese-Canadians and once referring specifically to problems interacting with Euro-Canadians. In this case, heritage acculturation predicted a pattern of interpersonal problems with Chinese-Canadian others and mainstream acculturation predicted a similar pattern with Euro-Canadian others. These results support the use of interpersonal adjustment measures in acculturation research, and suggest that such instruments should be modified so that questions refer directly to salient cultural groups in the respondent's social world.

Social anxiety is associated with low positive affect (PA), a factor that can significantly affect psychological well-being and adaptive functioning. Despite suggestions that individuals with high levels of social anxiety would benefit from PA enhancement, the feasibility of doing so remains an unanswered question. Accordingly, in the current study, individuals with high levels of social anxiety (N = 142) were randomly assigned to conditions designed to enhance PA (Kind Acts), reduce negative affect (NA; Behavioral Experiments), or a neutral control (Activity Monitoring). All participants engaged in the required activities for 4 weeks and completed prepost questionnaires measuring mood and social goals, as well as weekly email ratings of mood, anxiety, and social activities. Both the prepost and weekly mood ratings revealed that participants who engaged in kind acts displayed significant increases in PA that were sustained over the 4 weeks of the study. No significant changes in PA were observed in the other conditions. The increase in hedonic functioning was not due to differential compliance, frequency of social activities, or an indirect effect of NA reduction. In addition, participants who engaged in kind acts displayed an increase in relationship satisfaction and a decrease in social avoidance goals, whereas no significant changes in these variables were observed in the other conditions. This study is the first to demonstrate that positive affect can be increased in individuals with high levels of social anxiety and that PA enhancement strategies may result in wider social benefits. The role of PA in producing those benefits requires further study.

Cognitive theorists hypothesize that individuals with social anxiety are prone to memory biases such that event recall becomes more negative over time. With few exceptions, studies have focused primarily on changes in negative self-judgments. The current study examined whether memory for positive social events is also subject to recall bias. Undergraduate participants (N = 138) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their performance. They rated their memory of the received feedback following a 5-minute delay and again 1 week later. Results revealed that higher scores on social anxiety symptoms predicted significant reductions in the recalled valence of positive feedback over time, whereas no changes were observed for neutral feedback. The results suggest that social anxiety may lead to erosion in memory of positive events.

Background and objectives Individuals with posttraumatic stress disorder (PTSD) are hypothesized to have a “sense of current threat.” Perceived threat from the environment (i.e., external threat), can lead to overestimating the probability of the traumatic event reoccurring ( Ehlers & Clark, 2000 ). However, it is unclear if external threat judgments are a pre-existing vulnerability for PTSD or a consequence of trauma exposure. We used trauma analog methodology to prospectively measure probability estimates of a traumatic event, and investigate how these estimates were related to cognitive processes implicated in PTSD development. Methods 151 participants estimated the probability of being in car-accident related situations, watched a movie of a car accident victim, and then completed a measure of data-driven processing during the movie. One week later, participants re-estimated the probabilities, and completed measures of reexperiencing symptoms and symptom appraisals/reactions. Results Path analysis revealed that higher pre-existing probability estimates predicted greater data-driven processing which was associated with negative appraisals and responses to intrusions. Furthermore, lower pre-existing probability estimates and negative responses to intrusions were both associated with a greater change in probability estimates. Reexperiencing symptoms were predicted by negative responses to intrusions and, to a lesser degree, by greater changes in probability estimates. Limitations The undergraduate student sample may not be representative of the general public. The reexperiencing symptoms are less severe than what would be found in a trauma sample. Conclusions Threat estimates present both a vulnerability and a consequence of exposure to a distressing event. Furthermore, changes in these estimates are associated with cognitive processes implicated in PTSD.

Clinical observations indicate that individuals with Social Anxiety Disorder (SAD) use a variety of safety behaviours; however, virtually no research has examined the functional effect of different safety-seeking strategies. Accordingly, we conducted two studies to address this issue. Study 1 measured global patterns of safety behaviour use in a large analogue sample. Factor analysis revealed two primary safety behaviour categories, avoidance and impression management. Study 2 assessed situational use of safety behaviours during a controlled social interaction in a clinical sample of 93 patients with Generalised SAD. Factor analysis again revealed support for avoidance and impression-management subtypes. Notably, the two types of safety behaviours were associated with different social outcomes. Avoidance safety behaviours were associated with higher state anxiety during the interaction and negative reactions from participants' interaction partners. Impression-management strategies appeared to impede corrections in negative predictions about subsequent interactions. These findings suggest that it may be beneficial to consider the unique effects of different safety-seeking strategies when assessing and treating SAD.

Background: Our objective was to compare personality traits between urologists and other surgeons, as well as between surgeons and non-surgeons. Methods: Eighty-six surgeons (57 faculty, 29 residents) completed the Revised NEO Personality Inventory (NEO PI-R), a validated measure of normal personality traits. Subjects agree or disagree with 240 statements to generate a score in each of the 5 major character traits: extraversion (E), openness (O), conscientiousness (C), agreeableness (A) and neuroticism (N). Each factor is subdivided into 6 component facets. Scores for urology faculty and residents were compared to the other surgical groups and 21 pediatricians. Results: The 3 groups differed significantly on extraversion (p < 0.001). Post-hoc analyses indicated that urologists obtained significantly higher extraversion scores than other surgeons (p < 0.05) and non-surgeons (p < 0.001) Other surgeons also scored significantly higher than non-surgeons on the extraversion factor (p < 0.05). No significant differences emerged on openness, conscientiousness, agreeableness or neuroticism. Of the 6 extraversion facets, urologists obtained significantly higher scores on gregariousness and excitement-seeking (p < 0.05) than non-urologist surgeons, and significantly higher scores on gregariousness (p < 0.05), activity (p < 0.01), excitement seeking (p < 0.001), and positive emotions (p < 0.05) than non-surgeons. Non-urologist surgeons obtained significantly higher scores than non-surgeons on Activity and Excitement-seeking (p < 0.01).There were no significant differences in the facets of warmth or assertiveness. Interpretation: Urologists appear to be more extraverted compared to other surgeons. Both groups of surgeons were more extraverted than non-surgeons. If these findings can be confirmed on a wider basis, the data may be helpful in resident selection, mentoring, evaluation and career counselling. Contexte : Notre objectif etait de comparer des urologues a d’autres chirurgiens, ainsi que des chirurgiens avec des medecins non chirurgiens, sur le plan de certains traits de personnalite. Methodologie : Quatre-vingt-six chirurgiens (57 membres du personnel universitaire, 29 residents) ont rempli le questionnaire NEOPI- R (Revised NEO Personality Inventory), un instrument valide de mesure de traits normaux de la personnalite. Les sujets doivent indiquer leur accord ou desaccord avec 240 enonces et obtiennent ainsi un score pour chacun des 5 principaux traits de personnalite : extraversion (E), ouverture (O), caractere consciencieux (C), personnalite agreable (A) et nevrosisme (N). Chaque facteur est sous-divise en 6 facettes. Les scores pour les urologues et les residents ont ete compares a ceux d’autres groupes de chirurgiens et a ceux de 21 pediatres. Resultats : Les 3 groupes differaient de facon significative sur le plan de l’extraversion (p < 0,001). Les analyses ulterieures ont indique que les urologues avaient obtenu des scores significativement plus eleves sur le plan de l’extraversion que les autres chirurgiens (p < 0,05) et les medecins non-chirurgiens (p < 0,001). Les autres chirurgiens ont aussi obtenu des scores significativement plus eleves que les non-chirurgiens pour l’extraversion (p < 0,05). Aucune difference significative n’est ressortie quant a l’ouverture, au caractere consciencieux, a la personnalite agreable ou au nevrosisme. Sur les 6 facettes de l’extraversion, les urologues ont obtenu des scores significativement plus eleves pour l’instinct gregaire et la recherche de stimulation (p < 0,05) par rapport aux chirurgiens non-urologues, et des scores significativement plus eleves pour l’instinct gregaire (p < 0,05), le niveau d’activite (p < 0,01), la recherche de stimulation (p < 0,001), et les emotions positives (p < 0,05) par rapport aux medecins non-chirurgiens. Les chirurgiens non-urologues ont obtenu des scores significativement plus eleves que les medecins non-chirurgiens quant au niveau d’activite et a la recherche de stimulation (p < 0,01). On n’a note aucune difference significative pour les facettes de la personnalite chaleureuse ou de l’affirmation de soi. Interpretation : Il semble que les urologues soient plus extravertis que les autres chirurgiens. Les deux groupes de chirurgiens etaient plus extravertis que les non-chirurgiens. Si ces resultats sont confirmes dans un echantillon plus important, les donnees pourraient aider a la selection des residents, au mentorat, a l’evaluation et au counselling professionnel.

We incorporated strategies based on relational and interpersonal circumplex research within a standard cognitive-behavioral regimen for Generalized Social Anxiety Disorder (GSAD, Generalized Social Phobia) to determine whether these techniques increased the social approach behaviors that facilitate relationship development. Individuals seeking treatment for GSAD were randomly assigned to either the integrated interpersonal cognitive-behavioral group treatment (ICBT) or a wait list condition (WL). Results revealed that the interpersonal techniques were readily implemented by the majority of patients. ICBT produced significant increases in frequency of social approach behaviors and relationship satisfaction, in addition to GSAD symptom reductions comparable to other group CBT regimens. The current research highlights the feasibility and potential benefit of incorporating strategies based on relational and circumplex theories into cognitive-behavioral regimens for GSAD.

The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder (SAD). Eighty individuals diagnosed with generalized SAD took part in a "getting acquainted" conversation with a trained experimental confederate. Participants were then randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition and completed a 2nd conversation with the same interaction partner. Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group. However, whereas the safety behavior manipulation influenced participants' appraisals of their partner's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors, in reality, the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior. Thus, although both parties recognized positive changes in the social exchange following the safety behavior manipulation, different sources of social information accounted for participant versus partner interpersonal judgments. The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD.

The current study compared the predicted social and career impact of socially withdrawn and reticent behaviors among participants from Western and East Asian countries. Three hundred sixty-one college students from 5 Western countries and 455 students from 3 East Asian countries read hypothetical vignettes describing socially withdrawn and shy behaviors versus socially outgoing and confident behaviors. Participants then answered questions following each vignette indicating the extent to which they would expect the subject of the vignette to be socially liked and to succeed in their career. Participants also completed measures of their own social anxiety and quality of life. The results indicated significant vignette-by-country interactions in that the difference in perceived social and career impact between shy and outgoing vignettes was smaller among participants from East Asian countries than from Western countries. In addition, significant negative correlations were shown between personal level of shyness and experienced quality of life for participants from both groups of countries, but the size of this relationship was greater for participants from Western than East Asian countries. The results point to the more negative impact of withdrawn and socially reticent behaviors for people from Western countries relative to those from East Asia.

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.

Background: Structural equation modeling was used to develop and test an integrated model of how emotional and cognitive factors contribute to the development of intrusive memories after a distressing event. Methods: The emotional constructs included preexisting emotion and emotional reactivity to the distressing event. Cognitive constructs included peritraumatic cognitive processing and maladaptive coping strategies. Results: Using a prospective design, 148 undergraduate students viewed a distressing film and recorded their film-related intrusive memories over the following week. Results: The results indicated that emotional reactivity and, to a lesser extent, preexisting emotion, predicted peritraumatic cognitive processing during the film, which in turn predicted the use of maladaptive coping strategies (i.e., rumination, thought suppression, and safety behaviors). Furthermore, emotional reactivity and maladaptive coping strategies directly predicted intrusive memories. Conclusions: The observed model supported the importance of cognitive variables central to cognitive models, placing them in a broader context. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc.

We compared post-traumatic stress disorder (PTSD) symptom severity and symptom cluster profiles in hospital emergency department (ED) medical staff (N=100) who experienced an emotionally distressing work event that presented either a direct threat to themselves or a witnessed threat to patients. The two groups displayed similar levels of PTSD symptoms, however, they differed on symptom profiles and work consequences. The direct threat group experienced significantly greater fear during the event, more ongoing arousal symptoms, and more job dissatisfaction than the witnessed threat group. The witnessed threat group was more likely to appraise their PTSD symptoms as reflecting personal weakness. Overall, the results point to the need for further research to identify distinctive features of responses to different types of traumatic stressors.

Objectives Patients with social anxiety disorder (SAD) not only fear social rejection, but accumulating evidence also shows that they are indeed less liked than their non-anxious counterparts. Three factors are hypothesized to play a role in this social anxiety–social rejection relationship: (1) social performance; (2) elicited negative emotions, and (3) perceived similarity. Method Patients with SAD (N = 63) and control participants (N = 27) were observed during a 5 minutes ‘getting acquainted’ conversation with a male and female confederate who rated their social performance. Video-observers rated their own negative emotions and perceived similarity with the patients, while other video-observers rated their wish to engage in future contact with them (a measure of social rejection). Results Analysed by way of structural equation modelling (SEM), the results supported the social anxiety–social rejection relationship. More specifically, poor social performance was associated with perceived dissimilarity ratings and mediated by evoked negative emotions, both of which were in turn associated with social rejection. Conclusion These results suggest that a sequence of events links social anxiety to social rejection. Treatment should aim to improve social performance and perceived similarity to reverse SAD's vicious, negative interpersonal cycle.