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Objectives: To understand the nature and effectiveness of interventions aimed at improving informal stroke caregiver burden, stress, and strain., Data Sources: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of CENTRAL, CINAHL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted in May 2022., Review Methods: Studies were eligible if they included an intervention designed for informal stroke caregivers, reported on caregiver burden, strain, or stress, were published in English, and used a randomized controlled trial design. An updated search was conducted in June 2024. The methodological quality of studies was appraised using the Cochrane risk-of-bias tool for randomized trials. The data were pooled, and a meta-analysis was completed for caregiver burden and strain outcomes., Results: Nineteen studies met inclusion criteria and were meta-analyzed. Interventions ranged from 4 days to 12 months. Most studies incorporated educational and/or support components. Meta-analyses revealed nonsignificant effects on caregiver burden or strain. Significant between-group differences for caregiver strain and burden were, however, found in seven studies., Conclusion: Limited studies, small sample sizes, and conflicting results made definitive conclusions on the most effective intervention characteristics for improving caregiver outcomes difficult. Of the 19 studies, seven found significant between-group differences for caregiver outcomes postintervention, and these tended to incorporate educational components and comprised between seven and nine sessions. Further high-quality research is required to identify optimal format, duration, and frequency for improving caregiver outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: In this review, we aim to determine the efficacy of Solution-Focused Interventions (SFI) among caregivers of persons living with different conditions., Method: Articles published between 1 January 2000 and 31 December 2022 were used. Databases used included EBSCOhost, PubMed, ProQuest, ERIC, and Google Scholar. We used Zotero to remove the duplicate studies. Further, we used the Risk of Bias for RCTs and the JBI Critical Appraisal Checklist for Quasi-Experimental and non-randomized experimental studies., Results: Total number of studies from five databases was 2,693. After evaluating the eligibility and duplication removal, 10 relevant articles were found suitable for this review, including 3 RCTs, 3 single group pre-post, 2 quasi-experimental, and 1 each from case study, and multiple baseline designs. Stress, quality of life, and coping variables were studied. Studies compared with alternative treatments: Though 9 out of 10 studies were superior to alternative treatment, and none were equivalent to solution-focused intervention. SFI has shown efficacy on all the variables selected in the study. In these studies, the efficacy is compared with the alternative treatment, and SFI has demonstrated better outcomes than the alternative treatments., Conclusion: Based on the studies reviewed, robust evidence supports SFI as a treatment approach for caregivers. SFI can also benefit caregivers in shorter sessions, making it more affordable than other treatments.

Stress Recovery Theory (SRT) suggests that time spent in nature reduces stress. While many studies have examined changes in stress physiology after exposure to nature imagery, nature virtual reality, or nature walks, this study is the first to examine changes in heart rate (HR) and vagally mediated HR variability, as assessed by Respiratory Sinus Arrythmia (RSA), after a longer duration of nature exposure. Consistent with SRT, we hypothesized that immersion in nature would promote stress recovery, as indexed by an increase in RSA and a decrease in HR. We also predicted that exposure to nature would improve self-reported mood. We used a within-subjects design (N = 67) to assess changes in peripheral physiology before, during, and after a 5-day nature trip. Results demonstrated a significant decrease in RSA and a significant increase in HR during the trip compared to before or after the trip, suggesting that immersion in nature is associated with a shift toward parasympathetic withdrawal and possible sympathetic activation. These results were contrary to our hypotheses and may suggest increased attentional intake or presence of emotions associated with an increase in sympathetic activation. We also found an improvement in self-reported measures of mood during the trip compared to before or after the trip, confirming our hypotheses and replicating previous research. Implications of this study are discussed in the context of SRT., (© 2020 Society for Psychophysiological Research.)

Purpose: The COVID-19 outbreak poses a global crisis in health care delivery system, including habilitation and rehabilitation services. In this study, we shared our experiences on telerehabilitation services established primarily for students with visual disabilities (SwVD) amidst COVID-19 pandemic and its outputs., Methods: Following the lockdown declared on March 23, 2020, the rehabilitative team of a tertiary eye center in north India received information that many visually challenged students (VCS) were stranded in schools for the blind in Delhi, and feeling with anxiety and panic in absence of teachers. Shortly, the room for vision rehabilitation clinic was set-up for telefacilities. The intended services were explained while disseminating the mobile numbers. A semi-structured questionnaire consisting of closed and open-ended was developed to record COVID-19 knowledge and concerns. Inductive content analysis was used to report the qualitative information., Results: As of June 30, 2020, a total of 492 clients contacted the team, with maximum from Delhi (41.5%), and predominantly males (78.8%). Around 80.3% of callers were VCS with age range of 11 to 30 years. The two most frequently encountered health needs were itching in eyes (36.1%) and headache (29%). Television news was the most used medium among callers to get COVID-19 information. Cough is a less frequently known mode of transmission (28%), similarly handwashing as a less known for prevention (17.2%). Eight concerns were recorded based on qualitative data analysis., Conclusion: Telerehabilitation provides valuable insights and has the potential to address various concerns, uncertainty, anxiety, and fear among VCS during the pandemic., Competing Interests: None

Background: Patients with Alzheimer's disease (AD) experience various stressors that negatively impact well-being. Most studies have, however, small effect size and are limited by the experiences of severe patients. Therefore, we conducted a single-blind, randomized controlled trial, which has included patients at different stages., Objective: The stressor-oriented multicomponent program was designed as an intervention for AD patients to enhance well-being., Methods: Patients were randomly assigned to control or SOUL-P conditions according to disease severity. The SOUL-P group received 15 intensive sessions over 6 months and 6 maintenance sessions over a 6-month follow-up by a multidisciplinary team comprising psychologists, occupational therapists, and community nurses. The control group received a similar number of sessions by community nurses. Stress-related outcomes (primary stressors and well-being outcomes) were obtained from in-person baseline and follow-up interviews conducted at 6- and 12-months post-baseline. A treatment compliance survey was conducted at the intervention endpoint for patients., Results: Of the 863 patients screened, 218 (25.3%) were eligible. At 6 months, compared to controls, SOUL-P patients had improved quality of life (QoL) (p < 0.001; Cohen d = 0.56), depression (p = 0.020; Cohen d = -0.33), neurobehavioral symptoms (p = 0.034; Cohen d = -0.30), perceived stress (p = 0.030; Cohen d = -0.31), and family conflict (p = 0.026; Cohen d = -0.32). QoL, depression, perceived stress, and family conflict were still significantly different at 12 months. Most patients were satisfied with SOUL-P, while caregivers in the SOUL-P group reported overloading tasks., Conclusion: SOUL-P may reduce perceived stress and improve psychological outcomes in AD patients. Stressor-based interventions, patient-oriented goals, and a multidisciplinary team are essential features for a successful SOUL-P.

Background.: Trauma experienced in one generation can affect the health and well-being of subsequent generations, such as impairing life skills, personal contentment, behaviour patterns and sense of self. This phenomenon has predominantly been explored with descendants of European refugees and is not fully understood from an occupational perspective., Purpose.: This research explores how intergenerational trauma manifests in the occupational lives of second-generation Ilankai Tamil and Vietnamese refugees., Methods.: Using qualitative narrative inquiry, 12 adult children of Tamil and Vietnamese refugees residing in the Greater Toronto Area participated in semi-structured interviews. Narratives were thematically analysed., Findings.: Findings illustrate how sociohistorical, cultural and familial contexts influence the way second-generation refugees view what they can and should do. Many healing responses to intergenerational trauma include occupations focused on communal care., Implications.: Findings from this study reveal the unique struggles and needs of two understudied populations and the possibilities for healing through occupation.

Transplant recipients have significant psychosocial stressors due to unique posttransplant sequela that results in an increased incidence of psychopathology. Posttransplant psychological interventions, especially in lung transplant recipients, are understudied, as the focus of prior research has emphasized pretransplant interventions. However, posttransplant psychological stability affects medical outcomes. The importance of posttransplant psychological intervention is highlighted. Recommendations exist which call for attention to specific psychological domains in the posttransplant recovery period and highlight the impact of psychological rehabilitation on overall wellness and success in recovery. A novel psychological rehabilitation intervention is outlined as a response to posttransplant intervention recommendations to demonstrate implementation.

Background: It is well known that women suffer from negative consequences following breast cancer (BC) treatment and that their largely varying needs for rehabilitation are often unmet. Up to 43% of these women are at risk of developing chronic distress requiring complex interventions; however, how to early identify and meet these women's needs is unknown, leaving them with suboptimal chances of rehabilitation. The aim of the ReScreen study is to develop a model for and evaluate the effect of screening-based, individualized rehabilitation following primary BC treatment., Methods: The ReScreen study is designed as a complex intervention. Women with newly diagnosed BC are consecutively included in a three-armed randomized controlled trial. At inclusion, patients score their distress level on the Distress Thermometer (scale of 0-10) aiming to identify patients with extended rehabilitation needs. Patients scoring ≥5 are randomized to the intervention or control group while patients scoring ≤4 are followed longitudinally as an observational group. Patients in the intervention group, in conjunction with a dedicated research nurse, create an individualized rehabilitation plan based on an evidence-based decision support tool that was developed to create a solid base for the intervention. The research nurse will act as a continuous health care contact and be responsible for proactively and systematically evaluating patients' needs to ensure that potential new problems or changed rehabilitation needs are identified throughout the 1-year follow-up period. The intervention will be evaluated through self-reported data focusing on physical and psychological outcomes as well as evaluation of satisfaction with care at baseline, 2 weeks and 3, 6, 9 and 12 months. Evaluation will also include health economic aspects based on register data and patients' and relatives' experiences of the rehabilitation process. In addition, optimal cut-off levels for distress as an indicator for extended rehabilitation needs will be investigated., Discussion: This study will provide important knowledge related to effectiveness of screening-based identification of rehabilitation needs and standardized evidence-based, individualized rehabilitation after primary BC treatment. With a complex intervention design, this study has the potential to form a comprehensive knowledge base which includes tools and guidelines for implementation into clinical practice., Trial Registration: ClinicalTrials.gov NCT03434717. Registered February 15, 2018.

Background: Patients with high-grade gliomas (HGG) often suffer from high distress and require psychosocial support. However, due to neurological and neurocognitive deficits, adequate assessment of distress and support needs remains challenging in clinical practice. The objective of the present study is to investigate whether a systematic implementation of signaling questions into the routine outpatient consultation will be helpful to bridge this gap., Methods/design: This is a multicenter cluster randomized study with two arms. Randomization is done on a cluster level with 13 hospitals providing regular neuro-oncological outpatient services conducted by neurologists and/or neurosurgeons. The intervention will include an assessment of psychosocial distress of patients in doctor-patient conversation compared to assessment of psychosocial distress via questionnaire (control, standard of care). In total, 616 HGG patients will be enrolled. The outcome will be the number of HGG patients with increased psychosocial distress who receive professional support from psychosocial services. Secondary endpoints are inter alia number of patients reporting psychosocial distress and unmet needs detected correctly by the respective method; quality of life; psychological well-being and burden of the patients before and after doctor-patient consultation; as well as the length of the doctor-patient consultation., Discussion: Patients with HGG are confronted with an oncological diagnosis and at the same time with high symptom burden. This often leads to distress, which is not always adequately recognized and treated. So far, only a limited number of adequate instruments are available to assess HGG patient's distress. Yet, an adequate care and support network might facilitate the course of the disease and tumor therapies for patients. Our hypothesis is that an assessment conducted directly by attending doctors and in which the doctors talk to patients with HGG will be more effective than an assessment via a questionnaire, leading to better identifying patients in need of support. This may lead to an improvement of health care in these patients. Further, this method might be implemented also in other brain tumor patients (e.g., patients with brain metastases)., Trial Registration: German Clinical Trials Register, DRKS00018079. Registered on 3rd September 2019.

The present study evaluated the effect of a three-week intervention aimed at improving psychological health in university students. Participants included 200 Australian students randomly assigned to an experimental or waitlist control group, with 42 adhering to intervention instructions. Participants in the experimental group read a story about someone who used the natural environment to decrease stress and burnout levels and to increase their perceived satisfaction with life. They were then instructed to spend 20 minutes each week, for three weeks, in any chosen natural environment. Waitlist control participants received intervention instructions three weeks later. Restorativeness was positively associated with life satisfaction and negatively related to stress and burnout. Experimental participants, compared to waitlist control participants, experienced a significant decrease in stress; however, the intervention had no effect on life satisfaction or burnout. More research is still needed to determine the practical significance of nature exposure on university students' psychological health., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Emma A. Payne et al.)

Background: Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education., Aims: The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group., Methods: Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected., Results: Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group., Conclusions: Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Work-related stress is considered one of the biggest health and safety challenges among the member states of the European Union. A critical factor is recovery between periods of stress. The primary purpose of this study was to investigate whether a brief behaviorally oriented stress-recovery management intervention delivered in an individual setting could reduce stress symptoms among individuals with high levels of perceived stress. A single-subject experimental design with multiple baselines across three individuals was used. The results indicate, with at least moderate experimental control, a temporal relation between the start of the intervention and beneficial changes from baseline in continuous self-recordings of stress symptoms. The changes were maintained at 1-year and 5-year follow-up assessments. Also, self-reporting inventories measuring perceived stress, worry, anxiety, depression, burnout, type A behavior, unwinding and recuperation from work stress, and insomnia showed overall changes in beneficial directions at post-assessment, as well as the two follow-up assessments. The results indicate that a behaviorally oriented stress-recovery management intervention delivered in an individual setting can reduce stress symptoms in individuals with high levels of perceived stress. However, for firm conclusions to be drawn, further research is needed.

Cultural mismatch theory suggests that a poor fit between the cultural values endorsed by individuals and the institutions to which they belong results in emotional distress and activation of physiological stress processes, particularly for underrepresented groups. To test a novel paradigm for reducing perceptions of this cultural mismatch, the current experiment evaluated whether reminding first-year Latino university students (N = 84; M age  = 18.56; SD = 0.35; 63.1% female; 85.7% Mexican descent; 65.5% first-generation college students) about institutional support for cultural diversity and inclusion would reduce neuroendocrine and affective responses to psychosocial stress. Prior to completing a modified version of the Trier Social Stress Test, participants were randomly assigned to view either a video conveying university commitment to cultural diversity and inclusion (n = 45) or a control video (n = 39) depicting a campus tour. Five saliva samples assayed for cortisol and corresponding negative affect measures were collected to assess stress reactivity and recovery patterns (pre-task baseline, post-task +30 min, +45 min, +60 min, +75 min). Repeated measures data were analyzed using bilinear spline growth models. Viewing the culture video (compared to control) significantly reduced cortisol reactivity to the TSST and post-task negative affect levels, specifically for students endorsing higher Latino cultural values (e.g., familism, respect). Post-task cortisol levels were also reduced for students endorsing higher U.S. mainstream cultural values (e.g., self-reliance, competition). Results provide novel evidence for cultural diversity in stress responsivity and individual variation in approaches to reduce perceived cultural mismatch., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To examine three levels of need for recovery (NFR) after work in relation to effort from work demands, demand compensatory strategies, effort-moderating or -reversing resources, and health including health behaviors. A further purpose was to examine occupational characteristics determining NFR., Methods: 5000 engineers, carpenters, nurses, and home care nurses were invited to participate. NFR k-means clusters were calculated from 1289 participants. The effect from three levels of NFR regarding demands, compensatory strategies, resources at work, health, and health behaviors was examined using analysis of variance (ANOVA) and post hoc analysis. Prevalence ratios (PRs) of suboptimal health for three levels of NFR were calculated using Poisson regression. Linear stepwise multiple regression predictors explaining NFR were examined also occupation wise., Results: NFR centroids at 5.8/33, 13.1/33, and 21.0/33 points were identified. ANOVA showed corresponding effects from NFR levels on work demands and compensatory strategies. The inversed proportion concerned levels of resources at work. Only the low NFR cluster negated regular health effects. The other two cluster groups also repeatedly worked while ill and presented PRs concerning health effects from 1.9 to 3.9 when compared to the low NFR group. Making good quality work, recovery opportunities, and thinking of work when off work were the most important predictors of NFR among 1289 participants with also occupation-wise interpretable profiles., Conclusions: Three levels of NFR meant corresponding levels of work demands, work-demand compensatory strategies, and unfavorable health behaviors. An inversed proportion of resources related to the same levels of NFR. Low NFR meant no regular health effects which could guide limit values regarding salutary NFR. Important predictors of NFR were resources making a good quality work, recovery opportunities, and reversely effort from rumination when off work. Occupation-wise predictors could guide interventions.

Background: The COVID-19 pandemic has become a major cause of stress and anxiety worldwide. Due to the global lockdown, work, employment, businesses and the economic climate have been severely affected. It has generated stress among people from all sections of society, especially to workers who have been assigned to cater to healthcare service or those constrained to secure daily essential items. It is widely perceived that elderly or those affected by diabetes, hypertension and other cardiovascular diseases are prone to COVID-19. As per an ongoing survey, the initial data shows that the above-mentioned anxiety and stress cause insomnia, and has the considerable potential to weaken the immune system, the sole protection against the virus., Objective: This study focuses on the need of Yoga practice at work places and at home during the global lockdown due to the COVID-19 pandemic., Methods: Literature was searched using PubMed and Google Scholar for COVID-19-related stress and anxiety at work and society due to the worldwide lockdown. The predisposing comorbidities, viral mechanism of action and treatment regimen were also searched. Yoga-based intervention studies and online programs were also searched., Results: As the lockdown cannot last forever and workplaces will have to be functional soon, there is an increased possibility of recurrent infection. Therefore, Yoga can provide the necessary tool for risk reduction, amelioration of stress and anxiety and strengthening of the immune function. The online platforms provide a good media for Yoga training at work places and homes., Conclusion: Due to social distancing norms, the availability of Yoga trainers has become restricted. Yoga practice is actively sought to achieve reduced anxiety and stress so that improved sleep may positively impact immunity. As a consequence, there is a spurt in social media, catering to daily online Yoga sessions which apparently prove useful in providing accessible means to achieve mental as well as physical well-being.

Background: A stroke event, sometimes referred to as a cerebrovascular accident (CVA), is a sudden and often traumatic life event that results in life-changing consequences with which affected people must cope. There are nearly 800,000 instances of stroke annually in the U.S. (American Heart Association, 2018). Stroke is the leading cause of disability in adults, and more than one-third of people who survive a stroke will have severe disability in the U.S. (Mayo, 2005). Between 35% and 75% of stroke survivors will have significant cognitive impairment (Tatemichi et al., 1994; Nys et al., 2007). An estimated one-third of people suffer depression after stroke (Hackett et al., 2005), about one-fourth experience significant anxiety (Barker-Collo, 2007), and about one-fifth suffer from insomnia (Leppavuoria et al., 2002). These and other stroke-related psychological issues negatively influence rehabilitation and outcomes through a variety of mechanisms. For example, post-stroke depression has been shown to be related to more negative functional consequences (Kneebone et al., 2000; Matsuzaki et al., 2015). Psychological disturbances may affect rehabilitation outcomes through a reduction in adherence to home exercise programs, reduced energy level, increased fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future., Objectives: This manuscript aims to identify and describe the role of rehabilitation psychology in treating these common post-stroke complaints and, ultimately, optimizing post-stroke outcomes via two case examples., Methodology: This manuscript describes two cases of individuals in post-acute rehabilitation who had psychological issues which were negatively affecting outcomes., Conclusion: Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients' emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes.

Memory problems are reported in 40%-60% of people with multiple sclerosis (MS). These problems affect independence and may limit the ability to benefit from rehabilitation. Our aim was to evaluate the effectiveness of NeuroPage for people with MS living in the community. A multicentre, single-blind, randomised controlled crossover trial was conducted. The intervention comprised the NeuroPage service, which sends reminder messages to mobile phones at pre-arranged times. In the control condition participants received "non-memory texts", that is, messages not aimed at providing a reminder; for example, supplying news headlines or sport updates. Outcome measures were completed using postal questionnaires after each condition. There were 38 participants aged 28 to 72 (mean 48, SD 11) and 10 (26%) were men. There were no significant differences between NeuroPage and control conditions on the Everyday Memory Questionnaire ( p  = 0.41, d  = 0.02). The number of daily diary items forgotten in the NeuroPage condition was significantly less than in the control (9% vs. 31%, p  = 0.01, d  = -0.64). Psychological distress was less in the NeuroPage condition than control ( p  = 0.001, d  = -0.84). Further evaluation of the effect on everyday memory is required.

Background: Mindfulness practice and exercise are ways by which older adults can improve and maintain their physical, emotional and cognitive health., Methods: This single-site qualitative study gathered insights of older adults' perceptions about initiating and maintaining mindfulness and exercise practices. We carried out focus groups with 41 adults aged 65-85 who had recently initiated Mindfulness Based Stress Reduction (MBSR), structured exercise, or their combination as part of participation in a clinical trial. We used a semi-structured interview to ask them open-ended questions regarding the benefits, barriers and facilitators of participating in mindfulness and/or exercise interventions. The interview also included questions regarding translation of these practices into community settings as well as the long-term maintenance potential of these practices., Results: Older adults indicated that the mindfulness training increased their awareness and self-reflection and fostered a more self-accepting attitude. Furthermore, they improved their self-care habits and reported having better familial and social relationships. The main barrier for both the exercise and Mindfulness group was time management. The social benefits and sense of community were some of the primary motivators for older adults in the exercise and/or MBSR interventions. However, the research on how to motivate older adults to initiate healthy behavioral changes also needs to be answered. The benefits of exercise and MBSR are a motivation in and of themselves, as indicated by some of the participants., Conclusions: This study indicates that mindfulness training and exercise can serve as tools to cultivate important health lifestyle qualities among older adults, who are in the midst of mental, social, emotional and physical change. If it were not for the purpose of the research or the incentives provided by the research team, these older adults may have never started the healthy behavioral changes. From the responses, this may indicate that older adults may need more incentives to begin and maintain behavioral changes other than for their own health benefit.

Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR's potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.

Background: Every second employee in Europe complains about work-related stress. Occupational stress due to an imbalance between efforts spent and rewards gained (effort-reward imbalance = ERI) is well investigated and it is associated with mental and physical health. A common guess is that leisure-time physical activity (LTPA) has beneficial effects on work-related stress. Yet, evidence in support of this assumption is weak, especially regarding ERI-stress. Longitudinal studies investigating the role of LTPA on ERI are missing. Therefore, this study aims to investigate the effect of LTPA on work-related stress by ERI over time., Methods: 3961 socially insured employees that were born in 1959 or 1965 and working in the first (t 1 : 2011) and second wave (t 2 : 2014) of the lidA-study were included. Work-related stress was measured by ERI, LTPA by the self-rated weekly frequency of physical activities. Besides the direct effect, a moderating effect of LTPA on ERI over time was tested in the multiple linear regression analysis., Results: The ERI at t 1 was strongly associated with ERI at t 2 . While LTPA had no direct effect on ERI(t 2 ), it was a significant moderator of ERI from t 1 to t 2 : The higher the frequency of LTPA, the lower ERI was over time. This interaction of LTPA with ERI remained after adjustment for socio-demographic factors., Conclusions: The long-term moderating effect of LTPA on ERI is in agreement with former investigations on the role of LTPA on work-related stress, generally, and on its cross-sectional effect on ERI-stress, specifically. Some of Hill's criteria of a causal association in epidemiology (biological gradient, temporality, consistency) support our findings. As LTPA has also been shown to exert a protective effect on health outcomes that are associated with ERI, the moderation of ERI by LTPA could partly explain this protective effect. Future observational and interventional studies are required to support our results over more than two age groups and study times.

Objective: Some veterans may benefit from psychosocial interventions to facilitate reintegration and prevent chronic impairments following discharge from the service. In a randomized controlled trial, an online expressive writing intervention for Iraq and Afghanistan War veterans with reintegration difficulties reduced distress relative to control conditions, albeit with small between-group effect sizes (Sayer, Noorbaloochi et al., 2015). The aims of this study were to further explore changes in distress severity in the parent study's experimental group by identifying subgroups with similar trajectories and examining predictors of those trajectories., Method: We used latent class growth modeling to identify trajectories of change in distress among veterans randomized into expressive writing (N = 508). We also tested six predictors of trajectory membership: baseline probable PTSD, social support, combat exposure, sex, VA user status, and active-duty versus National Guard/Reserve status. The sample was mostly White, middle-aged, Army veterans deployed from active duty, all of whom reported reintegration difficulties., Results: A four-class model, with the following classes, best fit the data: Low Baseline Distress-Moderate Decrease (60%; Cohen's d = -0.69), Moderate Baseline Distress-No Change (25%; Cohen's d = -0.16), Severe Baseline Distress-Small Increase (10%; Cohen's d = 0.23), and Severe Baseline Distress-Very Large Decrease (5%; Cohen's d = -4.80). Veterans without probable PTSD, with less combat exposure, and with higher social support were more likely to be in classes with decreasing distress., Conclusion: Analyses revealed several subgroups with unique patterns of change. Non-therapist-assisted expressive writing may be most suitable for veterans with less complex psychosocial problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: This study aims to test the association between family support and coping strategies and anxiety at Dr. Pirngadi General Hospital Medan., Methods: The study was a correlational descriptive study with a cross-sectional approach. The samples were 102 cancer patients undergoing chemotherapy, who were selected through purposive sampling technique. Data was collected using a family support questionnaire instrument developed based on the concept of the House and Friedman theory, a coping strategy questionnaire modified from the Revised Ways of Coping questionnaire by Folkman and Lazarus, and an anxiety questionnaire modified from the Hamilton Anxiety Rating Scale (HAM-A). Bivariate analysis was conducted using the Product Moment correlation coefficient to test the association between family support, coping strategies, and anxiety. Multivariate analysis was conducted using the logistic regression test to investigate dominant variables associated with coping strategies and anxiety., Results: The results of the bivariate analysis showed a significant positive association (p=0.001) and strong correlation (r=0.612) between family support and Problem Focused Coping (PFC) strategy, while there was a significant negative association (p=0.001) and moderate correlation (r=-0.462) with the Emotion Focused Coping (EFC) strategy. A significant negative association (p=0.001) and strong correlation (r=-0.646) was found between family support and anxiety. The multivariate analysis showed a dominant association (p = 0.001) between family support with PFC strategy (OR = 12.2), EFC (OR = 0.142), and anxiety (OR = 0.039)., Conclusion: Based on the results, it can be concluded that there was an association between good family support and effective coping strategies and lower anxiety levels in cancer patients undergoing chemotherapy. These results can be an input for health services to increase family support for cancer patients undergoing chemotherapy in combination with effective coping strategies to decrease anxiety levels.

Objective: Children with congenital heart disease and their families are at risk of psychosocial problems. Emotional and behavioural problems, impaired school functioning, and reduced exercise capacity often occur. To prevent and decrease these problems, we modified and extended the previously established Congenital Heart Disease Intervention Program (CHIP)-School, thereby creating CHIP-Family. CHIP-Family is the first psychosocial intervention with a module for children with congenital heart disease. Through a randomised controlled trial, we examined the effectiveness of CHIP-Family., Methods: Ninety-three children with congenital heart disease (age M = 5.34 years, SD = 1.27) were randomised to CHIP-Family (n = 49) or care as usual (no psychosocial care; n = 44). CHIP-Family consisted of a 1-day group workshop for parents, children, and siblings and an individual follow-up session for parents. CHIP-Family was delivered by psychologists, paediatric cardiologists, and physiotherapists. At baseline and 6-month follow-up, mothers, fathers, teachers, and the child completed questionnaires to assess psychosocial problems, school functioning, and sports enjoyment. Moreover, at 6-month follow-up, parents completed program satisfaction assessments., Results: Although small improvements in child outcomes were observed in the CHIP-Family group, no statistically significant differences were found between outcomes of the CHIP-Family and care-as-usual group. Mean parent satisfaction ratings ranged from 7.4 to 8.1 (range 0-10)., Conclusions: CHIP-Family yielded high program acceptability ratings. However, compared to care as usual, CHIP-Family did not find the same extent of statistically significant outcomes as CHIP-School. Replication of promising psychological interventions, and examination of when different outcomes are found, is recommended for refining interventions in the future., Trial Registry: Dutch Trial Registry number NTR6063, https://www.trialregister.nl/trial/5780.

This study aimed to investigate (1) the time-variations and (2) the repeated measures relationship between training load (TL) and psychological and physiological parameters and performance. Data were collected around 12-weeks of training in fifteen national swimmers. Psychological states were assessed using the RESTQ-36-R-Sport Questionnaire and the Sport Emotion Questionnaire. Subjects collected four saliva samples throughout the day at 1) 7 a.m. immediately after waking, 2) 30 min after waking, 3) 60 min after waking, and 4) 8 p.m., allowing us to calculate the area under the curve with respect to ground (AUCg) and the sAA over cortisol ratio (AOC). Finally, heart rate variability was computed using a submaximal 5'-5' running test. Time variations were analyzed throughout repeated measures ANOVA and repeated measures correlations were run using the "rmcorr" R package. Recovery-stress states and emotional markers showed quadratic curves, while parasympathetic markers showed linear trajectories over time. Significant associations over time were found between TL and recovery, stress, emotional states, lnRMSSD and the AOC. Taken together, these results provided evidence that psychological and physiological states do not follow the same dynamics (i.e., linear vs. quadratic vs. no variation) in the functional training periodization condition. Our study also provided evidence that recovery-stress states, emotional states, lnRMSSD, and the AOC were of interest due to their intra-individual associations around the time with TL., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The purpose of this pilot study was to describe and explore a group-based multifaceted intervention for patients with fatigue after acquired brain injury (ABI). We hypothesised that post-intervention changes would result in reduced fatigue, in addition to improved emotional health, sleep and attentional control. Eight subjects with traumatic brain injury (n = 3) and cerebrovascular insults (n = 5) were included. Inclusion was based upon the presence of fatigue complaints. The participants received 36 hours of intervention. Changes related to fatigue, emotional health and sleep was assessed with self-rating measures. Additionally, a neuropsychological test (Conners' Continuous Performance Test II) was included as a measure of attentional control. All subjects were assessed at baseline, post-intervention, and at 3 and 9 months follow-up. Findings indicated reduced fatigue levels (post-intervention and 3 months follow-up), anxiety (9 months follow-up), and daytime sleepiness (3 and 9 months follow-up). Pilot results suggest that multifaceted group-based interventions may have the potential to alleviate symptoms of fatigue, anxiety and sleepiness after ABI. At an individual level, a low load of psychological distress, insomnia symptoms, dysexecutive symptoms, in addition to a strong sense of self-efficacy, may be central in order to reduce levels of fatigue.

A number of studies have shown that chronic stress can negatively impact both physiology and behavior in a variety of organisms. What has yet to be extensively explored is whether these changes permanently alter an animal's functioning, or if they can be reversed. In this study, we used wild-caught house sparrows (Passer domesticus) to assess how recovery periods influence the physiological and behavioral impacts of an initial four days and subsequent four days of repeated stressors. Birds were randomly assigned to a recovery group and either experienced 0, 24, or 72 h of recovery between the two sets of stressors (cage rolling and cage tapping). We measured the regulation of the hypothalamic pituitary adrenal (HPA) axis by quantifying baseline and stress-induced corticosterone as well as negative feedback strength. We also assessed behavior using neophobia trials to measure how birds altered their approach towards novel objects and their overall activity. Both behavior and corticosterone responses were assessed before the experiment, after the recovery time, and following the final 4 days of stressors. We found that birds that experienced 24 h of recovery had reduced stress-induced corticosterone, but enhanced negative feedback relative to the pre-experiment sample. Additionally, 4 days of stressors was enough to significantly reduce approach latency towards novel objects; however, pre-experiment levels returned with longer periods of recovery. Finally, recovery time did not significantly influence responses to the second 4 days of stressors. Our results indicate that brief recovery periods partially ameliorate the hormonal and behavioral effects of repeated stress., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The cultural, linguistic, and religious diversity of Australia's population presents challenges for mental health service delivery. Arabic-speaking communities in Australia underutilise mental health services despite high levels of trauma and psychological distress. Clinicians who work with this population lack linguistically and culturally appropriate clinical resources. The aim of this study was to explore the acceptability and clinical utility of a Mindfulness Skills CD translated into formal Arabic. The 70 participants were Arabic-speaking adults, mostly Lebanese-born Muslim women, who enrolled in a 5-week mindfulness program using the CD and agreed to follow-up at 12 weeks. Both recruitment and data collection were undertaken by a female project officer who is a widely respected member of the Arabic community in south-east Sydney. Compliance with the program protocol was high and all but 4 participants continued to use the CD beyond the 5 weeks. Overall, participants reported that mindfulness techniques fitted well with their way of life and were compatible with their cultural and religious practices. Most found mindfulness complementary to their regular reflective prayer. Using the Mindfulness Skills CD was associated with statistically significant reductions in psychological distress as measured by the Kessler Scale (K10) and the Depression, Anxiety, and Stress Scale (DASS21) postprogram (K10; DASS21 Depression and Stress subscales) and at follow-up (all measures). The evaluation showed that the Arabic Mindfulness Skills CD is an effective and culturally appropriate mental health resource for this population group. This low-cost, easily distributed resource is suitable for use in individual self-management and as an adjunct to primary and specialist mental health care.

Objectives: Women and men might experience psychological distress differently during a disaster. This study investigated gender differences in the factors associated with psychological distress among working-age people 1 to 2 years after the Great East Japan Earthquake., Methods: A cross-sectional household survey of victims who remained living in their homes was conducted between May and December 2012 in Ishinomaki City, Japan. Psychological distress was defined as a Kessler Psychological Distress Scale ≥5, and gender differences were examined using a logistic regression analysis., Results: Data were obtained from 2593 individuals, and 1537 participants were included in the analyses. Psychological distress was observed in 28.0% of the participants. Living in a household without a salaried income and a low frequency of leaving the house were associated with psychological distress among women. Young age, lack of occupation and no informational support were associated with psychological distress among men. Income change due to the disaster and health complaints were associated with psychological distress in both genders., Conclusions: For women, stable household income and frequently leaving the house can be protective factors. For men, intervention focusing on young people, occupational support, and informational support may be useful. Income change after the disaster and health complaints may be risk factors in both genders. (Disaster Med Public Health Preparedness. 2019;13:487-496).

Background and Purpose: A massage therapy program was implemented to address the psychological well-being of family caregivers to patients in a rehabilitation hospital. The impact of massage "dosage" on caregiver stress and psychological well-being was examined in this study. Participants' perspectives on the program were also explored., Materials and Methods: Thirty-eight family caregivers were randomized to receive either one massage per week or three massages per week for two weeks. Caregivers reported psychological symptoms and stress pre- and post-program. Program acceptability was assessed via responses on an exit survey., Results: Overall, 79% of massages were received (89% among program completers). Post-program symptom scores were lower than baseline scores for both groups (F (1, 31) = 8.74 - 24.50, P < 0.01). Exit surveys indicated high program acceptability and perceived benefits., Conclusion: Findings suggest that massage services would be welcomed, utilized, and beneficial for improving the psychological well-being of family caregivers in a rehabilitation hospital., (Copyright © 2019. Published by Elsevier Ltd.)

Purpose: Family caregivers are essential assets in the rehabilitation process, and their psychophysical health should represent a concern for healthcare services. This study aims to investigate the psychometric properties of the Adult Carer Quality of Life Questionnaire, Italian version, and its convergent-discriminant validity with measures of caring burden, resilience, health, and well-being., Materials and Methods: Participants were 591 parents (89.2% females; aged 25-69) of children treated as outpatients in 14 centers of "Istituto Medea - La Nostra Famiglia", an Italian rehabilitation institution. They completed: Adult Carer Quality of Life Questionnaire, a 40-item scale assessing care-related challenges, resources, and benefits; Caregiver Burden Inventory; Resilience Scale for Adults; Satisfaction With Life Scale; Health Survey SF-36. The psychometric properties of the Adult Carer Quality of Life Questionnaire were investigated through exploratory and confirmatory factor analyses and reliability evaluation; correlation coefficients assessed convergent and discriminant validity with burden and well-being measures., Results: The original eight-factor structure of the Adult Carer Quality of Life Questionnaire showed good adequacy and internal consistency; convergent and discriminant validity with measures of burden, resilience, satisfaction, physical and mental health were satisfactory., Conclusions: The Italian version of the Adult Carer Quality of Life Questionnaire is a reliable and valid instrument to assess caregivers' perceived challenges and resources. As a parsimonious and easily administrable tool, it can be used to evaluate caregivers' quality of life and related interventions. Implications for Rehabilitation Family caregivers are essential assets for the rehabilitation process, and their challenges and resources need to be considered by healthcare services. Information on caregivers' frailties to be reduced and strengths to be empowered allows to design interventions promoting well-being and social integration of people with disabilities and their families. The Adult Carer Quality of Life is a comprehensive measure of burden and well-being dimensions that can be easily administered to caregivers of any age.

The aim of the present study was to investigate the effectiveness of a stress management program regarding mitigating psychological repercussions in women who experience intimate partner violence (IPV). This randomized controlled trial took place from January 2015 to June 2015, in Attica, Greece. A total of 60 women were randomly assigned into an intervention and control group, with the intervention group ( n = 30) receiving stress management and a lifestyle program. Self-reported measures were used to assess stress, depression and anxiety levels, daily routine, severity of abuse, self-esteem, health locus of control, and self-efficacy. Statistical analysis showed a significant improvement in measures of stress, depression, anxiety, self-esteem, and self-efficacy in the intervention group. Daily routine and physical exercise also improved. Based on these findings, we strongly encourage health professionals to advise women experiencing current and past IPV to adopt stress management techniques to their daily program, as a further means of empowerment.

Background: This study protocol describes the clinical trial of the Fex-Can intervention, a web-based self-help program targeting sexual dysfunction and fertility-related distress. The psycho-educational intervention has been developed in collaboration with young patients with cancer and shown to be feasible. The primary objective is to determine whether the Fex-Can intervention, provided in addition to standard care, is superior to standard care in terms of reduction of sexual dysfunction and fertility-related distress directly after end of the 12-week program. The trial also aims to determine whether the intervention has an effect on the secondary outcomes including health-related quality of life, anxiety, depression, body image, fertility knowledge, and self-efficacy related to sexuality and fertility., Methods: The trial has an randomized clinical trial (RCT) design with two parallel arms. The active groups receive either the version of the Fex-Can intervention targeting sexual problems or the version targeting fertility-related distress. Control groups receive standard care. Primary outcomes will be sexual function assessed with the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction measure version 2.0 (SexFS) and fertility-related distress assessed with the Reproductive Concerns After Cancer scale (RCAC). The effect of the intervention will be evaluated directly after end of the program. Primary and secondary outcomes will also be assessed at the short- (12 weeks after end of program) and long-term (20 and 44 months after end of program) follow-up. At least 64 completers will be needed in each arm (total n = 256) to achieve adequate statistical power in the analyses. In order to increase the understanding of how the intervention brings about a possible change, semi-structured interviews will additionally be conducted with a purposeful sample shortly after completion of the intervention., Discussion: If the Fex-Can intervention proves to be efficacious the necessary steps will be taken to implement it in routine care for young adults diagnosed with cancer. Healthcare could thereby be provided with an easily accessible, cost-effective intervention to offer to young adults suffering from fertility-related distress or sexual problems., Trial Registration: ISRCTN36621459 . Registered 25 January 2016.

Purpose: The aim of the current study was to examine the associations between coping and psychological well-being among adults with sensory loss and their spouses., Methods: A total of 183 adults with sensory loss and 133 spouses participated in an online survey and were followed up six months later. Coping and well-being were measured using the Brief Coping Orientation to Problems Experienced Scale (Brief COPE) and the five-item World Health Organization Well-Being Index (WHO-5), respectively. Cross-sectional and longitudinal intra- and interpersonal effects of coping on psychological well-being were analyzed using a structural equation modeling approach., Results: Results showed that a significant portion of adults with sensory loss (32.4%) and spouses (23.8%) had poor well-being, and this remained stable over the six-month period. Coping styles associated with the well-being of adults with sensory loss included active coping, avoidance, distraction, venting and spouse support seeking. Coping styles associated with the well-being of spouses included support seeking, distraction, venting, avoidance (by partner) and humor (by partner)., Conclusion: The results highlight the need to support the well-being of adults with sensory loss and their spouses in rehabilitation, and the importance of both intra- and interpersonal coping in the adjustment process. Implications for rehabilitation Rehabilitation specialists and social workers working with adults with sensory loss should, where possible, incorporate family members into support plans. Rehabilitation specialists and social workers working in sensory rehabilitation should be mindful of how the coping styles of one partner can impact the well-being of their significant other. In addition to promoting positive coping behaviors, such as planning and support seeking, rehabilitation specialists and social workers should also take care to identify and reduce maladaptive coping behaviors such as avoidance and distraction. Online and print information for spouses on how to cope with a partner's sensory loss should be available and accessible for couples attending sensory rehabilitation clinics.

Few studies evaluated the effect of cardiac rehabilitation programs on perceived emotional and health status of left ventricular assist device (LVAD) patients, and none explored their effect on caregivers' strain. We enrolled 119 adult LVAD patients, together with their caregivers (n = 91), in two Rehabilitation Institutes that provided inpatient multidisciplinary activities. At admittance and prior to discharge they completed questionnaires evaluating patient emotional state and subjective perception of health status, caregiver strain, and patient and caregiver perception of the VAD. Six months after discharge, patients and caregivers were contacted again and asked specific questions about their quality of life. Patients' state anxiety and depression symptoms significantly diminished at discharge (0.000), whereas their perception of general health status rose (0.000). Caregivers' perceived strain also significantly decreased (0.001) and the perceived device management skill grew both for patients and caregivers (0.000). A substantial amount (36%) of psychologically frail patients and caregivers, although improving their emotional condition, never reached that of the less frail subjects. At the 6-month follow-up, both patients and caregivers appeared stable in evaluating respectively their general health and their caregiving-related strain, compared to discharge. Our data show that a comprehensive inpatient rehabilitation program improves the emotional state of LVAD patients and of their caregivers, even in psychologically frailer subjects. Team approach makes patients and caregivers self-confident about device management, increasing their knowledge, clarifying their doubts, and encouraging them to handle the difficulties met during the rehabilitation period, suggesting strategies to cope with daily life at home., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Objectives: This study investigates whether a programme of mindfulness-based weekend retreats (Panta Rhei) is able to improve mood states, mindfulness qualities, and self-compassion in family members and friends of suicide victims (suicide survivors)., Design: Longitudinal prospective study., Methods: Sixty-one suicide survivors participated in a mindful-self-compassion retreat. The Five-Facet Mindfulness Questionnaire, the Profile of Mood States (POMS), and the Self-Compassion Scale were administered 4-6 days before and after the retreat., Results: A significant reduction in all dimensions of the POMS (except Vigor-Activity) and lower levels of overidentification were observed after the retreat., Conclusions: Although further research is warranted, this study highlights the potential beneficial effect of brief mindfulness-based weekend retreats on the well-being of suicide survivors., Practitioner Points: Mindfulness-based weekend retreats seem to be effective in alleviating the psychological distress of suicide survivors in the short term. The benefit may depend on standard mindfulness practices and on more tailored interventions aimed at promoting acceptance of loss, forgiveness and rage management, and thus reducing rumination. Since there is no established treatment for this population, this type of intervention, which seems feasible and well accepted by participants, paves the way for future research in this area., (© 2018 The British Psychological Society.)

Survivorship care includes surveillance and prevention of cancer recurrence, addressing side effects of cancer and cancer treatment and coordination of follow-up care. This article reviews guidelines for surveillance of women with ovarian, endometrial, cervical, and vulvar cancer. It also reviews many of the long-term physical side effects of gynecologic cancer treatment including fatigue, neuropathy, lymphedema, cognitive dysfunction, sexual health concerns, menopausal symptoms, infertility, and economic stressors. Finally, survivorship care plans are reviewed as a tool for coordinating care for women with a history of gynecologic cancer., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications., Methods: The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment., Results: The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%., Conclusion: ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.

Relapse remains the most prominent hurdle to successful rehabilitation from alcoholism. The neural mechanisms underlying relapse are complex, but our understanding of the brain regions involved, the anatomical circuitry and the modulation of specific nuclei in the context of stress and cue-induced relapse have improved significantly in recent years. In particular, stress is now recognised as a significant trigger for relapse, adding to the well-established impact of chronic stress to escalate alcohol consumption. It is therefore unsurprising that the stress-responsive regions of the brain have also been implicated in alcohol relapse, such as the nucleus accumbens, amygdala and the hypothalamus. Environmental enrichment is a robust experimental paradigm which provides a non-pharmacological tool to alter stress response and, separately, alcohol-seeking behaviour and symptoms of withdrawal. In this review, we examine and consolidate the preclinical evidence that alcohol seeking behaviour and stress-induced relapse are modulated by environmental enrichment, and these are primarily mediated by modification of neural activity within the key nodes of the addiction circuitry. Finally, we discuss the limited clinical evidence that stress-reducing approaches such as mindfulness could potentially serve as adjunctive therapy in the treatment of alcoholism. This article is part of the Special Issue entitled "Neurobiology of Environmental Enrichment"., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose of Review: With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention., Recent Findings: Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program - referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses., Summary: Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.

Background: Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress., Methods: Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above., Results: As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress., Conclusions: Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population's great potential to benefit from improved access and care coordination., Trial Registration: This study does not report the results of a health care intervention on human subject's participants.

Background: Prescription opioid medications negatively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid-using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease., Methods: The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. Prescription opioid use during hospital admission and at 30 days postoperatively were compared with preoperative use. Thirty-day postoperative patient-reported outcomes for pain, disability, and quality of life were compared with preoperative patient-reported outcomes. Dose-response effect of mindfulness courses was assessed using Mindful Attention Awareness Scale scores., Results: In this pilot study, 24 participants were included in each group. Most intervention patients (70.83%) completed 1 session, and the mean Mindful Attention Awareness Scale score was 4.28 ± 0.71 during hospital admission. At 30 days, mean visual analog scale back pain score was lower in the intervention group (P = 0.004) but other patient-reported outcomes did not differ., Conclusions: During hospital admission, no significant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In this experiment we investigated how individual differences in orientation towards built vs. nature environment as well as noise sensitivity affect psychological and physiological restoration in a constructed urban park, urban woodland and city centre of Helsinki, Finland. The participants, 30-61-year-old healthy women (N = 83), visited each study site once. The experiment consisted of a 15-min viewing session, followed by a 30-min walking session in each environment. We measured restorative effects: perceived restorative outcomes, vitality, and blood pressure in these three environments. The data were analysed in SAS with a linear mixed model. We found significant differences between environments in psychological restorative effects, but not in blood pressure. The urban-nature orientedness, and to a lesser extent noise sensitivity, modified the effect of environment on restoration. In conclusion, individual characteristics affect psychological restoration provided by various urban environments. Varying needs of individuals should be taken into account in city planning., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The development of post-traumatic growth was studied longitudinally within 14 months poststroke. The predictions of two models of post-traumatic growth were examined., Method: Forty-three stroke survivors were investigated at two time points (i.e., time 1 and time 2), six months apart. Each completed the Post-traumatic Growth Inventory, Rumination Scale, Impact of Events Scale, Multidimensional Scale of Social Support, the Barthel Index and the COPE scale., Results: Post-traumatic growth was evident four to five months after stroke, increasing significantly over the next six months at which point levels resembled those reported in cross-sectional stroke studies. Active and denial coping and rumination at time 1 were positively associated, and age was negatively associated, with post-traumatic growth at time 2, but acceptance coping was not associated. Neither active coping nor rumination mediated the effect of social support on post-traumatic growth as predicted. As predicted, rumination mediated the relationship between post-traumatic stress and post-traumatic growth. Exploratory stepwise regression demonstrated rumination and active coping at time 1 accounted for 45% of variance in post-traumatic growth at time 2., Conclusions: Post-traumatic growth can develop soon after stroke. Deliberate rumination is a key factor in post-traumatic growth. Both active coping and denial coping were associated with post-traumatic growth demonstrating the psychological complexity of poststroke adjustment. Implications for rehabilitation Therapists can expect stroke survivors to show post-traumatic growth in the first months after stroke. Therapists should look to promote post-traumatic growth and positive adjustment through working with survivors to increase active coping (attempts to deal effectively with the impact of stroke) and rumination (cognitive processing of the impact of the stroke). Since denial coping was also associated with posttraumatic growth, stroke survivors who maintain overly optimistic views about the severity and impact of their stroke are likely to benefit from therapists continually facilitating capacity for growth and well-being.

Agitation in people with dementia is a growing concern as it causes distress for both patients and their nurses and may contribute to relational disorders. Previous studies involving patients with dementia living in long-term care facilities have reported decreased agitation following massage. The objective of this pilot study was to investigate the effect of hand massage on agitation and biological markers of stress in patients with dementia hospitalized in an acute geriatric psychiatry service. In this randomized controlled trial we included 40 agitated patients with dementia with an intervention group and a control group. The study is designed to test the effect of seven hand massages over three continuous weeks on agitation and levels of salivary cortisol (sC) and alpha-amylase (sAA). Compared to the control group, the intervention group exhibited larger increases in sC and sAA at week 1 from before to after the massage, but larger decreases at week 2 and 3, with a significant group effect for sAA at week 2. Agitation scores were not significantly different between the groups but tended to decrease more in the intervention group than the control group. This study provides first encouraging results suggesting that hand massage might have beneficial effects on stress and agitation in hospitalized patients with dementia. It also highlights the challenges associated with conducting such studies with this complex patient population. Further studies are needed to confirm these findings and the benefits of hand massage as part of routine care for patients with dementia.

Research in affective science has shown that trait positive affect reduces the risk of developing disease and is protective against the progression of certain diseases. Research also suggests that trait positive affect predisposes individuals to more frequent experiences of positive emotional states. The undoing effect has been proposed as a potential mechanism explaining how positive emotions influence health outcomes. According to this hypothesis, the experience of state positive emotions or positive affect contributes to faster recovery from the body's physiological response to stress. This paper critically reviews literature concerning the undoing hypothesis. Several common methodological weaknesses were identified, including conceptual and design issues. Based on the reviewed studies two separate conclusions were drawn. First, there was insufficient evidence to conclude that the occurrence of positive emotional states speeds physiological recovery. Second, there was insufficient evidence to evaluate the undoing hypothesis as a potential mechanism through which state positive emotions affect health. Future research should focus on identifying the key parameters responsible for demonstrating the undoing effect when it is observed in order to understand how the experience of positive emotions may exert positive effects on health outcomes.