BackgroundPhysician behaviors that undermine a culture of safety have gained increasing attention as health-care organizations strive to create a culture of safety and reduce medical errors. We developed, implemented, and assessed a course to teach physicians skills regarding effective coping and interpersonal communication skills and present our results regarding outcomes.MethodsWe examined a professional development program specifically designed to address unprofessional or distressed behaviors of physicians, and we evaluated the impact on burnout, quality of life, and emotional flooding scores of the physicians. Assessments of burnout, quality of life, and emotional flooding were assessed preintervention and postintervention.ResultsResults demonstrated statistically significant reductions over time in physicians' emotional flooding and emotional exhaustion (EE). Specifically, using a Wilcoxon Signed-Rank test, results revealed that flooding scores at follow-up were statistically significantly lower than at baseline, V = 590, p < 0.05, and EE and personal accomplishment distributions were found to significantly deviate from normal as indicated by Shapiro–Wilks tests (p < 0.05). A Wilcoxon signed-rank test indicated that EE scores were significantly higher at baseline compared to follow-up 1, V = 285, p < 0.05.ConclusionWe conclude that the physician participants who enrolled in the educational skills training program improved scores on emotional flooding and EE and that this may be indicative of improved skills related to their experiences and learning in the program. These improved skills in physicians may have a positive impact on the overall culture of safety in the health system setting.
Over the past few decades, there have been minimal advances in effective new behavioral or psychotherapeutic interventions for people living with autoimmune diseases such as systematic lupus erythematosus. This is problematic due to the severe, debilitating and potentially lifethreatening nature of these diseases. Mindfulness based interventions, such as Mindfulness Based Stress Reduction, have demonstrated effectiveness in a wide range of patient populations and we hypothesize such treatment would also benefit patients with autoimmune disorders and related symptoms. We further hypothesize that these therapies will work by impacting physiological mechanisms, such as inflammatory markers, associated with such disease symptoms. We present our findings below.
Abbreviations: CBASP, cognitive behavioral analysis system of psychotherapy; HAM-D, hamilton rating scale for depression; CIWA, clinical institute withdrawal assessment for alcohol; SA, situational analysis; SDU, standard drinking units; CBT, cognitive behavioral therapy; MI, motivational interviewing; CSQ, coping survey questionnaire; IMI-C, impact message inventory circumplex IntroductionAlcohol use disorder is frequently comorbid with other psychiatric disorders such as major depression, and professionals working with these patients are facing a unique challenge. 1 The estimated cost of excessive drinking in 2010 was $249.0 billion, which equates to $2.05 per drink or $807 per person. 2 The prevalence rate for major depression rose from 13.8 million to 15.4 million adults between 2005 and 2010, and this increased the cost by 21.5 % from $173.2 billion to $210.5 billion in 2010. 3 As a result of the deleterious psychological impact on the individual and the economic burden on society, there is a growing need to develop and evaluate effective treatments for these significant and prevalent disorders.There are currently multiple empirically supported behavioral treatments for depression and alcoholism as individual disorders. However, there have been few well-specified, empirically supported behavioral therapies with an integrated approach to treating symptoms of both disorders. [4][5][6] The most commonly evaluated types of behavioral therapies for co-occurring disorders include motivational interviewing (MI), cognitive behavioral therapy (CBT) and contingency management (CM); 4 research supports that an integrated therapy possessing components of MI, CBT, and CM would be most ideal to target co occurring depression and alcoholism. [4][5][6] The lack of successful treatment options for chronically depressed alcohol dependent individuals may be due in part to the complex characteristics these individuals possess that make their treatment more challenging. [7][8][9][10] Comorbid depression is associated with poorer prognosis during and after alcoholism treatment and depressed mood may be an important trigger of alcoholic relapse. 7,11 Interpersonal avoidance behaviors are salient variables in individuals diagnosed with both alcoholism and depression. These patients typically report a high rate of adverse early home environments, a lifelong history of intrapersonal and interpersonal failure, an earlier onset of depression and alcohol use disorders, more comorbidity, a more severe course of illness, and they demonstrate interpersonal avoidance and detachment. 8,12,13 Early abuse/trauma history impairs development of adequate interpersonal coping skills, resulting in depression, social isolation, or withdrawal. 14 In addition, real-world and prolonged environmental stressors usually accompany these individuals' presenting complaints. They are often skeptical or ambivalent about change, and the processes of change are often slow, irregular, and inconsistent. In fact, a pattern of success followed by a setback is commo...
In 2015, over 1.1 billion people smoked tobacco worldwide [1]. The World Health Organization (WHO) has estimated that tobacco use (smoking and smokeless) is responsible for the death of about six million people across the world each year [1]. This total includes about 600,000 people who are also estimated to die from the effects of second-hand smoke [1]. In the United States, smoking costs more than $193 billion in health care costs and lost productivity per year [2]. Although over 70% of smokers want to quit, fewer than 5% achieve this goal annually [2]. Mainstay behavioral treatments for smoking have focused on teaching individuals to avoid cues, foster positive affective states, develop lifestyle changes that reduce stress, divert attention from cravings, substitute other activities for smoking, learn cognitive strategies that reduce negative mood, and develop social support mechanisms. These interventions and methods have shown modest success, with abstinence rates between only 20-30% holding steady over the past thirty years. This low rate of abstinence attainment and lack of improvement in outcomes is presumably due to the complex nature of the acquisition and maintenance of nicotine addiction, including associative learning mechanisms as well as positive and negative reinforcement.The complex learning mechanisms behind the acquisition of nicotine dependence is related to the fact that over time cues that are judged to be positive or negative can induce affective states, which can then trigger a craving to use [3,4]. Though the centrality of craving remains controversial, evidence suggests that craving is strongly associated with using, which, mainly through the physiological properties of nicotine, results in the maintenance or improvement of positive or reduction of negative affective states [4]. This sets up reinforcement loops by reinforcing memories between affect and smoking [3]. Thus, recent attention has been focused on additional strategies to help people tolerate negative affect and cravings rather than only avoiding cues or substituting activities.Recent research suggests that another psychological intervention called mindfulness training (MT) may decouple the association between craving and smoking, thus facilitating smoking cessation. Mindfulness means paying attention in the present moment, non-judgmentally, without commentary or decision-making. MT targets affective or craving states by teaching individuals to observe aversive body and mind states instead of responding to them with habitual reactions, thus allowing more adaptive, healthier responses [5]. MT has shown promise in reducing anxiety and depression and has recently been explored in the treatment of addictions. Davis et al. [6] conducted a pilot study to explore the effect of using Mindfulness Based Stress Reduction (MBSR) (with minor modifications) as a smoking intervention. MBSR was employed in its standard 8 weekly group session format. Subjects attempted smoking cessation during week seven without pharmacotherapy. The researche...
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