State-Trait Anxiety Inventory for Adults

s were further reviewed by the first author who searched for terms related to breast cancer survivorship with any mention of fear, distress, uncertainty or recurrence. Citations and abstracts were excluded that did not have a group of breast cancer patients included in the sample, if the main subjects had a breast cancer recurrence, if the study

Music performance anxiety can adversely affect musicians. There is a need for additional treatment strategies, especially those that might be more acceptable to musicians than existing therapies. This pilot study examined the effectiveness of a 9-week yoga practice on reducing music performance anxiety in undergraduate and graduate music conservatory students, including both vocalists and instrumentalists. The intervention consisted of fourteen 60-minute yoga classes approximately twice a week and a brief daily home practice. Of the 24 students enrolled in the study, 17 attended the post-intervention assessment. Participants who completed the measures at both pre- and post-intervention assessments showed large decreases in music performance anxiety as well as in trait anxiety. Improvements were sustained at 7- to 14-month follow-up. Participants generally provided positive comments about the program and its benefits. This study suggests that yoga is a promising intervention for music performance anxiety in conservatory students and therefore warrants further research.

Cancer-related dyspnea is a common, distressing, and difficult-to-manage symptom in cancer patients, resulting in diminished quality of life and poor prognosis. Buspirone, a non-benzodiazepine anxiolytic which does not suppress respiration and has proven efficacy in the treatment of generalized anxiety disorder, has been suggested to relieve the sensation of dyspnea in patients with COPD. The main objective of our study was to evaluate whether buspirone alleviates dyspnea in cancer patients.We report on a randomized, placebo-controlled trial of 432 patients (mean age 64, female 51%, lung cancer 62%) from 16 participating Community Clinical Oncology Program (CCOP) sites with grade 2 or higher dyspnea, as assessed by the Modified Medical Research Council Dyspnea Scale. Dyspnea was assessed by the Oxygen Cost Diagram (OCD; higher scores are better) and anxiety by the state subscale of the State-Trait Anxiety Inventory (STAI-S; lower scores are better) at baseline and after the 4-week intervention (post-intervention).Mean scores from baseline to post-intervention for buspirone were OCD 8.7 to 9.0 and STAI-S 40.5 to 40.1 and for placebo were OCD 8.4 to 9.3 and STAI-S 40.9 to 38.6 with raw improvements over time on both measures being greater in the placebo group. Analysis of covariance (ANCOVA) controlling for baseline scores showed no statistically significant difference between groups for OCD (P = 0.052) or STAI-S (P = 0.062).Buspirone did not result in significant improvement in dyspnea or anxiety in cancer patients. Thus, buspirone should not be recommended as a pharmacological option for dyspnea in cancer patients.

1. Some clients suffering from post-traumatic stress disorder (PTSD) are sensitive to having their personal space invaded by health care providers. 2. PTSD patients may react violently to personal space intrusions, such as when a health care provider wakes them suddenly, grabs them without permission, or when they are cornered and staff moves toward them without warning. 3. Through careful assessment and identification of violence as a nursing diagnosis, the nurse not only has information necessary to provide therapeutic intervention, but also has the capability to prevent physical harm to patients and staff.

BackgroundPremedication aims at alleviating preoperative anxiety and nervousness and also at minimizing adverse effects. To our knowledge there is no study comparing efficacy and patient satisfaction of different premedications in age-adjusted dosage.MethodsIn 139 patients anxiety, sedation and adverse effects were measured at 6 consecutive perioperative time points after administration of midazolam, clonidine or a placebo.ResultsMidazolam showed the strongest sedative and anxiolytic effects, clonidine less and placebo none. Clonidine and midazolam reduced the risk of postoperative nausea and vomiting (PONV). Midazolam showed minimal adverse effects and the best patient satisfaction.ConclusionMidazolam was the most anxiolytic, sedative and favored premedication with the least adverse effects. Most patients would choose midazolam next time.

This study determined the prevalence and severity of obsessive-compulsive symptoms/disorder (OCS/OCD), aggression and suicidal in schizophrenic patients. Also we compared the prevalence and severity of aggression and suicidal in schizophrenic patients with and without OCS/OCD considering anxiety, depression and substance abuse as confounding factors.During 2007 and 2008, 100 schizophrenic patients were evaluated with Yale-Brown Obsessive Compulsive Scale, Positive and Negative Syndrome Scale, Beck Depression Inventory, Spilberger State/Trait Anxiety Inventory, Beck Scale for suicide Ideation, and Overt Aggression Scale.OCS/OCD and suicidal attempts were seen in 33%, 10% and 12% of patients respectively. The most common form of aggression was against others (55%), and aggressive obsessions were seen in 10% of the patients. Comparing patients with and without OCS/OCD, there were no significant differences in the severity of schizophrenia, suicidal and overt aggression. The severity of overt aggression was related to the patients' age and education reversely. Also, there was a relationship between their suicidal thoughts and residence in the cities.High rate of aggressive obsessions and lack of relationship between severity of aggression and presence of OCD indicated that these patients did not act on these thoughts. The risk of suicide was more serious in patients living in the cities, and risk of violence was more serious in younger and less educated patients.

During pregnancy, the basal activity is increased in both of our major stress response systems: the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. At the same time, the rea ...

To examine the psychological impact of chronic hepatitis C (CHC) diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications.One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale (VAS), the degree of stress caused by the learning of CHC diagnosis and the perceived severity of their disease. Diagnosis-related stress was compared to four other stressful life events and perceived CHC severity was compared to four other common chronic diseases.Learning of CHC diagnosis was considered a major stressful event (mean+/-SD scores: 72+/-25), significantly less than death of a loved-one (89+/-13, P<0.0001) and divorce (78+/-23, P<0.007), but more than job dismissal (68+/-30, P<0.04) and home removal (26+/-24, P<0.0001). CHC was considered a severe disease (74+/-19), after AIDS (94+/-08, P<0.001) and cancer (91+/-11, P<0.001), but before diabetes (66+/-23, P<0.001) and hypertension (62+/-20, P<0.001). Perceived CHC severity was not related to the actual severity of liver disease, assessed according to Metavir fibrosis score. In multivariate analysis, diagnosis-related stress was related to perceived disease severity (P<0.001), trait anxiety (P<0.001) and infection through blood transfusion (P<0.001).Our results show the considerable psychological and emotional burden that a diagnosis of CHC represents, even in the absence of significant liver disease. They should be taken into account when announcing a diagnosis of CHC in order to reduce its negative effects.

Individual differences in underlying, "basal" pain sensitivity are large and have clinical implications. Some studies have suggested that basal pain sensitivity may also predict the outcome of pain treatment. Multidisciplinary chronic pain management programs are effective, but treatment success is individually very different. Therefore, identification of predictors of treatment success is important. This study investigated if basal pain sensitivity predicted the outcome of a 4-week outpatient multidisciplinary pain management program.Cohort study.Chronic pain outpatient clinic at the Department of Anesthesiology, Intensive Care Medicine and Pain Therapy of the University of Münster.Basal pain sensitivity was measured at treatment onset, using comprehensive experimental pain testing (thermal, pressure, and pinprick pain) and the pain sensitivity questionnaire. Primary (clinical pain intensity) and secondary (depression, anxiety, pain-related disability) outcome parameters were assessed at treatment start, at discharge and 6 months later.Sixty five adult chronic pain patients with mixed pain diagnoses.There were significant improvements in clinical pain intensity (from 6.1 ± 2.0 to 5.1 ± 1.8 [0-10]), depression and anxiety at discharge (all P < 0.001) and of clinical pain intensity (to 5.3 ± 2.3 [0-10]) and pain-related disability at 6 months (all P < 0.05). However, treatment outcome was not predicted by any of the basal pain sensitivity measures.Results show that basal pain sensitivity is not a reliable predictor of treatment outcome in mixed diagnosis multidisciplinary pain management programs, possibly due to the heterogeneity of patients enrolled in such programs. Clinically useful predictors of treatment success in this setting remain to be identified.

When pain becomes chronic it assumes an almost absolute central role in the disease experience: it characterises and qualifies it, and constantly interferes with the daily life of the patient (Bonica, 1992). It could be said that chronic pain becomes a disease in itself in the patient’s perception; daily activities, interpersonal relationships, feelings, are profoundly disturbed by living with pain (Loeser, 2000). While modern medicine has made notable progress in understanding, diagnosing and treating chronic pain, it continues to be a very widespread problem that significantly compromises the professional, social and family life of the patient, and is often not adequately managed (Manchikanti et al., 2010). The problem of inadequately managed pain is still a considerable one (Breivik et al., 2006), although the World Health Organization [WHO] (1990) has stated that to be pain free should be considered a right of every patient. The consequences of inadequately treated pain not only have an impact in terms of the physical and psychological suffering of the patient and his family, they also have an enormous economic impact on society as a whole (Brennan et al., 2007; van Leeuwen et al., 2006). Options for the treatment of chronic pain include both pharmacological treatments (e.g. non steroidal anti-inflammatory drugs, opioids) and non-pharmacological treatments (e.g. physical therapies, acupuncture, cognitive-behavioural therapy, surgical procedures). Choice of treatment should be guided by a complex initial assessment of the patient, which includes the collection of historical information (e.g. pain history and treatments tried, surgical procedures, psychosocial and family history), a physical examination and appropriate diagnostic tests (Passik, 2009). Opioids are considered one of the most efficacious groups of drugs in treating mediumsevere pain (Portenoy, 2000), and their use can result in a significant improvement in the patient’s quality of life (Dillie et al., 2008); while there is unanimous agreement on their use in acute and cancer pain, their long-term use for non-cancer chronic pain remains controversial (Dews & Mekhail, 2004; Manchikanti et al., 2010; Rosenblum et al., 2008). The discovery of the properties of these substances, and their use as analgesics, is lost in the mists of time: the Sumerians were starting to cultivate poppies as early as 3400 B.C. (Booth, 1986, as cited in Dews & Mekhail, 2004). In 1803, Friedrich Serturner, a German pharmacist,

A contemporary psychodynamic framework can add much to our understanding of eating disorders. Eating disorders are associated with complex comorbidities, high levels of mortality, and therapist countertransferences that can complicate psychological treatments. Mainstream models currently focus on cognitive, biological, or cultural factors to the near exclusion of attachment functioning, and the individual’s dynamics. As such, standard models appear to exclude person-centred and developmental considerations when providing treatments. In this article, we describe a contemporary psychodynamic model that understands eating disorder symptoms as a consequence of vulnerability to social pressures to be thin and biological predispositions to body weight. Individual vulnerabilities are rooted in unmet attachment needs causing negative affect, and subsequent maladaptive defenses and eating disorder symptoms as a means of coping. We describe how this model can inform transdiagnostic eating disorder treatment that focuses on symptoms as well as specific attachment functions including: interpersonal style, affect regulation, reflective functioning, and coherence of mind. Two clinical examples are presented to illustrate case formulations and psychological treatments informed by these conceptualizations.

The purpose of this study was to examine the influencing factors of postoperative pain among children undergoing elective surgery.A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in Singapore.Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional behaviors were significant influencing factors for postoperative pain. Boys reported less postoperative pain than girls.Effective strategies for assessing and managing children's preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.

In recent years, the startle reflex has become an exciting new tool to investigate affective responses to aversive stimuli in humans. The popularity of this methodology is largely based on the substantial amount of animal research available on this topic. Several procedures have been developed to examine startle potentiation in humans, but most studies have been carried out in adults and may not be appropriate for children or adolescents. The present study is a multi-site project (Yale University, Harvard University, and the University of Minnesota) investigating two new procedures to examine the potentiation of startle in adolescents. The subjects were 50 male and female aged 13-17 years old. One procedure examined fear-potentiated startle to the threat of an unpleasant airblast directed to the larynx. The second examined the facilitation of startle in darkness. Potentiation was found using each procedure and the degree of potentiation was similar across laboratories. These results suggest that both the threat of an airblast and darkness can reliably be used to examine startle potentiation in young subjects.

Researchers and practitioners have cited the advantage of such flexible work scheduling options as flex‐time, compressed workweeks, job sharing, and reduced hours for employees. The assumption underlying these options has been that more flexible schedules allow employees to meet their family requirements and still work a sufficient number of hours to advance in their careers. In this paper we focus on the unintended consequences of such job‐design modifications. In particular, we explore the impact of reduced‐hours career options for women in the healthcare sector. One potential consequence of reduced hours concerns the effects of violations of psychological contracts, or the beliefs that employers and employees hold regarding their mutual obligations. We test two hypotheses that state that professionals and reduced‐hours employees are more likely to express an intention to turn over when such contracts are violated. We test these hypotheses in a random sample of 178 Boston‐area married female healthcare ...

BACKGROUND: Sexual problems are common among people with cardiovascular disease. Although clinical guidelines recommend sexual counselling for patients and their partners, there is little evidence ...

Addiction/dependence is a chronically relapsing disorder that is characterized by a compulsion to take drugs and loss of control in limiting intake; brain stress systems can contribute to the compulsivity of drug-taking and therefore participate in the development and persistence of dependence (Koob, 2008). The concept of craving for alcohol can be recognized as a central component of the alcohol dependence syndrome together with the loss of control over and relapse to alcohol use (Anton, 1999). Gradual adaptation of brain function (neuroadaptation) to the presence of alcohol seems to be a central feature in the development of alcohol dependence (Koob & Le Moal, 2008). The neuroadaptation is not a conscious process and many alcohol dependent persons are likely to deny any craving for alcohol. Craving seems to emerge fully only when a person is prevented from access to alcohol or consciously attempts to quit alcohol use (Tiffany, 1990). Certain similarities exist between obsessive-compulsive disorder (OCD) and some aspects of craving (Anton et al., 1996) in form of recurrent and irresistible thoughts about alcohol during early recovery and during later recovery when experiencing stimulus clues or stressful states. Several scales have been developed to assess certain specific aspects of the craving phenomenon as a multidimensional and temporary phenomenon; the Obsessive Compulsive Drinking Scale (OCDS) (Anton et al., 1996) is suitable for determining the amount of craving experienced over a longer time interval (e.g. one week) and not only as a momentary urge to drink. Concurrent depression and anxiety symptoms are among the most common problems in alcohol dependent patients: heavy drinkers with co-occurring depressive and anxiety symptoms evidence heavier alcohol use and increased risk of relapse (Hasin et al., 2007). In detoxified alcoholics, in early abstinence, overall dopaminergic neurotransmission in the ventral striatum of alcohol dependent patient is reduced. Brain studies with positron emission tomography revealed a reduction of availability and sensitivity of central dopamine D2-receptors in alcohol dependent patients, which may reflect a compensatory down-regulation after chronic alcohol intake and was associated with the subsequent relapse risk (Heinz et al., 2009). Dysfunction of dopaminergic, glutamatergic, and opioidergic neurotransmission in the brain reward system can be associated with alcohol craving. In early abstinence state of higher levels of glutamate and noradrenergic activity

Australian workers’ compensation figures consistently reveal that physical and psychological injuries pose a costly burden to the Australian economy. Since the 1980s, many employers have increasingly been providing workplace massage programs to their staff as one initiative to redress this trend. Masseurs have promoted the effectiveness of this intervention for improving musculoskeletal disorders and reducing stress, and claim massage therapy contributes toward increased employee engagement with the workplace, thus resulting in increased productivity and reduced levels of absenteeism. Clearly, one of the underlying aims for employers in providing such facilities is to prevent and manage work-related injuries and stress. However, notwithstanding these claims, there remains a paucity of scholarly literature investigating: (a) reasons why managers implement and subsidise workplace massage, (b) what employees feel are the work-related effects such programs, and, (c) the therapeutic intentions of masseurs who offer this therapy. Using three conceptually linked studies, this thesis explores the stories of managers, employees, and therapists in order to gain a greater understanding of their perceptions about the overall benefits of workplace massage.