Work-related rumination, that is, perseverative thinking about work during leisure time, has been associated with a range of negative health and wellbeing issues. The present paper examined the association between work-related rumination and cognitive processes centred around the theoretical construct of executive functioning. Executive functioning is an umbrella term for high level cognitive processes such as planning, working memory, inhibition, mental flexibility; and it underlies how people manage and regulate their goal directed behaviour. Three studies are reported. Study I, reports the results of a cross-sectional study of 240 employees, and demonstrates significant correlations between work-related rumination and three proxy measures of executive functioning: cognitive failures (.33), cognitive flexibility (-.24) and situational awareness at work (-.28). Study II (n = 939), expands on the findings from study 1 and demonstrates that workers reporting medium and high work-related rumination were 2.8 and 5 times, respectively, more likely to report cognitive failures relative to low ruminators. High ruminators also demonstrated greater difficulties with ?lapses of attention? (OR = 4.8), ?lack of focus of attention? (OR = 3.4), and ?absent mindedness? (OR = 4.3). The final study, examined the association between work-related rumination and executive functioning using interview data from 2460 full time workers. Workers were divided into tertiles low, medium and high. The findings showed that high work-related rumination was associated with deficits in starting (OR = 2.3) and finishing projects (OR = 2.4), fidgeting (OR = 1.9), memory (OR = 2.2), pursuing tasks in order (OR = 1.8), and feeling compelled to do things (OR = 2.0). It was argued that work-related rumination may not be related to work demands per se, but appears to be an executive functioning/control issue. Such findings are important for the design and delivery of intervention programmes aimed at helping people to switch off and unwind from work

OBJECTIVE: To test the hypothesis that work stress (persistent high job demands over 1 year) in combination with high reactivity to mental stress predict ambulatory blood pressure. DESIGN: Assessment of cardiovascular responses to standardized behavioural tasks, job demands, and ambulatory blood pressure over a working day and evening after 12 months. PARTICIPANTS: We studied 81 school teachers (26 men, 55 women), 36 of whom experienced persistent high job demands over 1 year, while 45 reported lower job demands. METHODS: Participants were divided on the basis of high and low job demands, and high and low systolic pressure reactions to an uncontrollable stress task. Blood pressure and concurrent physical activity were monitored using ambulatory apparatus from 0900 to 2230 h on a working day. RESULTS: Cardiovascular stress reactivity was associated with waist/hip ratio. Systolic and diastolic pressure during the working day were greater in high job demand participants who were stress reactive than in other groups, after adjustment for age, baseline blood pressure, body mass index and negative affectivity. The difference was not accounted for by variations in physical activity. CONCLUSIONS: Cardiovascular stress reactivity and sustained psychosocial stress may act in concert to increase cardiovascular risk in susceptible individuals.

OBJECTIVE: To assess the influence of abdominal obesity and work stress (operationalised as low control over work) on ambulatory blood pressure on a working day and evening. PARTICIPANTS AND METHODS: 156 school teachers (58 men and 98 women) carried out ambulatory blood pressure and heart rate monitoring on a work day and evening. Cardiovascular activity was also measured under baseline conditions on another occasion, when body weight, height, waist and hip circumference were assessed. Perceived control over work was assessed by questionnaire, along with mental health, anger expression and social support. 126 participants repeated the protocol after 12 months. Waist/hip ratio was used as the index of abdominal obesity. RESULTS: Baseline blood pressure was positively associated with waist/hip ratio in men, but ambulatory blood pressure and heart rate were not independently related to waist/hip ratio or job control. However, blood pressure and heart rate recorded during the working day and evening were elevated in men with high waist/hip ratio who experienced low job control, independently of age and body weight. Effects for diastolic blood pressure and heart rate were replicated after 12 months. Body mass index was not related to blood pressure or heart rate during the day or evening after adjustment for age and waist circumference. Low job control was associated with poor psychological well-being, negative mood and lack of social support. CONCLUSIONS: The results are consistent with the hypothesis that abdominal obesity in men is characterised by a tendency towards heightened stress-induced physiological activation, but that this tendency will only be manifest in the presence of appropriate environmental challenges such as chronic work stress.

Aims To examine the acute effects of a guided relaxation routine (body scan) and isometric exercise on desire to smoke and tobacco withdrawal symptoms.

Design Experimental comparison of three conditions.

Participants Forty-eight individuals reporting smoking e10 cigarettes daily.

Intervention Random assignment to one of three interventions delivered via a 10-minute audio: isometric exercise (IE, n = 14), body scanning (BS, n = 18) or a reading about natural history (control group, n = 16). Interventions were delivered twice on the same day: in the laboratory, then in their ?normal? environment.

Measurements Desire to smoke (primary outcome) and withdrawal symptoms were rated at pre-intervention and up to 30 minutes post-intervention.

Findings Controlling for baseline scores, post-intervention desire to smoke and withdrawal symptoms were significantly lower for IE and BS groups, compared with the controls, in both environments. There were no significant differences for IE versus BS. For desire to smoke, controlling for baseline values, ratings in the laboratory were significantly lower for IE and BS versus the control up to 30 minutes post-intervention. In the normal environment, these ratings were significantly lower only up to 5 minutes post-intervention.

Conclusions Brief IE and BS interventions are effective for reducing desire to smoke and withdrawal symptoms in temporarily abstaining smokers. These interventions were found to be more effective in the laboratory than in the smoker's normal environment, but this may be an artefact of there not being a sufficient ?wash-out? period between interventions. These techniques may be beneficial for managing desire to smoke and tobacco withdrawal.

Objective: This study examined the association between three conceptualisations of work-related rumination (affective rumination, problem-solving pondering and detachment) with sleep quality and work-related fatigue. It was hypothesised that affective rumination and poor sleep quality would be associated with increased fatigue; and problem-solving pondering, and detachment would be associated with decreased fatigue. The mediating effect of sleep quality on the relationship between work-related rumination and fatigue was also tested. Method: An on-line questionnaire was completed by a heterogeneous sample of 719 adult workers in diverse occupations. Results: The following variables were entered as predictors in a regression model: affective rumination, problem-solving pondering, detachment, and sleep quality. The dependent variables were chronic work-related fatigue (CF) and acute work-related fatigue (AF). Affective rumination was the strongest predictor of increased CF and AF. Problem-solving pondering was a significant predictor of decreased CF and AF. Poor sleep quality was predictive of increased CF and AF. Detachment was significantly negatively predictive for AF. Sleep quality partially mediated the relationship between affective rumination and fatigue; and between problem-solving pondering and fatigue. Conclusions: Work-related affective rumination appears more detrimental to an individual?s ability to recover from work than problem-solving pondering. In the context of identifying mechanisms by which demands at work are translated into ill-health, this appears to be a key finding; and suggests that it is the type of work-related rumination, not rumination per se, that is important.

BACKGROUND: School teaching is regarded as a stressful occupation, but the perception of the job as stressful may be influenced by coping responses and social support. AIMS: To assess the associations between teacher stress, psychological coping responses and social support, taking into account the plaintive set engendered by negative affectivity. METHOD: Questionnaire survey of 780 primary and secondary school teachers (53.5% response rate). RESULTS: In stepwise multiple regression, social support at work and the coping responses behavioural disengagement and suppression of competing activities predicted job stress independently of age, gender, class size, occupational grade and negative affectivity. High job stress was associated with low social support at work and greater use of coping by disengagement and suppression of competing activities. CONCLUSIONS: It is suggested that behavioural disengagement and suppression of competing activities are maladaptive responses in a teaching environment and may actually contribute to job stress. Coping and social support not only moderate the impact of stressors on well-being but influence the appraisal of environmental demands as stressful.

The aim of this study was to explore the experiences of ambulance dispatch personnel, identifying key stressors and their impact on staff well-being.Qualitative methodology was used. Nine semistructured interviews were conducted with National Health Service (NHS) ambulance Emergency Operations Centre (EOC) dispatch personnel in the UK between July and August 2014. Participants were asked about their experiences of the role, stress experienced and current strategies they use to deal with stress. Transcripts were analysed using an inductive, bottom-up thematic analysis.Three key themes were identified: (1) 'How dispatch is perceived by others', (2) 'What dispatch really involves' and (3) 'Dealing with the stresses of dispatch'. All participants expressed pride in their work, but felt overloaded by the workload and undervalued by others. Several sources of additional stress, not directly related to the execution of their work, were identified, including the need to mentally unwind from work at the end of a shift. Participants were able to identify a number of ways in which they currently manage work-related stress, but they also suggested changes the organisation could put in place in order to reduce stress in the working environment.Building on existing theory on work stress and postwork recovery, it was concluded that EOC dispatch staff require greater support at work, including skills training to promote postshift recovery, in order to reduce the likelihood of sickness absence, and prevent work-related fatigue.

Perseverative cognitions such as rumination and worry are key components of mental illnesses such as depression and anxiety. Given the frequent comorbidity of conditions in which rumination and worry are present, it is possible that they are underpinned by the same cognitive process. Furthermore, rumination and worry appear to be part of a causal chain that can lead to long-term health consequences, including cardiovascular disease and other chronic conditions. It is important therefore to understand what interventions may be useful in reducing their incidence. This systematic review aimed to assess treatments used to reduce worry and/or rumination. As we were interested in understanding the current treatment landscape, we limited our search from 2002 to 2012. Nineteen studies were included in the review and were assessed for methodological quality and treatment integrity. Results suggested that mindfulness-based and cognitive behavioural interventions may be effective in the reduction of both rumination and worry; with both Internet-delivered and face-to-face delivered formats useful. More broadly, it appears that treatments in which participants are encouraged to change their thinking style, or to disengage from emotional response to rumination and/or worry (e.g., through mindful techniques), could be helpful. Implications for treatment and avenues for future research are discussed.

Smoking during pregnancy is widely known to increase health risks to the foetus, and understanding the quitting process during pregnancy is essential in order to realise national government targets. Qualitative studies have been used in order to gain a greater understanding of the quitting process and the objective of this systematic review was to examine and evaluate qualitative studies that have investigated the psychological and social factors around women attempting to quit smoking during pregnancy. Electronic databases and journals were searched with seven articles included in this review. The findings demonstrated that women were aware of the health risks to the foetus associated with smoking; however knowledge of potential health risks was not sufficient to motivate them to quit. Several barriers to quitting were identified which included willpower, role, and meaning of smoking, issues with cessation provision, changes in relationship interactions, understanding of facts, changes in smell and taste and influence of family and friends. A further interesting finding was that cessation service provision by health professionals was viewed negatively by women. It was concluded that there is a shortage of qualitative studies that concentrate on the specific difficulties that pregnant women face when trying to quit smoking.

Rationale. A previous study found that a 10-min bout of moderate intensity exercise reduced cigarette withdrawal symptoms and desire to smoke in sedentary smokers but the effect may have been due to participants focusing attention on physical activity rather than the activity itself. Objectives. This study examined the effect of 5 min of moderate intensity exercise and 5 min of light intensity exercise on tobacco withdrawal symptoms amongst sedentary smokers. Methods. Eighty-four smokers attended a laboratory session having abstained from smoking for between 11 and 14 h. Participants were randomly allocated to one of three conditions: (i) light intensity exercise [n=28; 10-20% of heart rate reserve (HRR)]; (ii) moderate intensity exercise (n=28; 40-60% HRR), (iii) a passive control condition (n=28). Both exercise conditions involved 5 min of stationary cycling and participants rated tobacco withdrawal symptoms and cravings immediately before exercise (baseline), during exercise at 2.5 min, immediately following exercise, then after 5 and 10 min of rest. Control participants made the same ratings across an equivalent time period. Results. For moderate intensity exercise compared to light intensity exercise and control there was a significant reduction in strength of desire to smoke, relative to baseline, both during exercise and up to 5 min post-exercise. Relative to baseline, there were also significant reductions in restlessness, stress, tension and poor concentration at 5 and 10 min post-exercise, for moderate intensity exercise compared to light intensity exercise and control. Conclusions. Five minutes of moderate intensity exercise is associated with a short-term reduction in desire to smoke and tobacco withdrawal symptoms. Very brief bouts of exercise may therefore be useful as an aid to smoking cessation.

Although ageing itself does not lead to insomnia, changes in sleep architecture (the 'typical' physiological progression from wakefulness to deep sleep) and health status create a vulnerability to the development of insomnia, which can be precipitated by a trigger event. This review highlights some of the problems associated with insomnia in older people and offers insights into the possible approaches to stop insomnia from becoming a 'rite of passage'. The main conclusion from this review however, is that sleep research focusing specifically on the ageing population is badly needed, alongside a unified diagnostic system and research structure (Leger, 2000). These findings are also discussed in relation to both healthcare policy and practice. © Copyright - 2001 MCB UP Ltd. All rights reserved.

Diagnosis and treatment of fibromyalgia syndrome (FMS) currently focuses on the experience of widespread pain. However, the symptom experience described by patients with FMS in clinical practice is far more diverse. This study aims identify the most common and severe symptoms in female patients diagnosed with FMS.

From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. Statement of Relevance: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.

This quasi-experimental longitudinal study assessed the effect of a one-day Cognitive Behaviour Therapy (CBT)-based workshop on work-related rumination, chronic fatigue and sleep quality. We hypothesised that participants who attended the workshop would report lower levels of affective work-related rumination and chronic fatigue and improved sleep quality, at follow-up, six months after workshop completion. Two hundred and twenty seven participants took part in the study, with 102 participants attending a one-day workshop delivered in their place of work. Participants completed an online questionnaire at two time-points, with follow-up occurring 6 months after initial survey completion. Results showed that participants who took part in the CBT workshop reported significantly lower levels of affective rumination (p=.03) and chronic fatigue (p=.003), at follow-up in comparison to individuals who did not attend the workshop; however there were no significant differences between the groups in self-reported sleep quality (p=.06). A combination of more effective recovery both at work and outside of work may explain the reductions in both affective rumination and fatigue over time. This study adds to the recovery from work literature by providing initial support for a one-day CBT-based workshop delivered in the workplace.

BACKGROUND: This study examined the association between job strain and psychiatric morbidity using interview-based assessments of mental health. We assessed the prevalence of neurotic disorder in high job strain (high demand, low control) and low job strain (low demand, high control) school teachers, and compared these rates with data from individuals with similar educational qualifications from the National Psychiatric Morbidity Survey of Great Britain. METHODS: One hundred and sixty primary and secondary school teachers were selected from a larger survey on the basis of high or low job strain, and were assessed for psychiatric morbidity using the Revised Clinical Interview Schedule (CIS-R). The prevalence of neurotic symptoms and a total psychiatric morbidity score were calculated. RESULTS: After adjusting for age, gender and occupational grade, the prevalence of psychiatric morbidity was greater in high job strain than low job strain individuals. The prevalence of severe anxiety, worry and fatigue symptoms was significantly greater in the high job strain teachers. In comparison with the British psychiatric morbidity survey, the prevalence of neurotic disorders was greater in the high job strain, but not in low job strain teachers. Individuals in the low job strain group were more likely to report severe anxiety, irritability and fatigue in the week prior to interview, than comparably educated individuals in the national survey. CONCLUSION: Job strain is associated with psychiatric morbidity. The high levels of neurotic psychopathology among teachers is consistent with previous research that has found teaching to be a highly stressful occupation.

This study compared the accessibility of the pros (advantages) and cons (disadvantages) of exercise in a group of non-exercisers and regular exercisers, using the Transtheoretical Model of behaviour change as a theoretical framework. Pre-contemplators (n
=
18), and maintainers (n
=
25), were asked to generate a list of 'advantages to taking part in exercise' (pro reasons), and a list of 'disadvantages to taking part in exercise' (con reasons). The time to generate their first item was recorded as well as the total number of items generated within 60 s. The results showed that pre-contemplators provided more con reasons relative to pro reasons; and maintainers provided more pro reasons relative to con reasons for exercise. Pre-contemplators were also quicker to provide their first con reason, relative to their first pro reason, but there was no difference in pro and con latencies in the maintainers. It was concluded that one reason pre-contemplation individuals do not participate in regular exercise may be because they cannot think of reasons to exercise.

OBJECTIVE: The association between cardiovascular disease risk and job strain (high-demand, low-control work) may be mediated by heightened physiological stress responsivity. We hypothesized that high levels of job strain lead to increased cardiovascular responses to uncontrollable but not controllable stressors. Associations between job strain and blood pressure reductions after the working day (unwinding) were also assessed. DESIGN: Assessment of cardiovascular responses to standardized behavioral tasks, and ambulatory monitoring of blood pressure and heart rate during a working day and evening. PARTICIPANTS: We studied 162 school teachers (60 men, 102 women) selected from a larger survey as experiencing high or low job strain. METHODS: Blood pressure, heart rate and electrodermal responses to an externally paced (uncontrollable) task and a self-paced (controllable) task were assessed. Blood pressure was monitored using ambulatory apparatus from 0900 to 2230 h on a working day. RESULTS: The groups of subjects with high and low job strain did not differ in demographic factors, body mass or resting cardiovascular activity. Blood pressure reactions to the uncontrollable task were greater in high than low job-strain groups, but responses to the controllable task were not significantly different between groups. Systolic and diastolic blood pressure did not differ between groups over the working day, but decreased to a greater extent in the evening in subjects with low job strain. CONCLUSIONS: Job strain is associated with a heightened blood pressure response to uncontrollable but not controllable tasks. The failure of subjects with high job strain to show reduced blood pressure in the evening may be a manifestation of chronic allostatic load.

Research on the feeling of embitterment at work is still in its infancy. The present study investigated the predictors and consequences of the feeling of embitterment at work. It was hypothesised that organisational injustice as well as over-controlling supervision would predict embitterment at work and that embitterment would be associated with work-related rumination. Three hundred and thirty-seven employees completed an online survey. Regression analysis revealed that procedural injustice and over-controlling supervision were significant predictors of embitterment and that embitterment contributed significantly to the prediction of increased affective rumination and reduction in detachment. Mediation analysis indicated that embitterment at work was a significant mechanism through which organisational injustice and over-controlling supervision exerted their effect on affective rumination, which is indicative of insufficient recovery from work. Findings suggest that breaches in organisational justice can generate feelings of embitterment at work, which in turn can interfere with employees? ability to adequately recover from work. Practitioner Summary: The purpose of this study was to investigate predictors and consequences of embitterment in the workplace, by using an online questionnaire. Findings suggest that perceived unfairness, because of structural and organizational aspects, predict feelings of embitterment and that feeling embittered at work can prevent employees from adequately recovering from work.

Background: The demand for organ donation is increasing worldwide. One possible way of increasing the pool of potential posthumous donors is to encourage more members of the general public to join an organ donor registry. Objective: A systematic review was conducted to investigate the effectiveness of psychological interventions designed to increase the number of individuals in the community who register as organ donors. Methods: PsycINFO and PubMed databases were searched. No date limits were set. Randomized and non-randomized controlled trials exploring the effects of community-based interventions on organ donor registration rates were included. Methodological quality was assessed using the ?Quality Assessment Tool for Quantitative Studies?. Results: 24 studies met the inclusion criteria; 19 studies found a positive intervention effect on registration. Only eight studies were assessed as having reasonable methodological robustness. A narrative synthesis was conducted. Factors influencing registration rates include providing an immediate registration opportunity and using brief interventions to challenge misconceptions and concerns about organ donation. Discussion: Community based interventions can be effective at increasing organ donor registrations amongst the general public. Factors that may increase effectiveness include brief interventions to address concerns, and providing an immediate registration opportunity. Particular consideration should be paid to the fidelity of intervention delivery.

The aim of this thesis was to investigate the effects of the guided body scan on cigarette cravings and nicotine withdrawal symptoms in temporarily abstinent smokers. In light of evidence that a combination of pharmacotherapy and behavioural support can result in even greater success rates than either strategy alone (Stead & Lancaster, 2012), study one was the first randomised placebo-controlled trial to examine how the body scan interacts with traditional nicotine replacement therapy. Unfortunately, the magnitude of an anti-placebo effect meant that neither the nicotine nor placebo patches had an effect on ratings of withdrawal symptoms and tobacco cravings. The results did however show that the body scan produced significant post intervention reductions relative to baseline, whilst unexpectedly finding that the control audio also yielded similar levels of efficacy. This cast doubt on the theory that the body scan reduces cravings and withdrawal symptoms via the promotion of non-judgemental acceptance of thoughts and feelings, although the idea that both audio interventions acted as a form of cognitive distraction seemed more plausible. The secondary aim was therefore to explore whether cognitive distraction is a mechanism underlying the efficacy of the body scan, with study three comparing a guided body scan to two distraction tasks. The results indicated that relative to baseline, all three interventions produced reductions in withdrawal symptoms up to 10 minutes post task, however the body scan out performed the two distraction tasks in reducing the desire to smoke. This implies that whilst the processes associated with cigarette withdrawal might be vulnerable to disruption via cognitive distraction, the desire for a cigarette is less susceptible. Instead, the body scan may provide additional benefits via the moderation of negative affect or a relaxation response.

The internet and mobilisation of information and communication technologies (ICTs) have made non-manual work increasingly portable and remotely accessible. As a result, a considerable number of employees use their ICTs to engage in work-related tasks during designated non-work time, even without contractual obligation. However, existing research on such voluntary work-related ICT use remains fragmented and spread across disciplines. We conducted a narrative review of 56 studies to identify themes in existing research, synthesise the evidence base, as well as identify gaps in our understanding. We identify five themes, namely: (1) Social-normative organisational context, (2) Job-related characteristics and work processes, (3) Person characteristics, (4) Designated non-work time and well-being, and (5) Empowerment/Enslavement Paradox. A conceptual model of voluntary ICT use is developed by integrating the identified themes with existing organisational research, outlining the relationships between the identified themes and voluntary ICT use. In the discussion, we emphasise the need for more conceptual clarity on voluntary ICT use and related constructs, and for the integration of different disciplines and methodological approaches to advance knowledge in the field. We further identify person-centred research as critical future avenue to explore different ICT user types. Additionally, more research into the mechanisms and moderating influences regarding voluntary ICT use and its outcomes is considered advisable to advance our knowledge on the Empowerment/Enslavement Paradox and its potential resolution. We conclude with preliminary implications to inform practice, addressing the need for employers to provide control over voluntary ICT use, as well as employees enacting this control.

Background and purpose. Evidence suggests that exercise decreases nicotine withdrawal symptoms in humans; however, the mechanisms mediating this effect are unclear. We investigate, in a mouse model, the effect of exercise intensity during chronic nicotine exposure on nicotine withdrawal severity, binding of ±4²2*, ±7 nicotinic acetylcholine (nAChR), ¼-opioid (¼ receptors) and D2 dopamine receptors, and on brain-derived neurotrophic factor (BDNF) and plasma corticosterone levels.

Experimental approach. Male C57Bl/6J mice treated with nicotine (minipump, 24 mg kg-1 day-1) or saline for 14 days underwent one of three concurrent exercise regimes: 24, 2 or 0 hrs day-1 voluntary wheel running. Mecamylamine-precipitated withdrawal symptoms were assessed on day 14. Quantitative autoradiography of ±4²2*, ±7 nAChRs, ¼ receptors and D2 receptor binding was performed in brain sections of these mice. Plasma corticosterone and brain BDNF levels were also measured.

Key results. Nicotine-treated mice undertaking 2 or 24 hrs day-1 wheel running displayed a significant reduction of withdrawal symptom severity compared with the sedentary group. Wheel-running induced a significant upregulation of ±7 nAChR binding in the CA2/3 area of the hippocampus of nicotine-treated mice. Neither exercise nor nicotine treatment affected ¼ or D2 receptor binding or BDNF levels. Nicotine withdrawal increased plasma corticosterone levels and ±4²2* nAChR binding, irrespective of exercise regimen.

Conclusions and implications. We demonstrate for the first time a profound effect of exercise on ±7 nAChRs of nicotine-dependent animals, irrespective of exercise intensity. These findings shed light onto the mechanism underlining the protective effect of exercise in the development of nicotine dependence.

KEY POINTS

" In clinical settings, rumination can be defined as a maladaptive and repetitive thinking process that focuses on symptoms, causes and consequences of one?s illness
" A cross-sectional study was designed to investigate the incidence of rumination and its determinants in two samples of 98 breast and lung cancer patients
" Results showed that rumination related to cancer was evident in almost half of the participants and was significantly correlated with general rumination
" Rumination was also negatively correlated with social support and quality of sleep and positively correlated with the perception of individual responsibility in having cancer
" The high prevalence of rumination in cancer patients suggests the need for future longitudinal studies to analyze its long-term effects on illness prognosis, patient quality of life, and psychological wellbeing, as well as the need to develop specific interventions to help reduce its impact on illness management in patients

Background. The study objective was to investigate and synthesize available evidence
relating to the psychological health of Emergency Dispatch Centre (EDC) operatives,
and to identify key stressors experienced by EDC operatives.

Methods. Eight electronic databases (Embase, PubMed, Medline, CINAHL, PsycInfo,
PsycArticles, The Psychology and Behavioural Sciences Collection, and Google Scholar)
were searched. All study designs were included, and no date limits were set. Studies
were included if they were published in English, and explored the psychological health
of any EDC operatives, across fire, police, and emergency medical services. Studies were
excluded if they related solely to other emergency workers, such as police officers or
paramedics. Methodological quality of included studies was assessed using checklists
adapted from the Critical Appraisal Skills Programme. A narrative synthesis was
conducted, using thematic analysis.

Results. A total of 16 articles were included in the review. Two overarching themes were
identified during the narrative synthesis: `Organisational and Operational Factors' and
`Interactions with Others'. Stressors identified included being exposed to traumatic
calls, lacking control over high workload, and working in under-resourced and pres-
sured environments. Lack of support from management and providing an emotionally
demanding service were additional sources of stress. Peer support and social support
from friends and family were helpful in managing work-related stress.

Discussion. EDC operatives experience stress as a result of their work, which appears to
be related to negative psychological health outcomes. Future research should explore
the long-term effects of this stress, and the potential for workplace interventions to
alleviate the negative impacts on psychological health.

Embitterment has been described as the emotion generated in the aftermath of an event experienced as unjust and unfair. Although embitterment is most commonly presented in the work context, research on workplace embitterment has remained scarce due to the fact that the concept of embitterment is rather new. This thesis aimed to shed some light on the prevalence of this emotion, its developmental context, outcomes and ways of treating it.
Three studies were carried out. In study 1, results from a cross-sectional study (N = 337) showed that procedural injustice and over-controlling supervision were significant predictors of workplace embitterment. Findings also showed that embitterment contributes significantly to the prediction of increased affective rumination and reduction in detachment, which are indicative of insufficient recovery from work. In study 2, results from a six month longitudinal study design (N = 169) showed that distributive injustice and informational injustice as well as over controlling supervision in Time 1 significantly predicted workplace embitterment six months later. Results also suggested that workplace embitterment in Time 1 significantly predicted reduced levels of work engagement and job satisfaction six months later. In study 3, results from a randomized control trial using participants who were embittered in their workplace showed that participants who completed an expressive writing exercise (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, work engagement, job satisfaction, either improved sleep quality, compared to participants who completed the factual writing (N = 21).
In summary, results from this thesis suggests that breaches in organisational justice, can trigger feelings of workplace embitterment which can impact negatively employees? ability to psychologically unwind from work, as well as their work engagement and job satisfaction levels. The unfolding of further features of workplace embitterment and the development of interventions to improve this feeling seems a worthwhile future endeavor.

Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure to nature, operationalized using photographs presented as a slideshow, could aid reduction in levels of state rumination. An experimental, within-between (Time x Condition) participant design was used; participants (n = 58) undertook a presentation task designed to induce rumination and influence mood. Participants were then randomly allocated to either: watch a slideshow of a natural environment, watch a slideshow of an urban environment, or wait patiently with no distractions. Data were collected at baseline, after the presentation, and after the slideshow. Environmental exposure had no effect on levels of rumination or negative mood, but did have a significant effect on levels of positive mood, ?being away?, and ?fascination?. Positive mood declined in those who saw the urban slideshow, but remained the same in those who saw the nature slideshow, whilst levels of being away and fascination were highest in those who saw the nature slideshow. This study extends previous restorative environment research by exploring the effects of nature on rumination.

Twenty-first century workplaces have changed considerably, not least through technological developments which enable employees to engage in voluntary information and communication technology (ICT) use for work-related purposes during non-work time without contractual obligation. The overall aim of this thesis was to examine the concept of voluntary ICT use, its antecedents and consequences for employee recovery and well-being in order to develop an evidence-based conceptual model as a theoretical basis to advance future research in this area.

One systematic review and three empirical studies were conducted. In the systematic review, literature on voluntary ICT use (i.e., 73 studies) was systematically identified and synthesised in order to establish the existing evidence base. This resulted in an operational definition and conceptual model of voluntary ICT use which provided a framework for the subsequent empirical studies. In Study 1, a two-part cross-sectional questionnaire study, antecedents of voluntary ICT use at the social-normative organisational level (Study 1a, N = 157) and at the individual level (Study 1b, N = 165) were examined. Study 1 identified the supervisor?s availability expectations and colleagues? ICT use during non-work time as the most influential antecedents at the social-normative organisational level, and lack of psychological detachment at the individual level. In both parts, autonomous ICT use motivation explained a considerable amount of variance in voluntary ICT use. In Study 2, a daily diary study over five consecutive workdays (nbetween = 197, nwithin = 823), voluntary ICT use during workday evenings was found to negatively affect recovery and affective well-being reported at bedtime by impeding psychological detachment; these indirect effects were also observed regarding well-being the following morning, but were less pronounced. Study 3 comprised an experimental field study which evaluated the effectiveness of a three-week intervention that encourages an active boundary management in relation to voluntary ICT use. It was found that participants reported a short-term reduction in voluntary ICT use at the weekend, as well as delayed increases in ICT-related self-control and decreases in need for recovery in comparison to a waitlist control group (T2; N = 55).

In summary, this thesis contributes to the establishment of voluntary ICT use as a concept and to existing theories of boundary management and work-related recovery by highlighting their interrelations with voluntary ICT use. Drawing on the findings from the empirical studies, evidence-based, practical guidance is provided, encouraging a more conscious, purposeful management of voluntary ICT use. Directions for future research are suggested in relation to the extension of the conceptual model, the added value of person-centred research and the practical implementation of lessons learnt in a holistic way, aiming to progress in informing policy-makers, employers and employees effectively.

The objective of this study was to examine the association between perseverative cognition in the form of work-related rumination, and heart rate variability (HRV). We tested the hypothesis that high ruminators would show lower vagally mediated HRV relative to low ruminators during their leisure time. Individuals were classified as being low (n = 17) or high ruminators (n = 19), using the affective scale on the work-related rumination measure. HRV was assessed using a wrist sensor band (Microsoft Band 2). HRV was sampled between 8 pm and 10 pm over three workday evenings (Monday to Wednesday) while individuals carried out their normal evening routines. Compared to the low ruminators, high affective ruminators demonstrated lower HRV in the form of root mean square successive differences (RMSSDs), relative to the low ruminators, indicating lower parasympathetic activity. There was no significant difference in heart rate, or activity levels between the two groups during the recording periods. The current findings of this study may have implications for the design and delivery of interventions to help individuals unwind post work and to manage stress more effectively. Limitations and implications for future research are discussed.

Background:

Embitterment has been described as the emotion generated by an event experienced as unjust. Although clinicians working in occupational health services readily recognise features of embitterment in organisations, little attention has been given to workplace embitterment. Research is warranted to identify predictors and features of employees? embitterment.

Aims:

To explore the predictors and the chronicity of workplace embitterment over six months.

Methods:

A longitudinal study investigating the chronicity of workplace embitterment and its antecedents among employees from various occupations. Data were collected by online questionnaires including measures of workplace embitterment, organisational justice and employees? perceptions of supervisory control.

Results:

The survey was completed by 352 employees at Time 1, and 169 at Time 2. The final sample (assessed at two time points) was 147 employees. The feeling of workplace embitterment appeared to be very stable during the six-month period. Hierarchical regression analysis revealed that perceptions of distributive injustice, informational injustice, and employees? perceptions on supervisory over-control in Time 1 significantly predicted embitterment in Time 2. Only the relationship between employees? perceptions of supervisory control and embitterment remained significant after controlling for baseline levels of embitterment.

Conclusion:

This study provides evidence for the negative impact perceived organisational injustice can have on employees? experience of workplace embitterment. Results indicate that employees who perceive their supervisor as being over controlling are more likely to suffer from workplace embitterment. The finding that workplace embitterment is stable during a six-month period highlights the need for effective interventions in ameliorating and preventing workplace embitterment.

Mindfulness interventions have been shown to be effective for health and wellbeing, and delivering mindfulness programmes online may increase accessibility and reduce waiting times and associated costs; however, research assessing the effectiveness of online interventions is lacking. We sought to: (1) assess the effects of an online mindfulness intervention on perceived stress, depression and anxiety; (2) assess different facets of mindfulness (i.e. acting with awareness, describing, non-judging and non-reacting) as mechanisms of change and (3) assess whether the effect of the intervention was maintained over time. The sample was comprised of 118 adults (female, n = 95) drawn from the general population. Using a randomised waitlist control design, participants were randomised to either an intervention (INT) or waitlist control (WLC) group. Participants completed the online intervention, with the WLC group starting after a 6-week waitlist period. Participants completed measures of depression (PHQ-9), anxiety (GAD-7) and perceived stress (PSS-10) at baseline, post-treatment, 3- and 6-month follow-up. Participants who completed the mindfulness intervention (n = 60) reported significantly lower levels of perceived stress (d = ? 1.25 [? 1.64, ? 0.85]), anxiety (d = ? 1.09 [? 1.47, ? 0.98]) and depression (d = ? 1.06 [? 1.44, ? 0.67]), when compared with waitlist control participants (n = 58), and these effects were maintained at follow-up. The effect of the intervention was primarily explained by increased levels of non-judging. This study provides support for online mindfulness interventions and furthers our understanding with regards to how mindfulness interventions exert their positive effects.

This study aimed to extend our theoretical understanding of how mindfulness-based interventions exert their positive influence on measures of occupational health. Employing a randomised waitlist control study design, we sought to: (1) assess an Internet-based instructor-led mindfulness intervention for its effect on key factors associated with ?recovery from work?, specifically, work-related rumination, fatigue and sleep quality; (2) assess different facets of mindfulness (acting with awareness, describing, non-judging, and non-reacting) as mechanisms of change; and (3) assess whether the effect of the intervention was maintained over time by following up our participants after three and six months. Participants who completed the mindfulness intervention (N=60) reported significantly lower levels of work-related rumination and fatigue, and significantly higher levels of sleep quality, when compared with waitlist control participants (N=58). Effects of the intervention were maintained at three and six month follow-up with medium to large effect sizes. The effect of the intervention was primarily explained by increased levels of only one facet of mindfulness (acting with awareness). This study provides support for online mindfulness interventions to aid recovery from work and furthers our understanding with regards to how mindfulness interventions exert their positive effects.

Major Depressive Disorder (MDD) is associated with hypothalamic-pituitary-adrenal axis (HPA) dysregulation and altered cortisol awakening response (CAR), a non-invasive biomarker for HPA axis reactivity. We theorized that the CAR resembles the accumulated effects of depression over time, and may therefore predict depressive symptom severity once patients return home following inpatient treatment. Two studies are reported. In Study 1 (n/=/101; 57% female), the CAR was measured at intake and self-ratings of depression severity was assessed six weeks following discharge. Study 2 (n/=/127; 58% female) was a replication and extension of Study 1 where a follow-up assessment of self-rated depression severity was added at six months following discharge. In Study 1 the CAR at intake showed a tendency towards a negative association with self-reported depression six weeks after discharge. Study 2 extended this finding within a more severely depressed, larger sample, where a blunted CAR predicted self-reported depressive severity six weeks and six month following discharge. These findings suggest that a blunted CAR can predict mood deterioration post treatment in inpatients diagnosed with severe MDD.

Background: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery.

Objective: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor.

Methods: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min).

Results: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (PÂ.001), the percentage of successive interbeat (RR) intervals that differ by Ã50 ms (pNN50; PÂ.001), and high-frequency (PÂ.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery.

Conclusions: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress.

Clinicians working in occupational health services often recognise features of embitterment in organisations, however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomised control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation is warranted.

The impact of gynaecological cancers is multifaceted. Whilst many women enjoy good quality of life post treatment, a significant minority continue to experience poor emotional and physical wellbeing. Ineffective management of these consequences in follow-up care leads to lack of support and information contributing to ongoing unmet needs. This thesis explores the experience of women in the survivorship phase and efficacy of a psychosocial intervention to improve quality of life. Six studies were carried out. Study 1 (N=150), a Service Evaluation using the Holistic Needs Assessment (HNA), indicates women diagnosed with gynaecological cancers have heterogeneous concerns across the cancer trajectory, with varying levels of distress. Study 2, a systematic review of psychosocial interventions demonstrates promising results for use in women with gynaecological cancers, with most effective studies using relaxation or counselling/CBT techniques. Study 3 (N=49), a feasibility study, showed health and wellbeing events (HWE) were well received by patients and women intended to make behavioural changes post intervention. In study 4 (N=7), a focus group explored the experience of attending a HWE and, using thematic analysis, four themes emerged: 1) Sharing and validation of experience, (2) Individual and specific information, (3) Adjusting to a new self, (4) Behaviour change. Study 5 (N=216), a quasi-experimental design study on HWE?s indicated short-term improvements in social functioning, increases in fruit consumption, and trend for improvement in physical activity, yet a reduction in perceived social support and increase in depression; whilst long-term improvements in emotional/social/cognitive functioning, fatigue and financial difficulties were seen, increases in vegetable consumption, and the intervention may protect against depression and decreased resilience over time. In study 6 (N=12) focus group data explored patients? experience of attending the HWE and thematic analysis revealed four themes: (1) Support; (2) Timing; (3) Reticence; (4) Understanding disease and the cancer experience. In summary, the results from this thesis suggest benefits in the use of health and wellbeing event interventions in a gynaecological cancer sample. However, further research is required to identify key intervention components suitable in this sample. Additional strategies may need to be considered to meet the unmet needs and ongoing physical and psychological sequelae these women face.