Professor Mark Cropley

Background The use of bystander video livestreaming from scene in Emergency Medical Services (EMS) is becoming increasingly common to inform decisions about the resources and support required. Possible benefits include clinical and financial gains, but evidence is sparse. We aimed to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of its use in major trauma incidents. Objectives: (i) To obtain data required to design a subsequent RCT. (ii) To test trial processes. (iii) To embed a process evaluation. Design A feasibility RCT with embedded process and economic evaluations where working shifts (n=62) in six trial weeks were randomised 1:1 to video livestreaming or standard care only; and two observational sub-studies: (i) assessment of acceptability in a diverse inner-city EMS that routinely uses video livestreaming; and (ii) assessment of staff wellbeing in an EMS that does not use livestreaming (for comparison to the trial site). Qualitative data collection included observations (286 hours) and interviews with staff (n=25) and bystander callers (n=2). Setting A pre-hospital EMS in South-East England, with follow-up in associated major trauma centres and trauma units; Sub-studies in (i) London and (ii) East of England EMS. Participants (i) Patients involved in trauma incidents (n=269); (ii) bystander callers (n=11); and (iii) ambulance service staff (n=67). Intervention Video livestreaming using GoodSAM Instant-on-Scene. Main outcome measures Progression to a definitive RCT based on four pre-defined criteria and consideration of qualitative data: (1) ≥ 70% bystanders with smartphones agreeing and able to activate livestreaming; (2) ≥50% requests to activate livestreaming resulting in footage being viewed; (3) Helicopter Emergency Medical Services stand-down rate reducing by ≥10% due to livestreaming; (4) no evidence of psychological harm to bystanders or staff caused by livestreaming. Results Sixty-two shifts were randomised, contributing 240 eligible incidents (132 control; 108 intervention). In a further three shifts we randomised by individual call which contributed four eligible incidents (2 control; 2 intervention), thereby totaling 244 incidents involving 269 patients. Video livestreaming was successful in 53 incidents in the intervention arm. Patient recruitment (to access medical records to assess appropriateness of dispatch), and bystander recruitment (to measure potential harm) were both low (58/269, 22% of patients, 4/244, 2% of bystanders). Two progression criteria were met: (1) 86% of bystanders with smartphones agreed and were able to activate livestreaming; (2) 85% of requests to activate livestreaming resulted in viewed footage; and two were indeterminate due to insufficient data: (3) 2/6 (33%) stand down due to livestreaming; (4) no evidence of psychological harm from survey, observations, or interviews. In sub study (i), dispatch staff reported that non/limited English language and older age may present barriers to video livestreaming. Limitations Poor recruitment of patients and bystanders limited assessment of appropriateness of dispatch decisions and potential psychological harm. Conclusions Video livestreaming is feasible to implement, acceptable to both bystanders and dispatchers, and may aid dispatch decision-making, but further assessment of benefits and harm is required. Future work Findings support the design and conduct of a future multi-centre study taking account of different triage systems and dispatch personnel, potentially using an alternative to an RCT due to rapid uptake of video livestreaming in this setting.

BACKGROUND: Much is known about the physical effects of work and health, but less is known about how older workers unwind mentally from work, and their post-work ruminative thinking. OBJECTIVE: The present study aimed to explore the association between age, gender and two types of work-related rumination, affective rumination, and problem-solving pondering. METHODS: This study utilized a sample of 3991 full-time employees (working 30 or more hours per week), who were stratified into five age bands (18-25, 26-35, 36-45, 46-55, & 56-65 yrs.). RESULTS: Affective rumination was found to significantly decline in the older age groups (46+ yrs.), but this finding was moderated by gender. Males reported lower work-related rumination over the entire age range, but the greatest difference between males and females was observed in the 56-65 age category. The results for problem-solving pondering mirrored those of affective rumination but with the only exception that there was no significant difference in gender between those aged 18-25 years. CONCLUSION: These findings add to our understanding about how workers (between different age groups) mentally switch off from work and highlight the need for interventions to help older workers mentally recover from the effects of work.

BACKGROUND: Recent research indicates that as men age, their tendency to ruminate about work decreases, while ruminating remains high in women, which poses an increased risk for impaired health among older women. OBJECTIVE: This study explored gender differences/similarities in the process of unwinding from work in men and women aged between 56-65 years. METHODS: Semi-structured qualitative interviews were conducted online with eight men and eight women, recruited from a UK leading organization that provides health care solutions between May and June 2022. Participants were asked about their job role and responsibilities, their leisure time activities, how they unwind post work, and their experiences of thinking about work related thoughts outside of work. Transcripts were analyzed using an inductive analysis. RESULTS: Three superordinate themes were identified that underpinned their ability to unwind: ‘Work style’, ‘Creating work-life balance’ and ‘Switching off from one’s responsibilities’. Women reported a more perfectionist approach, they set high standards for themselves, were worried about making mistakes, and demonstrated, if in a supervisory role, a more nurturing and holistic approach to their colleagues/subordinates, while men, were more focused on task completion. Most women, but not men, also described difficulties in psychologically switching off from work, and stated they could only truly relax outside the home, when they are away from household activities. CONCLUSION: The study provides nuanced insights into the experiences of unwinding from work, and the findings suggest the need for person-centric approaches in developing interventions to help workers over 56 years to psychologically disengage from work. 

Rumination is an established transdiagnostic factor in mental illness, but there remains a significant gap in understanding the subjective experiences of those affected by it. This study explored the lived experiences of depressive rumination in early adulthood, a population notably susceptible to its effects. We interviewed 20 participants aged between 18-35 years using a semi-structured approach and generated five distinct but interconnected themes using reflective thematic analysis. The first theme delved into recurrent narratives of past traumas and unresolved pain, with participants unable to move on from their past. The second theme illustrated how participants, due to real or perceived pressure, often equated their self-worth with their ability to meet expectations, leading to a distorted self-view and diminished self-esteem. The third theme captured the relentless pursuit of mental peace, with tranquillity remaining ever elusive despite the frequent use of distraction. The fourth theme highlighted the profound isolation stemming from internalised mental health stigma, with participants grappling with fears of being perceived as burdensome and facing rejection from their close ones. Finally, the fifth theme underscored the far-reaching and interconnected repercussions of rumination on mental, emotional, and physical health, and individuals’ ability to achieve their life goals. These findings emphasise the intertwined nature of psychological, physiological, and social risk factors for the development and maintenance of rumination, advocating for a holistic treatment approach to rumination, and paving the way for more timely, tailored care.

We explored the differences in dietary habits and dietary patterns between individuals characterized by irrational beliefs with no or low anxiety and depressive symptoms and individuals characterized by irrational beliefs with high anxiety and depressive symptomatology. Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of cardiovascular disease (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent mental health assessment through the irrational beliefs inventory (IBI), the Zung self-rating depression scale (ZDRS) and the state–trait anxiety inventory (STAI). Demographic characteristics, a thorough medical history, dietary behaviour and other lifestyle behaviours were also evaluated and analysed using factor analysis. Five main factors related to dietary patterns were extracted for the high-IBI/low-STAI group of participants (explaining the 63% of the total variation in consumption), whereas four factors were extracted for the high-IBI/high-STAI participants, the high-IBI/low-ZDRS participants and the high-IBI/high-ZDRS participants, explaining 53%, 54% and 54% of the total variation, respectively. A Western-type dietary pattern was the most dominant factor for individuals reporting irrational beliefs and anxiety or depressive symptomatology. The high refined carbohydrates and fats dietary pattern was the most dominant factor for individuals with irrational beliefs but without psychopathology. Linear regression analysis showed that irrational beliefs, in combination with anxiety or depression, age, sex and BMI, were important predictors of adherence to the Mediterranean diet. Dietary habits interact with irrational beliefs and, in association with the consequent psychological disorders, are associated with overall diet, and presumably may affect the health status of individuals.

Objectives: To investigate the combined role of irrational beliefs and anxiety, depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors. Methods: Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of CVD [453 men (45±13 years) and 400 women (44±18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI, range 0-88), the Zung Self-Rating-Depression-Scale and the State-Trait-Anxiety-Inventory. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. Results: Mean IBI score was 5310 in men and 5111 in women (p=0.68). Participants with high irrational beliefs who also had anxiety symptoms had 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with increased levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations. Conclusions: Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions.

Objectives: The aim of this study was to evaluate the dietary habits of apparently healthy individuals in relation to their irrational beliefs’ status, as well as 10-year diabetes incidence. Methods: The ATTICA study (2002–2012) is a prospective population-based cohort study, in which 853 participants without a history of cardiovascular disease (CVD) [453 men (aged 45±13 years) and 400 women (aged 44±18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a brief, self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary and other lifestyle habits were also evaluated. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. Results: Mean IBI score was 5310 in men and 5111 in women (p=0.68). IBI was positively associated with 10-year type 2 diabetes incidence (Hazard Ratio 1.14; 95%CI 1.04, 1.25) in both men and women, and more prominently among those with lower education status, married, overweight, smokers, with anxiety and depressive symptomatology and unhealthy dietary habits. Especially, participants with increased irrational beliefs and low adherence to the Mediterranean diet were 37% more likely to develop type 2 diabetes compared to those with a reverse status (HR 3.70; 95%CI 2.32, 5.88). Conclusions: These data support the need to promote a shift towards healthier eating by educating people to recognize false and unhelpful thoughts in order to prevent negative psychological and clinical outcomes, such as mental health disorders and type 2 diabetes.

Objective: The aim was to establish the validity and reliability of the English version of MisoQuest, a 14-item misophonia questionnaire initially validated in the Polish language. Design: Reliability was examined through internal consistency, measurement error, and test-retest reliability. Validity was evaluated with confirmatory factor analysis, convergent, and discriminant validity. Participants completed the English MisoQuest at two-time points and participated in follow-up interviews.Study Sample: The study included 451 adult participants, with an average age of 36.4 years (SD = 12.8).Results: The English MisoQuest showed very good internal consistency (α and ω = 0.93) and high test-retest reliability (ICC = 0.89). While CFA indicated adequate overall model fit, it did not fully support a one-factor structure, as some items shared variance even when controlled for the latent variable. Convergent validity was demonstrated by moderate to strong correlations with established misophonia questionnaires. Weak correlations with non-misophonia measures supported discriminant validity. Unexpectedly, moderate correlations were found with Hyperacusis Impact Questionnaire (r = 0.34; p < 0.01) and Three-dimensional Fatigue Inventory (r = 0.31; p < 0.01).Conclusion: The study found that the English version of MisoQuest is a reliable and valid tool for measuring misophonia within the English-speaking adult population.

The cortisol awakening response is a non-invasive biomarker for hypothalamic-pituitary-adrenal axis (HPA) dysregulation, reflecting accumulated stress over time. In a previous study we reported that a blunted CAR before an inpatient treatment predicted self-reported depressive symptoms six weeks and six months after discharge (XXXXXXXXX et al., 2019). This replication study adopted an improved overall methodology with more stringent assessment protocols and monitoring. The longitudinal design included 122 inpatients from a psychosomatic hospital with a diagnosis of Major Depression Disorder displaying symptoms of moderate to severe major depression (n=80 females). The Cortisol awakening response (CAR) was measured at intake. Depression severity was assessed as Beck Depression Inventory II scores at intake, discharge, six weeks and six months following discharge. Results from the original study were replicated in terms of effect size but did not reach statistical significance (correlation between BDI-II 6 months after discharge and AUCg: r=-.213; p=.054). The replication study yielded nearly identical correlation coefficients as in the original study (BDI-II 6 months and CAR, r=-.223, p

Mindfulness-based interventions (MBIs) are effective in reducing chronic stress, but their therapeutic mechanisms are unclear. One possibility is that MBIs act by re-training attention monitoring and acceptance skills that have been impaired by chronic stress exposure. However, little research has investigated the association between chronic stress, monitoring, and acceptance. In this cross-sectional study we hypothesised observing correlations between stress, and (impaired) monitoring and acceptance. Moreover, we exploratively compared the magnitude of the correlations between chronic stress and four acceptance measures. Finally, we explored whether the association between stress and monitoring is moderated by acceptance. Eighty-five adults participated in the study and completed self-reported chronic stress and acceptance questionnaires and a mindful attention behavioural task. The results revealed that chronic stress was associated with reduced acceptance (all ps < 0.01) but not with monitoring. Exploratory analyses revealed no differences in the magnitude of the correlations between stress and each acceptance measure, except for the combined facets of mindfulness acceptance subscales and nonreactivity subscale (p = 0.023). Further analyses revealed a significant negative association between stress and the interaction between acceptance and the target detection component of monitoring (p = 0.044). Surprisingly, these results show that stress is associated with reduced monitoring at higher levels of acceptance. Theory-driven intervention studies are warranted to complement our results.

In order of first author surname

There is growing interest in how workers recover and unwind from work during leisure, as poor unwinding has been associated with negative health. This research explores the recovery process to gain a greater understanding of how individuals switch‐off from work‐related thoughts post work. Specifically, we conducted interviews with workers who habitually find it difficult to switch‐off from work (i.e. high ruminators), and workers who find it easy to switch‐off from work (i.e. low ruminators). Three master themes were elicited using Interpretative Phenomenological Analysis: (1) work philosophy, (2) coping strategies and (3) coping outcomes. The findings revealed differences in core beliefs about work; high ruminators perceive blurred boundaries between work and home life, and they allowed work to mentally predominate during their leisure time, whereas low ruminators viewed their work and leisure as two distinct spheres, and actively developed strategies to switch‐off and disengage from work. Both high and low ruminators acknowledged the health benefits of unwinding post work, yet only low ruminators managed to successfully do so. It was concluded that there is a need for organisations to educate their employees, particularly high ruminators, about the importance of strategic unwinding post work to optimise the quality of leisure time and prevent them from becoming fatigued and burnt out.

Despite the cost and health consequences, a large number of people continue to smoke cigarettes worldwide every day. Notwithstanding, there have been a number of interventions to help people stop smoking but, in general, these have produced only limited success, and better interventions are needed. Accruing evidence affirmed that rumination and executive function play a pivotal role in cigarette smoking behavior, and in this editorial, we describe and discuss the key findings between these constructs and smoking, and argue that an impairment in executive functions does not act alone, but interacts with rumination by directing attention to depressive thoughts, thereby reducing the ability of smokers to engage in constructive behaviors, such as quitting smoking. Finally, we offer a new theory-driven model based on a deep understanding of the interactions between executive functions and rumination and potential moderator effects.

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.

The objective of this study was to assess long-term job strain impact on morning and evening salivary cortisol secretion. In all 77 white-collar workers (31% women; sample mean age, 42 years at baseline) volunteered to sample morning (immediately after waking up) and evening (10 p.m.) salivary cortisol for 7 consecutive days. By median split on aggregated self-reported isostrain from three consecutive questionnaires distributed in a period of approximately 3.5 years the participants were classified into a high or low long-term isostrain condition. Regardless of strain condition, there was a significant reduction in morning salivary cortisol secretion from the working week to the weekend, whereas evening salivary cortisol secretion showed no significant variation during the week. Although chronic isostrain did not affect the morning saliva cortisol measures, evening cortisol secretion was significantly elevated in the chronic high isostrain group throughout the whole week. The elevated evening cortisol measures associated with chronic high strain are concordant with the findings in other studies on long-term strain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The objective of this study was to examine whether functional social support buffers the effects of chronic and recent life stress on physical symptom reporting in men and women and assess whether perceptions of support remain stable over time. A longitudinal design was used. Self-ratings of stressful experiences were completed every 3 months over a period of 1 year. Physical symptoms were assessed at 6 and 12 months, and perceptions of social support were measured at baseline and at 12 months. Three groups were formed on the basis of average stress values for the first and second 6 months of the year: chronic low stress, chronic high stress and a recent high-stressed group consisting of individuals who reported low stress for the first 6 months, but high stress for the second 6 months of the year. As expected, high life stress was associated with greater symptom reporting. Perceptions of support remained stable and did not decline over the 12 months. After controlling for negative affectivity and physical symptoms at 6 months, no main effects of social support were found on reported physical health. However, perceived social support did moderate physical symptom reporting in those reporting recent high stress. For chronically high-stressed individuals there was no significant difference in physical symptoms between those with high or low social support. It was concluded that social support moderates the impact of recent but not chronic life stress on physical symptom reporting. © 2005 Taylor & Francis Group Ltd.

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.

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 primary aim of this study was to assess the effectiveness of a short bout (10 min) of moderate-intensity exercise to reduce withdrawal symptomatology, craving and negative affect; while the secondary aim was to assess how the effectiveness of a short bout of moderate exercise can be modulated by the perception of intensity in physically active and low-activity smokers. Fifty low-activity and physically active smokers were recruited (24 male and 26 female) and randomized in three different conditions. Prescribed (objective) moderate intensity (OBJ) and perceived moderate intensity (PER), and passive waiting (PW). After the intervention (T3), smokers reported less desire to smoke in the PER (p < 0.001) and OBJ (p < 0.001) conditions, relative to the PW condition. At T3 smokers in the PER condition reported less negative affect than smokers in the PW condition relative to the baseline (T1) (p < 0.007). Further, smokers in the PER condition reported less negative affect than smokers in the PW condition (p < 0.048). Physically active (PA) smokers perceived less exertion than low-activity (LA) smokers, and the effects were stronger in the PER condition relative to OBJ. Generally, our results suggest that a short bout of moderate exercise helps both LA and PA smokers. These findings provided a novel insight into the psychological mechanisms that affect the efficacy of the exercise in smoking cessation and suggest that exercise should be tailored according to individual perception of intensity.

With the introduction of a new curriculum and increased targets for schools, children are facing increased pressure to succeed in examinations at increasingly earlier ages. It is therefore necessary to emphasize the need for greater awareness of the distress that may be experienced by young children and adolescents as a result and implement provision for early interventions. The aim of this study was to investigate changes occurring in anxiety, affect, depression and self-esteem in secondary school children as they approached important school examinations and to examine variations between schools of differing design and status. There were a total of 520 participants, from four different schools in two school years (year 9, age 13-14 and year 11, age 15-16). Participants completed self-report questionnaires at two time points - firstly during regular term time and the second in the week immediately prior to the examinations. Gender differences were found in the majority of measures with females displaying greater levels of anxiety and negative affect immediately before the examinations, whereas males reported higher positive affect and self-esteem and lower depression and anxiety, even within the week prior to the examinations. Differences between the schools were also found. However, there were no significant differences between the two school years and the two times of testing. A number of trends were identified in relation to both gender differences and the influence of the type of school attended. Females, particularly those attending independent or grammar schools, reported a greater negative mood overall and before the examinations. It is suggested that there is a need for a school-based provision aimed at pro-actively increasing pupils self-esteem and to develop skills for dealing with stressful, situations particularly important examinations.

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 α4β2*, α7 nicotinic acetylcholine (nAChR), μ-opioid (μ 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 α4β2*, α7 nAChRs, μ 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 α7 nAChR binding in the CA2/3 area of the hippocampus of nicotine-treated mice. Neither exercise nor nicotine treatment affected μ or D2 receptor binding or BDNF levels. Nicotine withdrawal increased plasma corticosterone levels and α4β2* nAChR binding, irrespective of exercise regimen. Conclusions and implications. We demonstrate for the first time a profound effect of exercise on α7 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.

Inability to unwind about work during leisure time has been associated with a number of negative health outcomes. This study was concerned with a possible behavioural pathway between unwinding and disease and examined the relationship between work-related rumination and food choice. Work-related rumination is arguably a core to understanding the ‘unwinding process’, and food choice is a well-established indicator of nutritional health. Two hundred and sixty-eight full-time workers from a range of white-collar occupations completed a self-report measure of ruminative thinking about work and an eating behaviour questionnaire. Three types of ruminative thinking were identified by factor analysis and labelled affective rumination, problem-solving pondering and detachment. In terms of food choice, high-relative to low-affective ruminators reported eating more unhealthy foods, and low detachers reported eating less cooked meals and more processed foods compared to high detachers. Problem-solving pondering was not associated with food choice, and none of the factors were associated with healthy food choice. It was concluded that failure to unwind from work is not necessarily related to unhealthy food choices. What appears to be the crucial factor is the type of perseverative thinking that people engage in post-work. Limitations and future directions are discussed.

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.

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.

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.

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

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.

Much of the burden associated with poor mental health is associated with symptom experience in the general population. We conducted a systematic review and meta-analysis of studies conducted in nonclinical samples, evaluating mindfulness-based programs (MBPs) for outcomes related to psychological health and well- being. We focused on mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) because they have the strongest evidence base. We searched MEDLINE, PsycINFO, EMBASE, and CINAHL (from 2006 to February 2019) for published peer-reviewed journals articles of intervention studies evaluating MBCT or MBSR for psychological health and well-being in nonclinical samples. Data were pooled using a random-effects model, and effect estimates were reported as Hedges' g. We included 49 studies conducted in nonclinical samples (n = 4,733). When compared with a passive control, MBPs significantly reduced symptoms of rumination/ worry (g = -1.13, [-2.17, -0.08]), stress/psychological distress (g = -0.52 [-0.68, -0.36]), depression (g = -0.45 [-0.64, -0.26]), and anxiety (g = -0.44 [-0.65, -0.23]), and significantly improved quality of life/well-being (g = 0.32 [0.10, 0.54]). In general, MBCT generated larger effect sizes than MBSR for all outcomes. This study provides evidence that in nonclinical samples, MBPs are associated with benefits to health and well-being. These findings add to the growing evidence base suggesting that MBSR and MBCT may be effective approaches for subclinical levels of mental ill-health and could form part of the public mental health agenda.

Much of the burden associated with poor mental health is associated with symptom experience in the general population. We conducted a systematic review and meta-analysis of studies conducted in non-clinical samples, evaluating Mindfulness-Based Programs (MBPs) for outcomes related to psychological health and well-being. We focussed on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) because they have the strongest evidence base. We searched MEDLINE, PsycINFO, EMBASE and CINAHL (2006 – February, 2019) for published peer-reviewed journals articles of intervention studies evaluating MBCT or MBSR for psychological health and well-being in non-clinical samples. Data were pooled using a random-effects model and effect estimates were reported as Hedges’ g. We included 49 studies conducted in non-clinical samples (n=4733). When compared to a passive control, MBPs significantly reduced symptoms of rumination/worry (g=-1.13, [-2.17, -0.08]), stress/psychological distress (g=-0.52 [-0.68, -0.36]), depression [g=-0.45 [-0.64, -0.26]), and anxiety (g=-0.44 [-0.65, -0.23]); and significantly improved quality of life/well-being (g=0.32 [0.10, 0.54]). In general, MBCT generated larger effect sizes than MBSR for all outcomes. This study provides evidence that in non-clinical samples, MBPs are associated with benefits to health and well-being. These findings add to the growing evidence-base suggesting that MBSR and MBCT may be effective approaches for sub-clinical levels of mental ill-health and could form part of the public mental health agenda.

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 cortisol awakening response is a non-invasive biomarker for hypothalamic-pituitary-adrenal axis (HPA) dysregulation, reflecting accumulated stress over time. In a previous study we reported that a blunted CAR before an inpatient treatment predicted self-reported depressive symptoms six weeks and six months after discharge (XXXXXXXXX et al., 2019). This replication study adopted an improved overall methodology with more stringent assessment protocols and monitoring. The longitudinal design included 122 inpatients from a psychosomatic hospital with a diagnosis of Major Depression Disorder displaying symptoms of moderate to severe major depression (n=80 females). The Cortisol awakening response (CAR) was measured at intake. Depression severity was assessed as Beck Depression Inventory II scores at intake, discharge, six weeks and six months following discharge. Results from the original study were replicated in terms of effect size but did not reach statistical significance (correlation between BDI-II 6 months after discharge and AUCg: r=-.213; p=.054). The replication study yielded nearly identical correlation coefficients as in the original study (BDI-II 6 months and CAR, r=-.223, p

Work-related rumination has been associated with a number of health complaints, however, little is known about the underlying factors associated with rumination. Previous work using proxy measures of executive function showed work-related rumination to be negatively associated with executive function. In this paper, we report two studies that examined the association between work-related rumination and executive function utilizing an ecological valid measure of executive function: the Behavior Rating Inventory of Executive Function (BRIEF-A, Roth et al., 2005). In study 1 (N = 63), high, relative to low work-related ruminators, were found to demonstrate lower executive function skills, in eight of the nine subscales of the BRIEF. The aim of study 2 (N = 237) was to identify, the key executive function subscale/s associated with work-related rumination. Controlling for known factors associated with work-related rumination (fatigue and sleep), regression analysis identified the behavioral regulation subscale “shift” as the key predictor within the model. Shift relates to our ability to switch attention, to think about different solutions, and dealing with and accepting change. It was concluded that these findings lend support for future research to develop interventions for enhancing shift ability, as an aid to reduce work-related ruminative thinking.

Objective: Does snoring during pregnancy influence development of pre-eclampsia? Method: Five hundred and three pregnant women were presented a questionnaire concerning snoring, daytime sleepiness and edema. Epworth Sleepiness score (ESS) and symptoms of restless legs syndrome were also included. The questionnaire was presented in the 1st, 2nd and 3rd trimester and blood pressure was recorded. Women snoring often-always at visit 2 and/or 3 were denoted habitual snorers, those snoring never-seldom non-snorers and there was also a category occasional snorers. Habitual snorers were offered a sleep respiratory recording (Embletta); 34 volunteered. Results: 36/503 women (7,2%) snored habitually already at the first visit. At the end of pregnancy the fraction had increased to 19,5%. At the first visit BMI of habitual snorers was 25,3 compared to 22,9 for non-snorers (s.), but there was no difference concerning increase during pregnancy. Habitual snorers reported more edema at visit 2 and 3, higher scores in morning and daytime tiredness and ESS score compared to non-snorers at all visits (s.). Their systolic blood pressure increased more (s.) already between 1st and 2nd visit. Weight and Apgar scores of the newborns showed no difference. Pre-eclampsia developed in 18 women, twice as common among habitual snorers than in those snoring never-occasionally (n.s.). Their snoring scores were higher at all visits; the greatest difference at visit 3 (P50,058). Their diastolic pressure increased more already at the 2nd visit (s.), they had more edema and higher increase in BMI (s.). ESS and tiredness scores did not differ. 9/34 sleep recordings showed supine AHI 45. Two women who later developed pre-eclampsia were recorded; both had supine AHI 45. Conclusions: Habitual snorers had higher BMI from start, more daytime tiredness, higher ESS scores and their diastolic blood pressure increased more already during early pregnancy. Preeclampsia was twice as common among snorers as non-snorers; not significant due to the low number of cases. The relation between pre-eclampsia and snoring therefore remains elusive.

With the completion of the Human Genome project, it is now possible to offer genetic testing for an increasing number of diseases. This chapter discusses the role of stress in predictive genetic testing, with a focus on whether stress influences decisions to have genetic tests, the impact of test results on feelings of stress, and the cognitive appraisal of genetic risk information. © 2007 Copyright © 2007 Elsevier Inc. All rights reserved.

Background. Patient-centered measures of the inpatient neurorehabilitation experience are needed to assess services. Objective. The objective of this study was to develop a valid and reliable Neurorehabilitation Experience Questionnaire (NREQ) to assess whether neurorehabilitation inpatients experience service elements important to them. Methods. Based on the themes established in prior qualitative research, adopting questions from established inventories and using a literature review, a draft version of the NREQ was generated. Focus groups and interviews were conducted with 9 patients and 26 staff from neurological rehabilitation units to establish face validity. Then, 70 patients were recruited to complete the NREQ to ascertain reliability (internal and test-retest) and concurrent validity. Results. On the basis of the face validity testing, several modifications were made to the draft version of the NREQ. Subsequently, internal reliability (time 1 α = .76, time 2 α = .80), test retest reliability (r = 0.70), and concurrent validity (r = 0.32 and r = 0.56) were established for the revised version. Whereas responses were associated with positive mood (r = 0.30), they appeared not to be influenced by negative mood, age, education, length of stay, sex, functional independence, or whether a participant had been a patient on a unit previously. Conclusions. Preliminary validation of the NREQ suggests promise for use with its target population.

This study applied psychophysiological methods to the investigation of social roles and well-being, using cardiovascular function over a working day and evening as an index of physiological activation. One hundred and sixty-two full-time school teachers (102 women and 60 men) were assessed using automated ambulatory blood pressure monitoring apparatus, with readings every 20 min through the working day (9.00 am-5.40 pm), and every 30 min in the evening (6.00-10.30 pm). The influence of gender, marital status and parenthood (defined as having at least one child living at home) on blood pressure during the working day and on day-evening differences was examined. There were no differences in blood pressure and heart rate across the working day in relation to marital roles or family structure. However, the decrease in blood pressure between working day and evening was greatest in parents, intermediate in married non-parents, and smallest in single participants without children. Differences in systolic pressure adjusted for age and body mass index averaged -4.46, -1.76 and +0.22 mmHg in the three groups, respectively. A similar pattern was observed for diastolic pressure but not heart rate. We also found that the day-evening fall in systolic pressure was moderated by social support, with the greatest change (mean adjusted difference -6.76 mmHg) in parents who reported high levels of social support. These blood pressure responses did not differ between men and women, and there was no indication of multiple role strain for full-time working mothers. The results were independent of concomitant physical activity, location during measurement, or reported job strain. We argue that findings are consistent with an enhancement model of multiple social roles, and with lower allostatic load on individuals who are working, married and parents. Psychophysiological studies of daily life can complement epidemiological and sociological investigations of social roles and health.

According to the Effort-Recovery model, mental or physical detachment from work is an important mechanism of work related recovery, as delayed recovery has been associated with range of negative health symptoms. In this paper, we examine whether recovery from work (in the form of mentally disengagement from work) is affected by the concept of ‘work ethic’, which refers to beliefs workers hold about their work and leisure and the effects of experiencing interruptions at work. Two indices of post-work recovery were utilized: problem solving pondering and psychological detachment. The study was conducted with 310 participants employed from diverse occupational sectors. Main effects of positive and negative appraisal of work interruption and beliefs were analysed using mediated and moderated regression analysis on problem-solving pondering and detachment. Weakened belief in wasted time as a partial mediator, reduced problemsolving pondering post work when interruptions were appraised as positive, and a high evaluation of leisure partially mediated problem-solving pondering when interruptions were appraised as positive. The results also showed that a high evaluation of centrality of work and leisure moderated the effect of negative appraisal of work interruption on elevated problem-solving pondering. Positive appraisal of work interruption was related to problem-solving pondering, and the strength of this association was further moderated by a strong belief in delay of gratification. In addition, employees’ positive appraisal of work interruption was related to work detachment, and the strength of this association was further moderated by strong beliefs in hard work and self-reliance. These findings are discussed in terms of their theoretical and practical implications for employees who are strongly influenced by such work beliefs.

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.

Purpose. Sleep disturbance affects a high proportion of people with fibromyalgia syndrome (FMS). This study aims to explore people's perceptions of their sleep quality and the influence sleep has on their symptoms and daily lives. Method. Semi-structured interviews were conducted with sixteen participants diagnosed with primary FMS, covering all aspects of the sleep experience. The audio recorded qualitative interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Results. Poor sleep dominated participants' lives, affecting levels of pain and fatigue, engagement in daily activities and ability to cope. Participants reported experiencing blocks of sleep, with the most profound difficulty for participants being able to go back to sleep after a night time awakening. They also felt a lack of control in their ability to manage their sleep difficulties and use of day-time napping appeared to be the only perceived beneficial coping strategy for relieving daytime sleepiness and symptoms of fatigue. Conclusions. Greater emphasis on screening for sleep disorders and how to manage poor sleep is needed in rehabilitation programmes provided for patients with FMS.

Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors. The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria. Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99). The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

Background and aims: Various bio-psychological mechanisms underlying the association between mental health problems and metabolic syndrome remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety, depression and hostility in the 10-year metabolic syndrome (MetS) incidence, and the effect of biochemical and sociobehavioral factors on the aforementioned associations.Methods and results: ATTICA is a prospective, cohort study (2002-2012). The sample included 591 participants [51.3% men (aged 41.5 +/- 10 years) and 48.7% women (aged 37.5 +/- 11.5 years)], free of MetS at baseline. Detailed biochemical, clinical, and lifestyle evaluations were performed, while participants' irrational beliefs, anxiety, depression and hostility were assessed using the Irrational Beliefs Inventory, the Spielberger State-Trait Anxiety Inventory, the Zung Self-Rating Depression Scale and the Hostility and Direction of Hostility Questionnaire, respectively. Multiple logistic regression was applied to estimate the odds ratio (OR) of developing MetS and to control for confounders, as well as stratified logistic regression to detect moderator effects. High irrational beliefs were associated with 1.5-times higher odds of developing MetS than low irrational beliefs. Especially, participants with high irrational beliefs and high anxiety were 96% more likely to develop MetS, compared with those with low irrational beliefs and low or high anxiety (OR = 1.96; 95% CI = 1.01, 3.80).Conclusion: The findings of the study underline the important role of irrational beliefs and anxiety in the development of MetS and the need to build new holistic approaches focused on the primary prevention of both mental health and MetS.(c) 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

One of the challenges with working from home (WFH) is the question of its effect on health and well-being. The impact of home working on health has so far not been studied extensively. We address this gap by investigating the association between internal recovery, operationalised as rest break frequency (low, medium, and high) during the working day, on self-reported musculoskeletal pain, and post-work recovery symptoms in WFH knowledge workers (n = 382). The analysis showed that failing to take frequent breaks was associated with a dose-response increased risk of reporting headaches. For post-work recovery symptoms, failing to take rest breaks throughout the day was associated with an increased risk of reporting psychological fatigue, physical fatigue, and sleep problems, and a decreased risk of psychologically detaching from work and experiencing adequate rest. Our findings emphasise the importance of remote workers taking recovery breaks from work demands in the maintenance of health and well-being. Practitioner Summary: For the foreseeable future, many knowledge workers will be obliged to work from home for at least, some days of the week. It is therefore important for workers to learn to regulate their behaviour, and workers need to be educated about the value of taking regular rest breaks throughout the working day.

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.

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.

With increased pressures in the workplace, more people are at risk of poor health. Individuals frequently take stress home with them and ruminate on problems, which can prevent them from recovering from work. More research is needed to identify and understand which factors can enhance or prevent nurses from effectively unwinding after a shift.

The topic of recovery from the demands of work has received considerable attention over recent years. In fact, it is now well-recognized that people need to recover from the strains of work. The relevance of ‘recovery’ from work has increased over the last decade, which can be largely attributed to management practices that have led to an intensification of work. In many occupations the demands are primarily of a cognitive nature (i.e. responsibility, information processing, and so on). As a consequence, approximately half of the working population complains about ‘work pressure’ (Paoli & Merllié, 2001). This chapter aims to focus on the cognitive aspects of work and its relationship with recovery. It will be argued that, since the cognitive demands are dominant, ‘thinking of work’ is one of the main determinants for (absence of or delayed) recovery. In order to make this point we will start with a brief historic overview.

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.

Police officers have been found to experience high levels of operational and organisational stressors, and are at considerable risk of emotional exhaustion, psychological distress, burnout and PTSD. The demands inherent in police work can have a negative impact on family life, with police officers at high risk of marital dissatisfaction, divorce and domestic violence. Although police officers experience the type of work demands that have been associated with work-conflict in other occupational groups (such as working long shifts or night shifts, and performing physically and emotionally demanding duties) few studies have systematically examined the nature and impact of work-life conflict in UK police. This study examined relationships between aspects of work-life conflict and job satisfaction and work-related wellbeing in a sample of UK police officers. The respective role played by time-based, strain-based and behavior conflict is examined Compared to research conducted on time- and strain-based work-life conflict, behaviour-based conflict has been under-researched as it is typically considered irrelevant to most occupations. More recently, however, it has been argued that behavior-based conflict may be more salient in jobs with more interdependence and interpersonal contact such as policing. Previous research on police and other emergency response service workers indicates that leisure activities and relaxation is the strongest predictor of successful coping with stress. Other studies indicate that sufficient opportunities for recovery during non-working time are necessary to promote psychological and physical health and enhance job performance and interpersonal relationships at work more generally. The ability to effectively disengage from work issues is considered particularly important. Therefore, this study also investigated associations between specific strategies related to the disengagement process (i.e. psychological detachment, and affective and problem solving rumination) and job-related wellbeing, and the extent to which these processes mediate relationships between job demands and wellbeing. Finally, the study utilised qualitative data to explore the type of strategies utilised by police officers to balance their work and home lives in greater depth. The data presented here was collected as part of study examining the working conditions of police officers and staff in a UK police force, using a bespoke on-line questionnaire. For this analysis we used the subsample of uniformed officers only (N= 547) serving police officers (61% male). A three dimensional measure of work-life conflict was utilised that encompassed time-based, strain-based and behaviour-based conflict (Carlson et al., 2000). Quantitative job demands were also assessed and a measure of recovery developed by Cropley (2008) was utilised to measure affective rumination, problem solving rumination and detachment. Scales developed by Warr (1990) assessed job satisfaction and job-related mood (i.e. depression-enthusiasm and anxiety-contentment). Open-ended questions were included to examine the strategies that police officers use to disengage from work more specifically. Levels of time-based, strain-based and behaviour-based work-life conflict were moderately high. Police officers who reported more time-based, strain-based and behaviour-based conflict also tended to report lower levels of job satisfaction and less job-related enthusiasm and contentment. Affective rumination was associated with poorer job-related wellbeing and less job satisfaction, whereas a greater ability to detach from work-related issues was related to better job satisfaction and more positive job-related mood. Although problem-solving rumination was related to work-life conflict and poorer job-related mood, these relationships were generally weaker with no significant association found with job satisfaction. The potential mediation effects of recovery strategies on the relationship between job demands and strain-based work-life conflict were examined using bootstrapping analysis (Preacher and Hayes, 2008). Evidence was found for partial mediation for all three recovery strategies (i.e. affective rumination, problem solving rumination and detachment) suggesting that job demands may impair work-life balance via the utilisation of these strategies. Thematic content analysis of the qualitative data highlighted a wide range of strategies utilised by officers to recover from work demands. These include spending time with family and friends, engaging in voluntary work and hobbies, and exercise. Negative health behaviours such as smoking and drinking alcohol were commonly reported. The risk of unpredictable job demands interfering with recovery strategies was highlighted, with a high proportion of respondents indicating that they had little or no time available to disengage from work activities and concerns. The findings of this study highlight the important role played by work-life conflict in predicting the job-related wellbeing of police officers. The salience of behaviour-based conflict in this occupational group has been confirmed, but strain-based work-life conflict had the strongest relationship with poor job-related mood and lack of job satisfaction. Recovery strategies appear to be important mechanisms by which job demands manifest themselves as work-life conflict, with affective rumination posing the greatest threat to work-life balance. Problem-solving rumination, as well as affective rumination about work during non-working time, also appears to have negative implications for work-life balance and job-related mood. Whilst several UK police forces have active programmes in place to encourage healthier lifestyles, including advice on diet, sleep and exercise, there is a need to develop targeted interventions to help police officers create more effective physical and psychological barriers between work and non-working life to enhance the unwinding process. These need to draw on psychological theories to encourage and sustain behaviour change, and also ensure that a supportive and facilitative organisational climate is developed simultaneously.

There is debate within the literature about whether resilience should be considered a stable character trait or a dynamic, changeable process (state). Two widely used measures to assess resilience are the Connor-Davidson Resilience Scale (CD-RISC) and the Resilience Scale for Adults (RSA). The aim of this study was to evaluate the true stability (invariance) and change across time in resilience captured by these two measures. Using the perspective of Latent State-Trait theory, the aim was to decipher if the CD-RISC and the RSA are more trait-like or more state-like and to address whether true differences in resilience between participants increased (or decreased) across time. In this longitudinal study, UK-based employees ( N  = 378) completed the CD-RISC (10-item version) and the RSA (33-item version, aggregated and analyzed under six parcels) at three occasions over six months. A latent-state model and latent-state model with indicator specific residual factors were utilized. The analysis suggested that both questionnaires capture trait and state components of resilience. These results contribute to the discussion about how resilience scales are measuring change and stability, and how we define resilience as a more trait-like or state-like phenomena. The findings also highlight the issue of what resilience scales are measuring and whether resilience is a quantifiable construct.

The purpose of this research was to examine differences in levels of compensatory (sleep hygiene) sleep practices between older insomniacs and older 'normal sleepers'. Two assumptions were tested. First, that compensatory sleep practices differentiate insomniacs from normal sleepers and second, that these practices relate to the long-term maintenance of chronic insomnia. The participants were 414 older adults who responded to an advertisement in a periodical targeted at older people. They were given a questionnaire to determine their insomnia status, use of compensatory practices and levels of daytime sleepiness. A series of chi-square analyses, t-tests and regression analyses showed both assumptions to be predominantly false. There were however relationships between pre-sleep cognitive activity, irregular sleep patterns, use of medication, and a noisy bedroom environment with insomnia classification. In addition, caffeine use after 2pm was associated with a longer duration of insomnia. The results are discussed in relation to sleep medicine education, interventions for older people in primary care settings, and recent models of insomnia.

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.

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.

OBJECTIVE: The objective of this study was to assess the impact on noninvasive ambulatory blood pressure monitoring on physical activity measured objectively by use of triaxial accelerometers. METHODS: Twenty-four working men and women performed ambulatory blood pressure plus activity monitoring for 1 working day and evening and activity monitoring alone for a separate day and evening. Blood pressure measures were taken at 20-minute intervals during the day and 30-minute intervals in the evening and were accompanied by diary assessments of mood, location, and posture. Comparisons were made of energy expenditure on the 2 days and of activity levels during the minutes surrounding each blood pressure reading and diary completion. RESULTS: Energy expenditure assessed in terms of activity calories per hour was significantly lower during blood pressure plus activity monitoring compared with activity monitoring alone (mean 37.3, SD = 16.3 vs. mean = 43.0, SD = 18.7 kcal, respectively: p = .02). Energy expenditure was lower during the 4 minutes surrounding each blood pressure reading than in the intervals between blood pressure readings. However, energy expenditure was also lower in the intervals between blood pressure readings than during comparable times on the activity only monitoring day. Blood pressure, heart rate, and physical activity were moderately correlated within individuals. CONCLUSIONS: Ambulatory blood pressure recording using automated sphygmomanometers is associated with reduced physical activity during the monitoring day. This is due partly to regular periods of immobility during cuff inflation and deflation and diary completion and partly to more general self-imposed restrictions on activity. This pattern has implications for the representativeness of ambulatory blood pressure monitoring, and the construction of ambulatory monitoring diaries.

AIMS: Following the psychological contract model of the employee-employer exchange relationship is offered as a means of understanding the expectations of a UK sample of 223 National Health Service (NHS) nurses in association with their leaving intentions. DESIGN AND METHODS: A pilot study involving 21 NHS nurses, using the repertory grid technique was conducted to elicit contract expectations. Twenty-nine categories of expectation were identified through content analysis. The study proper, employed a survey developed on the basis of results from the pilot study to identify contract profiles among 223 nurses from three London/South-east NHS hospitals, using the Q-sort method. Type of contract held (relational/transactional), satisfaction (job and organization), and leaving intentions were also examined. RESULTS: Q-analysis yielded four contract profiles among the nurses sampled: 'self-development and achievement'; 'belonging and development'; 'competence and collegiality' and 'autonomy and development'. Correlation analysis demonstrated that leaving intentions were associated with a need for personal autonomy and development, and the violation of expectations for being appreciated, valued, recognized and rewarded for effort, loyalty, hard-work and achievement, negative endorsement of a relational contract, positive endorsement of a transactional contract, and job and organizational dissatisfaction. CONCLUSION: Findings illustrate the diagnostic utility of the term psychological contract for understanding the expectations of NHS nurses. The potential significance of these findings for managing nurse retention is highlighted.

If perfectionists avoid engaging in preventive health behaviours, they may be putting their long-term health and well-being at risk. Correlational analyses based on a sample of 370 university students identified maladaptive perfectionism to be associated with decreased levels of engagement in preventive health behaviours, life satisfaction and well-being and increased levels of self-concealment and psychological distress. Adaptive perfectionism was associated with higher levels of engagement in preventive health behaviours. Self-concealment was identified as a partial mediator in the relationship between maladaptive perfectionism and both engagement in preventive health behaviours and psychological distress. Implications of the findings are discussed.

According to the perseverative cognition hypothesis, prolonged activation for example, via work-related rumination impairs recovery and thereby poses a risk to employee health. The extent to which gender, age, occupation or longitudinal stress exposure may alter work-related rumination is an ongoing debate. Whether group or longitudinal comparisons of work-related rumination are valid, however, has never been tested. In this multistudy report, we therefore investigated measurement invariance of the widely used Work-Related Rumination Questionnaire (WRRQ) across gender, age, occupation, and longitudinal measurements by performing secondary analyses of preexisting data on work-related rumination. We examined the psychometric properties of WRRQ measurements in two languages and expand knowledge about the nomological network of affective rumination, problem-solving pondering and detachment in relation to individual employee characteristics (e.g., personality, work engagement, commitment), job stressors (e.g., work intensity, decision latitude, social relations with colleagues and supervisors) and employee health outcomes (e.g. wellbeing, irritation, somatic symptoms). Multigroup confirmatory factor analyses showed partial scalar invariance of English and German WRRQ measurements and full scalar invariance across gender, age, occupation and over the period of one week (Study 1, n = 2207). Correlation analyses supported criterion, convergent and discriminant validity of WRRQ measurements (Study 2, n = 4002). These findings represent a prerequisite for comparisons of work-related cognition across groups and further the understanding of the antecedents and outcomes of different types of work-related cognition.

The objective of this review was to evaluate the effectiveness of smoking cessation interventions prior to surgery and examine smoking cessation rates at 6 months follow-up. The Cochrane Library Database, PsycINFO, EMBASE, Medline, and Cinahl databases were searched using the terms: smok$, smoking cessation, tobacco, cigar$, preop$, operati$, surg$, randomi*ed control$ trial, intervention, program$, cessation, abstinen$, quit. Further articles were obtained from reference lists. The search was limited to articles on adults, written in English and published up to December 2006. Only randomized control trials (RCTs) that incorporated smoking cessation interventions to patients awaiting elective surgery were included. Seven studies met the inclusion criteria. Methodological quality was assessed by all the authors. The findings revealed that short-term quit rates (or a reduction by more than half of normal daily rate) ranged from 18% to 93% in patients receiving a smoking intervention (mean 55%), compared with a range of 2%-65% of controls (mean = 27.7%). Two studies examined smoking status at 6 months but these revealed no significant difference in abstinence rates between patients who had received an intervention and those that had not. Studies that incorporated counseling in addition to nicotine replacement therapy appeared to show greater benefits. It is concluded that smoking cessation interventions prior to surgery are effective in helping patients to quit smoking. However, such effects appear to be short-lived. Future research needs to examine intervention and patient factors to see whether tailoring the smoking cessation intervention specifically to the patient improves overall abstinence rates.

Background Diet is a critical component of healthy lifestyle, especially in cardiac rehabilitation. Psychological interventions, as well as mix-treatment interventions including psychological components, appear promising approaches in the adoption and maintenance of a healthy diet in patients with cardiovascular disease (CVD). Objective Given the variety of clinical intervention programs available, we aimed to determine whether psychological interventions and interventions that incorporate psychological components provide better lifestyle outcomes compared to traditional care, specifically targeting dietary outcomes, and what types of psychological or mix-treatment interventions are more likely to benefit patients with CVD. Methods A systematic literature search was performed using MEDLINE (PubMed), Scopus, Cochrane Library, and PsycINFO to identify interventional studies, published from 2012 to 2022, written in English, evaluating psychological and mix-treatment intervention programs for dietary outcomes in patients with CVD. In total, 33 intervention studies (n= 5,644 patients) were retrieved and analyzed using fixed and random effects models. Results No significant effect of the psychological intervention was observed regarding fruits and vegetables intake (Hedge's g=+1.06, p-value=0.766), whereas a significant reduction was observed in alcoholic beverages consumption in the intervention group, as compared to the control group (Hedge's g=-7.33, p-value

Physical rehabilitation day hospitals are widely used community‐based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored goals be used to assess outcomes. This study considered whether such goal achievement demonstrated validity with respect to a standardised measure. The association between goal achievement and change in Nottingham Health Profile‐Part 1 (NHP‐1) scores was considered for 102 people attending four physical rehabilitation day hospitals. The predicted significant positive relationship between the percentage of goals achieved by participants and NHP‐1 scores was not found. This remained evident when functional goals were considered separately to medical goals. Further subsidiary analyses identified a complex relationship between goal achievement and NHP‐1 change scores. For those with higher change scores, there was a significant negative association between NHP‐1 change and goal achievement; while for those with lower (or negative) change scores, there was a significant positive association. A curve estimate regression confirmed a highly significant quadratic (curvilinear) relationship. Possible reasons for this finding might include the timing and nature of the goals set, the potential complication of some participants having cognitive impairment, as well as the use of the NHP‐1 as a comparison measure. At this time it is recommended that goal achievement only be used alongside other measures of day hospital outcome.

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.

Method ATTICA is a prospective, cohort study (2002–2012). The working sample included 845 participants (18–89 years), free of diabetes at baseline. Α detailed biochemical, clinical, and lifestyle evaluation was performed, while participants’ irrational beliefs and health anxiety were assessed through the Irrational Beliefs Inventory and the Whiteley index scale, respectively. We evaluated the association between the participants’ family history of diabetes mellitus with the 10-year risk of diabetes mellitus, both in the total study’s sample and separately according to their levels of health anxiety and irrational beliefs. Results The crude 10-year risk of T2DM was 12.9% (95%CI: 10.4, 15.4), with 191 cases of T2DM. Family history of diabetes was associated with 2.5 times higher odds (2.53, 95%CI 1.71, 3.75) of T2DM compared to those without family history. Among participants with family history of diabetes, the highest likelihood of developing T2DM, regarding their tested psychological features (i.e., low/high irrational beliefs in the entire group, low/high health anxiety in the entire group, and low/high irrational beliefs, low/high healthy anxiety), had people with high irrational beliefs, low health anxiety (OR 3.70, 95%CI 1.83, 7.48). Conclusions The findings underline the important moderating role of irrational beliefs and health anxiety in the prevention of T2DM, among participants at increased risk of T2DM.

This is the protocol for a review and there is no abstract. The objectives are as follows: 1. To review the efficacy of mind and body therapies in comparison to standard care 2. To review the efficacy of mind and body therapies in comparison to an attention placebo 3. To review the comparative efficacy of different types of mind and body therapies 4. To compare the efficacy of mind and body therapies at 1, 3 and 6 month follow-up

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.

Introduction Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.Methods and analysisThe SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.Ethics and disseminationThe study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.Trial registration numberISRCTN11449333.

Smoking remains a leading cause of morbidity and mortality. Exercise improves physical health and reduces cigarette cravings and nicotine withdrawal symptoms, but has required attendance at multiple sessions using specialised equipment that limits delivery in a service. The purpose of this study was to test the feasibility of delivering a simple and brief home-based exercise intervention with existing smoking cessation support in a stop-smoking service. We used a mixed-methods approach in a UK stop-smoking service operating from general practitioner surgeries and libraries near the most deprived areas in Surrey. Smokers recruited through the service gave written consent and received a 12-week exercise programme that included 5 min of home-based jumping activities and an activity diary with educational instructions 1 week before their quit date. Feasibility was assessed by recruitment, retention, adherence to the exercise programme, and follow-up and completion of assessments. Semi-structured interviews with trial participants (n=16), people who declined to take part (n=21), and smoking cessation advisors (n=10) assessed views and attitudes to participation and delivery of the intervention. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis (NVivo, version 12.0). 30 eligible trial participants consented, with 14 (47%) lost to follow-up, 16 participants (eight females, eight males; mean age 48 years [SD 11]) completed a mean of 47 (SD 18) of 74 prescribed exercise sessions over the 12-week period, resulting in 63% adherence. The exercise programme was received positively by most who engaged with it; fitting into their daily routine was an important outcome for completion. Of the participants who declined to take part (15 females, six males; mean age 48 years [SD 12]), many were positively disposed to the idea of participation, especially if the programme could be offered later in their treatment. All smoking cessation advisors (six females, four males; mean age 48 years [SD 20]) were supportive of the exercise programme, but several favoured the delivery by someone independent of the service. A simple and brief exercise intervention may be feasible for smokers receiving smoking cessation treatment in a UK stop-smoking service. However, substantial attrition and non-compliance, along with some delivery components, need to be addressed before to a definitive trial. Medical Research Council Public Health Intervention Development Scheme (MR/P017142/1).

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.

Various bio-psychosocial mechanisms underlying the link between anxiety, depression and cardiovascular disease risk, remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety and depression in the 10-year cardiovascular disease (CVD) incidence, and the effect of biochemical and socio-behavioral factors. 853[453 men (45 ± 13 years) and 400 women (44 ± 18 years)] from the ATTICA study (2002-2012) and without evidence of CVD were assessed. The Irrational Beliefs Inventory (IBI), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI) were used for the assessments. Incidence of CVD was defined according to the International Coding Diseases (ICD)−10 criteria. Participants with high irrational beliefs and anxiety symptoms had a 138% greater risk of developing CVD during the 10-year follow-up (2.38; 95%CI 1.75, 3.23) as compared to those without anxiety. Among others, C-reactive protein, interleukin-6 and total antioxidant capacity were mediators in the tested association. Interaction of irrational beliefs and depression was not associated with the 10-year CVD in all models. Inflammation and oxidative stress, partially explained the associations between irrational beliefs and anxiety in predicting CVD risk. These findings advance psychological research in the area of primary prevention of mental health and cardiovascular diseases.

BACKGROUND: Mental stress has been linked to increased morbidity and mortality in coronary artery disease and to atherosclerosis progression. Experimental studies have suggested that damage to the endothelium may be an important mechanism. METHODS AND RESULTS: Endothelial function was studied in 10 healthy men (aged 50. 4+/-9.6 years) and in 8 non-insulin-dependent diabetic men (aged 52. 0+/-7.2 years). Brachial artery flow-mediated dilation (FMD, endothelium dependent) and response to 50 microg of sublingual glyceryl trinitrate (GTN, endothelium independent) were measured noninvasively by use of high-resolution ultrasound before and after (30, 90, and 240 minutes) a standardized mental stress test. The same protocol without mental stress was repeated on a separate occasion in the healthy men. In healthy subjects, FMD (5.0+/-2.1%) was significantly (P:

Police officers have been found to experience high levels of operational and organisational stressors, and are at considerable risk of emotional exhaustion, psychological distress, burnout and PTSD. The demands inherent in police work can have a negative impact on family life, with police officers at high risk of marital dissatisfaction, divorce and domestic violence. Although police officers experience the type of work demands that have been associated with work-conflict in other occupational groups (such as working long shifts or night shifts, and performing physically and emotionally demanding duties) few studies have systematically examined the nature and impact of work-life conflict in UK police. This study examined relationships between aspects of work-life conflict and job satisfaction and work-related wellbeing in a sample of UK police officers. The respective role played by time-based, strain-based and behavior conflict is examined Compared to research conducted on time- and strain-based work-life conflict, behaviour-based conflict has been under-researched as it is typically considered irrelevant to most occupations. More recently, however, it has been argued that behavior-based conflict may be more salient in jobs with more interdependence and interpersonal contact such as policing. Previous research on police and other emergency response service workers indicates that leisure activities and relaxation is the strongest predictor of successful coping with stress. Other studies indicate that sufficient opportunities for recovery during non-working time are necessary to promote psychological and physical health and enhance job performance and interpersonal relationships at work more generally. The ability to effectively disengage from work issues is considered particularly important. Therefore, this study also investigated associations between specific strategies related to the disengagement process (i.e. psychological detachment, and affective and problem solving rumination) and job-related wellbeing, and the extent to which these processes mediate relationships between job demands and wellbeing. Finally, the study utilised qualitative data to explore the type of strategies utilised by police officers to balance their work and home lives in greater depth. The data presented here was collected as part of study examining the working conditions of police officers and staff in a UK police force, using a bespoke on-line questionnaire. For this analysis we used the subsample of uniformed officers only (N= 547) serving police officers (61% male). A three dimensional measure of work-life conflict was utilised that encompassed time-based, strain-based and behaviour-based conflict (Carlson et al., 2000). Quantitative job demands were also assessed and a measure of recovery developed by Cropley (2008) was utilised to measure affective rumination, problem solving rumination and detachment. Scales developed by Warr (1990) assessed job satisfaction and job-related mood (i.e. depression-enthusiasm and anxiety-contentment). Open-ended questions were included to examine the strategies that police officers use to disengage from work more specifically. Levels of time-based, strain-based and behaviour-based work-life conflict were moderately high. Police officers who reported more time-based, strain-based and behaviour-based conflict also tended to report lower levels of job satisfaction and less job-related enthusiasm and contentment. Affective rumination was associated with poorer job-related wellbeing and less job satisfaction, whereas a greater ability to detach from work-related issues was related to better job satisfaction and more positive job-related mood. Although problem-solving rumination was related to work-life conflict and poorer job-related mood, these relationships were generally weaker with no significant association found with job satisfaction. The potential mediation effects of recovery strategies on the relationship between job demands and strain-based work-life conflict were examined using bootstrapping analysis (Preacher and Hayes, 2008). Evidence was found for partial mediation for all three recovery strategies (i.e. affective rumination, problem solving rumination and detachment) suggesting that job demands may impair work-life balance via the utilisation of these strategies. Thematic content analysis of the qualitative data highlighted a wide range of strategies utilised by officers to recover from work demands. These include spending time with family and friends, engaging in voluntary work and hobbies, and exercise. Negative health behaviours such as smoking and drinking alcohol were commonly reported. The risk of unpredictable job demands interfering with recovery strategies was highlighted, with a high proportion of respondents indicating that they had little or no time available to disengage from work activities and concerns. The findings of this study highlight the important role played by work-life conflict in predicting the job-related wellbeing of police officers. The salience of behaviour-based conflict in this occupational group has been confirmed, but strain-based work-life conflict had the strongest relationship with poor job-related mood and lack of job satisfaction. Recovery strategies appear to be important mechanisms by which job demands manifest themselves as work-life conflict, with affective rumination posing the greatest threat to work-life balance. Problem-solving rumination, as well as affective rumination about work during non-working time, also appears to have negative implications for work-life balance and job-related mood. Whilst several UK police forces have active programmes in place to encourage healthier lifestyles, including advice on diet, sleep and exercise, there is a need to develop targeted interventions to help police officers create more effective physical and psychological barriers between work and non-working life to enhance the unwinding process. These need to draw on psychological theories to encourage and sustain behaviour change, and also ensure that a supportive and facilitative organisational climate is developed simultaneously.

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.

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

The aim of this study was to investigate the long-term effects of need for recovery from work and trait rumination on saliva cortisol secretion. The sample consisted of 76 white-collar workers, 52 men and 24 women who had previously provided baseline data four years earlier and volunteered to participate in the present study. In the present study, saliva cortisol secretion was measured over seven consecutive days, on awakening, and at 10 p.m. No relationships were found between the independent variables and morning saliva cortisol levels. High trait rumination at baseline, however, was significantly related to higher evening cortisol levels for both women and men. Baseline need for recovery from work was strongly related to evening cortisol secretion for women, but in the opposite direction than expected. The present results add to the small but equivocal body of literature that has examined the long-term effects of work strain on cortisol secretion.

Objective: To evaluate the effectiveness of the Mitchell Method Relaxation Technique (MMRT) in reducing symptoms of fibromyalgia. Design: A randomised controlled trial was used to compare the effectiveness of self-administered MMRT (n= 67) with attention control (n = 66) and usual care (n = 56) groups. Main Outcome Measures: Primary outcomes included self-reported fatigue, pain, and sleep. Secondary outcomes were daily functioning, quality of life, depression, and coping, anxiety and perceived stress. Outcomes were assessed at baseline, post-intervention (four weeks) and follow-up (eight weeks). Results: A significant combined improvement on outcomes (p

Abstract Background: Hyperacusis can be defined as intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. Misophonia is defined as a high magnitude of emotional and behavioural reaction to certain sounds produced by human beings, such as eating sounds and breathing sounds. Several psychometric instruments have been developed to assess symptoms and the impact of hyperacusis and misophonia; however, to the author's knowledge, no study has evaluated and compared the methodological quality of the studies on psychometric properties of the existing instruments. Purpose: To systematically review the research studies assessing the psychometric properties of the instruments used for hyperacusis and misophonia and assess the quality and appropriateness of the methodologies used. Research Design: Systematic review. Data Collection and Analysis: A systematic literature search was performed using five electronic literature databases (PubMed, Scopus, PsycINFO, Google Scholar and Web of Science). Studies were included if they were written in English and reported information about the psychometric properties of instruments measuring hyperacusis or misophonia symptoms or their impact. The quality of the studies and that of the psychometric instruments were evaluated using the consensus-based standards for the selection of health measurement instruments (COSMIN) tool. Results: The title and abstracts of 916 articles were screened and 39 articles were selected for full-text evaluation, with 14 articles meeting the inclusion criteria. From these 14 articles, eight different instruments (5 for hyperacusis and 3 for misophonia) were identified and reviewed comprising: (1) Hyperacusis Questionnaire (HQ), (2) Inventory of Hyperacusis Symptoms (IHS), (3) questionnaire on hypersensitivity to sound (GUF), (4) Hyperacusis Handicap Questionnaire (HHQ), (5) Short Hyperacusis Questionnaire, (6) Amsterdam Misophonia Scale (A-MISO-S), (7) MisoQuest, and (8) the Misophonia Questionnaire (MQ). Conclusion: None of the papers reviewed reported all the information required to meet the COSMIN standards. The studies' methodological quality varied between 'very good' and 'inadequate' depending on their grade on the COSMIN tool. There is a need for further research on the psychometric properties of the instruments included in this review.

Objective: Drawing upon the social exchange theory, this study developed and tested a theoretical model to identify factors predicting intentions to stay within a global energy business. Methods: Structural equation modeling was applied to an annual employee survey (N = 30,094). Results: The most significant factors predicting intention to stay were organizational engagement (when employees are seen to role model company values and behaviors) and relationship with supervisor (when "my manager treats me fairly"). Perceived supervisor support (when employees believe that the company "really cares about my health and well-being") and communication significantly predicted both work engagement and organizational commitment. Conclusion: When employees believe that their supervisor is concerned about their well-being, recognizes their contributions, and role-models the organization's values, they reported more engagement and a stronger commitment to remain with the organization.

This is the protocol for a review and there is no abstract. The objectives are as follows: 1. To review the efficacy of mind and body therapies in comparison to standard care 2. To review the efficacy of mind and body therapies in comparison to an attention placebo 3. To review the comparative efficacy of different types of mind and body therapies 4. To compare the efficacy of mind and body therapies at 1, 3 and 6 month follow-up

Rationale: The effects of acute bouts of physical activity (PA) on Strength of Desire (SoD) and Desire to Smoke (DtS) using individual participant data (IPD) from 19 acute randomised controlled studies were quantified. However, there is a need to identify factors influencing this relationship. Objectives: To understand who most benefits from PA, whether changes in affect mediate these effects and whether any specific attributes of PA are associated with cigarette cravings. Methods: IPD (n = 930) contributed to one-stage IPD meta-analyses. Participants engaging in PA were compared against controls, using post-intervention DtS and SoD (when DtS is not available) with baseline adjustments. The craving scales were linearly rescaled to 0-100 % (a mean difference between groups of -10 would indicate that post-intervention cravings were 10 % lower in the PA compared with the control group). Demographic, smoking and other characteristics were examined as predictors and potential moderators, whereas change in affect was considered as a mediator. PA was categorised according to type, duration and intensity, to determine PA attributes associated with cravings reduction. Results: None of the included covariates were shown to moderate or mediate the effects of PA. Intensity of PA was significantly associated with a reduction in cravings; moderate and vigorous intensity PA offered the most benefits. A one-stage IPD meta-analysis yielded effect sizes of -9.22 (-15.24; -3.20) for light, -34.57 (-42.64; -26.50) for moderate and -31.29 (-38.00; -24.57) for vigorous intensity in comparison with controls. Conclusions: Moderate intensity PA could be recommended to all smokers regardless of demographic, smoking and other characteristics. © 2014 Springer-Verlag Berlin Heidelberg.

“What is already know on this subject” The need for recovery from the demands of work has been associated with workers detachment from work and wellbeing. Recovery from work can occur both during the working day, by way of rest breaks (i.e., internal recovery), and outside or work, during leisure time, by not working in the evening (i.e., external recovery). Recovery can be compromised when workload is high. It remains unclear how the experience of exposure to persistent high workload over time effects health and wellbeing, and whether similar effects are found for internal and external workload. Most research has focused on external workload and there is a lack of studies that have examined the effects of workload longitudinally. “What does this study add?” This study showed that chronic workload both during the day and evening is associated with increased risk of reporting psychological fatigue, physical fatigue and sleep problems. Interestingly, the effects on health are particularly salient when recovery opportunities are not taken during the working day. These results highlight the importance of workers needing to take time away from the demands of work by taking regular recovery breaks throughout the day as a prerequisite for maintaining health and wellbeing.

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 ≥10 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.

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 (P˂.001), the percentage of successive interbeat (RR) intervals that differ by ˃50 ms (pNN50; P˂.001), and high-frequency (P˂.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.

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.

Vagally mediated heart rate variability (HRV) is a psychophysiological indicator of mental and physical health. Limited research suggests there is reduced vagal activity and resulting lower HRV in patients with Major Depressive Disorder (MDD); however little is actually known about the association between HRV and symptoms of depression and whether the association mirrors symptom improvement following psychotherapy. The aim of this study was to investigate the association between antidepressant therapy, symptom change and HRV in 50 inpatients (68% females; 17-68 years) with a diagnosis of MDD. Severity of depressive symptoms was assessed by self-report (Beck Depression Inventory II) and the Hamilton Rating Scale of Depression. Measures of vagally mediated HRV (root mean square of successive differences and high-frequency) were assessed at multiple measurement points before and after inpatient psychotherapeutic and psychiatric treatment. Results showed an expected negative correlation between HRV and depressive symptoms at intake. Depressive symptoms improved (d = 0.84) without corresponding change in HRV, demonstrating a de-coupling between this psychophysiological indicator and symptom severity. To our knowledge, this study is the first to examine an association between HRV and depressive symptoms before and after psychotherapy. The observed de-coupling of depression and HRV, and its methodological implications for future research are discussed.

The long-term impact of role stress (conflict and ambiguity), cognitive rumination and their interaction were analysed upon morning and evening saliva cortisol secretion. The sample consisted of 52 male and 24 female British white-collars who had participated in a survey study on psychosocial working conditions 3.5 years earlier. Saliva cortisol secretion was measured over seven consecutive days with two measures: in the morning on awakening and at 22.00 hours. Stepwise linear multiple regression analyses was used for the statistical analyses. Role ambiguity at baseline and the interaction between role ambiguity and trait rumination contributed to explaining elevations in morning saliva cortisol secretion 3.5 years later (R(2) = 0.045; F = 4.57; p < 0.05), while role conflict at baseline significantly predicted increases in long-term evening saliva cortisol (R(2) = 0.057; F = 8.99; p < 0.01). The findings support a long-term relationship between chronic stress exposure and saliva cortisol secretion and some support for the assumption of cognitive rumination moderating the stressor-strain relationship. STATEMENT OF RElevance: The study is of interest for ergonomics practice because it demonstrates that work role ambiguity and role conflict, typically associated with organisational downsizing and restructuring, may contribute to long-term psycho-physiological reactivity. This could expose workers to increased health risks. Therefore, stress management programmes should include the concept of role stress, especially at a time where many work organisations are undergoing significant change. Management should also be made aware of the importance of communicating clear goals, objectives and lines of authority as well as providing sufficient training for those in new job roles.

This study aimed to evaluate the association between irrational beliefs and the 10-year cardiovascular disease (CVD) incidence among apparently healthy adults. The ATTICA study is a population-based, prospective cohort (2002–2012) consisting of 853 participants without evidence of CVD (453 men and 400 women) who underwent psychological evaluations. Participants completed the Irrational Beliefs Inventory (IBI, range 0–88), a self-reported measure consistent with the Ellis model of psychological disturbance. We conducted a factor analysis to develop irrational beliefs factors to evaluate the association between subcategories of irrational beliefs and CVD incidence. Demographic characteristics, detailed medical history, other psychological factors, and dietary and other lifestyle habits were also evaluated. The incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. The identified dominant irrational beliefs factor, “cognitive vulnerability to anxiety,” consisted of demandingness, perfectionism, emotional irresponsibility, anxious overconcern, dependence on others, and overconcern for the welfare of others, was strongly associated with an increased 10-year CVD risk. Nested multi-adjusted regression analysis revealed that anxiety, as well as negative physical well-being, mediated this relationship, and subset of irrational beliefs predicted CVD risk directly and indirectly through anxiety and negative physical well-being. These findings further map the path through which irrational beliefs can contribute to CVDs and provide insights in favor of preventive healthcare.

Introduction: To date, little is known about the characterological make-up of acute insomniacs and in what ways they differ from chronic insomniacs. This lack of direction negates the possibility of understanding the key processes involved in the transition from acute to chronic insomnia and limits efforts to develop and refine preventative strategies. The aim of the present study was to compare acute and chronic insomniacs with an aim to determine differences in perceptions of stress and coping as well as higher order cognitive processing strategies. Method: In a cross-sectional survey, 524 participants were recruited from the general population, using a convenience sampling technique (74 chronic insomniacs; 146 acute insomniacs; and 304 normal sleepers). Participants completed a demographic and screening questionnaire to determine their sleep status as either (normal sleeper, acute insomniac, or chronic insomniac). Additionally, participants completed the Perceived Modes of Processing Inventory (PMPI), which measures the type of processing used when faced with threatening information, and the Positive and Negative Affect Scale-State Version (PANAS), which measures stress-related coping resources. Results: A multinomial logistic regression showed that the introduction of the independent variables significantly increased prediction accuracy (from 52.2% to 61.8%). However, demographic variables did not significantly increase prediction accuracy. Type of processing and negative affective state significantly differentiated group membership for both the acute and chronic insomniacs. Discussion and Conclusion: The results suggest that there are significant differences between the groups, with acute insomniacs predominately employing automatic processing and chronic insomniacs employing emotional processing. However, we could not ascertain whether these results were indicative of the transition or the condition. A longitudinal study, examining the transition between acute and chronic insomnia is needed to fully explore the relationship between stress, coping and insomnia status.

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

Aims: To conduct an updated systematic review and the first meta-analysis of experimental trials investigating the acute effects of short bouts of physical activity (PA) on strength of desire (SoD) and desire to smoke (DtS) using individual participant data (IPD). Methods: A systematic review of literature and IPD meta-analyses included trials assessing the acute effects of shorts bouts of PA on SoD and DtS among temporarily abstaining smokers not using pharmaceutical aids for smoking cessation. Authors of eligible studies were contacted and raw IPD were obtained. Two-stage and one-stage IPD random-effects meta-analyses were conducted. Participants engaging in PA were compared against control participants, using post-intervention SoD and DtS with baseline adjustments. Results: A two-stage IPD meta-analysis assessing effects of PA on SoD yielded an average standardized mean difference (SMD) between PA and control conditions (across 15 primary studies) of -1.91 [95% confidence interval (CI): -2.59 to -1.22]. A two-stage IPD meta-analysis assessing effects of PA on DtS yielded an average SMD between PA and control conditions (across 17 primary studies) of -2.03 (95% CI: -2.60 to -1.46). Additional meta-analyses, including those using a one-stage model, those including only parallel arm studies and meta-analyses comparing only moderate exercise against a control condition, showed significant craving reduction following PA. Despite a high degree of between-study heterogeneity, effects sizes of all primary studies were in the same direction, with PA showing a greater reduction in cravings compared with controls. Conclusions: There is strong evidence that physical activity acutely reduces cigarette craving. © 2012 Society for the Study of Addiction.

Previous research has suggested that high job strain (high demand, low control at work) is associated with an inability to “unwind” physiologically after work. It was speculated that one mechanism related to the “unwinding process” is an individual's ability to “cognitively switch-off” about work related issues after work. This hypothesis was tested in a diary study of primary and secondary school teachers who were asked to keep an hourly record of their work-related thoughts over a workday evening between 17.00 hrs and 21.00 hrs. As expected both groups demonstrated a degree of unwinding and disengagement from work issues over the evening. High strain (n = 34) teachers however took longer to unwind and ruminated more about work-related issues, relative to low job strain (n = 35) teachers. High job strain teachers also reported they had less personal control over what they were doing in the evening. Across the evening all individuals reported higher ruminative thoughts about work issues when alone than when with family and friends, but high strain teachers reported more ruminative cognitions when watching television and with family and friends than low strain teachers. The results could not be explained by work patterns as there was no difference in the number of hours worked in the evening between the two groups. It is argued that one reason why high job strain teachers failed to successfully unwind after work is that they ruminated more about work issues, than did low job strain teachers.

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.

Several previous studies have investigated the association between smoking, attachment style and personality, but they were either focused on personality or on attachment style and considered these variables separately. Starting from such findings, the study aims to investigate both factors, as they might not be independent, in order to clarify their role in the onset of smoking behavior in adolescence. This study was conducted on a convenience sample of 338 adolescents [male: 55% (186) - female: 45% (152)] (aged 16.63 ± 1.63). All participants completed a set of standardized questionnaires that assessed attachment style, personality and smoking behavior (starting age, daily cigarettes, nicotine dependence). Results showed that the dismissing attachment style, novelty seeking, and older age were associated with a higher likelihood of having a cigarette smoking experience; while self-directedness and gender (being female) were associated with a lower likelihood of having a cigarette smoking experience (p < .001). The secure and avoidant attachment styles were associated with a late smoking onset, whereas dismissing attachment and reward dependence were associated with an earlier smoking onset (p < .009). These findings highlight the possibility of developing a psycho-cognitive profile of adolescent smokers, and help to describe a smoking trajectory that may aid in designing tailored interventions and treatments to discourage smoking.

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: The objectives of this study were to test the hypothesis that high job demands and low job control (job strain) are associated with elevated free cortisol levels early in the working day and with reduced variability across the day and to evaluate the contribution of anger expression to this pattern. METHODS: One hundred five school teachers (41 men and 64 women) classified 12 months earlier as high (N = 48) or low (N = 57) in job strain according to the demand/control model sampled saliva at 2-hour intervals from 8:00 to 8:30 hours to 22:00 to 22:30 hours on a working day. Anger expression was assessed with the Speilberger State-Trait Anger Expression Inventory, and negative affect was also measured. RESULTS: Free cortisol was significantly elevated at 8:00 to 8:30 hours in the high job strain group but not at later times of the day or evening. After adjustment for age and negative affect, cortisol was an average of 21.7% higher early in the working day in the high job strain group. This effect was significantly greater in high job strain teachers, who also reported high anger-out. The cortisol decline from morning to evening was greater in the high than low job strain individuals. Independently of job strain, women had a higher cortisol concentration at 8:00 to 8:30 hours than men, whereas cortisol concentration was greater in men than women in the middle of the working day between 12:00 and 16:30 hours. CONCLUSIONS: Job strain is associated with elevated free cortisol concentrations early in the working day but not with reduced cortisol variability. The interaction with outward anger expression suggests that individual characteristics modulate the impact of chronic work stress on the hypothalamic-pituitary-adrenocortical system.

Sleep has strong links to the symptomology of fibromyalgia syndrome (FMS), a diffuse musculoskeletal pain disorder. Information about the involvement of the circadian clock is, however, sparse. In this study, 1548 individuals with FMS completed an online survey containing questions on demographics, stimulant consumption, sleep quality, well-being and subjective pain, chronotype (assessed by the Munich ChronoType Questionnaire, MCTQ), and FMS impact. Chronotype (expressed as the mid-sleep-point on free days, corrected for sleep deficit on workdays, MSF(sc)) significantly correlated with stress-ratings, so-called "memory failures in everyday life," fatigue, FMS impact, and depression but not with anxiety. When chronotypes were categorized into 3 groups (early, intermediate, late), significant group differences were found for sum scores of perceived stress, memory failures in everyday life, fatigue, FMS impact, and depression but not anxiety, with late chronotypes being more affected than early chronotypes. Sleepiness ratings were highest in early chronotypes. Challenges of sleep quality and subjective pain were significantly increased in both early and late chronotypes. The results show that according to their reports, late chronotypes are more affected by fibromyalgia.

The heterogeneity of COVID-19 experience and response for each individual is irrefutable; nevertheless, similarities can be observed between countries with respect to people’s psychological responses. The main aim of this Commentary is to provide a cultural perspective of the sources of trauma, at the individual and social level, in three different countries: Italy, US and UK. The evidence from previous outbreaks, such as SARS, H1N1 flu, Ebola, and the ongoing Italian, the US and the UK experience of COVID-19 shows that COVID-19 has introduced not only an individual trauma, but also a collective trauma, that researchers should attend to now and in future global emergencies. Future clinical interventions should aim to reconnect dissociated parts both in the individual and in society. This commentary discusses four potential sources of trauma: high-stakes decision fatigue in healthcare professionals, traumatic grief and bereavement in people who have lost loved ones, loss of roles and identity, and social divisions related to economic shutdown.

The objectives of this study were, firstly, to examine the association between job strain and sleep quality in a sample of primary and secondary school teachers and, secondly, to assess whether the relationship between job strain and sleep quality is mediated or moderated by an individual's inability to "switch-off" from work-related issues during leisure time. School teachers (N= 143) completed an hourly record of their work-related thoughts over a workday evening between 5 p.m. and bedtime, and then rated their sleep quality the following morning. Individuals were classified as reporting high (n=46) or low (n=52) job strain using predetermined cut-off scores. Consistent with previous research, the results showed that both groups demonstrated a degree of unwinding and disengagement from work issues over the evening. However, compared to the low job strain group, the high job strain teachers took longer to unwind and ruminated more about work-related issues, over the whole evening, including bedtime. There was no difference in total sleep time between the groups, but high job strain individuals reported poorer sleep quality compared to low job strain individuals. With respect to the second objective, across the whole sample (N= 143), work rumination and job strain were significantly correlated with sleep quality, but work rumination was not found to mediate, or moderate the relationship between job strain and sleep quality. It was speculated that the initial low contribution of job strain to sleep quality (r = -.18) may have contributed to this null finding. The current findings may have implications for how we assess and manage sleep disturbance in stressed workers.

Associations between cardiovascular stress reactivity and blood pressure and heart rate recorded in everyday life were hypothesized to depend on the stressfulness of the ambulatory monitoring period relative to standardized tasks and on activity levels at the time of measurement. One hundred two female and 60 male school teachers carried out high- and low-demand tasks under standardized conditions and ambulatory monitoring during the working day. Stress ratings during the day were close to those recorded during the low-demand task. Reactions to the low-demand task were significant predictors of ambulatory blood pressure and heart rate independent of baseline, age, gender, and body mass. Associations were more consistent for ambulatory recordings taken when participants were seated than when they were standing and when the ambulatory monitoring day was considered to be as stressful as usual or more stressful than usual, and not less stressful than usual. Laboratory-field associations of cardiovascular activity depend in part on the congruence of stressfulness and physical activity level in the 2 situations.

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.

It is now believed that up to 43% of children can experience a sleep problem at some stage during their development. Reduced quality of sleep can have important implications for the developing child as it can impair growth, learning and emotional development. It is important for health professionals to understand the significance of sleep and the ways to alleviate problems so that these can be tackled at an early age. By educating people in how to get a good night's sleep we shall hopefully move towards a more happy, healthy and capable child population.

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.

Sleep disturbance is a widely reported and debilitating concomitant of fibromyalgia syndrome (FMS) and plays a pivotal role in exacerbating patients’ reporting of symptoms. Bigatti and colleagues report a longitudinal study that examined self-reported sleep, pain, depression and physical functioning in FMS patients at baseline and again at a 12-month follow-up. Their results support previous research in showing that there is a bidirectional correlation between sleep and pain experience. Moreover, the results demonstrated that sleep predicted pain, pain predicted physical functioning, and physical functioning predicted depression, although causality was not actually demonstrated. Nonetheless, this research highlights the prevalence of sleep problems in FMS, and the critical role sleep plays in the quality of life for many patients.

BACKGROUND: The aim of this study was to explore the experiences of ambulance dispatch personnel, identifying key stressors and their impact on staff well-being. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

RATIONALE: Suppressing smoking thoughts has been shown to result in elevated smoking. However, the effect of suppressing smoking thoughts on desire to smoke and withdrawal symptoms has not been investigated. OBJECTIVES: We examined the effects of suppressing smoking thoughts on the subsequent desire to smoke and on tobacco withdrawal symptoms, relative to groups that were either thinking about anything they wished or actively thinking about smoking. METHODS: A randomised experimental study compared the effects of three manipulations (suppressed smoking thoughts, expressed smoking thoughts and thoughts of anything they wished) on desire and withdrawal immediately after the manipulation and 5 and 10 min after. RESULTS: Suppressing smoking thoughts did not result in elevated subsequent desire to smoke, relative to the other manipulations. Suppressing smoking thoughts resulted in a significant elevation in hunger ratings, relative to the other manipulations, at all measurement times. There were no significant effects for the other withdrawal symptoms. Self-reported greater use of thought suppression in everyday life was significantly associated with greater desire to smoke at baseline and was associated with lower mindfulness scores. CONCLUSIONS: Laboratory-instructed suppression of smoking thoughts is associated with increased reports of hunger but did not lead to increases in other withdrawal symptoms or elevated desire to smoke. Reports of everyday use of thought suppression are associated with elevated desire to smoke at baseline. Further investigations need to assess the effect of suppressing smoking cravings, instead of general smoking thoughts, on desire to smoke and tobacco withdrawal.

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.

STUDY OBJECTIVES: Theoretical accounts of the progression of insomnia from acute to chronic are lacking. A framework is proposed and tested to examine differences in cognitive coping styles between acute and chronic insomniacs and the relation of cognitive processing and sleep hygiene to causal attributions of insomnia. METHOD: In a cross-sectional design, the relationship among sleep disturbance, causal attributions and various psychological and behavioural variables was examined in a convenience sample of acute and chronic insomniacs from the general population (N=308). RESULTS: Negative appraisals and the cognitive coping styles 'Worry' and 'Punishment' were found to be associated with both acute and chronic insomnia, whereas 'Distraction' as a cognitive coping strategy significantly reduced reports of chronic insomnia. The results are discussed in relation to multi-level interventions and future directions in theory, research and application.

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.

Background: Sleep is one of the most important recovery mechanisms available to humans, allowing for recovery from daily strains, and therefore a prerequisite for health. Many workers complain that they are unable to get to sleep at night, and report poor sleep maintenance due to unwanted, ruminative thoughts and concerns about work-related issues. The present study investigated the effects of ruminative thinking on sleep, using self-reported diaries. Method: One-hundred and seven school teachers were asked to keep a diary record of their thoughts about work over a workday evening and were monitored hourly from 17.00 hrs until bedtime. Each individual also completed a diary assessment of their sleep patterns over the same night. Using information obtained from the diaries the sample was divided into high ruminators (those who thought about work issues a lot at bedtime) and low ruminators (those who thought about work issues little at bedtime) using tertile splits. Only individuals who did not work in the hour before bedtime were included in the analysis. Results: Logistic regression analysis revealed (after adjusting for age and gender), that high compared to low ruminators were: 3.5 time more likely to report 'difficulty falling asleep', 4.7 time more likely to report 'difficulty waking up', 5.7 times more likely to report 'difficulty getting back to sleep if awoken during the night', 6.8 times more likely to report 'restless sleep' and 3.4 times more likely to 'feel unrefreshed after awaking'. Relative to the low ruminators, high ruminators also reported that they had thought about work related issues - while trying to fall asleep (p < 0.001), and in the morning before they got out of bed (p < 0.5). Conclusion: Ruminating about work-related issues appears to be associated with self-reported sleep disturbance. It is important therefore that individuals learn to 'switch-off' from work during the evening in order to obtain good quality sleep.

Background: Depression is common in those with MS. The hopelessness theory of depression, emphasizing the role of attributional style, is supported in this population. Cognitive behaviour therapy (CBT) that can affect attributional style can reduce depression in people who have MS. Aims: The present study aimed to consider whether changing attributional style would reduce depression in two people with MS, thereby supporting the importance of this component of CBT with this population. Method: Two female participants with MS were offered a 5-session intervention designed to alter attributional style. The study followed an ABA design. Attributional style and depressive symptoms were the principal measures considered. Negative life events and MS related stresses were also monitored. Results: The intervention appeared effective for one of the participants, with predicted changes in attributional style and sizeable reductions in depressive symptoms from pre- to post-treatment that were sustained at 3-month follow-up. Improvement was still evident at 6 months, although with some reduction of effect. The intervention was less successful for the other participant who declined further treatment after three sessions. Conclusions: Some support for the hopelessness theory of depression was found, indicating its relevance to CBT interventions for those who have MS and depression.