Emotional adaptation to relationship dissolution in parents and non-parents: A new conceptual model and measure

Relationship dissolution can cause declines in emotional well-being, particularly if there are children involved. Individuals’ capacity to cope with the pragmatics of the situation, such as agreeing childcare arrangements, can be impaired. Before now, there has been no psychometric test to evaluate individuals’ emotional readiness to cope with these demands. This paper presents a model of emotional adaptation in the context of relationship dissolution and its key assumptions, and validates the Emotional Adaptation to Relationship Dissolution Assessment (EARDA). In Study 1 (Sample 1, n = 573 separated parents, Sample 2, n = 199 mix of parents and non-parents), factor analyses support the EARDA as a unidimensional scale with good reliability. In Study 2 (using Sample 1, and Sample 3, n = 156 separated parents) the convergent, discriminant, concurrent criterion-related, and incremental validity of the EARDA were supported by tests of association with stress, distress, attachment style, and co-parenting communication and conflict. In Study 3, the nomological network of emotional adaptation to relationship dissolution was explored in Sample 2 using cluster analysis and multi-dimensional scaling (MDS). Emotional adaptation clustered with positive traits and an outward focus, and was negatively associated with negative traits and an inward focus. Emotional adaptation was conceptually located in close proximity to active and adaptive coping, and furthest away from maladaptive coping. In Study 4 (n = 30 separated parents embarking on mediation), high, medium, and low emotional adaptation to relationship dissolution categories correlated highly with mediators’ professional judgement, offering triangulated face validity. Finally, in Study 5, EARDA scores were found to mediate between separation characteristics (time since break up, whether it was a shock, and who initiated the break up) and co-parenting conflict in Sample 1, supporting the proposed model. The theoretical innovation of this work is the introduction of a new construct that bridges the gap between relationship dissolution and co-parenting. Practical implications include the use of the measure proposed to triage levels of support in a family law setting

Constraints to liberty of movement and attachment styles significantly account for well-being in three Palestinian samples

Background: Political violence and constraints on liberty of movement can have consequences for health and well-being but affect individuals differently. Objective: In three Palestinian samples, we sought to examine the relationship between key environmental and psychological factors and general and mental health, including the previously unexplored roles of constraints to liberty of movement and attachment orientation. Method: Participants (n=519) in the Occupied Palestinian Territories and Jordan completed questionnaires on constraints to liberty of movement (4-item scale devised by the authors for the purpose of the current study), attachment insecurity (Experiences in Close Relationships Scale – Short Form, Wei et al., 2007), resource loss (Conservation of Resources Evaluation scale, Hobfoll & Lilly, 1993), experience of political violence (Experience and fear of political violence, Hobfoll et al., 2011), demographics, general health (adapted from DeSalvo et al, 2006) and mental health (PHQ4 for depression, and Ballenger et al.’s, (2001) 2 item screener for anxiety). All measures were translated from English to Arabic and back-translated into English. Results: Findings from regression and mediation analyses indicated that (i) differences in general and mental health among Palestinians in the Occupied Palestinian Territories and the diaspora in Jordan, can be explained by the assessed constructs; (ii) constraints to liberty of movement, attachment avoidance, and resource loss significantly accounted for poor general health; (iii) constraints to liberty of movement, attachment anxiety, and resource loss significantly explained general anxiety symptoms; and (iv) attachment anxiety, resource loss, and experience of political violence significantly explained depression symptoms. Conclusion: Findings have theory-building implications for psychological models of human flourishing and suffering, suggesting that they are incomplete without consideration of liberty as a context, as well as implications for policymakers and champions of global health initiatives, as they highlight the psychological effects of constraints to liberty of movement on health

Does the structure (tunneled vs. free-roam) and content (if-then plans vs. choosing strategies) of a brief online alcohol intervention effect engagement and effectiveness? A randomized controlled trial

© 2019 Society of Behavioral Medicine. All rights reserved. Despite the potential of brief online interventions for reducing alcohol consumption, their effectiveness may be compromised by low levels of engagement and the inclusion of ineffective behavior change techniques. To test whether (i) a tunneled version of an intervention (where the content is delivered in a prespecified order) leads to greater engagement and greater reductions in alcohol consumption than a free-roam version (where the content can be viewed in any order) and (ii) forming if-then plans linking strategies to cut down with high-risk situations leads to greater reductions in alcohol consumption than only choosing strategies to cut down. Participants (N = 286 university staff and students) were randomly allocated to one of four versions of a brief online alcohol intervention in a 2 (structure: Tunneled vs. free-roam) by 2 (planning: Strategies vs. if-then plans) factorial design. Engagement (pages visited, time) was recorded automatically. Alcohol consumption (weekly units) was assessed at baseline and 1- A nd 6-month follow-up. Participants who received the tunneled version viewed significantly more pages and spent significantly more time on the website than those who received the free-roam version. Significant reductions in alcohol consumption were observed at follow-up; however, neither the structure of the intervention nor planning had a significant effect on reductions in alcohol consumption. Tunneled online interventions can increase engagement, but this may not translate into greater changes in behavior. Further experimental research using factorial designs is needed to identify the key behavior change techniques to include in brief online interventions

E-therapies in England for stress, anxiety or depression: What is being used in the NHS A survey of mental health services

Objective: To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England. Design: The study was conducted using Freedom of Information (FOI) requests and systematic website searches. Data sources: Data were collected via FOI requests to NHS services between 13 February 2015 and 31 March 2015, and searches conducted on NHS apps library websites between 26 March 2015 and 2 November 2015. Data collection/extraction methods: Data were compiled from responses to: (1) FOI requests sent to all Improving Access to Psychological Therapies (IAPT) services and NHS Mental Health Trusts in England and (2) NHS apps library search results. Results: A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust). Conclusions: Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines

Usability, Acceptability, and Effectiveness of Web-Based Conversational Agents to Facilitate Problem Solving in Older Adults: Controlled Study.

BACKGROUND: The usability and effectiveness of conversational agents (chatbots) that deliver psychological therapies is under-researched. OBJECTIVE: This study aimed to compare the system usability, acceptability, and effectiveness in older adults of 2 Web-based conversational agents that differ in theoretical orientation and approach. METHODS: In a randomized study, 112 older adults were allocated to 1 of the following 2 fully automated interventions: Manage Your Life Online (MYLO; ie, a chatbot that mimics a therapist using a method of levels approach) and ELIZA (a chatbot that mimics a therapist using a humanistic counseling approach). The primary outcome was problem distress and resolution, with secondary outcome measures of system usability and clinical outcome. RESULTS: MYLO participants spent significantly longer interacting with the conversational agent. Posthoc tests indicated that MYLO participants had significantly lower problem distress at follow-up. There were no differences between MYLO and ELIZA in terms of problem resolution. MYLO was rated as significantly more helpful and likely to be used again. System usability of both the conversational agents was associated with helpfulness of the agents and the willingness of the participants to reuse. Adherence was high. A total of 12% (7/59) of the MYLO group did not carry out their conversation with the chatbot. CONCLUSIONS: Controlled studies of chatbots need to be conducted in clinical populations across different age groups. The potential integration of chatbots into psychological care in routine services is discussed

Evaluating the impact of sling provision and training upon maternal mental health, wellbeing and parenting: A randomised feasibility trial

Background Close body contact interventions such as Kangaroo Mother Care have been shown to improve maternal mental health following birth. Infant carriers (‘slings’) facilitate hands-free close body contact. No studies have specifically examined whether sling use improves maternal mental health. A full-scale efficacy study is needed to examine whether sling use is beneficial to maternal mental health. The current study is a feasibility study designed to gather information to support the design of a future RCT, such as acceptability and study parameters, including recruitment rates, consent rate and attrition. Method Mothers of infants aged 0–6 weeks were randomised to one of two conditions: intervention (n = 35) vs. waitlist control (n = 32). Intervention participants received sling training, support, and free sling hire for 12 weeks. Participants completed self-report measures of mood, wellbeing and parenting at baseline (Time 1), and 6- (Time 2) and 12- (Time 3) weeks post-baseline. Results Eligibility and consent rates met feasibility objectives, though there were some difficulties with retention of participants in the study. Preliminary effectiveness analyses showed a non-significant improvement with a small effect size in postnatal depression from T1 to T3, and a significant improvement with a medium effect size in maternal self-efficacy from T1 to T3. Qualitative feedback indicated acceptability of the intervention and study participation. Intervention participants attributed greater autonomy, bonding with their baby, and parental self-confidence, to the intervention. Conclusions These findings indicate a randomised study of the impact of a sling and related support intervention upon maternal mental health is feasible. These findings should be interpreted within the context of sampling bias (due to the use of volunteer sampling methods), an absence of feedback from those who discontinued participation in the study, and the study not being adequately powered

Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis.

BACKGROUND: There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development. OBJECTIVE: This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom. METHODS: Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls. RESULTS: A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found. CONCLUSIONS: Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184

E-Therapies in England for stress, anxiety or depression: How are apps developed? A survey of NHS e-therapy developers

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. To document the quality of web and smartphone apps used and recommended for stress, anxiety or depression by examining the manner in which they were developed. Design The study was conducted using a survey sent to developers of National Health Service (NHS) e-therapies. Data sources Data were collected via a survey sent out to NHS e-therapy developers during October 2015 and review of development company websites during October 2015. Data collection/extraction methods Data were compiled from responses to the survey and development company websites of the NHS e-therapies developers. Results A total of 36 (76.6%) out of the 48 app developers responded. One app was excluded due to its contact details and developer website being unidentifiable. Data from the missing 10 was determined from the app developer's website. The results were that 12 out of 13 web apps and 20 out of 34 smartphone apps had clinical involvement in their development. Nine out of 13 web apps and nine out of 34 smartphone apps indicated academic involvement in their development. Twelve out of 13 web apps and nine out of 34 smartphone apps indicated published research evidence relating to their app. Ten out of 13 web apps and 10 out of 34 smartphone apps indicated having other evidence relating to their app. Nine out of 13 web apps and 19 out of 34 smartphone apps indicated having a psychological approach or theory behind their app. Conclusions As an increasing number of developers are looking to produce e-therapies for the NHS it is essential they apply clinical and academic best practices to ensure the creation of safe and effective apps

Understanding the relationship between self‐compassion and body dissatisfaction

Body dissatisfaction reflects a person's negative perceptions, thoughts, and feelings regarding their body. Two factors—(1) self‐compassion, a positive attitude of self‐acceptance despite flaws, and (2) gratitude, the capability to notice and appreciate the positive aspects of life—may help to reduce body dissatisfaction. The present research aimed to provide further evidence for the relationship between gratitude, self‐compassion, and body dissatisfaction and test whether meditation focusing on self‐compassion can reduce body dissatisfaction. Two online studies were conducted with samples of adult women recruited in the United Kingdom (N = 342 and 117). Study 1 found that self‐compassion, but not gratitude, significantly predicted lower levels of body dissatisfaction. Study 2 found that participating in a 3‐week meditation program—whether focused on self‐compassion or relaxation—increased self‐compassion over time and reduced body dissatisfaction. Taken together, the findings that regular meditation can bring positive outcomes to women with body dissatisfaction, regardless of the specific focus or content of the meditation