Acceptance and commitment therapy for people experiencing appearance - related distress associated with a visible difference: A rationale and review of relevant research

© 2018 Springer Publishing Company. People may have a visibly different appearance due to various causes, such as congenital conditions, injury, disease, or medical treatment. Some individuals with a visible difference experience social anxiety and isolation, body image dissatisfaction, shame and self-stigma, psychological trauma, and challenges managing their condition. In this article, we synthesize the relevant literature and present the theoretical rationale for the application of Acceptance and Commitment Therapy (ACT), a third-wave behavioral therapy combining mindfulness skills and value-driven action, to those experiencing distress relating to an unusual or altered appearance. We also outline how ACT may be tailored to the specific considerations of this population and recommend next steps in researching its acceptability and clinical effectiveness

The Effectiveness of Desensitization Therapy for Individuals with Complex Regional Pain Syndrome: A Systematic Review

Authors: Kira L, Donnelly, SPT; Lauryn M. Helmers, SPT; Olivia M. Verberne, SPT; Roger J. Allen, PT, PhD Title: The Effectiveness of Desensitization Therapy for Individuals with Complex Regional Pain Syndrome: A Systematic Review Purpose: Systematically review evidence supporting the use of desensitization therapy to treat Complex Regional Pain Syndrome (CRPS). Subjects: This systematic review evaluated 10 studies from peer-reviewed journals fitting research criteria. Materials/Methods: Databases were searched between Mar and Aug of 2014 with the following search terms: complex regional pain syndrome, CRPS, allodynia, desensitization, neuropathic pain, physical therapy, tactile desensitization, pressure desensitization, hydrotherapy, physiotherapy, capsaicin and somatosensory. Results: Initial search yielded 42 articles with 10 fitting inclusion/exclusion criteria. Articles were evaluated with the STROBE scale and organized by desensitization type: chemical, tactile, thermal and pressure desensitization. Outcome measures varied, including assessing functional use, pressure tolerance and pain tolerance. Conclusions: Despite lacking a standard desensitization protocol, research suggests implementing desensitization by selecting the proper somatosensory modality and using a graded protocol in order to reduce allodynia. Clinical Relevance: Desensitization is often a component of a multifaceted treatment approach for patients with CRPS, which is difficult to isolate within research. To make solid conclusions about desensitization efficacy, studies need to isolate desensitization as a treatment using larger numbers of subjects with CRPS with clear, controlled and replicable protocols. Given current research limitations, existing evidence is promising for continued utilization of graded desensitization therapy for individuals with CRPS. Keywords: desensitization, complex regional pain syndrome, allodynia, tactile desensitization, pressure desensitization, hydrotherapy, capsaicin, physical therap

Sea-level rise will drive divergent sediment transport patterns on fore reefs and reef flats, potentially causing erosion on Atoll Islands

Author Posting. © American Geophysical Union, 2020. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Earth Surface 125 (2020): e2019JF005446, doi: 10.1029/2019JF005446.Atoll reef islands primarily consist of unconsolidated sediment, and their ocean‐facing shorelines are maintained by sediment produced and transported across their reefs. Changes in incident waves can alter cross‐shore sediment exchange and, thus, affect the sediment budget and morphology of atoll reef islands. Here we investigate the influence of sea level rise and projected wave climate change on wave characteristics and cross‐shore sediment transport across an atoll reef at Kwajalein Island, Republic of the Marshall Islands. Using a phase‐resolving model, we quantify the influence on sediment transport of quantities not well captured by wave‐averaged models, namely, wave asymmetry and skewness and flow acceleration. Model results suggest that for current reef geometry, sea level, and wave climate, potential bedload transport is directed onshore, decreases from the fore reef to the beach, and is sensitive to the influence of flow acceleration. We find that a projected 12% decrease in annual wave energy by 2100 CE has negligible influence on reef flat hydrodynamics. However, 0.5–2.0 m of sea level rise increases wave heights, skewness, and shear stress on the reef flat and decreases wave skewness and shear stress on the fore reef. These hydrodynamic changes decrease potential sediment inputs onshore from the fore reef where coral production is greatest but increase potential cross‐reef sediment transport from the outer reef flat to the beach. Assuming sediment production on the fore reef remains constant or decreases due to increasing ocean temperatures and acidification, these processes have the potential to decrease net sediment delivery to atoll islands, causing erosion.This study was supported by the Strategic Environmental Research and Development Program through awards SERDP: RC‐2334, and RC‐2336. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.2021-03-2

The COVID-19 Clinician Cohort (CoCCo) Study: Empirically Grounded Recommendations for Forward-Facing Psychological Care of Frontline Doctors

In this book, we focus on health and wellbeing in the workforce within the context of the global COVID-19 pandemic, and the post-pandemic era. We begin by exploring the impacts of the pandemic on diverse occupational groups, considering the broader mental health impacts of the pandemic, reactions to national lockdowns and behavioural strategies to control the spread of the virus, such as social distancing and self-isolation, attitudes towards infection control and work presenteeism. Next, we explore the relationship between job factors, working conditions and psychological wellbeing of employees. The papers that follow examine changes in work patterns and locations, such as remote, hybrid, and on-site working, the impact of organizational climate on mental wellbeing, and organizational approaches to return-to-work after lockdown. Finally, we present innovative organizational- and individual-level pandemic mitigation interventions, including SARS-CoV-2 testing services and infection control approaches, digital mental health support, and COVID-19 Vaccine Education. This collection demonstrates the breadth of research on work, health and wellbeing, during and beyond the COVID-19 pandemic, covering workforce impacts and workforce interventions in various countries and settings. Learning from this research will help to build global preparedness for future pandemics and foster resilience for responding in times of crisis and uncertainty

Designing an mHealth intervention for people with visible differences based on acceptance and commitment therapy: Participatory study gaining stakeholders’ input

Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords

The COVID-19 Clinician Cohort (CoCCo) Study: Empirically grounded recommendations for forward-facing psychological care of frontline doctors

This study aimed to develop empirically grounded recommendations and a coherent model of psychological care derived from the experiences and psychological care needs of COVID-19 frontline doctors, using semi-structured interviews and thematic analysis. Participants were UK frontline doctors specialising in Emergency Medicine, Anaesthetics, or Intensive Care (n = 31) purposively sampled for maximum variation on gender, specialty, ethnicity, and trauma-related dis-tress; most worked in ICU during the pandemic (71%). Four themes were derived: (1) ‘coping strategies’, participants used many, including exercise, mindfulness, and “wait until it gets really bad”; (2) ‘sources of support’, participants valued embedded psychological support, digital services, and informal conversations with colleagues or family, though there was little opportunity; (3) ‘organisational influences on wellbeing’, participants reported a love–hate relationship for concepts like ‘wellbeing’, seen as important but insulting when basic workplace needs were unmet; (4) ‘improving engagement with support’, analysis suggests we must reduce physical and psychological barriers to access and encourage leaders to model psychologically supportive behaviours. Doctors’ front-line COVID-19 working experiences shine a ‘spotlight’ on pre-existing problems such as lack of physical resources and access to psychological care. Empirically grounded recommendations and a model of incremental psychological care are presented for use in clinical services

Training Health Professionals to Support Patients with Appearance-Affecting Conditions

Multidisciplinary health professionals (HPs) are involved in supporting patients who have conditions that affect their appearance. With appearance-associated distress common in this group, acceptance and commitment therapy (ACT) and enhanced communication skills both show effectiveness in helping patients adjust to their conditions. Multidisciplinary HPs are perfectly placed to provide low-level psychological support as paraprofessionals. We present the real-world evaluation of a training programme, ACT Now, which was delivered via the train-the-trainer model to 149 multidisciplinary HPs in six European countries. Trainees completed a 16-item knowledge, attitude and practice survey covering psychoeducation on appearance concerns, ACT applied to the patient group and communication skills, at pre-training, post-training and at 3-or-6-month follow-up. Findings show that trainees’ confidence consistently improved in understanding specific facets of appearance concerns and ACT processes, with largely positive changes in other facets, skewed towards delivery nations in which psychologists delivered the training. Patient communication skills generally improved, though again these were more pronounced in psychologist-led countries. However, an absence of significant improvements in ACT comprehension suggests a challenge in transmitting the ACT model to HPs. Providing more initial training to non-psychologist trainers and embedding post-training skills practice for trainees may help reinforce the ACT component of the training