Compassion: a scoping review of the healthcare literature

BACKGROUND: Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare. METHODS: Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used. RESULTS AND DISCUSSION: Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students. CONCLUSIONS: This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary

UNT Speaks Out

This presentation is part of the faculty lecture series UNT Speaks Out on Coming Home and discusses the reintegration of veterans and families. The author directs the Family Attachment Lab and is conducting the Student Veteran Research Project. In this presentation, she discusses the family relationships of veterans after deployment

Depression and Stress Among HIV+ Adults 1 RUNNING HEAD: DEPRESSION AND STRESS AMONG HIV+ ADULTS Attachment Style, Stigma, and Psychological Distress Among HIV+ Adults

ABSTRACT This study explored the role of adult attachment style in reported experiences of HIV-related stigma, stress and depression in a diverse sample of HIV+ adults. Participants (N = 288) recruited from AIDS service organizations were administered the Experiences in Close Relationships Scale, Perceived Stress Scale, CES-D, HIV Stigma Scale, and a health information questionnaire. Adult romantic attachment style was significantly associated with perceived stress, depression, and HIV-related stigma. Results of regression analyses supported contentions that in addition to HIV symptomatology, other psychosocial risk factors such as attachment style and stigma contribute to perceived stress and depression among HIV+ men and women. Correspondence should be sent to Dr. Shelley A. Riggs, University of North Texas, Department of Psychology, 1155 Union Circle #311280, Denton, TX 76203-1280, [email protected]. Depression and Stress Among HIV+ Adults 3 Considerable evidence suggests that various aspects of personal relationships and psychological status have significant implications for physical health. Studies of individuals with human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) have often focused on stress and depression due to substantial evidence of their deleterious effects on physical health and the immune system, including those aspects affected by HIV Recently, researchers (Hunter & Maunder, 2001; The current study explored how adult attachment style might relate to the experience of psychological distress and HIV-related stigma, and further how attachment style and selfimage related to HIV stigma together might contribute to the prediction of stress and depression levels in a diverse sample of HIV+ men and women. Attachment Theory Drawing upon ethological, evolutionary, and biological conceptions, Bowlby (1973, 1980) theorized that humans, like other species, were inherently predisposed to seek out and bond with an attachment figure for protection. When security is threatened, fear and anxiety activate attachment behavior, which is defined as "any form of behavior that results in a person attaining proximity to some other differentiated and preferred individual," who is perceived as better able to cope with the world (Bowlby, 1980, p. 39). Although most visible in children when tired, ill, or afraid, attachment behavior can be observed throughout the life cycle in stressful circumstances Although theoretically rooted in the same innate system, romantic attachment style differs from parent-child bonds in several important ways, including reciprocity of Depression and Stress Among HIV+ Adults 5 attachment and caregiving, as well as sexual mating According to Bartholomew and her colleagues (1990; Three insecure adult attachment styles, on the other hand, are characterized by negative internal working models of self and/or other. Preoccupied individuals experience high levels of attachment anxiety because they believe they are unworthy of love and fear abandonment by others. In contrast, dismissing-avoidant adults view themselves as competent and capable and thus experience low levels of anxiety, while they view others as rejecting or unavailable and consequently seek to avoid emotional intimacy. Fearfulavoidant attachment style is characterized by negative internal models of both self and other with high levels of both attachment anxiety and avoidance, and is associated with the poorest adjustment of the four adult prototypes (e.g., Carnelley, Pietromonaco, & Jaffe, 1994; Riggs et al., in press). Although these internal working models self and other tend to persist through the life course and become increasingly resistant to change, they can be modified by different environmental experiences (see Belsky, 1999 for review). Systematic attachment style differences have been found in affective responses to stress HIV and Mental Health A diagnosis of a life-threatening disease is a major source of stress that is likely to activate the attachment system and can affect both physical and emotional well-being. In addition to the stress of chronic illness, HIV+ adults may also struggle to cope with other significant stressors. For example, a diagnosis of HIV may bring financial strain and unwelcome changes in lifestyle and close relationships (Antoni et al., 1991; Maj, 1990; HIV/AIDS is also uniquely related to the likelihood of knowing close friends or partners, who are ill or dead due to HIV/AIDS (Sikkema, Kochman, DiFranceisco, Kelly, & Hoffman, 2003; Stigmatized individuals are also vulnerable to feelings of self-hatred, which can result from the internalization of society's negative views Given the host of stressors associated with HIV+ status, it is not surprising that HIV+ individuals are likely to experience higher levels of stress and depression than healthy controls (see The Current Study Due to evidence suggesting that mental health status may affect the progression of disease We predicted that insecure attachment style would show significant associations with psychological distress, with preoccupied and fearful attachment styles associated with the highest levels of stress and depression. HIV-related stigma has not been previously examined in relation to romantic attachment, so we based our hypotheses on theoretical conceptualizations of the different attachment styles. Because they possess high levels of anxiety and negative internal working models of self, we expected that Depression and Stress Among HIV+ Adults 10 preoccupied and fearful adults would be more likely to endorse higher levels of personalized stigma and negative stigma-related self-image than secure or dismissing adults. On the other hand, due to high levels of avoidance and negative internal working models of others, we predicted that dismissing adults would endorse less concern regarding public attitudes toward HIV and lower levels of disclosure of their seropositve status. Finally, we expected adult attachment anxiety and HIV-related stigma to significantly predict levels of depression and stress above the contribution of demographic and HIV-related health factors. English to participate in a written survey. Women made up almost half (48%) of the sample and age ranged from 19 to 68 (M = 41.5, SD = 8.39). Ethnically, the sample consisted of 54.5% African Americans, 29.5% Caucasians, and 10.6% Latinos. A majority (69%) of participants were below the poverty line with annual incomes less than $10,000. HIV medications were reportedly used by 74.6$10,000 reporting greater concern regarding disclosure and more negative self-image compared to participants earning higher incomes. As a result, gender was used as a covariate in analyses involving perceived stress, and income was used as a covariate in analyses involving HIV stigma. Although not related to the ECR Anxiety and Avoidance subscales, sexual orientation was significantly associated with ECR attachment classification, χ 2 (3, 259) = 13.07, p < .04. Heterosexual participants were significantly more likely to be Secure or Fearful and less likely to be preoccupied or dismissing. In contrast, gay participants were more likely to be Preoccupied and less likely to be Secure, whereas bisexual participants were more likely to be Dismissing and less likely to be Secure or Fearful. Predictors of Stress and Depressive Symptoms Perceived stress and depression were significantly correlated with predictor variables in the expected direction. To test hypotheses regarding the predictive power of attachment style and HIV-related stigma, two hierarchical multiple regression analyses were conducted with stress and depression as outcomes. Missing data across instruments lowered the total N available for the regression analyses to 237 participants. Those with missing data were more likely to be female, χ 2 (1, 287) = 7.70, p < .006, but otherwise did not differ from participants included in the regressions. Data were entered into the regression models in four blocks. The first two blocks controlled for demographic and health-related predictors and the third block consisted of the ECR attachment anxiety and attachment avoidance scales, all of which were simultaneously entered. Because a new instrument was used to assess HIV stigma, the fourth block was exploratory and the HIVrelated stigma scales were entered stepwise to determine which stigma variables significantly contributed to the variance in our model. The full regression model for perceived stress accounted for approximately 30% of the variance [Adjusted R² = .305, F (11, 225) = 10.41, p < .000] (See [Adjusted R² = .241, F (9, 227) = 9.31, p < .000]. In the final step of the model, higher levels of HIV-related Negative Self-image predicted greater perceived stress, separately accounting for 6% of the 30% total variance explained by the full model. Thus, female gender, bisexuality, greater symptom load, higher levels of attachment anxiety, and a more negative self-image in relation to HIV stigma provided the best model of prediction for perceived stress

Mutuality, self silencing, and disordered eating in college women

ABSTRACT. The current study examined patterns of association among mutuality, self-silencing, and disordered eating in an ethnically diverse sample of college women (N = 149). Partner mutuality and overall selfsilencing were negatively correlated and together were associated with six disordered eating indices. All four self-silencing subscales were associated with disordered eating patterns. For example, external self-perception was associated with drive for thinness, bulimia, body dissatisfaction, and interoceptive awareness. Implications of the findings for college counselors are discussed

Pilot trial of Strength at Home Parents, a trauma-informed parenting support treatment for veterans

PTSD is associated with compromised parenting which is not adequately addressed in available evidence-based PTSD treatments

Trauma-informed parenting intervention for veterans: A preliminary uncontrolled trial of Strength at Home-Parents

Trauma exposure and posttraumatic stress disorder (PTSD) are highly prevalent in military and veteran populations and are associated with parenting difficulties. Unfortunately, there is a lack of accessible, trauma-informed, and evidence-based parenting support interventions within the Department of Veterans Affairs (VA). Strength at Home-Parents (SAHP) is a trauma-informed psychotherapy group that aims to improve parenting behaviors and overall parent-child and family functioning among U.S. military veterans with PTSD symptoms. SAHP was developed to maximize ease of use by VA providers and accessibility for parents. Here we report data from an uncontrolled trial of SAHP delivered using synchronous video technology in a sample of veterans using VA care (N = 53) who met the criteria for PTSD and parent-child functioning difficulties. Enrollment and retention rates met study goals and suggest feasibility and acceptability of study methods. Significant pre- to postintervention improvements were observed in measures of dysfunctional discipline, parenting stress, general family functioning, child psychosocial functioning, and parental PTSD and depression symptoms. Coupled with high satisfaction ratings, findings support further study of the intervention, including in an efficacy trial

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors. Violence and Victims

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions. Keywords: child abuse; family environment; attachment style; psychopathology A large body of evidence consistently indicates that adult survivors of physical, sexual, or psychological abuse in childhood are more likely than adults without a history of abuse to experience a wide range of psychological and personality dysfunction. Yet, not all abuse survivors suffer negative consequences, and those who do demonstrate a broad variety of clinical symptoms and personality disturbance. Significant heterogeneity within this population suggests that other factors, such as abuse characteristics and pathogenic early home environments, contribute to diverse developmental trajectorie