Distinct Negative Beliefs About Uncertainty and Their Association With Worry: An Exploration of the Factors of the Intolerance of Uncertainty Scale and Their Correlates

Intolerance of uncertainty, “a dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications” (Dugas & Robichaud, 2007, p. 24), has been implicated in worry/generalized anxiety disorder (GAD). Despite significant advances in our understanding of its role as a cognitive vulnerability for GAD, questions remain regarding its measurement and construct validity, as a reliable set of negative beliefs has yet to be identified. The goal of this research was therefore to discern the specific negative beliefs about uncertainty which result in intolerance of uncertainty. In the first study, the factor structure of the Intolerance of Uncertainty Scale (IUS; Buhr & Dugas, 2002; Freeston et al., 1994) was re-examined in separate large non-clinical samples, and the association of these factors with GAD symptomatology was explored. A second study further examined the convergent, discriminant, and criterion-related validity of these negative beliefs about uncertainty, as well as their specificity, in relation to similar behavioural and cognitive constructs and to information-processing biases. To this end, the Ambiguous Situations Questionnaire (ASQ) was developed to further assess interpretive biases in specific ambiguous situations and to differentiate the cognitive, behavioural, and emotional reactions that characterize these distinct beliefs about uncertainty. Two replicable negative beliefs about uncertainty were identified: 1) the belief that Uncertainty has Negative Behavioural and Self-Referent Implications, and 2) the belief that Uncertainty is Unfair and Spoils Everything. The first of these was specifically associated with indecisiveness, procrastination, the tendency to personalize negative situations, and with perceptions of specific ambiguous situations as having negative personal implications. This belief also showed stronger correlations with GAD analogue status, trait anxiety, somatic anxiety, and depressive symptoms. In contrast, the second of these beliefs was associated with a preference for order in the environment, with self-oriented and other-oriented perfectionism, and with perceptions of specific ambiguous situations as unfair and disruptive. Both negative beliefs about uncertainty were also associated with information-seeking, with negatively biased interpretations of ambiguous situations, and with pathological worry. Collectively, these studies’ findings suggest that uncertainty is experienced as aversive by individuals who believe it negatively impacts their ability to function and who show a tendency to personalize these perceived difficulties. It is also experienced as aversive by individuals who believe it to be unfair, as it contradicts their expectations of structure in the environment and may be perceived as hindering elevated personal standards from being met. These findings further support the validity of this construct, and are consistent with a growing literature which suggests that intolerance of uncertainty contributes to information-processing biases and confers vulnerability to excessive and uncontrollable worry

An investigation of cognitive avoidance in worry

These studies considered the nature of cognitive avoidance, a maintaining factor in worry and generalized anxiety disorder (Borkovec, Ray, & Stöber, 1998; Dugas, Gagnon, Ladouceur, & Freeston, 1998). First, the psychometric properties of the English translation of Gosselin et al.'s (2002) Cognitive Avoidance Questionnaire (CAQ) were examined. The CAQ assesses five cognitive avoidance strategies: Thought Substitution, the Transformation of Images into Thoughts, Distraction, Avoidance of Threatening Stimuli, and Thought Suppression. The CAQ was administered to 456 students at Concordia University in Montreal. The CAQ total scale and subscales demonstrated good to excellent internal consistency and good test-retest reliability. A confirmatory factor analysis supported the five-subscale structure, though the model's goodness-of-fit was lower than expected. Finally, the CAQ showed convergent validity with measures of worry, thought suppression, information-avoidant coping in controllable situations, and information-seeking coping in uncontrollable situations. The CAQ also demonstrated divergent validity, showing negative correlations with information-seeking in controllable situations. Subsequently, Study 2 examined whether two worry-related processes, negative beliefs about worry and the fear of anxiety, may be contributing to cognitive avoidance in worry. A total of 259 students participated in this study. In hierarchical multiple regression analyses, negative beliefs about worry and the fear of somatic symptoms of anxiety, rather than the fear of losing control over anxiety, were found to predict cognitive avoidance. All process measures were significantly correlated with worry. Negative beliefs about intrusive thoughts, the fear of the anxiety symptoms, and cognitive avoidance showed stronger relationships with catastrophic worry than with generalized worry

Providing Feedback Following Leadership Walkrounds is Associated with Better Patient Safety Culture, Higher Employee Engagement and Lower Burnout

Background There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. Methods This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. Results 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70). Conclusion This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent

The contribution of TRPC1, TRPC3, TRPC5 and TRPC6 to touch and hearing

Transient receptor potential channels have diverse roles in mechanosensation. Evidence is accumulating that members of the canonical subfamily of TRP channels (TRPC) are involved in touch and hearing. Characteristic features of TRP channels include their high structural homology and their propensity to form heteromeric complexes which suggests potential functional redundancy. We previously showed that TRPC3 and TRPC6 double knockout animals have deficits in light touch and hearing whilst single knockouts were apparently normal. We have extended these studies to analyse deficits in global quadruple TRPC1, 3, 5 and 6 null mutant mice. We examined both touch and hearing in behavioural and electrophysiological assays, and provide evidence that the quadruple knockout mice have larger deficits than the TRPC3 TRPC6 double knockouts. Mechano-electrical transducer currents of cochlear outer hair cells were however normal. This suggests that TRPC1, TRPC3, TRPC5 and TRPC6 channels contribute to cutaneous and auditory mechanosensation in a combinatorial manner, but have no direct role in cochlear mechanotransduction

A new look at an old well-being construct: evaluating the psychometric properties of 9, 5, and 1-item versions of emotional exhaustion metrics

ObjectiveTo compare the relative strengths (psychometric and convergent validity) of four emotional exhaustion (EE) measures: 9- and 5-item scales and two 1-item metrics.Patients and methodsThis was a national cross-sectional survey study of 1409 US physicians in 2013. Psychometric properties were compared using Cronbach’s alpha, Confirmatory Factor Analysis (CFA), Exploratory Factor Analysis (EFA), and Spearman’s Correlations. Convergent validity with subjective happiness (SHS), depression (CES-D10), work-life integration (WLI), and intention to leave current position (ITL) was assessed using Spearman’s Correlations and Fisher’s R-to-Z.ResultsThe 5-item EE scale correlated highly with the 9-item scale (Spearman’s rho = 0.828), demonstrated excellent internal reliability (alpha = 0.87), and relative to the 9-item, exhibited superior CFA model fit (RMSEA = 0.082, CFI = 0.986, TLI = 0.972). The 5-item EE scale correlated as highly as the 9-item scale with SHS, CES-D10, and WLI, and significantly stronger than the 9-item scale to ITL. Both 1-item EE metrics had significantly weaker correlation with SHS, CES-D10, WLI, and ITL (Fisher’s R-to-Z; p < 0.05) than the 5- and 9-item EE scales.ConclusionThe 5-item EE scale was repeatedly found equivalent or superior to the 9-item version across analyses, particularly with respect to the CFA results. As there is no cost to using the briefer 5-item EE scale, the burden on respondents is smaller, and widespread access to administering and interpreting an excellent wellbeing metric is enhanced at a critical time in global wellbeing research. The single item EE metrics exhibited lower convergent validity than the 5- and 9-item scales, but are acceptable for detecting a signal of EE when using a validated EE scale is not feasible. Replication of psychometrics and open-access benchmarking results for use of the 5-tem EE scale further enhance access and utility of this metric

The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey

ImportanceEmotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE.ObjectivesTo examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE.Design, setting, and participantsA large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded.Main outcomes and measuresThe frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles.ResultsFor the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ≥20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use.ConclusionFive linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE’s etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics

Assessing the Relationship between Sources of Stress and Symptom Changes among Persons with IBD over Time: A Prospective Study

Objective. To describe the sources of stress for persons with IBD and changes with changes in symptoms. Methods. 487 participants were recruited from a population-based IBD registry. Stress was measured at study entry and three months later, using a general stress measure and the Sources of Stress Scale. Four symptom pattern groups were identified: persistently inactive, persistently active, inactive to active, and active to inactive. Results. General stress levels were stable within each symptom pattern group over the three-month period, even for those with changing symptom activity. The persistently active group had higher general stress at month 0 and month 3 than the persistently inactive group and higher mean ratings of most sources of stress. IBD was rated as a highly frequent source of stress by 20-30% of the persistently active group compared to 1-2% of the inactive group. Finances, work, and family were rated as high frequency stresses in the persistently active group at a similar level to IBD stress. In the groups with fluctuating symptoms, there was little change in stress ratings with changes in symptom activity. Conclusion. Stress was experienced across several domains in addition to stress related to IBD. Persons with active symptoms may benefit from targeted stress interventions

TRPC3 and TRPC6 are essential for normal mechanotransduction in subsets of sensory neurons and cochlear hair cells

Transient receptor potential (TRP) channels TRPC3 and TRPC6 are expressed in both sensory neurons and cochlear hair cells. Deletion of TRPC3 or TRPC6 in mice caused no behavioural phenotype, although loss of TRPC3 caused a shift of rapidly adapting (RA) mechanosensitive currents to intermediate-adapting currents in dorsal root ganglion sensory neurons. Deletion of both TRPC3 and TRPC6 caused deficits in light touch and silenced half of small-diameter sensory neurons expressing mechanically activated RA currents. Double TRPC3/TRPC6 knock-out mice also showed hearing impairment, vestibular deficits and defective auditory brain stem responses to high-frequency sounds. Basal, but not apical, cochlear outer hair cells lost more than 75 per cent of their responses to mechanical stimulation. FM1-43-sensitive mechanically gated currents were induced when TRPC3 and TRPC6 were co-expressed in sensory neuron cell lines. TRPC3 and TRPC6 are thus required for the normal function of cells involved in touch and hearing, and are potential components of mechanotransducing complexes

The Primary PE and School Sport Premium

Central to London’s successful bid to host the 2012 Olympic and Paralympic Games, was the Government’s commitment to improve competitive sport and the sporting habits of young people (Ofsted, 2014). On the 12th March 2013, the then Prime Minister, David Cameron, announced that Primary Schools in England would receive funding worth £150 million per year to create a sustainable infrastructure for long-lasting change and improve the provision of physical education (PE) and sport across all state maintained primary schools. Speaking at the time, he said: ‘We can create a culture in our schools that encourages all children to be active and enjoy sport.’ He added: ‘The Olympic and Paralympic Games marked an incredible year for this country and I will always be proud that we showed the world what Britain can do. I want to ensure the Games count for the future too and that means capitalising on the inspiration young people took from what they saw during those summer months.’: https://www.bbc.co.uk/sport/21808982 Six years on, and with a total investment now of over £1.2 billion, the Primary PE and Sport Premium (here onwards referred to as the PESS Premium) has been a defining feature of the London 2012 legacy. Invariably funding streams at this level do not last forever or in the same format, which raises significant questions about what impact the funding has had on young people since 2013. We believe that a significant investment from Government merits debate and accountability at the highest possible level and that it should acknowledge where the opportunities and shortcomings of such a policy have left us. During the years of austerity, mounting concerns have arisen over the present and long term state of children’s health and the need for the debate to be heard is now imperative. To date there has been little critical appraisal of the PESS Premium funding. This report aims to begin a necessary process and in doing so, brings together evidence from across the sector to consider the future of the PESS Premium post 2018. During the course of the report, we outline and underpin the holistic value and importance of PE for every child. We examine the historic status and funding of PE and Sport and the nature and increasing diversity of the workforce. How has the PESS Premium funding impacted the way in which the subject is regarded and the ability of those tasked with delivering it to discharge their responsibilities? We have uncovered an abiding uncertainty about the nature of the PESS Premium itself; the ways in which it may be spent and its effect on an increasing divide between PE specialists, generalists and externally contracted coaches. Will its legacy be to have established a secure foundation for lifelong physical activity, sport and education – or is it, in effect, another temporarily seductive mirage, leaving PE precisely where it has become accustomed to be; regularly sidelined, delivered largely by those who are not qualified teachers and perpetuating the status quo for the children who already belong to groups that are perceived to be at a disadvantage? The PESS Premium funding is a significant sum and these questions deserve answers. This report is therefore our contribution to an essential debate, containing practical suggestions that we hope will be of use to policy makers. We invite all who care about the physical and mental health and emotional wellbeing of children to join the discussion