Improving Clinician Wellbeing in Mental Health Care

Mental health issues among children and youth have steadily been on the rise in Canada. One of the ways that the Provincial Government of British Columbia addresses this issue is by employing mental health clinicians (MHCs) on various community mental health teams across the province. It is well established in the literature that community MHCs experience considerably high levels of occupational stress (OS) in their therapeutic roles (O’Connor et al., 2018). Chronic exposure to OS makes MHCs vulnerable to the compassion fatigue and burnout, which are considered occupational hazards (OHs) of mental health care (Bride et al., 2007; O’Connor et al., 2018). This organizational improvement plan (OIP) addresses the problem that MHCs at Strong Communities (SC), are insufficiently practicing stress-reducing behaviours, proportionate to the OS-levels that are typical in the field. This problem, and the vision for change, were explored through the lenses of critical theory and servant leadership. Organizational change readiness was assessed, and the Wellbeing Workout (WW) (Hughes et al., 2019) was chosen as the solution to the Problem of Practice. A change implementation plan was created to operationalize the WW as a team-based change initiative. This OIP is influenced by my position as an informal leader and a front-line MHC. I utilize Kouzes and Posner’s (2017) Five Practices of Exemplary Leadership, and manage change using Change Path Model (Deszca et al., 2020) and Prochaska and DiClemente’s (2005) Stages of Change model. The change initiative is evaluated using three Plan, Do, Study, Act cycles (Deming, 1994/2018). Although the primary goal of this change initiative will be to reduce OS and OHs for MHCs, the long-term ambition of the plan is for SC to be re-conceptualized as a vicarious trauma-informed organization

Improving the Measurement of the Reinforcement Sensitivity Theory in Alcohol Misuse: Evidence from a New Laboratory Task

Gray’s revised Reinforcement Sensitivity Theory (RST) posits that the behavioural inhibition system (BIS) resolves motivational conflict by allocating resources for approach (behavioural activation system [BAS]) or avoidance (Fight/Flight/Freeze System [FFFS]). Persons with a strong BIS over-attend to threat, leading to elevated anxiety and behavioural ambivalence. The role of elevated BIS in alcohol use is complex, as anxiety may promote self-medication drinking, while attention to threat may be a protective factor. Theory and recent data suggests that a concurrent strong BAS makes the anxiolytic effects of alcohol more salient, biasing BIS conflict towards drinking. Existing laboratory tasks do not measure BIS as a conflict system and therefore, examinations of the complex interplay between the BIS and BAS for understanding alcohol use are limited. This study tested a new laboratory task [Motivational Flanker Task (MFT)] that better reflects the revised BIS and FFFS and used this new measure to test BAS as a moderator of the BIS-alcohol misuse relation. Undergraduates (N=150) completed self-reports of BAS/BIS/FFFS, and alcohol misuse, and completed the MFT and the Point Scoring Reaction Time Task (PSRTT). Results indicated that MFT measurement of BIS motivational conflict was consistent with self-report and PSRTT measures. MFT measurement of BAS (reward responsivity), but not FFFS (punishment sensitivity) was consistent with self-report measures. An elevated BIS was linked to alcohol misuse, but only at high BAS. These results demonstrate that the MFT is a promising measure of the revised BIS. Further, considering the joint effects of BIS and BAS clarified risk for alcohol misuse

Clarifying the revised Behavioural Inhibition System as a Risk Factor for Anxiety-Related Alcohol Misuse in Young Adulthood: New Insights from Experimental and Prospective Studies

ABSTRACT Clarifying the revised Behavioural Inhibition System as a Risk Factor for Anxiety-Related Alcohol Misuse in Young Adulthood: New Insights from Experimental and Prospective Studies Matthew Keough, Ph.D. Concordia University, 2016 Theoretical models posit that anxious persons drink alcohol to self-medicate negative emotions. However, existing data suggest that the anxiety pathway is complex. While there is high comorbidity of anxiety and alcohol use disorders in adults, evidence earlier in the risk trajectory (in young adulthood) is highly mixed. Gray’s Reinforcement Sensitivity Theory (RST) provides a useful framework for clarifying the anxiety-drinking pathway in young adults. The RST implicates the behavioural inhibition system (BIS) as a risk factor for alcohol misuse. Important theoretical revisions were made to the BIS 15 years ago, but these changes have been slow to enter the empirical literature. The revised BIS is a motivational conflict system. In response to competing goals (e.g., reward vs. punishment), the revised BIS inhibits behaviour, giving rise to high anxiety, attention to threat, and behavioural ambivalence. Accordingly, BIS-anxiety may promote self-medication drinking, while sensitivity to motivational conflict may lead to indecisiveness about drinking and attention to threat. Theory suggests that a strong Behavioural Approach System (BAS) should enhance the anxiolytic effects of alcohol use, which should be salient to those high in the BIS. However, few studies have been able to examine these interactive effects since most work has not tested the predictions of the revised RST. Using experimental (Study 1) and prospective (Study 2) studies, the primary aim of this dissertation was to clarify the BIS-related pathway to alcohol misuse among young adults. Study 1 (N = 110) was an experimental design that aimed to examine the cognitive mechanisms of this pathway. Results demonstrated that individuals with a strong BIS and a strong BAS expected elevated positive mood (rather than reduced anxiety) in response to an alcohol cue when feeling anxious. Study 2 (N = 119) sought to examine the BAS as a moderator of BIS-risk for alcohol misuse during the transition out of university. Findings indicated that those high in the BIS showed impeded maturing out of alcohol misuse during this transition if they were also strong in BAS impulsivity. Conversely, young adults with a strong BIS rapidly reduced alcohol misuse if they were concurrently low in BAS impulsivity. Overall, the moderating role of the BAS clarified BIS-risk for alcohol misuse. Findings shed light on the cognitive mechanisms underlying BIS-related drinking and provide a first look on how the BIS and the BAS interact to set the stage for long-term alcohol problems in young adulthood

MIUS integration and subsystems test program

The MIUS Integration and Subsystems Test (MIST) facility at the Lyndon B. Johnson Space Center was completed and ready in May 1974 for conducting specific tests in direct support of the Modular Integrated Utility System (MIUS). A series of subsystems and integrated tests was conducted since that time, culminating in a series of 24-hour dynamic tests to further demonstrate the capabilities of the MIUS Program concepts to meet typical utility load profiles for a residential area. Results of the MIST Program are presented which achieved demonstrated plant thermal efficiencies ranging from 57 to 65 percent

Live and recorded group music interventions with active participation for people with dementias: a systematic review

Background: This literature review examined the existing evidence base for the impact of both live and recorded music interventions involving active participation in a dementia population. Methodology: PsycINFO, Medline, CINAHL, Web of Science, PubMed and Cochrane Library were searched and 15 studies met inclusion criteria. Results: There was a positive impact on behavioural and psychological symptoms, quality of life, communication and some aspects of cognitive function; methodological limitations, however, make it difficult to offer firm conclusions. Interventions using recorded music resulted in more consistent positive behavioural and psychological outcomes, whereas interventions using live music reported a benefit to communication and relationships. Conclusions: Although live and recorded music showed benefits, and should be considered in dementia care, the use of different outcome measures made definitive comparisons problematic. In order to better understand mechanisms of change, one future research area should explore how group music interventions affect communication by more closely assessing processes during live and recorded music

Solitary drinking is associated with specific alcohol problems in emerging adults

Hazardous drinking in emerging adulthood is associated with multiple domains of alcohol problems, which range in type and severity. Alcohol problems at the severe end of the spectrum (e.g., impaired control) may be early warning signs of alcohol use disorders (AUDs) among emerging adults. However, given the emphasis in the literature on predictors of overall problem risk, we still know very little about predictors of these specific (and severe) domains of alcohol problems in emerging adults. Many emerging adults drink at social events (e.g., parties), but an estimated 15% engage in solitary drinking. Solitary drinking – a developmentally atypical behavior in emerging adulthood – may be especially risky. Data suggests that frequent solitary drinking may reflect a loss of control over drinking, leading to hazardous use and subsequent problems. Accordingly, we expected that frequent solitary drinking among emerging adults would predict severe alcohol problems that map onto diagnostic criteria for AUDs and these effects would be mediated by hazardous alcohol use. Undergraduates (N = 118) completed self-report measures as a part of a larger study on motivation and alcohol use. As predicted, path analysis showed that solitary drinking positively predicted hazardous alcohol use, and this in turn predicted severe alcohol problems associated with diagnostic criteria for AUDs, particularly risky behaviors and blackout drinking. Solitary drinking also positively predicted less severe problems of diminished self-perception and poor self-care through hazardous use. Though comparatively smaller, some indirect effects were observed from social drinking (at parties, but not at bars) to alcohol problems, via hazardous alcohol use. Overall, our results suggest that solitary drinking is particularly harmful in emerging adulthood

Chapter 18. DAYCENT Simulated Effects of Land Use and Climate on County Level N Loss Vectors in the USA

We describe the nitrogen (N) gas (NH3, NOx, N2O, N2) emission and NO3 leaching submodels used in the DAYCENT ecosystem model and demonstrate the ability of DAYCENT to simulate observed N2O emission and NO3 leaching rates for various sites representing different climate regimes, soil types, and land uses. DAYCENT simulated seven major crops, grazing lands, and potential native vegetation at the county level for the United States. At the national scale, NO3 leaching was the major loss vector, accounting for 86%, 66%, and 56% of total N losses for cropped soils, grazed lands, and native vegetation, respectively. NH3 volatilization + NOx emissions made up the majority of national N gas losses, accounting for 58%, 89%, and 86% of N gas losses from cropped soils, grazed lands, and native vegetation, respectively. However, there was considerable spatial variability in the N loss vectors, with leaching accounting for less than 20% of total N losses and NOx + NH3 emissions accounting for less than 50% of N gas losses in some counties. Land use area weighted mean annual N losses were 43.9 (SD = 26.8) and 12.3 (SD = 22.2)kg N/ha for cropped/grazed and native systems, respectively. Area weighted mean annual N gas losses were 11.8 (SD = 4.8) and 5.4 (SD = 2.1)kg N/ha for cropped/grazed and native systems, respectively. Total N losses and NO3 leaching tended to increase as N inputs and precipitation increased, and as soils became coarser textured. Total N gas losses also increased with N inputs and as soils became coarser textured, but N2O and N2 made up a larger portion of N gas losses as soils became finer textured and as precipitation increased

Young adult concurrent use and simultaneous use of alcohol and marijuana: A cross-national examination among college students in seven countries

Introduction: Many young adults report frequent co-use of alcohol and marijuana, with some individuals engaging in simultaneous use (SAM; use of both substances within the same occasion resulting in an overlap of their effects) and others in concurrent use (CAM; use of both substances during a similar time period [e.g., past 30 days] but not within the same occasion). Emerging work demonstrates that SAM relative to CAM use places individuals at a greater risk for substance-related harms; however, these results primarily rely on U.S. samples. The goal of the present multi-country study was to examine prevalence rates of CAM and SAM use and examine differences in past 30-day SAM/CAM use on alcohol/marijuana substance-related outcomes among college students from seven countries. Methods: A total of 9171 (70.5% women; Mean age = 20.28, SD = 3.96) college students participated in the cross-sectional online survey study. Results: Among students who endorsed use of both alcohol and marijuana in the past 30-days (n = 2124), SAM use (75.8%) was far more prevalent than CAM use (24.2%). Moreover, ∼75% of students endorsed SAM use within each country subsample. Regression models showed that SAM vs. CAM use was associated with greater alcohol and marijuana use and negative consequences. Conclusions: College students from around the world endorse high rates of SAM use, and this pattern of co-use is associated with greater frequency of use and substance-related harms. On college campuses, SAM use should be a target of clinical prevention/intervention efforts and the mechanisms underpinning the unique harms of SAM need to be clarified.Fil: Bravo, Adrian J.. College of William and Mary; Estados UnidosFil: Prince, Mark A.. State University of Colorado at Boulder; Estados UnidosFil: Pilatti, Angelina. Universidad Nacional de Córdoba. Instituto de Investigaciones Psicológicas. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones Psicológicas; ArgentinaFil: Mezquita, Laura. Universitat Jaume I; EspañaFil: Keough, Matthew T.. University of York; Reino UnidoFil: Hogarth, Lee. University of Exeter; Reino Unid

Examining co-patterns of depression and alcohol misuse in emerging adults following university graduation

Depression and alcohol use disorders are highly comorbid. Typically, alcohol use peaks in emerging adulthood (e.g., during university), and many people also develop depression at this time. Self-medication theory predicts that depressed emerging adults drink to reduce negative emotions. While research shows that depression predicts alcohol use and related problems in undergraduates, far less is known about the continuity of this association after university. Most emerging adults “mature out” of heavy drinking; however, some do not and go on to develop an alcohol use disorder. Depressed emerging adults may continue to drink heavily to cope with the stressful (e.g., remaining unemployed) transition out of university. Accordingly, using parallel process latent class growth modelling, we aimed to distinguish high- from low-risk groups of individuals based on joint patterns of depression and alcohol misuse following university graduation. Participants (N = 123) completed self-reports at three-month intervals for the year post-graduation. Results supported four classes: class 1: low stable depression and low decreasing alcohol misuse (n = 52), class 2: moderate stable depression and moderate stable alcohol misuse (n = 35), class 3: high stable depression and low stable alcohol misuse (n = 29), and class 4: high stable depression and high stable alcohol misuse (n = 8). Our findings show that the co-development of depression and alcohol misuse after university is not uniform. Most emerging adults in our sample continued to struggle with significant depressive symptoms after university, though only two classes continued to drink at moderate (class 2) and high (class 4) risk levels