BACKGROUND: Disparities in access to quality chronic pain treatment options disproportionately affect minorities. Although there is increasing evidence about the effectiveness of complementary and integrative medicine (CIM) to help in the treatment of pain, little is known about how low income minorities would benefit from having greater access to CIM. The Integrative Medical Group Visit (IMGV) model incorporates CIM in a medical group visit setting with the goal of increasing access to CIM. OBJECTIVE: The aims of this pilot study were to test 1) the feasibility of a Spanish language IMGV and 2) its effectiveness to reduce pain and improve function in Spanish speakers with chronic pain. METHODS: The study setting is the Family Medicine Clinic at Boston Medical Center. Adult Spanish speakers with chronic pain for at least 12 weeks were included; those pregnant, with psychosis, suicidal ideation or active substance abuse disorder were excluded. The intervention consisted of weekly, two-hour sessions for a total of 9 weeks. Main outcomes were pain level, pain interference, and physical and emotional function measured by the PROMIS 29 pre- and post-intervention, depression and stress, measured by PHQ-8 and PSS-10, respectively. Focus group participants discussed the feasibility of the intervention. Analyses involved t-tests to examine our outcome data, and qualitative thematic analysis for focus group data. RESULTS: This open study recruited 11 subjects, 10 women, average age of 51.9 years; 50% of participants attended more than four sessions. The outcomes showed a trend toward reduced depression, pain, fatigue, and anxiety. Qualitative themes of reduced pain, increased knowledge for healthier living, and improved access to pain treatment using an appropriately adapted intervention were found. CONCLUSIONS: It was feasible to implement the Latino IMGV model in the outpatient setting at BMC. Trends in reduction of pain and depression, as well as increased knowledge for healthier living and better access to CIM modalities were found. Future powered studies are needed to further implement this model.

This study investigates the concurrent and predictive validity of Power Management (PM), a newly developed online integrative therapeutic assessment. PM consists of a self-report personality inventory, the Relational Modality Evaluation Scale (RMES), a series of self-guided narrative prompts, and a detailed follow-up score-report. The study had three aims: (1) to evaluate the convergent validity of the RMES in relation to the Big Five Inventory-10 (BFI-10) and the Inventory of Interpersonal Problems Short-Circumplex (IIP-SC), (2) to investigate the test re-test reliability of the RMES, and (3) to investigate the therapeutic benefits of PM by comparing it with narrative and mindfulness self-guided interventions over time, on outcome measures evaluating affect, insight, psychopathology, well-being, self-esteem, ability to change, and personal relevance. Aim 3 was investigated using a short-term longitudinal design, in which outcome measures were administered at baseline (before interventions), immediately following interventions (post), and two weeks later (follow-up). The sample was recruited online through Mechanical Turk and at baseline included 82 men and 101 women, mean age = 35.82 years (SD = 9.61). Participants were randomly assigned to one of three interventions: PM (42 men, 56 women), narrative writing (26 men, 25 women), and mindfulness (14 men, 20 women). For Aim 1, partial correlations, controlling for demographics, identified statistically significant relationships between RMES, BFI-10, and IIP-SC subscales predicting personality constructs with high agency and high affiliation, high agency and low affiliation, low agency and high affiliation, low agency and low affiliation, as well as psychopathology. For Aim 2, The RMES showed strong test re-test reliability over a two-week period (r = .84, p < .000). For Aim 3, mixed-model repeated-measures ANOVAs indicated that the PM group had statistically significantly higher scores on outcome measures reflecting increased psychological well-being, insight, and motivation for change compared to the other groups. Scores improved between baseline and post for most psychotherapy outcome constructs across interventions. Gender mostly did not moderate results. Results suggest that PM is a promising therapeutic assessment worthy of further investigation. Mindfulness and narrative writing also showed evidence of effectiveness as delivered in an online format.

The concept of social axiom represents generalized beliefs regarding individuals, agencies and other social institutions, and the spiritual world. The relationship between social axioms and social and mental well-being has not been widely investigated. The aim of this research is to consider the role of culture in four distinct areas of study: 1) The role of social axioms and their dimensions in predicting mental well-being (subjective and psychological well-being) as well as the mechanism of the relationship between social axioms and well-being through controlling the variables of Iranian and UK students and the big five personality factors. 2) The mediation role of mindfulness and perspective taking. 3) The scope of influence of one's attachment to national or ethnic identity on well-being. 4) The understanding of the participants of various social beliefs, especially of the concept of divine providence and its impact on one's well-being. As method, the first three goals were addressed by correlational studies while the fourth goal was investigated using grounded theory. The research sample for the first study consisted of 73 Iranian students (37 females and 36 males) residing in Iran and 66 students (45 females and 21 males) living in the UK. The sample for the second study included 72 Iranian students (34 females and 38 males) who reside in Iran, and in the third study the sample was composed of 66 Iranians (35 females and 31 males) who live in the UK. In the qualitative research (fourth study), the participants were 14 Iranians living in the UK for at least 3 years (4 male and 10 female). Instruments used were the Social Axiom Survey (SAS; Leung et al., 2002), Big Five Inventory (BFI; John, Donahue, & Kentle, 1991; John & Srivastava, 1999), Psychological Well-Being Scale (Ryff, 1989), Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), Positive and Negative Affect Scale (Mroczek & Kolarz, 1998), the perspective taking subscale of the Empathy Questionnaire (Davis, 1980), the acceptance subscale of the Philadelphia Mindfulness Scale (Cardaciotto et al., 2008), Paullhus's Balanced Inventory of Desirable Responding (BIDR; Paulhus, 1984), and the Multigroup Ethnic Identity Measure-Revised (MEIM-R; Phinney & Ong, 2007). In the qualitative research, a structured interview was used. Results show that: 1) In both samples of students who live in the UK and in Iran iv social cynicism and fate control are related with well-being. Also, in the Iranian case reward for application, social complexity, and religiosity have significant relationships with well-being but in the UK based students this is not the case. Results also showed that social axioms can predict well-being over and above the role of country and personality traits. 2) The mediation role of mindful acceptance was not endorsed in the relationship between social cynicism and subjective well-being. It was found that the predictor (social cynicism) and the mediator (mindful acceptance) were not significantly correlated with the outcome (subjective well-being). However, the mediation role of perspective taking in the relationship between social complexity and psychological well-being was endorsed. 3) The moderation role of attachment to national identity in the relationship between social axioms and subjective well-being was endorsed. 4) The qualitative study indicated that Iranian immigrants have an indigenous strategy for attaining mental well-being in the face of complications and difficulties, relying on their national identity and religious background. This strategy is based on the concepts of free will and predestination of life events. Paying attention to negative events and ignoring positive events and inefficient problem-solving strategies can account for the relationship between social cynicism and low well-being and inattention to cultural elements. However, the Iranian collective culture, optimal coping style, and excessive insistence on religious elements as a cultural attribute can explain the relationship between religiosity, reward for application, and well-being in the Iranian sample. On the other hand, surrendering to divine will and the belief in divine will and predestination of life events along with the belief in human free will account for the role of attachment to national identity in the relationship between social axioms and well-being in the Iranian sample. In conclusion, it seems that though social axioms are related to well-being, different aspects of social axioms seem to be related to different aspects of well-being in different ways and this relationship is influenced by cultural attributes.

Dissertação apresentada ao Programa de Pós-Graduação em Saúde Coletiva (Mestrado Profissional) da Universidade do Extremo Sul Catarinense, para obtenção do Título de Mestre em Saúde Coletiva. / No Brasil, as Diretrizes da Política Nacional de Práticas Integrativas Complementares (PNPIC) recomendam a implementação da meditação no Sistema Único de Saúde (SUS), visando corroborar com a integralidade da atenção à saúde pela oferta de ações com diversas abordagens. Programas de mindfulness, ampliando os cuidados convencionais no manejo das cefaleias, especialmente na atenção básica na qual as queixas são particularmente comuns, poderiam impactar beneficamente, considerando o custo pessoal e econômico do tratamento tradicional, seus potenciais efeitos colaterais e, por vezes, sua ineficiência na resolução das crises altamente incapacitantes. O incentivo da PNPIC com vistas a subsidiar essas práticas no SUS, assim como estudos conflitantes frente à efetividade dessas intervenções nas cefaleias, justificam a busca de evidências relativas ao tema. Este estudo objetivou investigar a efetividade das práticas do mindfulness sobre características das cefaleias, sintomas associados, ansiedade, depressão, estresse e manejo da dor, por meio de revisão sistemática e metanálise de ensaios clínicos na literatura. A estratégia de busca ocorreu por meio de pesquisa exaustiva nas bases Medline, Embase, PsycINFO (e correlatas), incluindo a Literatura Cinza, em julho de 2017. Os descritores utilizados incluíram os termos: “mindfulness”, “headache”, e sinônimos do Medical Subject Headings. A metanálise foi desenvolvida nos softwares R 3.4.3 e Review Manager 5.3, e a qualidade dos estudos avaliada pelo checklist da Cochrane. Foram incluídos na metanálise 9 estudos, sendo os protocolos mais utilizados o Mindfulnes-Based Cognitive Therapy e o Mindfulness-Based Stress Reduction. Nos desfechos primários, a metanálise apontou tamanhos de efeito para a intensidade da dor: SMD= -1,02 (IC 95%: -2,08-0,05; I2=93%); incapacidade gerada pelas crises: SMD= -0,90 (IC 95%: -2,22-0,43; I2=91%); duração das crises: SMD= -0,16 (IC 95%: -0,70-0,38; I2=40%) e frequência das crises: SMD= -0,09 (IC 95%: -0,42-0,25; I2=0%). Nos desfechos secundários relativos ao manejo da dor, quanto à autoeficácia: SMD=0,63 (IC 95%: -0,536-1,14; I2=82%); catastrofização da dor: SMD- -0,29 (IC 95%: -1,70-1,13; I2=83%) e aceitação da dor: SMD= 0,05 (IC 95%: -1,02 - 1,11; I2=72%). Desfechos secundários relativos à ansiedade, estresse e depressão mostraram: SMD= -0,71 (IC 95%: -1,8811-0,46; I2=85%), SMD= -0,58 (IC 95%: -2,097-0,935; I2=88%) e SMD= -0,12 (IC 95%: -1,3162-1,076; I2=72%), respectivamente. Resultados sugerem que a direção do efeito favorece as intervenções baseadas em mindfulness, considerando o tamanho de efeito e tendência a significância estatística quanto à intensidade da dor (p=0,06). Contudo, a heterogeneidade entre os estudos nesse, e na maioria dos desfechos, assim como a ausência de significância estatística nos demais, o reduzido número de estudos incluídos em algumas análises, além da reduzida qualidade dos mesmos, impõe cautela em sua interpretação. Tendo em vista a implementação de práticas complementares no SUS que corroboram com a integralidade da atenção à saúde, esse estudo, ao indicar alguma direcionalidade de efeito dos programas de mindfulness sobre características das cefaleias, e o descrito empoderamento dos usuários alterando a forma como esses reagem à experiência da dor, alerta para a importância de aprofundamento desse tema emergente através de ampliação dos ensaios clínicos de elevada qualidade. É provável que pesquisas adicionais tenham um impacto importante na estimativa do efeito e possam alterar essa estimativa.

Traumatic incidences happen all around the globe. Some of the people who experience trauma develop post-traumatic stress disorder (PTSD), while some do not. Even more interesting is that some also experience growth afterwards (post-traumatic growth; PTG). The purpose of this paper is to look at neural aspects of why some people develop PTSD and others PTG after a traumatic event. To fulfill the aim, both PTSD and PTG will be reviewed to create an image of the existing research in behavioral and neurological terms. In addition to looking at the constructs separately, a chapter will also look at studies where both PTSD and PTG are acknowledged collaterally in participants. When looking deeper into the theories of PTSD divisions occur, and more research is needed to establish the most prominent explanation of PTSD. PTG on the other hand has only been studied for a short period of time but yields important insights into trauma-related outcomes. These fields need to be submerged and new multidisciplinary definitions are needed for future research. The key to PTSD is suggested to emerge within the new field.

The current study utilized an early-stage translational approach (Tashiro & Mortensen, 2006) to empirically test the immediate effect of a 15-minute mindfulness intervention on acute pain experience. The study employed a three-group, repeated measures experimental design with two active control conditions (sham mindfulness and attention control) and an analogue pain induction procedure (cold-pressor test). The sample consisted of 165 university students. Repeated measures analyses found an interaction effect between condition and time for subjective pain intensity and an interaction effect between gender and time for pain tolerance. Trends show that attention control increased pain intensity, whereas mindfulness decreased pain intensity. Females exhibited greater pain tolerance at post-intervention across conditions. Analyses yielded no significant differences between conditions among dependent variables of pain tolerance, state affect, or state anxiety. A moderate relationship was found between fear of pain and pain tolerance at pre-intervention, but failed to significantly moderate outcome in main analyses. Post-hoc analyses revealed a subset of "high pain tolerant" participants, who endorsed significantly higher trait mindfulness, lower fear of pain, and lower pain catastrophizing compared to the remainder of participants. Negative affect was related to increased pain intensity within the attention control condition. Suggestions for future research and clinical implications of research in this area are discussed.

Mindfulness, characterized with present-moment awareness, non-judgment, and non-reactivity, has demonstrated its potential in contemporary counseling psychology as a cultivatable coping mechanism for healing against negative emotions and symptomology. Researchers have identified health benefits for those who possess higher levels of this trait without practice. Limited research has explored the potential benefits of mindfulness in contributing to the cultivation of adaptive career decision-making. In particular, there is no study investigating the the role of mindfulness on college students' coping with career indecision stemming from emotional and personality concerns, or its influence on their occupational engagement. This study was a survey-based investigation of the relations among dispositional mindfulness, occupational engagement, and emotional career indecision in a diverse sample of college participants (N = 166). The results from analysis indicate that dispositional mindfulness is significantly related to emotional career indecision and occupational engagement, with multiple facets of mindfulness contributing a significant amount of variance in emotional career indecision. Future research and clinical implications are also discussed.

Use of restraint during crisis intervention is of great concern as these situations evoke stress responses in the direct care staff that respond to them. This stress response often leads to non- neutral reactions. Acceptance and Commitment Therapy (ACT) has been used to effectively de- literalize task-related stimuli in individuals that share similar physiological symptoms of stress to those that direct care staff might experience during crisis. The purpose of this study was to evaluate how an ACT intervention would improve direct care staff performance during crisis interventions and increase accuracy of incident report writing. Results indicated that four out of the six participants improved their performance following ACT training, while the most improvement was observed in accuracy in incident report writing. This study expands upon the limited research available on the utility of ACT in the workplace. Implications of this study suggest that ACT may be a beneficial intervention to increase staff performance during crisis.

The present study extends previous research on acceptance and commitment therapy (ACT) by using a new ACT protocol, the Fusion Management System (Dixon, 2013 in press) with a new population. Participants were 2 high functioning children with autism: an 8-year old boy and a 12 year-old girl. Using a multiple baseline design, 2 participants were exposed to 15 hours of therapy over the span of 12 weeks. Behavioral data was taken for each participant by their parent(s) on a problematic behavior that was of concern to them. Prior to and following the ACT intervention, both participants took three psychometric measures that were designed to measure ACT related processes: the Child and Adolescent Mindfulness Measure (CAMM), the Acceptance and Action Questionnaire-II (AAQ-II), and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Following the intervention one participant improved on all measures of the ACT related processes and the other participant's score improved on the AFQ-Y and slightly deteriorated on the CAMM and AAQ-II. During the intervention phase of this study both participants' problematic behavior significantly improved. Implications of the study and future research are also discussed.

Therapist burnout is of primary concern for individuals who provide ABA therapy for those with autism or related disabilities. Prolonged high levels of work-related stress increase the risk of negative interactions and emotional exhaustion among workers. Acceptance and Commitment Therapy (ACT) may alleviate this problem. ACT has been found to decrease levels of perceived work-related stress among direct care staff. The primary purpose of the study was to evaluate whether ACT would improve positive interactions among therapists for children with autism spectrum disorder. The results indicated that the percentage of positive interactions had improved an average of 23.1% and procedural fidelity improved an average of 7% across all three participants. This study extends that of previous research by supporting the efficacy of ACT in work environments. One implication of the current study is that it could benefit the psychological well-being of ABA therapists. Future studies should examine whether ACT-exercises influence the way therapists address challenging behavior as it pertains to the quality of services delivered.