Resilience and coping

فَإِنَّ مَعَ ٱلۡعُسۡرِ يُسۡرًا

So truly where there is hardship there is also ease

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ خُذُواْ حِذۡرَكُمۡ فَٱنفِرُواْ ثُبَاتٍ أَوِ ٱنفِرُواْ جَمِيعࣰ ا

You who believe, be on your guard. March [to battle] in small groups or as one body

بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِ In the Name of Allah, the Most Gracious, the Most Merciful. أَلَمْ نَشْرَحْ لَكَ صَدْرَكَ - وَوَضَعْنَا عَنكَ وِزْرَكَ - الَّذِي أَنقَضَ ظَهْرَكَ - وَرَفَعْنَا لَكَ ذِكْرَكَ - فَإِنَّ مَعَ الْعُسْرِ يُسْرًا - إِنَّ مَعَ الْعُسْرِ يُسْرًا - فَإِذَا فَرَغْتَ فَانصَبْ - وَإِلَىٰ رَبِّكَ فَارْغَب (1. Have We not opened your breast for you?)(2. And removed from you your burden.)(3. Which weighed down your back?)(4. And have We not raised high your fame?)(5. Verily, along with every hardship is relief,)(6. Verily, along with every hardship is relief.)(7. So when you have finished, devote yourself to Allah's worship.)(8. And to your Lord turn intentions and hopes.) The Meaning of opening the Breast Allah says, أَلَمْ نَشْرَحْ لَكَ صَدْرَكَ (Have We not opened your breast for you?) meaning, 'have We not opened your chest for you.' This means, 'We ill

Indeed, with difficulty and constraint, comes ease and options.

O you who believe take your precautions against your enemy that is be wary of him and be vigilant against him; then move forward prepare to fight him in companies in separate groups one raiding party followed by the next; or move forward all together in one assembly.

O you who believe! Take your precautions, and either go forth (on an expedition) in parties, or go forth all together (71)There is certainly among you he who would linger behind. If a misfortune befalls you, he says, "Indeed Allah has favored me in that I was not present among them. (72)But if a bounty comes to you from Allah, he would surely say ـ as if there had never been ties of affection between you and him, "Oh! I wish I had been with them; then I would have achieved a great success. (73)So fight those who trade the life of this world with the Hereafter, in the cause of Allah, and whoever fights in the cause of Allah, and is killed or gets victory, We shall bestow on him a great reward (74) The Necessity of Taking Necessary Precautions Against the Enemy Allah commands His faithful servants to take precautions against their enemies, by being prepared with the necessary weapons and

حَدَّثَنَا هَدَّابُ بْنُ خَالِدٍ، حَدَّثَنَا حَمَّادُ بْنُ سَلَمَةَ، ح وَحَدَّثَنِي زُهَيْرُ بْنُ حَرْبٍ، حَدَّثَنَا مُعَاذُ بْنُ مُعَاذٍ الْعَنْبَرِيُّ، ح وَحَدَّثَنِي مُحَمَّدُ بْنُ عَبْدِ الأَعْلَى، حَدَّثَنَا الْمُعْتَمِرُ، ح وَحَدَّثَنَا إِسْحَاقُ، بْنُ إِبْرَاهِيمَ أَخْبَرَنَا جَرِيرٌ، كُلُّهُمْ عَنْ سُلَيْمَانَ التَّيْمِيِّ، ح وَحَدَّثَنَا أَبُو كَامِلٍ، فُضَيْلُ بْنُ حُسَيْنٍ - وَاللَّفْظُ لَهُ - حَدَّثَنَا يَزِيدُ بْنُ زُرَيْعٍ، حَدَّثَنَا التَّيْمِيُّ، عَنْ أَبِي عُثْمَانَ، عَنْ أُسَامَةَ بْنِ زَيْدٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ قُمْتُ عَلَى بَابِ الْجَنَّةِ فَإِذَا عَامَّةُ مَنْ دَخَلَهَا الْمَسَاكِينُ وَإِذَا أَصْحَابُ الْجَدِّ مَحْبُوسُونَ إِلاَّ أَصْحَابَ النَّارِ فَقَدْ أُمِرَ بِهِمْ إِلَى النَّارِ وَقُمْتُ عَلَى بَابِ النَّارِ فَإِذَا عَامَّةُ مَنْ دَخَلَهَا النِّسَاءُ ‏"‏ ‏.‏

Usama b. Zaid reported that Allah's Messenger (way peace be upon him) said:I stood at the door of Paradise and I found that the overwhelming majority of those who entered therein was that of poor persons and the wealthy persons were detained to get into that. The denizens of Hell were commanded to get into Hell, and I stood upon the door of Fire and the majority amongst them who entered there was that of women

حَدَّثَنَا أَبُو كُرَيْبٍ، حَدَّثَنَا أَبُو أُسَامَةَ، عَنْ سَعِيدِ بْنِ أَبِي عَرُوبَةَ، سَمِعَ أَبَا رَجَاءٍ، عَنِ ابْنِ عَبَّاسٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم فَذَكَرَ مِثْلَهُ ‏.‏

This hadith is narrated likewise through another chain of transmitters

حَدَّثَنِي عَبْدُ اللَّهِ بْنُ مُحَمَّدٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ عَمْرٍو، حَدَّثَنَا زُهَيْرُ بْنُ مُحَمَّدٍ، عَنْ مُحَمَّدِ بْنِ عَمْرِو بْنِ حَلْحَلَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي سَعِيدٍ الْخُدْرِيِّ، وَعَنْ أَبِي هُرَيْرَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ مَا يُصِيبُ الْمُسْلِمَ مِنْ نَصَبٍ وَلاَ وَصَبٍ وَلاَ هَمٍّ وَلاَ حُزْنٍ وَلاَ أَذًى وَلاَ غَمٍّ حَتَّى الشَّوْكَةِ يُشَاكُهَا، إِلاَّ كَفَّرَ اللَّهُ بِهَا مِنْ خَطَايَاهُ ‏"‏‏.‏

Narrated Abu Sa`id Al-Khudri and Abu Huraira:The Prophet (ﷺ) said, "No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that

حَدَّثَنَا إِبْرَاهِيمُ بْنُ الْمُنْذِرِ، قَالَ حَدَّثَنِي مُحَمَّدُ بْنُ فُلَيْحٍ، قَالَ حَدَّثَنِي أَبِي، عَنْ هِلاَلِ بْنِ عَلِيٍّ، مِنْ بَنِي عَامِرِ بْنِ لُؤَىٍّ عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي هُرَيْرَةَ ـ رضى الله عنه ـ قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ مَثَلُ الْمُؤْمِنِ كَمَثَلِ الْخَامَةِ مِنَ الزَّرْعِ مِنْ حَيْثُ أَتَتْهَا الرِّيحُ كَفَأَتْهَا، فَإِذَا اعْتَدَلَتْ تَكَفَّأُ بِالْبَلاَءِ، وَالْفَاجِرُ كَالأَرْزَةِ صَمَّاءَ مُعْتَدِلَةً حَتَّى يَقْصِمَهَا اللَّهُ إِذَا شَاءَ ‏"‏‏.‏

Narrated Abu Huraira:Allah's Messenger (ﷺ) said, "The example of a believer is that of a fresh tender plant; from whatever direction the wind comes, it bends it, but when the wind becomes quiet, it becomes straight again. Similarly, a believer is afflicted with calamities (but he remains patient till Allah removes his difficulties.) And an impious wicked person is like a pine tree which keeps hard and straight till Allah cuts (breaks) it down when He wishes." (See Hadith No. 558, Vol)

حَدَّثَنَا عَبْدُ اللَّهِ بْنُ مَسْلَمَةَ بْنِ قَعْنَبٍ، حَدَّثَنَا سُلَيْمَانُ، - يَعْنِي ابْنَ بِلاَلٍ - عَنْ جَعْفَرٍ، عَنْ أَبِيهِ، عَنْ جَابِرِ بْنِ عَبْدِ اللَّهِ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم مَرَّ بِالسُّوقِ دَاخِلاً مِنْ بَعْضِ الْعَالِيَةِ وَالنَّاسُ كَنَفَتَهُ فَمَرَّ بِجَدْىٍ أَسَكَّ مَيِّتٍ فَتَنَاوَلَهُ فَأَخَذَ بِأُذُنِهِ ثُمَّ قَالَ ‏"‏ أَيُّكُمْ يُحِبُّ أَنَّ هَذَا لَهُ بِدِرْهَمٍ ‏"‏ ‏.‏ فَقَالُوا مَا نُحِبُّ أَنَّهُ لَنَا بِشَىْءٍ وَمَا نَصْنَعُ بِهِ قَالَ ‏"‏ أَتُحِبُّونَ أَنَّهُ لَكُمْ ‏"‏ ‏.‏ قَالُوا وَاللَّهِ لَوْ كَانَ حَيًّا كَانَ عَيْبًا فِيهِ لأَنَّهُ أَسَكُّ فَكَيْفَ وَهُوَ مَيِّتٌ فَقَالَ ‏"‏ فَوَاللَّهِ لَلدُّنْيَا أَهْوَنُ عَلَى اللَّهِ مِنْ هَذَا عَلَيْكُمْ ‏"‏ ‏.‏

Jabir b. Abdullah reported that Allah's Apostle (ﷺ) happened to walk through the bazar coming from the side of 'Aliya and the people were on both his sides. There he found a dead lamb with very short ears. He took hold of his ear and said:Who amongst you would like to have this for a dirham? They said: We do not like to have it even for less than that as it is of no use to us. He said: Do you wish to have it (free of any cost)? They said: By Allah, even if it were alive (we would not have liked to possess that), for there is defect in it as its ear is very short; now it is dead also. Thereupon Allah's Messenger (ﷺ) said: By Allah, this world is more insignificant in the eye of Allah than it (this dead lamb) is in your eye

حَدَّثَنِي مُحَمَّدُ بْنُ الْمُثَنَّى الْعَنَزِيُّ، وَإِبْرَاهِيمُ بْنُ مُحَمَّدِ بْنِ عَرْعَرَةَ السَّامِيُّ، قَالاَ حَدَّثَنَا عَبْدُ الْوَهَّابِ، - يَعْنِيَانِ الثَّقَفِيَّ - عَنْ جَعْفَرٍ، عَنْ أَبِيهِ، عَنْ جَابِرٍ، عَنِ النَّبِيِّ صلى الله عليه وسلم ‏.‏ بِمِثْلِهِ غَيْرَ أَنَّ فِي حَدِيثِ الثَّقَفِيِّ فَلَوْ كَانَ حَيًّا كَانَ هَذَا السَّكَكُ بِهِ عَيْبًا ‏.‏

Jabir reported Allah's Apostle (ﷺ) narrating a hadith like this with a slight variation of wording

ثم خاصية العقل واللب : التمييز بين مراتب المحبوبات والمكروهات بقوة العلم والتمييز وإيثار أعلى المحبوبين على أدناهما واحتمال أدنى المكروهين للتخلص من أعلاهما بقوة الصبر والثبات واليقين

وأمر المصاب بأنفع الأمور له وهو الصبر والاحتساب فإن ذلك يخفف مصيبته ويوفر أجره والجزع والتسخط والتشكى يزيد في المصيبة ويذهب الأجر

فالصبر مع نفسك و المصابرة بينك وبين عدوك و المرابطة الثبات وإعداد العدة وكما أن الرباط لزوم الثغر لئلا يهجم منه العدو فكذلك الرباط أيضا لزوم ثغر القلب لئلا يهجم عليه الشيطان فيملكه أو يخربه أو يشعثه

ويهيج أفراحهم قابلوه بالسكون والثبات والاستقرار حتى كأنه لم يهجم عليهم وقال كعب بن زهير في مدح المهاجرين :

الثالث اللزوم والثبات ومنه حب البعير وأحب إذا برك ولم يقم قال الشاعر

الركن الرابع: نفس الاحتساب، وله درجات وآداب.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors.: Objective: The palliative journey can be emotionally stressful for both patients with advanced cancer and their families. Psychological resilience is crucial in aiding with patients' adaptation and post-traumatic growth. The aim of this systematic review was to critically examine the definitions of psychological resilience and its associated factors in palliative patients with advanced cancer. Methods: Four databases were systematically searched from inception to August 2020. Both qualitative an

Resilience and related factors in colorectal cancer patients: A systematic review.: Purpose: To explore resilience and its related factors in adult colorectal cancer patients. Methods: Three databases (CINAHL, Scopus and PubMed) were searched for literature published from January 2009 to February 2021 using the terms colorectal and resilience or resilient or resiliency. The review was registered with PROSPERO and followed the PRISMA statement guidelines. Results: The studies (n = 11) showed that most colorectal cancer patients exhibit moderate levels of resilience. Resilience w

Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review.: Purpose: The diagnosis of a life-threatening illness can be an extremely stressful, traumatic experience. However, many survivors report also various positive changes, referred in empirical literature as post-traumatic growth (PTG). Empirical studies that documented stress disorders and PTG in patients and survivors of life-threatening diseases are reviewed in three areas: Predictors of PTG, relationships between PTG and indicators of mental health and the impact of PTG on the process of convale

A systematic review of resilience in the physically ill.: Background: Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness. Objective: We conducted a systematic review of resilience and related concepts in the physically ill to determine factors associated with predicting or promoting resilience. Methods: An electronic search of PsychInfo, Medline, and CINAHL databases between 1950 and May 2009 was performed using the terms resilience, and various types of

Resilience in Caregivers: A Systematic Review.: Background: Resilience is a multidimensional construct that explains why people facing the consequences of adversity and stress can have a positive outcome, emphasizing adjustment to experiences that are perceived as threatening. Objective: The aim of this study is to review the construct of resilience and associated variables in caregivers of patients with chronic, advanced illness and at the end of life. Methods: The review included studies published between January 2009 and January 2019, usin

Feasibility and acceptability of a resilience training program for intensive care unit nurses.: Background: The critical nursing shortage is particularly apparent in specialty areas such as intensive care units (ICUs). Some nurses develop resilient coping strategies and adapt to stressful work experiences, mitigating the development of common maladaptive psychological symptoms. Objectives: To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants. Methods: In a randomized and controlled 12-week intervention stud

A randomized clinical trial of group versus standard behavioral couples therapy plus individually based treatment for patients with alcohol dependence.

Objective: Multiple studies show that behavioral couples therapy (BCT) is more efficacious than individually based therapy (IBT) for substance use and relationship outcomes among patients with alcohol use disorder. To facilitate dissemination, a multicouple, rolling admission Group BCT (G-BCT) format has been suggested as an alternative to the 1 couple at a time, conjoint Standard BCT (S-BCT) format. This randomized study compared outcomes of G-BCT versus S-BCT over a 1-year follow-up. The authors predicted that G-BCT, as compared to S-BCT, would have equivalent (i.e., noninferior) improvements on substance and relationship outcomes. Method: Participants were patients (N = 101) with alcohol dependence and their heterosexual relationship partners without substance use disorder. Participants were mostly White, in their 40s, and 30% of patients were women. Patients were randomized to either…

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Mechanisms of Behavioral and Affective Treatment Outcomes in a Cognitive Behavioral Intervention for Boys.

Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress…

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Partner accommodation moderates treatment outcomes for couple therapy for posttraumatic stress disorder.

Objective: Partner accommodation of posttraumatic stress disorder (PTSD) symptoms (i.e., altering one's own behaviors to minimize patient distress and/or relationship conflict due to patients' PTSD symptoms) has been shown to be positively associated with patient and partner psychopathology and negatively associated with patient and partner relationship satisfaction cross-sectionally. However, the prognostic value of partner accommodation in treatment outcomes is unknown. The goals of the present study were to determine if partner accommodation decreases as a function of couple therapy for PTSD and if pretreatment partner accommodation moderates the efficacy of couple therapy for PTSD. Method: Thirty-nine patients with PTSD and their intimate partners (n = 39) were enrolled in a randomized controlled trial of cognitive-behavioral conjoint therapy (CBCT) for PTSD (Monson & Fredman, 2012) …

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Randomized Controlled Trial of Online Expressive Writing to Address Readjustment Difficulties Among U.S. Afghanistan and Iraq War Veterans.

We examined the efficacy of a brief, accessible, nonstigmatizing online intervention-writing expressively about transitioning to civilian life. U.S. Afghanistan and Iraq war veterans with self-reported reintegration difficulty (N = 1,292, 39.3% female, M = 36.87, SD = 9.78 years) were randomly assigned to expressive writing (n = 508), factual control writing (n = 507), or no writing (n = 277). Using intention to treat, generalized linear mixed models demonstrated that 6-months postintervention, veterans who wrote expressively experienced greater reductions in physical complaints, anger, and distress compared with veterans who wrote factually (ds = 0.13 to 0.20; ps < .05) and greater reductions in PTSD symptoms, distress, anger, physical complaints, and reintegration difficulty compared with veterans who did not write at all (ds = 0.22 to 0.35; ps ≤ .001). Veterans who wrote expressively …

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Heart rate variability is enhanced in controls but not maladaptive perfectionists during brief mindfulness meditation following stress-induction: A stratified-randomized trial.

Heart rate variability (HRV) is a vagal nerve-mediated biomarker of cardiac function used to investigate chronic illness, psychopathology, stress and, more recently, attention-regulation processes such as meditation. This study investigated HRV in relation to maladaptive perfectionism, a stress-related personality factor, and mindfulness meditation, a stress coping practice expected to elevate HRV, and thereby promote relaxation. Maladaptive perfectionists (n=21) and Controls (n=39) were exposed to a lab-based assessment in which HRV was measured during (1) a 5-minute baseline resting phase, (2) a 5-minute cognitive stress-induction phase, and (3) a post-stress phase. In the post-stress phase, participants were randomly assigned to a 10-minute audio-instructed mindfulness meditation condition or a 10-minute rest condition with audio-description of mindfulness meditation. Analyses reveale…

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Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study.

Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analy…

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Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers.

The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in bo…

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The three stages of building and testing mid-level theories in a realist RCT: a theoretical and methodological case-example.

Background: Randomised controlled trials (RCTs) of social interventions are often criticised as failing to open the 'black box' whereby they only address questions about 'what works' without explaining the underlying processes of implementation and mechanisms of action, and how these vary by contextual characteristics of person and place. Realist RCTs are proposed as an approach to evaluation science that addresses these gaps while preserving the strengths of RCTs in providing evidence with strong internal validity in estimating effects. Methods: In the context of growing interest in designing and conducting realist trials, there is an urgent need to offer a worked example to provide guidance on how such an approach might be practically taken forward. The aim of this paper is to outline a three-staged theoretical and methodological process of undertaking a realist RCT using the example o…

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Alexithymia, emotional dysregulation, and recovery from alcoholism: therapeutic response to assessment of mood.

This study is a secondary analysis of a randomized controlled trial that tested the effects of a gratitude intervention on well-being in a sample of individuals in outpatient treatment for alcohol use disorder (AUD). Follow-up qualitative interviews unexpectedly revealed that participants found the Positive and Negative Affect Schedule (PANAS) to be helpful to their recovery in the ways that it asked them to identify and rate their emotions. Participant statements were purposively sampled and analyzed using grounded theory methods to produce a conceptual framework illustrating the process of mood identification and its sequelae. Evidence of existing alexithymia and emotional dysregulation, dominance of negative mood, and increasing ability to identify, accept, and regulate mood as part of recovery was found. Findings suggest that emotion regulation is a compelling topic for those in reco…

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Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients.

Objective: To determine whether a brief self-administered cognitive coping and relaxation intervention (CCRI) would lead to decreased treatment termination in in vitro fertilization (IVF) patients compared with routine care (RC). Design: Randomized, controlled, prospective study. Setting: Private academically affiliated infertility center. Patient(s): One hundred sixty-six women about to begin their first IVF cycle. Intervention(s): Randomization to the self-administered CCRI or RC control group and then observation for 12 months. Main outcome measure(s): Treatment discontinuation within 12 months (primary outcome), clinical pregnancy rate and psychological well-being (secondary outcomes). Result(s): The 12-month pregnancy rate was similar for the RC and CCRI groups (odds ratio [OR] 1.02; 95% CI, 0.53-1.98). Of the patients who were not pregnant on the first cycle, 15 of 46 (15.2%) patie…

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A Randomized Trial of a Bereavement Intervention for Pregnancy Loss.

Objective: To examine the effects of a secondary bereavement intervention on grieving in women who experienced a miscarriage (pregnancy loss) at 12-20 weeks gestation. Design: Experimental, posttest only, control group design. Setting: Obstetric emergency center of a county hospital in a large city. Participants: Forty women who experienced complete spontaneous miscarriages in the first or second trimester (8-20 weeks gestation). Methods: Participants were randomly assigned to the grief intervention treatment group or usual standard care control group. The Medical Professional Guidelines for Health Care Professionals were used to construct the perinatal grief intervention. The Perinatal Grief Scale (PGS) was completed during a routine follow-up visit 2 weeks postloss. Results: A one-way multiple ANOVA (MANOVA) was used to examine the difference in grieving between the control and experim…

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A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up.

Non-metastatic breast cancer patients often experience psychological distress which may influence disease progression and survival. Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress during breast cancer treatment and long-term follow-ups. We examined whether breast cancer patients randomized to CBSM had improved survival and recurrence 8-15 years post-enrollment. From 1998 to 2005, women (N = 240) 2-10 weeks post-surgery for non-metastatic Stage 0-IIIb breast cancer were randomized to a 10-week, group-based CBSM intervention (n = 120) or a 1-day psychoeducational seminar control (n = 120). In 2013, 8-15 years post-study enrollment (11-year median), recurrence and survival data were collected. Cox Proportional Hazards Models and Weibull Accelerated Failure Time tests were used to assess group differences in all-cause mortality, breast canc…

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Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial.

Purpose: To determine the effect of early versus delayed initiation of a palliative care intervention for family caregivers (CGs) of patients with advanced cancer. Patients and methods: Between October 2010 and March 2013, CGs of patients with advanced cancer were randomly assigned to receive three structured weekly telephone coaching sessions, monthly follow-up, and a bereavement call either early after enrollment or 3 months later. CGs of patients with advanced cancer were recruited from a National Cancer Institute cancer center, a Veterans Administration Medical Center, and two community outreach clinics. Outcomes were quality of life (QOL), depression, and burden (objective, stress, and demand). Results: A total of 122 CGs (early, n = 61; delayed, n = 61) of 207 patients participated; average age was 60 years, and most were female (78.7%) and white (92.6%). Between-group differences …

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A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners.

Objective: The diagnosis and treatment of prostate cancer is followed by substantive sexual morbidity. The optimal approach for intervening remains unclear. Methods/design: A three-arm randomised control trial was undertaken with 189 heterosexual couples where the man had been diagnosed with prostate cancer and treated surgically. The efficacy of peer-delivered telephone support versus nurse-delivered telephone counselling versus usual care in improving both men's and women's sexual adjustment was investigated. Assessments were undertaken at baseline (pre-test) with follow-up at 3, 6 and 12 months. Results: At 12 months, men in the peer (p = 0.016) and nurse intervention (p = 0.008) were more likely to use medical treatments for erectile dysfunction (ED) than men in the usual care arm. Men in the nurse intervention more frequently used oral medication for ED than men in usual care (p = 0…

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Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial.

This study examined the effectiveness and feasibility of therapist-guided Internet-delivered exposure (EX) and behavioral activation (BA) for complicated grief and rumination. Forty-seven bereaved individuals with elevated levels of complicated grief and grief rumination were randomly assigned to three conditions: EX (N=18), BA (N=17), or a waiting-list (N=12). Treatment groups received 6 homework assignments over 6 to 8weeks. Intention-to-treat analyses showed that EX reduced complicated grief, posttraumatic stress, depression, grief rumination, and brooding levels relative to the control group at posttreatment (d=0.7-1.2). BA lowered complicated grief, posttraumatic stress, and grief rumination levels at posttreatment (d=0.8-0.9). At 3-month follow-up, effects of EX were maintained on complicated grief and grief rumination (d=0.6-1.2), and for BA on complicated grief, posttraumatic str…

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Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.

Importance: Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. Objective: To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy. Design, setting, and participants: We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disor…

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Feasibility of a prototype web-based acceptance and commitment therapy prevention program for college students.

Objective: This study examined the feasibility of a prototype Web-based acceptance and commitment therapy (ACT) program for preventing mental health problems among college students. Participants: Undergraduate first-year students (N = 76) participated between May and November 2011. Methods: Participants were randomized to ACT or a waitlist, with assessments conducted at baseline, posttherapy, and 3-week follow-up. Waitlist participants accessed the program after the second assessment. Results: Program usability/usage data indicated high program acceptability. Significant improvements were found for ACT knowledge, education values, and depression with ACT relative to waitlist. Subgroup analyses indicated that ACT decreased depression and anxiety relative to waitlist among students with at least minimal distress. Within the ACT condition, significant improvements were observed from baselin…

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CHESS improves cancer caregivers' burden and mood: results of an eHealth RCT.

Objective: Informal caregivers (family and friends) of people with cancer are often unprepared for their caregiving role, leading to increased burden or distress. Comprehensive Health Enhancement Support System (CHESS) is a Web-based lung cancer information, communication, and coaching system for caregivers. This randomized trial reports the impact on caregiver burden, disruptiveness, and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites. Methods: A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were randomly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS. Caregivers were provided a computer and Internet service if needed. Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months.…

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Harnessing benefits of helping others: a randomized controlled trial testing expressive helping to address survivorship problems after hematopoietic stem cell transplant.

Objective: Prior research supports the hypothesis that cancer survivors who help others face treatment experience a range of psychosocial and health-related benefits as a result of peer helping. This study investigates an expressive helping (EH) intervention designed to harness those benefits by targeting survivorship problems among cancer survivors treated with hematopoietic stem cell transplant. EH includes two components: (a) emotionally expressive writing (EW; writing one's deepest thoughts and feelings about the transplant experience in a series of brief, structured writing sessions) followed by (b) peer helping (PH; helping other people prepare for transplant by sharing one's own transplant experiences along with advice and encouragement through a written narrative). Method: EH was compared with neutral writing (NW), EW (without PH), and PH (without EW) in a 4-arm randomized contro…

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Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.

Background: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) …

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Self-compassion as an emotion regulation strategy in major depressive disorder.

Cognitive reappraisal and acceptance are two presumably adaptive emotion regulation strategies in depression. More recently, self-compassion has been discussed as another potentially effective strategy for coping with depression. In the present study, we compared the effectiveness of self-compassion with a waiting condition, reappraisal, and acceptance in a clinically depressed sample, and tested the hypothesis that the intensity of depressed mood would moderate the differential efficacy of these strategies. In an experimental design, we induced depressed mood at four points in time in 48 participants meeting criteria for major depressive disorder. After each mood induction, participants were instructed to wait, reappraise the situation, accept their negative emotions, or employ self-compassion to regulate their depressed mood. Self-ratings of depressed mood were assessed before and afte…

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Life enhancing activities for family caregivers of people with frontotemporal dementia.

Aberrant psychological and behavioral symptoms are common in patients with dementia. These symptoms have negative consequences for family caregivers, causing stress and burden. Frontotemporal dementia (FTD) symptoms cause more pronounced stress and burden on caregivers than those associated with Alzheimer dementia. In this randomized, attention control pilot study, we delivered 5-weekly, one-on-one, positive affect intervention sessions to family caregivers of people with FTD. The program, Life Enhancing Activities for Family Caregivers: LEAF was conducted in-person or by videoconference with caregivers across the United States. Measures of affect, caregiver mood, stress, distress, and caregiver burden were assessed at baseline, end of sessions, and 1 month after completion. Twenty-four caregivers (12 intervention and 12 attention control) participated. At the end of the intervention, sc…

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A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children.

The current study is a pilot trial to examine the effects of a nonelective, classroom-based, teacher-implemented, mindfulness meditation intervention on standard clinical measures of mental health and affect in middle school children. A total of 101 healthy sixth-grade students (55 boys, 46 girls) were randomized to either an Asian history course with daily mindfulness meditation practice (intervention group) or an African history course with a matched experiential activity (active control group). Self-reported measures included the Youth Self Report (YSR), a modified Spielberger State-Trait Anxiety Inventory, and the Cognitive and Affective Mindfulness Measure -Revised. Both groups decreased significantly on clinical syndrome subscales and affect but did not differ in the extent of their improvements. Meditators were significantly less likely to develop suicidal ideation or thoughts of …

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Restore: the journey toward self-forgiveness: a randomized trial of patient education on self-forgiveness in cancer patients and caregivers.

The present study evaluated "Restore: The Journey Toward Self-Forgiveness," a brief psycho-spiritual curriculum for encouraging self-forgiveness. This was a randomized, wait-list controlled trial including 83 cancer patients and caregivers. Restore encourages self-acceptance, self-improvement, and commitment using prayer/meditation, reflection, and expressive writing in a workbook format. Measures of self-forgiveness, acceptance, self-improvement, and optimism/pessimism were collected before and after participation. Using Analysis of Covariance to control initial levels, post-session levels showed that Restore participants scored higher than wait-list controls on self-forgiveness (F(1,78) = 9.85, p < .001), acceptance (F(1,77) = 4.84, p < .05), and self-improvement (F(1,79) = 5.28, p < .05) and lower than wait-list controls on pessimism (F(1,77) = 5.01, p < .05). Changes in acceptance, s…

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Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial.

Importance: Tadalafil is used to treat erectile dysfunction after prostate cancer treatment, but its role as a preventive agent is undefined. Objectives: To determine primarily whether tadalafil preserved erectile function in men treated with radiotherapy for prostate cancer, and secondarily to determine whether participant- or partner-reported overall sexual function and sexual and marital satisfaction were affected. Design, setting, and participants: Stratified, placebo-controlled, double-blind, parallel-group study with 1:1 randomization at 76 community-based and tertiary medical sites in the United States and Canada. Two hundred forty-two participants with intact erectile function scheduled to receive radiotherapy for prostate cancer were recruited between November 2009 and February 2012 with follow-up through March 2013. Interventions: One hundred twenty-one participants were assign…

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