HYPOTHESIS: Hardiness decreases perceived stress and increases happiness in nurses.
METHODS: 252 nurses in Tehran, completed the Personal Views Survey, the Perceived Stress Scale, and the Oxford Happiness Inventory.
RESULTS: Hardiness seemed to decrease perceived stress and increased happiness.
CONCLUSION: The hypothesis is confirmed. Hardiness decreases stress and increases happiness.
J Psychiatr Ment Health Nurs. 2014 Mar 25;
Friday, March 28, 2014
Wednesday, March 19, 2014
How to Beat Breast Cancer
Here are ways to decrease your chances of getting breast cancer, and increasing your odds of good health.
Contributor: Tom Heston MD
Published: Aug 12, 2012
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Contributor: Tom Heston MD
Published: Aug 12, 2012
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Mindfulness and acceptance-based behavioral therapies for anxiety disorders.
This article presents a brief conceptual overview of acceptance-based behavioral therapies (ABBTs) for anxiety disorders, followed by a review and summary of the recent efficacy studies of ABBTs for anxiety and comorbid disorders. We discuss clinical implications, including the importance of targeting reactivity and experiential avoidance in interventions for anxiety disorders through the use of mindfulness and other acceptance-based strategies, as well the encouragement of engagement in meaningful activities or valued action. We also address future directions for research, such as expanding research to include more randomized control trials comparing ABBTs for specific anxiety disorders to other active treatments, examining mechanisms of change, exploring adaptations in different care-delivery contexts, as well as determining the applicability of these approaches to clients from marginalized or non-dominant statuses.
Curr Psychiatry Rep. 2013 Nov;15(11):410
Curr Psychiatry Rep. 2013 Nov;15(11):410
Monday, March 17, 2014
A New Definition of Statistical Signifance
P-Values Corrected For Study Power More Accurately Represent Statistical Significance
The traditional definition of statistical significance is a p-value of less than or equal to 0.05. The p-value is the probability that the research data did not find anything significantly new.
When the p-value is 0.05, there is a 1 in 20 chance the research findings are due to normal variation. The p-value only says how likely the research findings are due to normal variation. It does not say how likely the research findings represent something new and statistically significant.
The scientific method compares two hypotheses: first is the null hypothesis, which is that nothing is going on; second is the alternative hypothesis, that something new and significant is happening. For example, imagine that a new medicine is developed that the researcher thinks may lower blood pressure. The null hypothesis is that it DOES NOT lower blood pressure, and the alternative hypothesis is that it DOES lower blood pressure.
The p-value indicates the probability that the null hypothesis is true, the probability that the new medicine does not lower blood pressure. It does not indicate the probability that the new medicine does lower blood pressure.
This find distinction leads us to a new definition of statistical significance. Instead of relying on p-values, which essentially represent the specificity of the test statistic, we find it more useful to know the probability that a positive test statistic indicates that the alternative hypothesis is true, not the probability that the null hypothesis is true.
From the above we can derive the following: a p-value alone does not indicate the likelihood of the alternative hypothesis being true. The positive predictive value of a test statistic requires us to know both study power and the p-value. The positive predictive value is the equal to: [power/(power + p-value)]. To achieve 95% confidence that a test statistic represents statistical significance, the cutoff p-value (i.e. maximum p-value) needs to be adjusted by study power.
Using standard definitions for 2 x 2 contingency tables, statistical significance only occurs when: [ a / (a+b) >= 0.95 ], or in other words, that the positive predictive value is 95% or higher.
REFERENCE: Statistical Significance: a New Definition by Tom Heston, MD
Originally published: Jan 15, 2013 on the now defunct Yahoo! Voices http://voices.yahoo.com/a-definition-statistical-signifance-11963283.html http://goo.gl/Vz04UJ
The ABC's of Healthy Exercise
This simple and comprehensive exercise program makes setting up a personalized exercise program easy and fast.
Contributor: Tom Heston MD
Published: Dec 10, 2012
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Contributor: Tom Heston MD
Published: Dec 10, 2012
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Friday, March 14, 2014
Mindfulness-Based Program for Infertility: efficacy study.
OBJECTIVE: does mindfulness meditation help women with infertility?
DESIGN: Controlled clinical trial.
PATIENTS: Fifty-five infertile women completed the mindfulness program and 37 infertile women were assigned to a control group.
RESULTS: The mindfulness group had significant decreases in depressive symptoms, internal and external shame, entrapment, and defeat. They also had improved self-efficacy to deal with infertility.
CONCLUSIONS: mindfulness therapy is an effective psychological intervention for women experiencing infertility.
Fertil Steril. 2013 Oct;100(4):1059-67
DESIGN: Controlled clinical trial.
PATIENTS: Fifty-five infertile women completed the mindfulness program and 37 infertile women were assigned to a control group.
RESULTS: The mindfulness group had significant decreases in depressive symptoms, internal and external shame, entrapment, and defeat. They also had improved self-efficacy to deal with infertility.
CONCLUSIONS: mindfulness therapy is an effective psychological intervention for women experiencing infertility.
Fertil Steril. 2013 Oct;100(4):1059-67
Wednesday, March 12, 2014
Mindfulness-based therapy: a comprehensive meta-analysis.
BACKGROUND: Mindfulness-based therapy (MBT) has become a popular form of intervention. However, the existing reviews report inconsistent findings.
OBJECTIVE: To clarify these inconsistencies in the literature, we conducted a comprehensive effect-size analysis to evaluate the efficacy of MBT.
DATA SOURCES: A systematic review of studies published in journals or in dissertations in PubMED or PsycINFO from the first available date until May 10, 2013.
REVIEW METHODS: A total of 209 studies (n=12,145) were included.
RESULTS: Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n=72; Hedge's g=.55), in comparisons with waitlist controls (n=67; Hedge's g=.53), and when compared with other active treatments (n=68; Hedge's g=.33), including other psychological treatments (n=35; Hedge's g=.22). MBT did not differ from traditional CBT or behavioral therapies (n=9; Hedge's g=-.07) or pharmacological treatments (n=3; Hedge's g=.13).
CONCLUSION: MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.
23796855
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Tuesday, March 11, 2014
One Step, One Breath
My climbing partners and I were high up on the Emmons Glacier, making a summit attempt on Mount Rainier. The weather was starting to come in so we were trying our best to climb quickly. But try as we might, and even though we were teenagers in good physical shape, I could go no faster than one step, one breath. I would take a single step, then pause 10 seconds for a full breath. Over and over again. Then finally, the summit. We reached it just in time for us to have a safe descent.
I was a teenager at the time, and this accomplishment was very satisfying. I had learned that persistence, determination, and patience had enabled me to reach what at the time was a big goal. And over the years, this lesson of one step, one breath has helped me keep going even when faced with great difficulty.
Then, as an intern at Duke University, the lesson of Mount Rainier took on an entirely different meaning. One day in clinic, I saw my first patient of the afternoon walk down the hall of the clinic. He was an elderly gentleman of about 83 and was moving very slowly. I barely noticed him at first, but then something clicked. He was taking one step, one breath.
When we had a chance to talk in the exam room, he was full of life. Although clearly he was physically weak, his conversation was energetic. Enthusiastically, he talked about a trick he had recently taught his dog. In many ways, he had just climbed his personal Mount Rainier, just getting from his home to his car, then from the car to the waiting room, then from the waiting room to the clinic. He clearly struggled physically, but he didn't seem to notice. With a smile on his face, he taught me the finer points of dog training all while I finished up his exam. Then he was gone.
Although he was a memorable patient, I soon started noticing how many of my other patients were also only able to take one step before having to pause for a full breath. They might have heart disease, or lung disease, or terrible arthritis, but the net effect was great physical difficulty accomplishing some of the most basic tasks of daily living. Their physical bodies were weakening in spite of the best medical care on earth. In some, the spirit also seemed to be worn down, but what most fascinated me was how others could somehow keep their spirit intact and their will to live strong in spite of an inevitable decline in physical health.
What was one step, one breath all about for them? Their truth was much greater than the lesson I learned as a teenager. Their lesson was one of the spiritual realm. I had once thought that patience and determination was the lesson of one step, one breath. But then my patients taught me a greater lesson. My body did the work, but it was my dream that led me to the summit. Although my physical body was exhausted, the goal is what kept me moving forward. Strength of spirit is our true strength.
Monday, March 10, 2014
Humorous responses to interpersonal complaints
Laughter and Your Heart
It was thus with great interest I read a research article looking at formal laughter therapy in patients awaiting organ transplantation. This particular group of patients was selected for the research study, in part because they have both significant physical challenges and a strong risk of psychological distress. The study was carried out at the University of Arizona in Tucson.
The researchers decided to look at the effect laughter yoga had on this group of patients. One of the key outcome variables that the researchers looked at in order to determine whether or not laughter yoga was helpful was the patient's heart rate variability. The heart rate variability is an important prognostic indicator of overall health, with a low heart rate variability being associated with worse health, and a high heart rate variability being associated with better health.
There were six patients who participated in this study. Each person had their heart rate, heart rate variability, blood pressure, and mood assessed before and after the yoga therapy sessions. These variables were also measured at the start of the research study, after a no-treatment control week, and finally at the end of the study.
The laughter sessions were 20 minutes long, and involved breathing, stretching exercises, chanting, clapping, meditation, and simulated laughter (laughter that is not dependent upon the environment). The control intervention involved a discussion on health topics with one of the researchers.
The result? The patients in the study showed an improvement in both their mood and their heart rate variability after laughter therapy. Although this was a small, pilot study, the researchers concluded that their results are promising, and may indicate that laughter therapy may work in part by increasing the heart rate variability.
This is fascinating research because it suggests in a scientific manner that laughter therapy isn't just mumbo-jumbo new age gobbly gook. It isn't just in your head, it's also in your heart. Why would this be so? Probably because laughter increases blood flow throughout the body, and at the same time the act of laughing exercises the nerves and muscles that control our heart rate.
The lesson here seems to be that laughter should be taken seriously. Laugh when you can, even (or especially) at bad jokes. Better yet, don't wait for a joke, just laugh at life for your own good. Even when great physical challenges are faced, sometimes laughter really is the best medicine.
The (Almost) Dead Fish
I was living and working on the Billiken, one of the fishing boats subsequently featured on the reality show Deadliest Catch, when I came across the (almost) dead fish. Well, to be honest, the fish was dead when we came up upon it. Why it caught our attention after we had already processed (i.e. frozen and killed) over a million pounds of herring was a bit perplexing, but nevertheless, there the salmon lay in the water, belly up, dead.
We had been at sea for a couple of months when finally the boat docked at Akutan, Alaska and the captain gave the crew shore leave. I was on the boat as a processor, which meant I helped freeze the fish that smaller boats brought to us. In assembly line fashion, the first person would line the tray, then the next person load the tray with fish, then the next package it up, then the next load it in the freezer. We did this over and over and over again below deck, hardly ever seeing daylight or nightlight. So by the time we landed to offload our full load of frozen fish, all of us were ready for shore leave.
Most of the crew upon getting off the ship went directly to the local bar, where all of us would ultimately end up. A few of us, however, first took a walk along the shore, looking at the dozens of bald eagles hover over the docked boats, swooping down whenever a stray fish fell out of the nets offloading the boats. It was a fascinating sight, seeing so many eagles at once, and seeing them fight over their food. But then I looked down, and saw in front of me a few of my crew mates clumped together along the shore, all staring down into the water. They were looking at the dead fish.
One of them said he could bring the fish back to life by gently stroking the fish's gills. For some unknown reason, this was quite fascinating to all of us who had frozen millions of fish over the last couple of months. So with a strange captivation, I looked at my buddy carefully stroke the fish's gills, stroke the gills over again and again, then remove his hands like a magician to let the fish swim off. Only it didn't swim off. Instead, it remained dead, upside down in the water with it's belly up and back down.
Then, for some inexplicable reason I immediately said "here, let me do this" and I stepped up to the edge of the water and approached the dead fish. But instead of gently stroking it's gills, I quickly grabbed it's tail and vigorously shook the fish back and forth exactly three times, then let it go. Instantly, the fish jumped to life and swam off, out into the bay, diving deep down into the cold Bering Sea never to be seen by us again. The fish didn't need gentle strokes in order to live. It needed a good jolt to the system.
Although the story of the (almost) dead fish occurred decades ago, long before I even imagined I would go into medicine and become a doctor, the lesson to me remains medically sound. Sometimes, in order to live, we need a good shaking. For example, a person in cardiac arrest frequently needs a sudden shock with hundreds of joules of electricity in order to live. Some people with depression benefit more from a new life direction than from supportive counseling. Sometimes, when we are almost dead, shaking things up brings back life.
It's odd. Somehow, the (almost) dead fish taught me an important life lesson. Change can be good.
- Tom Heston MD
We had been at sea for a couple of months when finally the boat docked at Akutan, Alaska and the captain gave the crew shore leave. I was on the boat as a processor, which meant I helped freeze the fish that smaller boats brought to us. In assembly line fashion, the first person would line the tray, then the next person load the tray with fish, then the next package it up, then the next load it in the freezer. We did this over and over and over again below deck, hardly ever seeing daylight or nightlight. So by the time we landed to offload our full load of frozen fish, all of us were ready for shore leave.
Most of the crew upon getting off the ship went directly to the local bar, where all of us would ultimately end up. A few of us, however, first took a walk along the shore, looking at the dozens of bald eagles hover over the docked boats, swooping down whenever a stray fish fell out of the nets offloading the boats. It was a fascinating sight, seeing so many eagles at once, and seeing them fight over their food. But then I looked down, and saw in front of me a few of my crew mates clumped together along the shore, all staring down into the water. They were looking at the dead fish.
One of them said he could bring the fish back to life by gently stroking the fish's gills. For some unknown reason, this was quite fascinating to all of us who had frozen millions of fish over the last couple of months. So with a strange captivation, I looked at my buddy carefully stroke the fish's gills, stroke the gills over again and again, then remove his hands like a magician to let the fish swim off. Only it didn't swim off. Instead, it remained dead, upside down in the water with it's belly up and back down.
Then, for some inexplicable reason I immediately said "here, let me do this" and I stepped up to the edge of the water and approached the dead fish. But instead of gently stroking it's gills, I quickly grabbed it's tail and vigorously shook the fish back and forth exactly three times, then let it go. Instantly, the fish jumped to life and swam off, out into the bay, diving deep down into the cold Bering Sea never to be seen by us again. The fish didn't need gentle strokes in order to live. It needed a good jolt to the system.
Although the story of the (almost) dead fish occurred decades ago, long before I even imagined I would go into medicine and become a doctor, the lesson to me remains medically sound. Sometimes, in order to live, we need a good shaking. For example, a person in cardiac arrest frequently needs a sudden shock with hundreds of joules of electricity in order to live. Some people with depression benefit more from a new life direction than from supportive counseling. Sometimes, when we are almost dead, shaking things up brings back life.
It's odd. Somehow, the (almost) dead fish taught me an important life lesson. Change can be good.
- Tom Heston MD
Saturday, March 8, 2014
Evaluation of a standardized humor group in a clinical setting: a feasibility study for older patients with depression.
BACKGROUND: Positive effects of humor on older patients with depressive symptoms have been repeatedly reported. Empirical evidence however is rare. We investigated the efficacy of a standardized humor therapy group in a clinical context especially for older depressed patients.
PATIENTS AND METHODS: An experimental group with treatment (49 patients) was compared with a control group with no treatment (50 patients) in a semi-randomized design. Included were patients with major depression according to ICD-10. A set of questionnaires (Geriatric Depression Scale, Short Form Health Survey, State-Trait-Cheerfulness Inventory, and Satisfaction with Life Scale) was administered pretreatment and posttreatment.
RESULTS: Both groups showed improvement for depression, suicidal tendency, state cheerfulness, and state bad mood. Only participants of the humor group showed changes of state seriousness and satisfaction with life (p < 0.05). Further trends could be demonstrated for higher changes in state cheerfulness and resilience for the humor group.
CONCLUSION: Our results indicate an additional benefit of this specific therapeutic intervention for older depressed patients.
23132732
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Friday, March 7, 2014
Acoustic differences between humorous and sincere communicative intentions.
Previous studies indicate that the acoustic features of speech discriminate between positive and negative communicative intentions, such as approval and prohibition. Two studies investigated whether acoustic features of speech can discriminate between two positive communicative intentions: humour and sweet-sincerity, where sweet-sincerity involved being sincere in a positive, warm-hearted way. In Study 1, 22 mothers read a book containing humorous, sweet-sincere, and neutral-sincere images to their 19- to 24-month-olds. In Study 2, 41 mothers read a book containing humorous or sweet-sincere sentences and images to their 18- to 24-month-olds. Mothers used a higher mean F0 to communicate visual humour as compared to visual sincerity. Mothers used greater F0 mean, range, and standard deviation; greater intensity mean, range, and standard deviation; and a slower speech rate to communicate verbal humour as compared to verbal sweet-sincerity. Mothers used a rising linear contour to communicate verbal humour, but used no specific contour to express verbal sweet-sincerity. We conclude that speakers provide acoustic cues enabling listeners to distinguish between positive communicative intentions.
23039331
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Thursday, March 6, 2014
Underage drinkers' responses to negative-restrictive versus proactive-nonrestrictive slogans in humorous anti-alcohol abuse messages: are humorous responsible drinking campaign messages effective?
This study examined underage drinkers' responses to negative-restrictive versus proactive-nonrestrictive slogans in humorous anti-alcohol abuse advertisements. The authors conducted a posttest-only control group experiment with 91 teenagers and college-aged participants. For underage moderate drinkers, the negative-restrictive slogans (e.g., "Don't drink") increased participants' perceived risk of excessive drinking and increased a level of intention to change their drinking behavior. However, for underage binge drinkers, the negative-restrictive slogans lowered participants' risk perception of excessive drinking and intention to change their drinking behavior.
23163605
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Wednesday, March 5, 2014
Too close for comfort, or too far to care? Finding humor in distant tragedies and close mishaps.
Humor is ubiquitous and often beneficial, but the conditions that elicit it have been debated for millennia. We examine two factors that jointly influence perceptions of humor: the degree to which a stimulus is a violation (tragedy vs. mishap) and one's perceived distance from the stimulus (far vs. close). Five studies show that tragedies (which feature severe violations) are more humorous when temporally, socially, hypothetically, or spatially distant, but that mishaps (which feature mild violations) are more humorous when psychologically close. Although prevailing theories of humor have difficulty explaining the interaction between severity and distance revealed in these studies, our results are consistent with the proposal that humor occurs when a violation simultaneously seems benign. This benign-violation account suggests that distance facilitates humor in the case of tragedies by reducing threat, but that closeness facilitates humor in the case of mishaps by maintaining some sense of threat.
22941877
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Humor in the classroom using faculty skits.
The infusion of humor in the classroom through faculty-developed skits is a teaching-learning strategy that engages nursing students in the learning process. Gardner's Multiple Intelligence Theory for Adult Learners provides the framework for the use of humor as a strategy in higher education. Three exemplars are presented with a description of the specific strategy, an objective for each strategy, and the effect of the strategy on student engagement in nursing education. In the exemplars, the authors provide "ready to use" ideas with some "pearls of wisdom" for other faculty interested in developing similar learning activities.
22914276
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Sunday, March 2, 2014
A funny thing happened on the way to the scanner: humor detection correlates with gray matter volume.
The detection and appreciation of humor is a complex cognitive process that remains poorly understood. Although functional neuroimaging studies have begun to map the brain systems involved in humor appreciation, there are virtually no data on the structural correlates between gray matter volume and this capacity. Using voxel-based morphometry, the present study examined the association between gray matter volume and the ability to detect and appreciate humor. Fifty-nine healthy adults aged 18-45 years (30 men) underwent structural MRI and completed the University of Pennsylvania Humor Appreciation Test (HAT). After controlling for age and sex, gray matter volume of the left inferior frontal gyrus, left temporal pole, and left insula correlated positively with the appreciation of visual and verbal humor on the HAT, whereas the gray matter volume of the right inferior frontal gyrus correlated only with verbal humor appreciation scores. There were no negative correlations between gray matter volume and HAT performance. These data support a neurobiological basis for humor appreciation, particularly involving left-hemispheric cortical systems, and further suggest that individual differences in humor appreciation may be related to differences in regional gray matter volume.
23108043
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Saturday, March 1, 2014
Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: a pilot study.
CONTEXT: Research shows that laughter has myriad health benefits, yet the medical community has not implemented it formally as a treatment. Patients awaiting organ transplantation have significant physical disabilities and are at risk for psychological distress. Attenuated heart rate variability (HRV) is a risk factor for a negative long-term outcome in some patients.
OBJECTIVE: The study intended to evaluate the clinical utility of laughter yoga in improving psychological and physiological measures in outpatients awaiting organ transplantation. Positive results would indicate promising areas to pursue in a follow-up study.
DESIGN: Six participants met for 10 sessions over 4 weeks. The research team measured each participant's heart rate, HRV, blood pressure (BP), and immediate mood before and after the laughter and control interventions. The team assessed participants' longer-term mood (anxiety and depression) at the study's initiation, after a no-treatment control week, and at the end of the study.
SETTING: The study occurred at the Department of Surgery and Medicine at the University of Arizona Health Sciences Center, Tucson.
PARTICIPANTS: Participants were patients awaiting transplants (three heart and three lung), two women and four men (ages 51-69 y). Participants had received no major surgery in the 3 months prior to the intervention, did not have a hernia or uncontrolled hypertension, and did not fall into the New York Heart Association function class 4.
INTERVENTION: The 20-minute laughter intervention involved breathing and stretching exercises, simulated laughter (ie, unconditional laughter that is not contingent on the environment), chanting, clapping, and a meditation. The 20-minute control intervention involved the study's personnel discussing health and study-related topics with the participants.
OUTCOME MEASURES: The research team measured BP, heart rate, and HRV and administered the Profile of Mood States, Beck Anxiety Inventory, and Beck Depression Inventory-II to evaluate immediate and longer-term mood. The team had planned quantitative statistical analysis of the data at the study's initiation but did not complete it because the number of enrolled participants was too low for the analysis to be meaningful. The team visually examined the data, however, for trends that would indicate areas to examine further in a follow-up study.
RESULTS: Participants showed improved immediate mood (vigor-activity and friendliness) and increased HRV after the laughter intervention. Both the laughter and control interventions appeared to improve longer-term anxiety. Two participants awaiting a lung transplant dropped out of the study, and no adverse events occurred.
CONCLUSION: This pilot study suggests that laughter yoga may improve HRV and some aspects of mood, and this topic warrants further research.
22894892
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