Walking the leadership walk: Integrating inclusivity in a large-scale health care organization.

This article focuses on the roles, actions, and resources developed by a group of leaders from the Office of Mental Health and Suicide Prevention (OMHSP) within the Department of Veterans Affairs during the unprecedented times of spring of 2020, when society was shaken by the fears and challenges of COVID-19 as well as social unrest sparked by the murder of George Floyd. We share a summary of our efforts to move beyond platitudes and statements and bring meaningful and sustainable change in justice, equity, diversity, and inclusion within OMHSP and across mental health services in Department of Veterans Affairs. This article is written through the lens of the founding members of the OMHSP's Diversity, Equity, and Inclusion Steering Committee. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric analysis of the Mental Health Recovery Measure in a sample of veterans with depression.

Using data from a sample of 398 veterans diagnosed with depression, the present study used principal components analysis to shorten the Mental Health Recovery Measure (MHRM) to a 10-item instrument. Results indicated the 10-item MHRM had excellent internal reliability. Construct validity for the 10-item MHRM was evidenced by correlations with measures of depression coping self-efficacy, social adjustment, hopelessness, and depression. The 10-item MHRM derived in the present study was compared with a 10-item version of the MHRM that was previously empirically derived in a sample of veterans with schizophrenia (Armstrong, Cohen, Hellemann, Reist, & Young, 2014). Results suggest that similar items represent the underlying construct of recovery for veterans with depression and veterans with schizophrenia. Veterans with depression reported lower average levels of recovery than veterans with schizophrenia. Study limitations, directions for future investigations, and the implications of routine assessment of mental health recovery in public mental health systems are discussed. (PsycINFO Database Record

Augmenting Ongoing Depression Care With a Mutual Peer Support Intervention Versus Self-Help Materials Alone: A Randomized Trial.

OBJECTIVE: Various models of peer support may be implemented in mental health settings. This randomized trial assessed the effectiveness of a telephone-delivered mutual peer support intervention. METHODS: A total of 443 patients receiving ongoing depression treatment from the U.S. Department of Veterans Affairs were enrolled in either enhanced usual care (N=243) or the peer support intervention (N=200). Intent-to-treat analyses assessed outcomes at six months postenrollment, excluding 56 patients who experienced an unplanned telephone platform shutdown. RESULTS: At baseline, patients had substantial depressive symptoms, functional limitations, and low quality of life. Both groups showed significant clinical improvements at six months, with no significant differences by group. CONCLUSIONS: Telephone-delivered mutual peer support for patients with depression did not improve outcomes beyond those observed with enhanced usual care. Other peer support models, with more "professionalized" peers delivering a structured curriculum, may be more effective.

The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial.

OBJECTIVE: Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. METHOD: We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. RESULTS: Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. CONCLUSIONS: The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.

The effects of different methods of emotional disclosure: differentiating post-traumatic growth from stress symptoms.

Research on emotional disclosure should test the effects of different disclosure methods and whether symptoms are affected differently than post-traumatic growth. We randomized 214 participants with unresolved stressful experiences to four disclosure conditions (written, private spoken, talking to a passive listener, talking to an active facilitator) or two control conditions. All groups had one 30-minute session. After 6 weeks, disclosure groups reported more post-traumatic growth than controls, and disclosure conditions were similar in this effect. All groups decreased in stress symptoms (intrusions, avoidance, psychological and physical symptoms), but disclosure did not differ from control. We conclude that 30 minutes of disclosure leads to post-traumatic growth but not necessarily symptom reduction, and various disclosure methods have similar effects. Research on the effects of disclosure should focus on the benefits of growth as well as symptom reduction.

Pain and emotion: a biopsychosocial review of recent research.

OBJECTIVE AND METHOD: Research on emotion and pain has burgeoned. We review the last decade's literature, focusing on links between emotional processes and persistent pain. RESULTS: Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. CONCLUSIONS: Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.

Does emotional disclosure about stress improve health in rheumatoid arthritis? Randomized, controlled trials of written and spoken disclosure.

Studies of the effects of disclosing stressful experiences among patients with rheumatoid arthritis (RA) have yielded inconsistent findings, perhaps due to different disclosure methods--writing or speaking--and various methodological limitations. We randomized adults with RA to a writing (n=88) or speaking (to a recorder) sample (n=93), and within each sample, to either disclosure or 1 of 2 control groups (positive or neutral events), which conducted four 20-minute, at-home sessions. Follow-up evaluations at 1, 3, and 6 months included self-reported, behavioral, physiological, and blinded physician-assessed outcomes. In both writing and speaking samples, the disclosure and control groups were comparably credible, and the linguistic content differed as expected. Covariance analyses at each follow-up point indicated that written disclosure had minimal effects compared with combined controls--only pain was reduced at 1 and 6 months, but no other outcomes improved. Spoken disclosure led to faster walking speed at 3 months, and reduced pain, swollen joints, and physician-rated disease activity at 6 months, but there were no effects on other outcomes. Latent growth curve modeling examined differences in the trajectory of change over follow-up. Written disclosure improved affective pain and walking speed; spoken disclosure showed only a marginal benefit on sensory pain. In both analyses, the few benefits of disclosure occurred relative to both positive and neutral control groups. We conclude that both written and spoken disclosure have modest benefits for patients with RA, particularly at 6 months, but these effects are limited in scope and consistency.

Pain, executive functioning, and affect in patients with rheumatoid arthritis.

OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. METHODS: A sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the Wechsler Adult Intelligence Scale-Third Edition and the Stroop Color Word Test tests, respectively. RESULTS: Consistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. DISCUSSION: These findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning and functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.

Different methods of single-session disclosure: what works for whom?

OBJECTIVE: Examine distress, emotional approach coping, and attachment as moderators of effects of written (WED) versus interpersonal (IED) emotional disclosure and written time management (WTM). DESIGN/METHODS: Fifty-seven undergraduates with stressful experiences randomized to a single session of WED, IED, or WTM. Assessment of immediate reaction (NA) and 6-week follow-up (intrusions/avoidance). RESULTS: Those with higher baseline distress had increased NA, avoidance and intrusions when engaged in WED or IED (vs. WTM). For emotional processors, WED (vs. IED) produced less NA, avoidance, and intrusions. Attachment predicted increased NA in WTM. CONCLUSIONS: Baseline distress and personality characteristics form boundary conditions for written disclosure.

An Emotional Exposure-Based Treatment of Traumatic Stress for People with Chronic Pain: Preliminary Results for Fibromyalgia Syndrome.

Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve post-traumatic stress, but have not been tested on chronic pain. We present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi-Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance. This treatment was pilot tested on 10 women with intractable FMS and trauma histories. Three months post-treatment, the sample showed moderate to large effects on stress symptoms, FMS impact, and emotional distress; and small to moderate improvements on pain and disability. Two patients showed substantial improvement, four made moderate gains, two showed modest improvement, and two did not benefit. This pilot study suggests that emotional exposure treatment for unresolved trauma may benefit some patients with FMS. Controlled testing of the treatment for FMS and other chronic pain populations is indicated.

The relationship between self-reported received and perceived social support: a meta-analytic review.

Social support is broad term encompassing a variety of constructs, including support perceptions (perceived support) and receipt of supportive behaviors (received support). Of these constructs, only perceived support has been regarded as consistently linked to health, and researchers have offered differing assessments of the strength of the received-perceived support relationship. An overall estimate of the received-perceived support relationship would clearly further the dialogue on the relationship between received and perceived support and thus assist in the theoretical development of the field. This study evaluated all available studies using the Inventory of Socially Supportive Behaviors (ISSB; Barrera, Sandler, & Ramsey, 1981, American Journal of Community Psychology, 9, 435-447) and any measure of perceived social support. Using effect sizes from 23 studies, we found an average correlation of r = .35, p < .001. Implications of this estimate for further development of models of social support as well as interventions to enhance social support are discussed.

Trait and social processes in the link between social support and affect: an experimental, laboratory investigation.

This study investigated the extent to which the link between perceived social support and affect reflected support recipients' trait perceived support as well as three distinct social processes: the objective supportiveness of providers, the unique relationships among recipients and providers that were stable over occasions, as well as the unique relationships that varied across occasions. Ten recipients interacted with each of the same four providers on five separate occasions, for a total of 200 interactions. Recipients and independent observers rated recipient affect and provider support. Greater perceived support was related to greater positive affect for recipients' trait perceived support, as well as for relationships that were stable over occasions and relationships that varied across occasions. No social support effects were found for negative affect. Perceived similarity was a consistent predictor of recipients' support perceptions. Implications for social support models and interventions were discussed.

Recipient-provider agreement on enacted support, perceived support, and provider personality.

This study examined agreement between recipients and providers about social support and personality. One hundred daughter caregivers of a parent with Alzheimer's disease and each caregiver's most important support provider independently reported supportive behaviors provided to caregivers, the perceived supportiveness of the provider, and providers' personality traits. For all indices, agreement was higher for enacted support than for perceived support and personality, which were similar to each other for some, but not all, indices of agreement. These findings support the validity of measures of enacted and perceived support.