Professional equipoise: Getting beyond dominant discourses in an interprofessional team.

In 2011, the US Department of Veterans Affairs established five Centers of Excellence to study training in the patient-centered medical home clinical microsystem. Early on, our center began a discourse analysis in order to better understand each profession's assumptions about roles, responsibilities, and the basis for "truth" in clinical care. We discovered that these different discourses were pervasive and led to unhelpful stereotypes of each other. This article describes the evidence we identified that led us to hypothesize these conflicting discourses and stereotypes. Specifically, we report on our attempts to identify the traditional discourses of four post-graduate professions--medicine, nurse practitioner, psychology, and pharmacy. We also share lessons from our efforts to defuse participants from their identified discursive assumptions, and develop appreciation and value for the discursive contributions of other professions--a process we call professional equipoise. We conclude that we can change these discourses and the professional identity formation of novices if we provide sustained, integrated interprofessional education curriculum. This implies that we need: embedded, longitudinal training; faculty role modeling of inquisitiveness, respectful relationships, and risk taking; and safe and honest discussion about our differences.

Cardiovascular responses to a laboratory stressor in women: Assessing the role of body awareness.

Body awareness (BA) is characterised by a general tendency towards awareness and recognition of normal, non-emotive bodily processes and physical sensations. BA considers one's sensitivity towards and belief in how well they can sense, predict, and describe their bodily functions and sensations. This study investigated the role of BA in haemodynamic and anxiety responses to a laboratory stressor. Women (n = 40) completed assessments of BA and state/trait anxiety. Women with low BA displayed higher blood pressure (BP) and heart rate (HR) reactivity in response to the stressor than women with high BA. Delayed HR recovery poststressor was observed in women with low BA. BA was a significant predictor of haemodynamic reactivity over and above trait anxiety. BA effects on state anxiety were not observed. Thus, greater BA is associated with less haemodynamic stress reactivity in women lending further support for the development of BA interventions aimed at stress reduction.

Relationships Among Premenstrual Symptom Reports, Menstrual Attitudes, and Mindfulness.

The physical and affective symptoms of a broad range of conditions are improved following mindfulness-based practices. One set of symptoms that has yet to be explored through the lens of mindfulness, however, is that associated with the premenstruum. Also, given the relationships among negative attitudes towards menstruation and amplified symptom reporting, it is reasonable to expect that mindfulness qualities cultivated through practices aimed at dispelling negative anticipatory and judgmental thinking will moderate these relationships. Thus, in this study we examined interrelationships among premenstrual symptom severity reports (PMSR), menstrual attitudes, and mindfulness qualities in a sample of 127 women (age range 18-26 years). Results revealed several statistically significant positive relationships between menstrual attitudes and PMSR. Also, higher scores on measures of mindfulness were significantly associated with lower PMSR. Moderating effects revealed that mindfulness significantly buffered the relationships between menstrual attitudes and PMSR, specifically between: anticipation of menses onset and PMSR as well as anticipation of menses onset and premenstrual water retention. These results may offer the first empirical evidence of relationships among menstrual attitudes, PMSR, and mindfulness qualities. Results from this study align with the body of research showing that mindfulness is predictive of improved symptomatology and well-being across varied conditions. We conclude with discussion supporting the development of a mindfulness-based intervention aimed at reducing symptom severity in premenstrual symptom sufferers.

Psychophysiological and neuroendocrine responses to laboratory stressors in women: implications of menstrual cycle phase and stressor type.

This study assessed stressor and menstrual phase effects on psychophysiological and neuroendocrine responses to laboratory stressors in freely cycling women (N=78, ages 18-45). Participants performed counterbalanced stressors [Paced Auditory Serial Addition Test (PASAT) or cold pressor test (CP)] during their follicular and luteal menstrual cycle phases between 1:00 and 3:00p.m. to control for cortisol rhythm. Participants rested 30-min, performed the stressor, and then recovered 30-min while electrocardiography continuously monitored heart rate (HR). Systolic (SBP) and diastolic blood pressure (DBP), salivary cortisol, and state anxiety were assessed at timed intervals. HR, SBP, and cortisol varied more over the course of luteal than follicular phase testing. A three-way interaction revealed state anxiety reactivity was greater with the PASAT during the follicular phase. DBP showed equal and persistent reactivity with both stressors during both cycle phases. Results extend the stressor-specific HPAA hypothesis and have important methodological implications for women's biopsychology research.

Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.