An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal. OBJECTIVE: In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles. METHODS: The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design). RESULTS: Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants' pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI -0.10 to 0.68) and alcohol consumption (P=.35; d=-0.06, 90% CI -0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant. CONCLUSIONS: The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964.

Testing the Effectiveness of an Intervention to Improve Romanian Teachers' LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial.

BACKGROUND: Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The "+" represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes. OBJECTIVE: This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements. METHODS: A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach. RESULTS: This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024. CONCLUSIONS: The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools. TRIAL REGISTRATION: ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54254.

The Within-Person Effect of Psychological Distress on Social Self-Efficacy: A Random Intercept Cross-Lagged Panel Model.

This study investigated the temporal relationship between social self-efficacy and psychological distress during 3 years in middle to late adolescence. The sample comprised 1508 participants (60.7% female; baseline mean age = 16.33, SD = .62; 52.9% high perceived family wealth; 70.6% born in Norway). We used a random intercept cross-lagged panel model to investigate the concurrent and subsequent associations between the two constructs. The results indicated (1) small to moderate and negative associations between the trait-like components and within-person fluctuations of social self-efficacy and psychological distress, (2) positive and significant carry-over stability effects on both constructs across time, and (3) that psychological distress predicted subsequent social self-efficacy more consistently across four time points, than social self-efficacy predicted later psychological distress.

Recovery at the Clubhouse: challenge, responsibility and growing into a role.

Purpose: To explore how people with mental illness experience recovery in the Clubhouse context, and which ingredients of the model they find active in promoting recovery.Methods: Hermeneutic-phenomenological design. Individual, semi-structured interviews with 18 Norwegian Clubhouse members. Systematic text condensation was used in analysis.Results: Three main themes emerged: "Balancing unlimited support with meeting challenges", with two sub-themes: "Unlimited membership: space for self-agency or hindering development?" and "Becoming a Clubhouse member: concerns and positive experiences". The second main theme was: "Learning how to build new skills and roles in the community". The third main theme was: "Getting better through and for work", with two sub-themes: "Work at the Clubhouse as a means to recovery" and "Preparing for a working life in society". Overall, participants experienced improved mental and social wellbeing and work readiness.Conclusions: Recovery in the Clubhouse context requires members' personal initiative, thus people having poor mental health might struggle with utilizing the Clubhouse. However, participants reported that lack of challenges within the community thwarted their recovery. Based on Salutogenesis, conscious application of challenge in Clubhouse activities might enhance members' recovery. Furthermore, participants' all-round involvement in their recovery journeys suggests the importance of shared decision-making in recovery-oriented services.

Salutogenesis as a theoretical framework for psychosocial rehabilitation: the case of the Clubhouse model.

Purpose: This study explored whether the holistic theory of salutogenesis may be a suitable theoretical framework for the Clubhouse model of psychosocial rehabilitation, a pioneer among psychosocial rehabilitation programmes.Methods: A systematic examination of elements of the Clubhouse model, as prescribed by the Clubhouse standards, was performed within the context of the theory of salutogenesis including its basic salutogenic orientation and the main concepts of sense of coherence and resistance resources.Results: We found that several standards and practices within the Clubhouse model can be understood as applications of salutogenesis. We have hypothesized that the Clubhouse model promotes peoples' sense of coherence and mental health. However, our investigation also showed that, to enhance the recovery of Clubhouse members, more explicitly incorporating some salutogenic principles, such as "appropriate challenges" and "active adaptation as the ideal in treatment", may benefit Clubhouse practice.Conclusions: The Clubhouse model of psychosocial rehabilitation is very consistent with the salutogenic orientation and main salutogenic concepts. The present study suggests that salutogenesis may be a suitable theoretical framework for the Clubhouse model and possibly in the psychosocial rehabilitation field in general.

"Finally, I belong somewhere I can be proud of" - Experiences of being a Clubhouse member in Norway.

Purpose: The number of psychosocial Clubhouses is growing rapidly in Norway. However, more knowledge is needed about the subjective experience of Clubhouse members in terms of their recuperation processes and experiences in the Clubhouse context. Therefore, this qualitative study explored what it is like to be a Clubhouse member in Norway, and further discuss it in light of the theory of Salutogenesis on successful pathways to coping and well-being.Methods: Using a hermeneutic-phenomenological approach, the present study included in-depth, semi-structured individual interviews with 18 Clubhouse members from three accredited Norwegian Clubhouses. Analysis was conducted using systematic text condensation.Results: Three main themes emerged from the analysis: "Finally, I belong somewhere I can be proud of," "I feel more like an ordinary citizen, just different," and "I feel somewhat equal to others." Overall, the participants experienced improved mental and social well-being owing to their membership of a Clubhouse.Conclusions: Our findings correspond with previous international research. Owing to the positive effect participation in the Clubhouse seem to have on members' motivation, Salutogenesis might help explain helpful processes within the model. Moreover, the model might be a relevant example for policy and service development in mental health care and the labour market.

Young adult cancer patients' experiences of private social network support during cancer treatment.

AIMS AND OBJECTIVES: To explore young adult cancer patients' experiences of support from their private social network during cancer treatment. BACKGROUND: Cancer treatment in young adulthood (aged 18-35 years) can be distressing. Social support is crucial for health and well-being, especially for young people and in times of crisis. Research indicates that young cancer patients experience a lack of social network support, but little is known about the types of private social network support available during cancer treatment. DESIGN: Qualitative study with interpretive descriptive design. METHODS: Twenty young adult cancer patients with different cancer diagnoses were interviewed retrospectively using a semi-structured interview guideline. Data were analysed using systematic text condensation. The COREQ checklist for qualitative research was followed. RESULTS: "From independence to dependence" was identified as a bridging theme, which was elaborated by four sub-themes: (1) "My partner was my rock-or not"; (2) "My family stood by me-or not"; (3) "My friends supported me-or not"; and (4) "I lacked young adult cancer peers-or not." CONCLUSION: The patients' major sources of private social network support were their partners and close family members. Only a few friends supported them during cancer treatment, and most lacked peer support. The type of social network support they received varied, and not all support was perceived as helpful. Helpful network support was experienced as being unconditional and given with empathy and without prompting. Patients without sufficient support from a partner or family members seem to be especially vulnerable. RELEVANCE TO CLINICAL PRACTICE: Nurses play a crucial role in educating young adult cancer patients about the importance of social support and helping them to map their social network and being explicit when requesting support. Nurses should inform patients' networks about both helpful and unhelpful support and should facilitate interaction between patients.

"I Got My Diagnosis on a Yellow Post-it Note": Young Adult Cancer Patients' Experiences of the Process of Being Diagnosed With Cancer.

BACKGROUND: Cancer in young adults is rare but young adult cancer patients (YACPs) are at an increased risk of severe physical and psychosocial impairments during cancer treatment and survivorship. However, little is known about the onset of this process. OBJECTIVE: The aim of this study was to explore how young cancer survivors experience the process of being diagnosed with cancer. METHODS: A qualitative method founded on a phenomenological-hermeneutical approach was used and included in-depth interviews with 20 young adult survivors (aged 24-35 years) with different cancer diagnoses, analyzed by Systematic Text Condensation. RESULTS: The participants' experiences of the diagnosis process were elaborated according to 3 main themes: (1) "I felt something was wrong, but…," (2) "The traumatic uncertainty," and (3) "The day my world collapsed." CONCLUSION: The findings indicate that the YACPs experienced a diagnosis of cancer as a highly traumatic and long-lasting process, characterized by lack of information and uncertainty. The findings indicate that healthcare professionals do not acknowledge the vulnerable phase of life and transitional challenges of YACPs. IMPLICATIONS FOR CLINICAL PRACTICE: The findings highlight the need to raise awareness of cancer in young adulthood in the public and in the primary healthcare system, to shorten the diagnosis process, and to clarify responsibility for age-related information and psychosocial follow-up during the diagnosis process. Further research is highly warranted.

Psychometric properties of the five-item version of the Mindful Awareness Attention Scale (MAAS) in Norwegian adolescents.

OBJECTIVES: The aim of the present study was to examine the factor structure, model-based reliability, measurement invariance and concurrent validity of the five-item version of the Mindfulness Attention Awareness Scale (MAAS) in Norwegian adolescents. METHODS: An initial pilot study was carried out using a sample of 77 fifteen year olds. For the main analyses, a sample of 2140 Norwegian adolescents was used who participated in the cross-sectional Health Behaviour in School-Aged Children (HBSC) study. All participants were asked to complete a questionnaire. RESULTS: Confirmatory factor analyses found support for the one-factor structure of the five-item version of the MAAS. Acceptable model fit was found in both the pilot sample (χ2=6.48, df=5, p=0.26; root mean square error of approximation [RMSEA]=0.06; comparative fit index [CFI]=0.99; standardised root mean square residual [SRMR]=0.03) and the HBSC sample (χ2=27.1, df=4, p<0.001; RMSEA=0.05; CFI=0.99; SRMR=0.01). The model-based reliability of the scale was good (ω=0.84 and ω=0.81, respectively). Scalar measurement invariance was established for sex, age and material affluence. Finally, the five-item MAAS displayed concurrent validity through moderate negative associations with health complaints ( r=-0.44; p<0.001) and school stress ( b=-0.44, p<0.001), and a positive moderate correlation with life satisfaction ( r=0.26; p<0.001). CONCLUSIONS: The five-item version of the MAAS is an adequate measure of mindfulness in Norwegian adolescents. Due to the brief nature of the scale, it can easily be included in epidemiological and clinical studies with an interest for trait mindfulness. The five-item MAAS may therefore have great potential to facilitate more knowledge about the role of mindfulness in adolescent health.

'It is the situation that makes it difficult': experiences of nursing students faced with a high-stakes drug calculation test.

Test anxiety affects the learning, performance and well-being of students, and it increases as the stakes get higher. Norwegian nursing students must pass a drug calculation test with a flawless performance if they are to qualify as nurses. The aim of the current study was to investigate the test anxiety experiences of students faced with such a high-stakes test. We used a mixed methods approach where the data were collected using a survey questionnaire and a focus group interview. In total, 203 freshman nursing students completed the questionnaire, six of whom also participated in the focus group interview. The survey results showed that 44.3% of the students reported high mathematics test anxiety in the months before the drug calculation test. More than 12% of the high-anxiety students reported a low mathematics self-concept. High and medium self-concept students also experienced high test anxiety. Our analysis of the focus group interview data confirmed that the high stakes of the test increased the test anxiety dramatically.