Integrated Care for Persons With Persistent Gynecologic Conditions.

Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly provided in traditional gynecologic practices. Several models of integrated behavioral health are reviewed. Each model holds specific applications in primary and specialty gynecology settings and may enhance the gynecologic patient experience. This article reviews current research supporting integrated care and describes implementation, funding, and evaluation to improve patient outcomes.

Cannabis use following bariatric surgery is associated with anxiety and maladaptive eating.

BACKGROUND: There are limited data regarding the association of cannabis use with outcomes after bariatric surgery. As such, it is challenging to know how to counsel patients using cannabis. OBJECTIVES: The purpose of this study was to examine whether postsurgical cannabis use was associated with psychiatric symptoms and maladaptive eating among individuals up to 4 years after bariatric surgery. SETTING: Single health system. METHODS: All patients who underwent bariatric surgery over a 4-year period were invited to participate. Participants (N = 765) completed questionnaires online regarding postsurgical cannabis use, psychiatric symptoms, and maladaptive eating. RESULTS: Any cannabis use after bariatric surgery was associated with increased likelihood of having elevated symptoms of anxiety (odds ratio [OR] = 1.88, P = .003; 37.8% versus 24.4%), increased likelihood of grazing behaviors (OR = 1.77, P = .01; 71.2% versus 58.2%), and higher scores for eating in response to depression (P = .01; 12.13 versus 10.75). Weekly cannabis use was associated with loss of control eating (OR = 1.81, P = .04; 37.2% versus 24.7%), binge eating (OR = 2.16, P = .03; 20.0% versus 10.4%), and night eating behaviors (OR = 2.11, P = .01; 40.0% versus 24.0%). Cannabis use was not associated with depression (P > .05). CONCLUSIONS: Cannabis use after bariatric surgery was associated with anxiety symptoms and engaging in maladaptive eating behaviors. Frequent cannabis use (i.e., ≥1 per week) was associated with additional types of maladaptive eating. Clinicians involved in presurgical and postsurgical care may want to counsel patients currently using cannabis, especially those who are engaging in frequent use.

Post-surgical cannabis use is associated with weight loss among individuals up to 4 years after bariatric surgery.

INTRODUCTION: Although cannabis is known to stimulate appetite, it is not clear whether cannabis use may impact weight loss outcomes following bariatric surgery. Although some work has suggested that pre-surgical cannabis use is not associated with post-surgical weight loss, the role of post-surgical cannabis use has not yet been examined. The purpose of this study was to measure pre- and post-surgical cannabis use and determine whether cannabis use was associated with weight loss outcomes following bariatric surgery. METHODS: Patients who underwent bariatric surgery over a 4-year period at a single health care system were invited to complete a survey regarding pre- and post-surgical cannabis use and report their current weight. Pre-surgical weight and BMI were extracted from medical records to calculate change in BMI (ΔBMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), whether participants experienced a successful weight loss outcome, and whether participants had weight recurrence. RESULTS: Among all participants (N = 759), 10.7% and 14.5% engaged in pre- and post-surgical cannabis use, respectively. Pre-surgical cannabis use was not associated with any weight loss outcomes (p > 0.05). Any post-surgical cannabis use was associated with lower %EWL (p = 0.04) and greater likelihood of weight recurrence (p = 0.04). Weekly cannabis use was associated with lower %EWL (p = 0.003), lower %TWL (p = 0.04), and a lower likelihood of having a successful weight loss outcome (p = 0.02). CONCLUSIONS: Although pre-surgical cannabis use may not predict weight loss outcomes, post-surgical cannabis was associated with poorer weight loss outcomes. Frequent use (i.e., weekly) may be especially problematic. Providers should consider screening patients for cannabis use and educate them about the potential impact of postoperative cannabis use on weight loss following bariatric surgery.

A Meta-Ethnography on the Impact of Cancer for Lesbian and Queer Women and Their Partners.

Lesbian and queer women face unique experiences navigating cancer care, including challenges in accessing services that incorporate their relational supports. Given the importance of social support for survivorship, this study examines the impact of cancer on lesbian/queer women in romantic relationships. We conducted the seven stages of Noblit and Hare's meta-ethnography. PubMed/MEDLINE, PsycINFO, SocINDEX, and Social Sciences Abstract databases were searched. Two hundred and ninety citations were initially identified, 179 abstracts were reviewed, and 20 articles were coded. Themes were (a) intersectionality of lesbian/queer identity in the cancer context; (b) institutional and systemic supports and barriers; (c) navigation of disclosure; (d) characteristics of affirmative cancer care; (e) survivors' critical reliance on their partner(s); and (f) shifts in connection after cancer. Findings indicate the importance of accounting for intrapersonal, interpersonal, institutional, and socio-cultural-political factors for understanding the impact of cancer for lesbian and queer women and their romantic partners. Affirmative cancer care for sexual minorities fully validates and integrates partners in care, removes heteronormative assumptions in services provided, and offers LGB+ patient and partner support services.

A group positive psychology intervention for cancer survivors and caregivers: A pilot study of Activating Happiness©.

The purpose of this study was to examine the feasibility and potential concept of a 4-week positive psychology group intervention (Activating Happiness©) for cancer survivors and caregivers that emphasized mindfulness, self-compassion, and gratitude. Nine facilitators led 6 intervention groups for 49 participants (35 cancer survivors, 14 caregivers). Of eligible participants, 63% enrolled and of those, 89% completed all study activities. Participants completed self-report measures at baseline, after the second and final sessions, and 3-month post-intervention, and provided qualitative feedback after the final session. Qualitative data demonstrated that participants found the intervention acceptable. The intervention's potential proof-of-concept was supported by benchmarking outcomes against those reported in randomized controlled trials, with effect sizes for mindfulness, self-compassion, anxiety, and depression for caregivers and survivors, and for pain for survivors comparable to size estimates for efficacy in clinical trials.

Sustaining factors, rewards, and challenges for psychologists providing clinical care in psycho-oncology.

OBJECTIVE: Many who choose to work in oncology manage an ongoing tension-the work is rewarding, yet simultaneously challenging. Given the need for psychosocial professionals to provide treatment for the increasing number of cancer survivors in our aging society, it is important to consider what helps and hinders professionals in their work. Therefore, this study sought to understand the work experiences of psychologists working in psycho-oncology, specifically clarifying the rewards and challenges they experience as a result of their occupation. METHODS: Twenty psychologists with oncology work experience in the United States completed semi-structured interviews; data were analyzed using the Consensual Qualitative Research method. RESULTS: In this paper, findings are presented for two of the domains that emerged from the data. In the domain of Sustaining Factors and Rewards, six themes were identified: (a) making a difference, (b) personal impact of the work on psychologists' lives and personal enrichment, (c) sense of purpose and fit with the work, (d) important relationships, (e) unique aspects of psycho-oncology, and (f) benefits derived from the workplace. In the domain of Challenges, five themes were identified: (a) job-related challenges, (b) emotional intensity, (c) financial challenges, (d) ambiguity in professional roles and psycho-oncology, and (e) ethical dilemmas. CONCLUSION: Psychologists employed in psycho-oncology found great meaning and purpose in their jobs, but also struggled with challenges related to the work and their workplaces. These findings can lead to better training, supervision, retention initiatives, and administrative policies to support productive employees.

Virtue, flourishing, and positive psychology in psychotherapy: An overview and research prospectus.

Researchers have increasingly called for the examination of both mental health symptoms and well-being when providing and evaluating psychotherapy, and although symptoms and well-being are typically inversely related, these appear to be distinct constructs that may require distinct intervention strategies. Positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on promoting well-being have emerged in response to, or perhaps in concert with, the calls for attention to symptoms and well-being. Our review of the relevant and vast research pockets revealed that these treatments demonstrated relative efficacy in promoting well-being, whereas evidence for relative efficacy when reducing symptoms was largely inconclusive, particularly in psychotherapy contexts. We organized our review around the virtue-ethics notion that growth in virtuousness fosters flourishing, with flourishing consisting of more than the absence of symptoms, and specifically, that flourishing also involves increased well-being. The lack of evidence for relative efficacy among active alternative treatment conditions in promoting flourishing may suggest equal effectiveness, and yet, this also suggests that there are yet-to-be-identified moderators and mechanisms of change and/or insufficient use of research designs and/or statistical procedures that could more clearly test this major tenet of the virtue-ethics tradition. Nevertheless, we know that evidence-based problem-focused psychotherapies are effective at reducing symptoms, and our review showed that positive psychology interventions, virtue-based treatments, and psychotherapies explicitly focused on well-being promote well-being and/or virtue development. We encourage researchers and psychotherapists to continue to integrate symptom reduction and well-being promotion into psychotherapy approaches aimed at fostering client flourishing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

You Can Only Go Full Speed for So Long: The Career Development of Psychologists Working in Psychosocial Oncology Settings.

Cancer centers have adopted a holistic approach to cancer treatment to better meet the psychosocial needs of cancer survivors. However, the current number of psychosocial providers in oncology is inadequate to meet the growing demand and psychosocial providers may face barriers in accessing oncology-specific training. The current study aims to explore the career development of psychologists working in oncology to inform training and workplace supports, as well as to inform training for health psychologists interested in other sub-specialties. Interviews were conducted with 20 psychologists with oncology work experience. Data were analyzed using the consensual qualitative research method. Results indicated three primary domains: (a) factors influencing entry into the field, (b) factors influencing ongoing career decision-making, and (c) factors influencing success in psychosocial oncology. The complexities of these domains are discussed; suggestions for supporting psychologists interested in psychosocial oncology at individual as well as systemic levels are provided.

Spontaneous Coronary Artery Dissection (SCAD): FEMALE SURVIVORS' EXPERIENCES OF STRESS AND SUPPORT.

PURPOSE: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic type of acute myocardial infarction that primarily affects young, healthy women without typical risk factors for heart disease. Few investigations have examined psychosocial variables in this population and none have looked at patient perceptions of the experience and stresses associated with having a SCAD event or the resources currently available to SCAD survivors. This investigation describes survivors' subjective experiences of SCAD. Participants also provided information about types and helpfulness of resources available to them post-SCAD, including cardiac rehabilitation. METHODS: Participants were recruited online and completed a one-time questionnaire. RESULTS: Participants (n = 409) completed a questionnaire concerning their experiences with their SCAD event in the 1 y and 2 wk prior to the SCAD event. Their responses reflected moderate to high perceptions of stress. Participants experienced the SCAD event as highly stressful and frightening and their heart health presents as a moderate-severe source of current, post-diagnosis stress. Spontaneous coronary artery dissection-based informational support was frequently rated as inadequate, whereas other supportive resources varied in their helpfulness and accessibility. Participants reported positive experiences in cardiac rehabilitation and strong interest in SCAD-specific, professionally led, online patient education and support groups. CONCLUSIONS: This study is the largest to date investigation of SCAD survivors and their experiences in this understudied and perhaps underrecognized condition. Opportunities for researchers and providers to develop, tailor, and disseminate SCAD-specific interventions are discussed.