Physician wellness: Managing stress and preventing burnout.

Physician burnout is increasing, but navigating its prevention involves a complex intersection of physical, psychological, social, and organizational strategies.

Gamers' and non-gamers' perspectives on the development of problematic video game play.

Gaming Disorder was recently included in the 11th Edition of the International Classification of Diseases and Internet Gaming Disorder may be introduced in the sixth edition of The Diagnostic and Statistical Manual. Much is not understood about how problems with video games develop. This qualitative study aimed to better understand the development of problematic gaming through focus groups. Eleven young adult "frequent gamers," twelve young adult "non-frequent or non-gamers," and five older adult "non-gamers" discussed vulnerabilities and risk factors of problematic gaming. Participants across all groups believed that problematic gaming developed when people used video games as a primary means of meeting basic psychological needs that were unsatisfied, thwarted, or blocked outside of video games. Frequent and non-frequent gamers, compared to older adult non-gamers, were more likely to view video games as a healthy way to meet basic psychological needs and less likely to stereotype gamers. Video games are equipped to meet basic psychological needs for autonomy, competence, and relatedness. That is, gamers often experience a sense of agency, skill, and connection to others when playing video games. However, problematic gaming may develop when people with unmet psychological needs rely exclusively on video games to meet them. Treatment and prevention approaches to problematic gaming can benefit from greater attention to helping at risk individuals meet needs for autonomy, competence, and relatedness outside of video games.

Birth Outcomes Related to Distance in Rural and Frontier Kansas.

Introduction: Women from rural communities must travel greater distances to secure obstetrical care. This study sought the extent to which distance traveled by mothers for obstetrical services affects birth outcomes in rural and frontier counties of Kansas. Methods: Medical students invited women over the age of 18 to participate in a recall survey regarding their children under three years old. Participants were a sample of convenience, and the length of data collection was a month. A bivariate analysis was performed on the responses gathered regarding obstetrical measures as a function of self-reported distance traveled to the hospital of delivery. Results: Eighty-five women completed the survey, but only 76 satisfied all eligibility requirements. No statistical difference in birth outcomes were found between women who travel more than or less than 20 miles. However, when correlating data to that of the Kansas Hospital Association and the Kansas Department of Health and Environment, counties without birth facilities had a higher percentage of very low birth weights (< 1,500 grams) and more babies born at full-term when compared to counties that offer birth facilities. Babies born to mothers who reside in counties with obstetrical services were born at an earlier gestational age than those without birth facilities. Lastly, babies born into a family with income less than $50,000 weighed less and had a shorter gestational age than those from a more affluent household. Conclusions: The results revealed counterintuitive findings that deserve to be explored further by a study with greater statistical power.

Providing addiction services during a pandemic: Lessons learned from COVID-19.

During the COVID-19 pandemic, social distancing measures have made in-person mutual help groups inaccessible to many individuals struggling with substance use disorders (SUDs). Prior to the pandemic, stakeholders in our community had sponsored a program to train volunteers to facilitate local Self-Management and Recovery Training (SMART Recovery) groups. As a result, the community established seven weekly SMART Recovery groups, which more than 200 community members attended. In March 2020, the community discontinued these groups due to the COVID-19 pandemic. To provide SMART Recovery during social distancing, we developed a one-on-one phone-in service for people with SUDs and addictions: the SMART Recovery Line (SMARTline). In this paper, we share our experience training volunteers to facilitate SMART Recovery groups and SMARTline. As a result of our experience, we have learned to: (1) establish plans in advance to migrate services from face-to-face settings to remote platforms; (2) consider remote platforms that are easily accessible to the greatest number of individuals; (3) include as many stakeholders in the planning process as possible; (4) consider recruiting volunteers to help in the provision of services, especially since many people want to help fellow community members during crises; and (5) anticipate and prepare for crises well before they occur.

Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic.

Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment (P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.

Insecure attachment and addiction: Testing the mediating role of emotion dysregulation in four potentially addictive behaviors.

Insecure attachment has been associated with an array of addictive behaviors. However, the mechanism by which insecure attachment leads to addictive behaviors remains largely unknown. In the present research we tested whether emotion dysregulation mediated the relationship between insecure attachment (anxious, avoidant) in substance use (alcohol, marijuana) and DSM-5 (Internet gaming) and non-DSM-5 (texting) behavioral dependencies. A sample (N = 712) of participants recruited from a university in the United States completed an online battery of instruments, assessing adult attachment style, emotion dysregulation, and self-reported DSM-5 symptoms adapted from substance use disorder criteria. In separate mediation analyses, anxious attachment was associated with self-reported DSM-5 symptoms for alcohol, marijuana, texting, but not Internet gaming; whereas emotion dysregulation was associated with self-reported DSM-5 symptoms of all four potentially addictive behaviors. Avoidant attachment was not associated with self-reported DSM-5 symptoms for any of the addictive behaviors. Emotion dysregulation mediated the relationship between both anxious and avoidant attachment and self-reported DSM-5 symptoms for alcohol, marijuana, and texting. In contrast, emotion dysregulation mediated the relationship between anxious but not avoidant attachment and Internet gaming. Insecure attachment, specifically anxious attachment and emotion dysregulation may be important psychological characteristics that increase the risk for alcohol, marijuana and texting, while Internet gaming corresponds with unique characteristics. Whereas attachment styles may be resistant to change, emotion dysregulation has been found to be modifiable and may provide a potential target in the treatment of substance use disorders and some behavioral dependencies for those who manifest attachment insecurities.

The Self-perception of Text-message Dependency Scale (STDS): Psychometric update based on a United States sample.

BACKGROUND: Some have suggested that text messaging is an addictive behavior. However, this characterization is uncertain, partly due to lack of well-validated measures of text messaging attitudes and behaviors. One standard instrument for measuring text messaging attitudes and behaviors is the Self-perception of Text-message Dependency Scale (STDS), though the psychometric properties of this scale have only been examined with a sample of Japanese youth. OBJECTIVES: The primary objective of this study was to evaluate the STDS in the United States to determine its utility as a measure of text messaging dependence. We were interested in examining the factor structure and determining the extent to which this scale would correlate with two important outcome measures: motor vehicle accidents (MVAs) and moving violations. METHODS: We analyzed data from 468 adults (age 18-74; 274 women) recruited via Amazon's Mechanical Turk (mTurk) service. Participants completed the STDS and provided information about their driving-related incidents in the past year. RESULTS: First we performed a confirmatory factor analysis, which supported the instrument's original factor structure. Then we tested the relationship between scores on the STDS and two important variables, MVAs and moving violations. We found that the STDS significantly correlated with both MVAs and moving violations. CONCLUSION: The present study confirms that the STDS is a potentially useful instrument for studying texting dependence in the United States and with adults of all ages. The instrument may be particularly useful in predicting motor vehicle outcomes.

College student marijuana involvement: Perceptions, use, and consequences across 11 college campuses.

BACKGROUND: Marijuana is currently the most commonly used illicit drug in the United States, and with the movement toward legalization of recreational marijuana, the country faces numerous issues regarding policy, prevention, and treatment of marijuana use. The present study examines the prevalence of marijuana use and consequences and compares users and non-users on a wide range of other marijuana-related constructs among college students across 11 universities. METHOD: Participants included 8141 college students recruited from the psychology department participant pools of 11 universities throughout the US, including four major regions of the US (West, South, Midwest, Northeast) and states with varying policies regarding the legality of marijuana use. RESULTS: We observed marijuana use rates similar to representative samples of young adults and college students (i.e., 53.3% lifetime marijuana users, 26.2% past month marijuana users). About 1 in 10 past month marijuana users experienced no consequences from their use, whereas nearly 1 in 10 experienced 19 or more consequences. Lifetime marijuana users had more positive perceptions of marijuana compared to non-users on a wide-range of marijuana-related constructs. CONCLUSIONS: We report descriptive statistics on a wide range of marijuana-related variables. We hope that these data provide a useful baseline prior to increased legalization of recreational marijuana use. Multi-site studies like this one are needed to study the risky and protective factors for problematic marijuana use. These findings can inform interventions and public policy.

Failing to diagnose and failing to treat an addicted client: Two potentially life-threatening clinical errors.

Psychotherapists risk making 2 types of errors with clients who struggle with addictive behaviors: failure to diagnose addictive behaviors and failure to effectively treat addictive behaviors. Given the high prevalence of addictive behaviors in clinical populations, therapists are in a unique position to assist individuals with these problems. It is assumed that therapists possess general diagnostic and treatment skills and yet many do not diagnose or do not treat addictive behaviors. Reasons for making these errors include prohibitive beliefs and limited knowledge about addictive behaviors. We offer specific recommendations to reduce these psychotherapy errors. These include: (a) more deliberate screening and diagnosis of addictive behaviors, (b) increased application of empirically supported addiction treatments, (c) required education and training in addictive behaviors, (d) modification of prohibitive attitudes about addressing addictive behaviors, and (e) increased attention paid to the addictive behaviors by professional psychotherapy organizations.

Concept mapping: A supervision strategy for introducing case conceptualization skills to novice therapists.

Case conceptualization, a term synonymous with case formulation, is an essential psychotherapy skill. Novice therapists enter into the practice of psychotherapy with limited case conceptualization skills. Hence, an important goal when supervising novice therapists is to effectively teach these skills. Concept mapping facilitates case conceptualization skills through the process of methodically creating graphic representations of clients' problems and dynamic relationships between these problems. This article introduces a highly structured and practical 4-stage approach to supervision that effectively introduces case formulation skills to novice therapists using concept mapping. It is assumed that concept maps, when shared with clients, function as an intervention to facilitate insight and change.

A controlled trial of bupropion added to nicotine patch and behavioral therapy for smoking cessation in adults with unipolar depressive disorders.

Although there is a strong relationship between depression and smoking, most nicotine dependence treatment trials exclude depressed smokers. Our objective was to determine whether bupropion improves abstinence rates and abstinence-associated depressive symptoms when added to transdermal nicotine replacement therapy (NRT) and group cognitive behavioral therapy (CBT) in smokers with unipolar depressive disorder (UDD). Adult smokers with current (n = 90) or past (n = 109) UDD were randomly assigned to receive bupropion or placebo added to NRT and CBT for 13 weeks. In the primary analysis, with dropouts considered smokers, 36% (35/97) of those on bupropion and 31% (32/102) on placebo attained biochemically validated 7-day point prevalence abstinence at end of treatment (not significant). Because of a high dropout rate (50%) and a significant difference in abstinence status at dropout by treatment group, a traditional intent-to-treat analysis with last observation carried forward imputation of abstinence status was performed. In this secondary analysis, 56% (54/97) of those on bupropion and 41% (42/102) on placebo met criteria for abstinence at end of trial, chi2 = 4.18, P = 0.04. Nicotine replacement therapy usage and absence of a comorbid anxiety disorder predicted abstinence. Abstinence was associated with increased depressive symptoms, regardless of bupropion treatment. Thus, in the primary analysis, bupropion neither increased the efficacy of intensive group CBT and NRT for smoking cessation in smokers with UDD nor prevented abstinence-associated depressive symptoms. Bupropion seemed to provide an advantage for smoking cessation for those who remained in the trial. The dropout rate was high and was characterized by a higher prevalence of current comorbid anxiety disorder. Given the high abstinence rate achieved with CBT plus NRT, a ceiling effect related to the high level of intervention received by all subjects may have prevented an adequate test of bupropion.