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BACKGROUND: Opioid use disorders (OUDs) are an epidemic causing catastrophic consequences to individuals, families, and society despite treatments including psychotherapy, substitution therapy or receptor blockers, and psychoeducation. We have developed a novel treatment that combines unilateral transcranial photobiomodulation (t-PBM) to the hemisphere with a more positive valence by Dual Brain Psychology (DBP). METHODS: We used a randomized, double blind, placebo-controlled protocol in which 22 patients with significant opioid cravings and a history of recent or current OUD attended three 1-h weekly sessions. After baseline measures of opioid craving and other psychometrics, subjects received two unilateral t-PBM applications (810 nm CW LED, 250 mW/cm2, 60 J/cm2, 4 min) or a sham (foil-covered LED) at F3 or F4. Prior to any treatment we used two tests to determine which hemisphere was more associated with a negative outlook and cravings and treated that side before the more positive hemisphere. Primary outcome measure was an opioid craving scale (OCS). Secondary outcomes were weekly Hamilton Depression (HDRS) and Anxiety (HARS) Rating Scales prior to treatments and at follow-up. RESULTS: Immediately after treatment the OCS improved significantly for both the sham and active treatments, but one week later the active treatment showed a 51.0% (SD 33.7) decrease in OCS while a week after the sham treatments there was a decrease of only 15.8% (SD 35.0) (by Wilcoxon Sign Rank Test, p = 0.004) and by a mixed model it was p = 0.0071. The effect size for the differences between active and sham was 0.73. For the active treatment from before and after treatment the effect size was 1.51 and for the sham, 0.45. The HDRS improved from a baseline of 15.1 to 8.8 (SD 10.3) a week after the active treatment and to 13.3 (SD 12.9) after the sham (p = 0.0071). HARS improved from 14.7 to 8.0 (SD 13.2) after the active treatments and to 14.3 (SD 16.0) after the sham, p = 0.08. Active treatment of the positive hemisphere after the negative hemisphere significantly improved the OCS, but there was no significant difference after the sham treatment. One patient complained of 2 h of abdominal bloating and dropped out; no other adverse effects were observed. DISCUSSION: Unilateral t-PBM to the hemisphere with a more positive hemispheric emotional valence was an effective and safe treatment for opioid cravings as well as for depression and anxiety. Our results also lend support to the underlying premises of DBP.
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Purpose: Burnout has been shown to develop due to chronic stress or distress, which has negative implications for both physical and mental health and well-being. Burnout research originated in the "caring-professions." However, there is a paucity of research which has focused specifically on how job demands, resources and personal characteristics affect burnout among practitioner psychologists. Methods: This PRISMA review (Moher et al., 2009) involved searches of key databases (i.e., Web of Knowledge, SCOPUS and Google Scholar) for articles published prior to 1st January, 2017. Articles concerning the prevalence and cause(s) of burnout in applied psychologists, that were published in the English language were included. Both quantitative and qualitative investigative studies were included in the review. The Crowe Critical Appraisal Tool (CCAT; Crowe, 2013) was used to appraise the quality of each paper included in this review. An inductive content analysis approach (Thomas, 2006) was subsequently conducted in order to identify the developing themes from the data. Results: The systematic review comprised 29 papers. The most commonly cited dimension of burnout by applied psychologists was emotional exhaustion (34.48% of papers). Atheoretical approaches were common among the published articles on burnout among applied psychologists. Workload and work setting are the most common job demands and factors that contribute to burnout among applied psychologists, with the resources and personal characteristics of research are age and experience, and sex the most commonly focused upon within the literature. Conclusions: The results of the current review offers evidence that burnout is a concern for those working in the delivery of psychological interventions. Emotional exhaustion is the most commonly reported dimension of burnout, with job and personal characteristics and resources also playing important roles in the development of burnout in the mental health care profession. Finally, tentative recommendations for those within the field of applied psychology.
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Well-being and mental health of psychologists and their clients can be strongly linked to the psychologists' experience of work. We know from general theories of occupational health psychology that certain work factors will have a greater impact on well-being than others. Work engagement is positively related with occupational health, while burnout and workaholic tendencies relate negatively. An individual's resources can buffer against these negative effects. Specifically, the environmental resource of social support can impede the impact and instance of workaholism and has a positive influence on burnout. Social support is often encouraged by sport psychologists in protecting an athlete's well-being. Drawing on theory and research from work and organizational, health and social psychology we explore the lived experiences of burnout and work engagement among applied sport psychologists, investigating their perceptions of how these experiences impact their well-being. Thirty participants from five countries were asked, using semi-structured interviews, to recall specific incidents when feelings of work engagement and burnout occurred. We examined the influence of social support and its impact on these incidents. Thematic analysis revealed that burnout is frequently experienced despite high levels of work engagement. Sources of social support differ between groups of high burnout versus low burnout, as does reference to the dimensions of work engagement. Avenues for future research including investigating the role of mindfulness and therapeutic lifestyle changes for practitioners are outlined.
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BACKGROUND: The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress. An alternative hypothesis is that risk depends on type and timing of maltreatment. This will also present as a linear increase, since exposure to more types of abuse increases likelihood of experiencing a critical type of abuse at a critical age. METHODS: 560 (223M/337F) young adults (18-25 years) were recruited from the community without regard to diagnosis and balanced to have equal exposure to 0-4 plus types of maltreatment. The Maltreatment and Abuse Chronology of Exposure Scale assessed severity of exposure to 10 types of maltreatment across each year of childhood. Major depressive disorder (MDD) and current symptoms were evaluated by SCID, interview, and self-report. Predictive analytics assessed importance of exposure at each age and evaluated whether exposure at one or two ages was a more important predictor than number, severity, or duration of maltreatment across childhood. RESULTS: The most important predictors of lifetime history of MDD were non-verbal emotional abuse in males and peer emotional abuse (EA) in females at 14 years of age, and these were more important predictors across models than number of types of maltreatment (males: t 9 = 16.39, p < 10(-7); females t 9 = 5.78, p < 10(-4)). Suicidal ideation was predicted, in part, by NVEA and peer EA at age 14, but most importantly by parental verbal abuse at age 5 in males and sexual abuse at age 18 in females. CONCLUSION: This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results. These findings fit with emerging neuroimaging evidence for regional sensitivity periods. The presence of sensitive exposure periods has important implications for prevention, preemption, and treatment of MDD.
