Jeanne Dalen

The Brief Resilience Scale: Assessing the ability to bounce back

Background: While resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. Previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. Purpose: To test a new brief resilience scale. Method: The brief resilience scale (BRS) was created to assess the ability to bounce back or recover from stress. Its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. Results: The BRS was reliable and measured as a unitary construct. It was predictably related to personal characteristics, social relations, coping, and health in all samples. It was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and Type D personality (high negative affect and high social inhibition) were controlled. There were large differences in BRS scores between cardiac patients with and without Type D and women with and without fibromyalgia. Conclusion: The BRS is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors.

Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity

OBJECTIVES The purpose of this study was to pilot a brief (6-week) group curriculum for providing mindfulness training to obese individuals, called Mindful Eating and Living (MEAL). SETTING AND DESIGN Participants were recruited through a local Young Mens Christian Association (YMCA) in spring 2006. Data was collected at three time points: baseline, completion of intervention (6 weeks), and 3-month follow-up (12 weeks). INTERVENTION Six weekly two-hour group classes (with two monthly follow-up classes). Content included training in mindfulness meditation, mindful eating, and group discussion, with emphasis on awareness of body sensations, emotions, and triggers to overeat. MAIN OUTCOME MEASURES Key variables assessed included changes in weight, body-mass index (BMI), eating behavior, and psychological distress. In addition, physiological markers of cardiovascular risk were evaluated including C-reactive protein (hsCRP), adiponectin, low-density lipoprotein (LDL), and plasminogen activator inhibitor-1 (PAI-1). RESULTS Ten obese patients enrolled with a mean BMI of 36.9 kg/m² [SD±6.2]. The mean weight was 101 kg/m² and the mean age was 44 years (SD=8.7; range=31-62). Compared to baseline data, participants showed statistically significant increases in measures of mindfulness and cognitive restraint around eating, and statistically significant decreases in weight, eating disinhibition, binge eating, depression, perceived stress, physical symptoms, negative affect, and C-reactive protein. CONCLUSIONS This study provides preliminary evidence that a eating focused mindfulness-based intervention can result in significant changes in weight, eating behavior, and psychological distress in obese individuals.

A Pilot Study Comparing the Effects of Mindfulness-Based and Cognitive-Behavioral Stress Reduction

OBJECTIVES The objective of this pilot study was to compare the effects of two mind-body interventions: mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR). SUBJECTS Fifty (50) subjects were recruited from the community and took part in MBSR (n = 36) and CBSR (n = 14) courses. Participants self-selected into MBSR or CBSR courses taught at different times. There were no initial differences between the MBSR and CBSR subjects on demographics, including age, gender, education, and income. INTERVENTION MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress. DESIGN Perceived stress, depression, psychological well-being, neuroticism, binge eating, energy, pain, and mindfulness were assessed before and after each course. Pre-post scores for each intervention were compared by using paired t tests. Pre-post scores across interventions were compared by using a general linear model with repeated measures. SETTINGS/LOCATIONS: Weekly meetings for both courses were held in a large room on a university medical center campus. RESULTS MBSR subjects improved on all eight outcomes, with all of the differences being significant. CBSR subjects improved on six of eight outcomes, with significant improvements on well-being, perceived stress, and depression. Multivariate analyses showed that the MBSR subjects had better outcomes across all variables, when compared with the CBSR subjects. Univariate analyses showed that MBSR subjects had better outcomes with regard to mindfulness, energy, pain, and a trend for binge eating. CONCLUSIONS While MBSR and CBSR may both be effective in reducing perceived stress and depression, MBSR may be more effective in increasing mindfulness and energy and reducing pain. Future studies should continue to examine the differential effects of cognitive behavioral and mindfulness-based interventions and attempt to explain the reasons for the differences.

Family and Physician Influence on Asthma Research Participation Decisions for Adolescents: The Effects of Adolescent Gender and Research Risk

OBJECTIVE. There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. STUDY DESIGN: Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. RESULTS: Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. CONCLUSIONS: Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians’ views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research participation decision-making in biomedical research are discussed.

Who Is Willing to Use Complementary and Alternative Medicine

OBJECTIVE The aim of this study was to identify individual differences associated with the willingness to use complementary and alternative medicine (CAM). DESIGN A questionnaire was administered and the relationship between individual differences and the willingness to use CAM was examined using correlation and multiple regression analyses. PARTICIPANTS The sample consisted of 276 undergraduate students (64% female) of diverse ethnicity (43% white, 33% Hispanic, 8% Native American, 16% other) and a wide range of incomes. MEASURES The willingness to use 16 types of CAM was assessed for six categories: whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, energy medicine, and spiritually based practices. The individual differences assessed included age, gender, income, ethnicity, the Big Five personality characteristics, optimism, spirituality, religiosity, and three aspects of emotional intelligence: mood attention, mood clarity, and mood repair. RESULTS The individual differences accounted for approximately one fifth of the variance in overall willingness to use CAM. Openness to experience, spirituality, and mood attention were the strongest predictors of overall willingness to use CAM and were related to the willingness to use most of the individual types of CAM. Older age or female gender was related to greater willingness to use most of the mind-body medicines. Hispanic ethnicity was related to greater willingness to use curanderismo, and Native American ethnicity was related to greater willingness to use Native American medicine and a spiritual/faith healer.

Posttraumatic Growth in Non-Hispanic White and Hispanic Women with Cervical Cancer

ABSTRACT This study examined posttraumatic growth (PTG) in Non-Hispanic White (NHW; n = 132) and Hispanic (HISP; n = 51) women who had been diagnosed with cervical cancer. Participants completed measures of PTG, spirituality, optimism, stage of cancer, and demographics variables. The results showed that women with cervical cancer reported PTG but at lower levels than in studies of women with breast cancer. Greater spirituality and more advanced cancer stage predicted more PTG, but optimism did not predict PTG. HISP women reported higher levels of PTG than NHW women, and greater spirituality in the HISP women partially accounted for the difference.

Empirically Derived Knowledge on Adolescent Assent to Pediatric Biomedical Research

Background: There has been a recent growth in empirical research on assent with pediatric populations, due in part to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. Methods: The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the effects of various social context variables on adolescent research participation decision making; and the interrelatedness of these psychological and social factors. Results: Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents’ psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time according adolescents appropriate decision-making autonomy. Conclusions: Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.

Using Structural Equation Modeling to Understand Child and Parent Perceptions of Asthma Quality of Life

OBJECTIVE Using structural equation modeling, test a conceptual model of associations between constructs predicting parent and child asthma quality of life. METHODS Children with a confirmed asthma diagnosis and their parents completed measures of health status and independently reported on psychological functioning, family functioning, and quality of life. RESULTS Measurement and structural models for predicting parent and child quality of life provided a good fit of data to the conceptual model. Parent and child independent reports of quality of life are dependent upon family functioning and child psychological functioning. Long-term asthma symptom control is the only health status variable that impacts quality of life. CONCLUSIONS With minor modifications, both parent and child data fit the conceptual model. Child psychological functioning and long-term asthma control jointly contribute to quality of life outcomes. Findings suggest that both acute and long-term asthma health status outcomes have different determinants.

Conceptualizing the Role of Research Literacy in Advancing Societal Health

‘Research literacy’ is proposed as a key concept for advancing societal health. To examine whether improvements in research literacy would affect knowledge of and ethical participation in research, parents of young children received a brief educational intervention designed to enhance their understanding of child research. Results demonstrated that the intervention improved research-related knowledge and increased parents’ comfort with their research participation decisions. Moreover, enhanced understanding of child volition increased parents’ willingness to enrol their children in research. The proposed research literacy model identifies methods to enhance population knowledge and appreciation of research, strengthening links between scientific advancement and health.

Predicting Adolescent Asthma Research Participation Decisions From a Structural Equations Model of Protocol Factors

PURPOSE To examine similarities and differences in the process that parents and adolescents use to make decisions concerning participation in an asthma clinical trial. We hypothesized that a single conceptual model, tested through structural equations modeling, could explain adolescent assent and parent consent for adolescent research participation. METHODS One hundred nine adolescents enrolled with at least one parent and received an asthma evaluation from a pediatric asthma specialist and then evaluated a hypothetical asthma research protocol. Family members independently evaluated the protocol and made research participation decisions. RESULTS Perceived risk, benefit, and compensation were direct predictors of participation decisions for parents and adolescents. Adolescents perceived direct study benefit from the relationship with the physician, however parents did not. Parent decisions were most strongly associated with perceived risk, and parents associated discomfort with risk more strongly than did adolescents. Protocol procedures contributed to perceptions of benefit and discomfort for parents and adolescents. CONCLUSIONS Parent and adolescent research participation decisions are influenced by protocol variables in similar ways, although there are differences that account for disagreements within families. Findings may help investigators develop protocols that appeal to parents and adolescents and highlight issues of particular importance to address during the process of informed consent.