The Efficacy of a Forgiveness Bibliotherapy: A Randomized Controlled Trial with Nursing Students

Purpose of study: The need for forgiveness education for nursing self-care and forgiveness facilitation has risen. Therefore, the present pilot study tested the efficacy of an 8-week forgiveness bibliotherapy with a small number of undergraduate nursing students. Design of study: Matched pairs of nursing students were randomly assigned to either the experimental group or no-contact control group. The experimental group, using 8 keys to forgiveness by R. Enright (2015) as the treatment manual, read one chapter a week for 8 weeks and provided weekly reflections. Forgiveness and forgiveness-related outcome measures were administered at pretest, posttest, and one-month follow-up. Findings: At the posttest, the experimental group had significantly greater improvement in forgiveness compared to the control group with a large effect size, which was maintained at one month follow-up. There was no other significant difference between the two groups. Within-group comparisons of the experimental group showed improvement in forgiveness, anxiety, depression, and fatigue from pre to post testing periods and forgiveness, anger, anxiety, depression, and fatigue from pre to follow-up testing periods. Conclusion: Use of bibliotherapy may be a cost-effective way to promote the virtue of forgiveness for students in nursing programs.

Longitudinal Assessment of a Manualized Group Treatment Program for Gambling Disorder: The Ohio Problem Gambling Treatment Model for Adults with Co-Occurring Disorders

Individuals with gambling disorder (GD) experience a host of negative psychosocial and physical health outcomes, yet few seek treatment. Of particular concern are individuals with co-occurring mental and behavioral health disorders, a group at higher risk for GD in the state of Ohio. To better serve this population, the Ohio Department of Mental Health and Addiction Services developed a group-based GD treatment manual for adults with co-occurring disorders. Over the course of 5 years, 353 individuals engaged in at least some of the manual’s 12 weekly modules, and more than one-third (n = 122) completed the entire curriculum. Participants who completed all 12 modules completed pre-and post-tests, and after controlling for covariates, participants significantly decreased their GD symptom severity, though changes in self-esteem and gambling urges were non-significant. These findings suggest the treatment manual holds promise at reducing gambling behaviors for individuals with co-occurring disorders, but further research is warranted to explore best practices on how to intervene on the psychological antecedents to gambling in this population.

Group Telehealth Interventions Fostering Social Connection Among Older Veterans and Their Families

During the early months of the COVID-19 pandemic, virtual and telephone visits rapidly replaced most in-person care within the Veterans Health Administration (VA) to reduce virus spread. To address the emerging mental health needs of older Veterans (e.g., isolation, loneliness), we developed an 8-week group treatment manual, deliverable over telephone or videoconference, to foster social connection and address pandemic anxieties. The manual was disseminated in March 2020 as a rapid response to emergent COVID-19 pandemic realities, during which many locations in the United States called for immediate self-quarantine measures for unknown durations. This talk will present the user-centered design of the manual, preliminary feasibility and acceptability findings from provider surveys, and introduce versions of the manual targeting specific populations (e.g., caregivers, Spanish speakers) currently in development or in pilot testing.

Development and Initial Evaluation of the Caring Through COVID-19 Psychotherapy Group for Family Care Partners

This project details the development and initial evaluation of a manualized psychotherapy support group for family care partners of persons living with dementia, specially designed to address pandemic-related stressors. The authorship team, consisting of clinical geropsychologists, developed a treatment manual based on existing protocols, such as: cognitive behavioral therapy for pandemic-related stress, grief management and ambiguous loss, and caregiver family therapy. The resulting 8-week Caring Through COVID-19 psychotherapy group was piloted in an outpatient mental health clinic via tele-mental health with six family care partners of persons living with dementia. All participants were women and spouses or partners of the care recipient; mean age was 70.5 (SD = 9.07). Preliminary data showed a non-significant and small reduction in depression (d = .22) and non-significant moderate reductions in caregiver burden (d = .52) and pandemic-related stress (d = .64). Moderate non-significant improvements were observed in general caregiver self-efficacy (d = .62) and self-efficacy for emotional regulation (d = .67). The majority of participants reported that the content of the group was novel (83%) and relevant (83%); the most utilized topics outside of the group were accepting emotions (100%) and challenging negative cognitions (83%). Overall, most participants were very or extremely satisfied with the group (67%). Additional data is currently being collected with another cycle of the group (n = 4). Preliminary findings suggest that the Caring Through COVID-19 group may be beneficial for supporting family care partners during the pandemic. Considerations for implementation and future plans for dissemination will be discussed.

IMPROVING MEASUREMENTS’ SPATIAL PRECISION BY MEANS OF 3D PRINTERS-BASED SYSTEMS. A CASE STUDY: COLORIMETRIC ASSESSMENT OF MODERNIST HYDRAULIC TILES

The ability to repeat analyses on the same very small area of a surface is crucial to obtain reliable comparative data. For example, in a painting the boundary between two different, small painted areas can be very blurred; if an analyst needs to track over the time a specific and tiny pigment spot (e.g., to assess the reliability of a conservation treatment), manual positioning of the analyser can lead to a mismatch that might undermine any data comparison. The use of automatic positioning systems can improve the ability to hit the right spot, so to collect reliable data. This work focuses on the development of an open hardware XYZ system based on 3D printers’ architecture and equipped with an imaging system. It demonstrates that the combination of image processing methods with the G-code generated during the movements of the XY axes can allows to avoid misalignment of the object that needs to be analysed, and thus to improve measurements’ spatial precision. The XYZ positioning system and the positioning calibration method are now tested on Modernist hydraulic tiles from Barcelona (Catalunya, Spain), a decorative and functional element in danger because of the estate speculation that is affecting the architectonic identity of the Catalan capital.

CT-Based Pelvic T1-Weighted MR Image Synthesis Using UNet, UNet++ and Cycle-Consistent Generative Adversarial Network (Cycle-GAN)

BackgroundComputed tomography (CT) and magnetic resonance imaging (MRI) are the mainstay imaging modalities in radiotherapy planning. In MR-Linac treatment, manual annotation of organs-at-risk (OARs) and clinical volumes requires a significant clinician interaction and is a major challenge. Currently, there is a lack of available pre-annotated MRI data for training supervised segmentation algorithms. This study aimed to develop a deep learning (DL)-based framework to synthesize pelvic T1-weighted MRI from a pre-existing repository of clinical planning CTs.MethodsMRI synthesis was performed using UNet++ and cycle-consistent generative adversarial network (Cycle-GAN), and the predictions were compared qualitatively and quantitatively against a baseline UNet model using pixel-wise and perceptual loss functions. Additionally, the Cycle-GAN predictions were evaluated through qualitative expert testing (4 radiologists), and a pelvic bone segmentation routine based on a UNet architecture was trained on synthetic MRI using CT-propagated contours and subsequently tested on real pelvic T1 weighted MRI scans.ResultsIn our experiments, Cycle-GAN generated sharp images for all pelvic slices whilst UNet and UNet++ predictions suffered from poorer spatial resolution within deformable soft-tissues (e.g. bladder, bowel). Qualitative radiologist assessment showed inter-expert variabilities in the test scores; each of the four radiologists correctly identified images as acquired/synthetic with 67%, 100%, 86% and 94% accuracy. Unsupervised segmentation of pelvic bone on T1-weighted images was successful in a number of test casesConclusionPelvic MRI synthesis is a challenging task due to the absence of soft-tissue contrast on CT. Our study showed the potential of deep learning models for synthesizing realistic MR images from CT, and transferring cross-domain knowledge which may help to expand training datasets for 21 development of MR-only segmentation models.

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

BACKGROUND: The presence of pain decreases survival rates in cancer. Pain management in clinical settings is often suboptimal and secondary to other cancer-related treatments, leaving many people undertreated. Opioid use is associated with side effects and decreased survival rate in cancer patients. Hence, there is an urgent need for considering factors such as perceived injustice that sustain post-cancer pain and trigger a behavioral pattern associated with opioid use. Injustice beliefs represent a maladaptive pattern of cognitive appraisal that may be a salient target for improving pain-related coping in these patients. Perceived injustice is associated with increased opioid prescription and prospectively predicted opioid use at 1-year follow-up, urging the need for targeted interventions to diminish perceived injustice. OBJECTIVES: Explain the importance of screening for perceived injustice in patients with pain following cancer treatment, its potential relevance for opioid abuse, and its potential impact on the management of pain following cancer. Also, prove clinicians with a clinical guide for an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions to account for perceived injustice in patients having pain following cancer. STUDY DESIGN: A narrative review, perspective and treatment manual SETTING: Several universities, a university of applied science department, a university hospital, and a private clinic (i.e., transdisciplinary pain treatment center). METHODS: Patients were cancer survivors with pain. Intervention included modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. Measurements were taken through the Injustice Experience Questionnaire (IEQ). RESULTS: The IEQ can be used to assess perceived injustice in a valid way. Education about pain, including discussing perceived injustice, should be the first part of the management of pain in cancer survivors. In order to obtain the often-required behavioral change towards a more adaptive lifestyle, motivational interviewing can be used. To thoroughly tackle perceived injustice in patients having pain following cancer, special emphasis should be given to the individual reasons patients identify for experiencing (continued) pain and related symptoms. Pain acceptance should also be thoroughly addressed. LIMITATIONS: Clinical trials exploring the benefits, including cost-effectiveness, of such a multimodal approach in patients with pain following cancer treatment are needed. CONCLUSIONS: In light of its potential relevance for opioid abuse and potential impact on conservative management strategies, clinicians are advised to screen for perceived injustice in patients with pain following cancer treatment. Therapeutic targeting of perceived injustice can be done through an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. KEY WORDS: Anger, cancer, counselling, education, medication use, motivational interviewing, neuroscience education, opioid, perceived injustice, rehabilitation, survivor

Relapse prevention for eating disorders: a randomized controlled trial targeting weight-related self-esteem

A high level of weight-related self-esteem (WRSE) at the end of eating disorder treatment is predictive of relapse. The first goal of this project was to develop a cognitive-behavioural intervention to target WRSE in partially remitted eating disorder clients to prevent relapse (WRSE protocol). The second goal (Study 1) was to conduct a pilot study to assess whether receiving the WRSE protocol leads to improvements in WRSE and related variables. The final goal of this project (Study 2) was to conduct a randomized controlled trial to determine whether the individual-based treatment added to treatment as usual (TAU) provided additional benefits to eating disorder clients, with respect to WRSE, eating disorder symptoms, and relapse. After the treatment manual was developed, 16 clients were recruited and administered the treatment protocol in Study 1. The results indicated that participants had significant improvements in levels of WRSE and related variables following treatment. For Study 2, 47 participants who had achieved behavioural symptom interruption were randomly assigned to either 1) TAU + WRSE protocol or 2) TAU. Results were mainly consistent across Complete Case and Last Observation Carried Forward procedures where participants who received the additional WRSE protocol had greater improvements in WRSE, body checking behaviour, and self-esteem. Groups did not differ with respect to body avoidance, general avoidance, fat talk, and other variables compared to participants who received TAU only. Multiple imputation procedures, which accounted for missing data, indicated no significant differences for all measured variables. Participants who completed the WRSE protocol had significantly greater adherence to their meal plan (i.e., less dietary restriction) compared to participants who only received TAU. Groups did not differ regarding level of binge eating and/or vomiting after the intervention period, and there were no differences in relapse between groups at 3-month follow-up. Overall, the newly developed treatment provided some benefit to eating disorder clients above and beyond TAU. However, the data appear to have been sensitive to attrition. Future research should include further refinement of the treatment protocol and evaluation across a longer follow-up period to assess its impact on relapse rates.

Relapse prevention for eating disorders: a randomized controlled trial targeting weight-related self-esteem

A high level of weight-related self-esteem (WRSE) at the end of eating disorder treatment is predictive of relapse. The first goal of this project was to develop a cognitive-behavioural intervention to target WRSE in partially remitted eating disorder clients to prevent relapse (WRSE protocol). The second goal (Study 1) was to conduct a pilot study to assess whether receiving the WRSE protocol leads to improvements in WRSE and related variables. The final goal of this project (Study 2) was to conduct a randomized controlled trial to determine whether the individual-based treatment added to treatment as usual (TAU) provided additional benefits to eating disorder clients, with respect to WRSE, eating disorder symptoms, and relapse. After the treatment manual was developed, 16 clients were recruited and administered the treatment protocol in Study 1. The results indicated that participants had significant improvements in levels of WRSE and related variables following treatment. For Study 2, 47 participants who had achieved behavioural symptom interruption were randomly assigned to either 1) TAU + WRSE protocol or 2) TAU. Results were mainly consistent across Complete Case and Last Observation Carried Forward procedures where participants who received the additional WRSE protocol had greater improvements in WRSE, body checking behaviour, and self-esteem. Groups did not differ with respect to body avoidance, general avoidance, fat talk, and other variables compared to participants who received TAU only. Multiple imputation procedures, which accounted for missing data, indicated no significant differences for all measured variables. Participants who completed the WRSE protocol had significantly greater adherence to their meal plan (i.e., less dietary restriction) compared to participants who only received TAU. Groups did not differ regarding level of binge eating and/or vomiting after the intervention period, and there were no differences in relapse between groups at 3-month follow-up. Overall, the newly developed treatment provided some benefit to eating disorder clients above and beyond TAU. However, the data appear to have been sensitive to attrition. Future research should include further refinement of the treatment protocol and evaluation across a longer follow-up period to assess its impact on relapse rates.