Feasibility and clinical usefulness of the Unified Protocol in women survivors of violence

Violence against women is a serious public health problem. Worldwide, one in three women experiences violence throughout their lives. According to the triple vulnerability theory, being a survivor of violence could constitute a psychological vulnerability that would favor the appearance of emotional disorders, affecting their health, their style of parenting, and family well-being. The objective of this study is to verify the feasibility and usefulness of Unified Protocol (UP) in a group format for improving emotion regulation in women survivors of violence attended in the Specific Child and Adolescent Intervention Team (SCAIT), a social community service. The sample consists of 11 women who have experienced different types of violence who received the UP through 11 weekly, two-hour long and in group format sessions. Assessments were conducted at pre and post intervention and at 3, 6, and 12 months follow-up. The results of the Multivariate Analysis of Variance (MANOVA) show an increase in quality of life (including family relationships), self-esteem and extraversion scores, and a reduction in interference (including family life), neuroticism, somatization, anxiety, emotional lack of control, negative affect, depression, and emotional rejection scores. This evolution of the scores with the MANOVA takes into account all the evaluation time points (post, and follow-up at 3, 6 and 12 months). The results were statistically significant (p < 0.05), and had large effect sizes (η2p > 0.14). In addition, the reliable change index was calculated to assess the change at an individual level of each of the participants for the different outcomes. 90.9% of the participants rated the quality of the program received as “excellent” and we obtained a high rate of session attendance (82.64%). These results justify the need for randomized controlled clinical studies to demonstrate the feasibility and clinical efficacy of the UP in this context. This intervention would allow to address the needs of this population, by offering them comprehensive care and improving their mental health from a biopsychosocial model. Likewise, it might indirectly improve the well-being of the rest of the family members.

Efficacy of cognitive-behavioral therapy for insomnia: a group format implementation in the Spanish National Health System

Background. Cognitive-behavioral therapy for insomnia (CBT-i) is considered the first-line treatment for this disorder, but it is not widely implemented in clinical settings. This study aims to examine the efficacy of a CBT-i in group format in the Spanish National Health System. Method. Fifty-two participants with a Primary Insomnia Disorder (55.8% women; Mage = 47.19, SD = 11.02) were assigned to a CBT-i (n =17) or waiting list condition (n = 21). Treatment consisted of eight group format sessions (2 hours/week). Results. Significant improvements in insomnia severity, sleep quality, and insomnia-related dysfunctional beliefs and attitudes were observed in patients who received CBT-i. Emotional symptoms also decreased after the intervention in the CBT-i group. Conclusion. Findings support the efficacy of cognitive-behavioral therapy for insomnia with a group protocol for patients with primary insomnia disorder. The maintenance role of insomnia-related dysfunctional beliefs and attitudes in this disorder is also suggested.

The “General practitioner learning stations”—development, implementation and optimization of an innovative format for sustainable teaching in general practice

Background Teaching general practice in a university setting is still challenging. In our department we have developed a teaching format with content from a previous lecture-style-teaching into an interactive small group format taught by frontline general practitioners (GPs). The “GP learning stations” introduce students to the skills and attributes of a GP working in primary care in a university setting. Our main objective was to understand whether the teaching format had proven itself sustainable in a university setting over eight years. Furthermore, we wanted to better understand the role of the GP as a medical educator. Methods More than eight years of experience in organizational and staff expenses were collected and analyzed. In addition, the grade point average of the students’ evaluation was calculated and their free text answers were categorized and evaluated descriptively. During two teach-the-teacher seminars attending GPs were asked why they teach and if they feel equipped to teach the format. Results The initially high organizational and staff expenses were significantly reduced. The recruitment of GPs, their didactic contribution, and their joint creation of content went smoothly throughout the whole period. A total of 495 students participated in the regular evaluation. The analysis yielded a grade point average of 1.9, on a scale from 1 = very good to 6 = insufficient. In the free text answers students praised the educators, the format and the practical relevance. The interactive transfer of the content, the didactic competence of the educators and the spatial environment were viewed critically. Reasons for GPs to teach were the joy to pass on knowledge and experience, and to make the work of GPs more attractive to students. Most GPs felt prepared to teach through their experience as a physician although some felt unprepared to teach through their lack of didactic knowledge. Conclusion Despite reducing the costs of the format, a grade point average of 1.9 could be achieved in the long term. This supports the teaching concept of learning stations and its “mixture of discussion, scientific background and role play, combined with (…) experiences and exciting individual cases from (GPs) everyday life”, hopefully making general practice more attractive to the students.

Transdisciplinary research on repository safety: challenges and opportunities

Since 2019, transdisciplinary research on the scientifically challenging and often controversially debated topic of nuclear waste management on a larger scale has been carried out for the first time in Germany within the co-operative project “TRANSENS” (http://www.transens.de, last access: 21 October 2021). While various and sometimes diverging definitions and understandings of the term “transdisciplinarity” can be found in the literature (e.g., Klein, 2013), we understand it as a specific type of “problem-orientated” basic research integrating a variety of knowledge bodies, values and expectations coming not only from academia but also from the dialogue with society. We consider transdisciplinarity a reflexive, integrative, methodology-guided scientific principle directed at the solution of a societal problem and related scientific challenges by involving non-specialists and actors from practise. Obviously, the safety of nuclear waste management and particularly of waste disposal is an important concern of stakeholders. For specialists, the Safety Case is an established and well-developed instrument supporting safety-informed decisions in a stepwise disposal programme (OECD/NEA, 2013). The idea of Sicherheitsuntersuchungen (safety evaluations) informing decisions in the German siting process is based on the Safety Case concept. However, different stakeholders and interested persons have different notions and views about safety and different values behind these notions (Röhlig and Eckhardt, 2017). The idea behind the TRANSENS Working Package SAFE is to elicit such views and, if possible, to derive conclusions on optimisation potential for the Safety Case. Specifics and potential challenges of this research and ways to address them include: While transdisciplinary research in many cases involves directly affected individuals and groups, TRANSENS is an application-orientated basic research project which does not aim at interfering with the site selection procedure in Germany. Therefore, our research partners from civil society include permanent groups of interested individuals – but not of stakeholders – recruited in a well-defined process. Transdisciplinary research often starts by performing “co-design”, i.e. by jointly formulating the research question(s), but project “funding logic” requires problem definitions already in the application phase of a project. We attempt to overcome this by working in “theme corridors”, which define overarching research questions but leave leeway for later adjustment within these corridors. Being a complex concept, the Safety Case as such might not be well amenable to non-specialists. We address the problem by (i) taking a stepwise approach starting with a preparatory focus group format involving individuals with “Safety Case experience”; (ii) aiming at continuous involvement of one of the permanent groups mentioned above, allowing focussed and in-depth discussions; (iii) being flexible concerning additional transdisciplinary formats and partnerships. The SAFE Working Package team has successfully completed the focus group format under pandemic conditions and is currently preparing the next steps. Preliminary findings include those related to the tool “Safety Case”, to the feasibility of the focus group format in a transdisciplinary context, to observations concerning social interactions within the focus group, and to the way forward. The SAFE team sees opportunities particularly in discussing aspiration and philosophy of safety demonstration, in reflecting potential disciplinary biases influencing both production and criticism of the Safety Case, and for developing new concepts for the interplay between civil society and experts on this complex and elaborated analytical tools in various transdisciplinary formats.

Problem-solving skills groups for female Syrian refugees in Lebanon: a study of a mental health intervention

Since the outbreak of the Syrian civil war in 2011, Lebanon has witnessed an influx of over one million refugees. This has placed a serious strain on Lebanon’s mental healthcare system, creating the need for an efficient intervention for refugees. Health workers were recruited from various centres and trained to deliver a module of 12 sessions in problem-solving skills in group format. Then, they recruited female Syrian refugees and Lebanese women to form groups and deliver the intervention in the host communities. Results showed that levels of anxiety and depression, as reported by the Hopkins Symptom Checklist screening tool, seemed to decrease significantly after the intervention. An additional outcome was that most of the participants felt supported by other women. These results demonstrated that a direct and short intervention with female refugees can lead to measurable improvements in their mental1 health and was perceived by participants as highly beneficial.

A group-based chronic pain intervention using the Unlearn Your Pain method: A retrospective one-arm cohort study

LAY SUMMARY Chronic pain is a frequent occurrence in military and Veteran populations. This study examined whether a group-based chronic pain treatment using the Unlearn Your Pain method was effective in reducing chronic pain in 21 military and Veteran participants. Participants completed measures of pain before and after engaging in the treatment, and results showed participants experienced large reductions in total pain and pain-related catastrophizing and moderate reductions in pain-related disability and pain-related fear of movement after completing the treatment. A smaller group of the participants completed the measures again eight weeks after completing treatment, and the size of their improvements was even greater. This study offers preliminary support for the Unlearn Your Pain method offered in a group format to military and Veteran populations. Further study is warranted.

“Thinking About Thinking” in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition

Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.

Predictors of Discontinuation From Individual Treatment in Men Perpetrators of Intimate Partner Violence

Practitioners working with male perpetrators of intimate partner violence (IPV) observe high rates of treatment dropout in their clientele, which can undermine their ability to reduce the occurrence of IPV. Studies have also mostly documented predictors of dropout from group-format IPV treatment programs, but not from individual-format treatment modalities. This study aimed to identify the predictors and key moments of dropout in 206 French-Canadian men seeking individual treatment for IPV. Results of Cox regression survival analyses indicate that age, education, employment, court-ordered treatment, adult attachment, and the number of perpetrated acts of psychological violence were significant predictors of dropout. Findings highlight the need to assess and target those predictors early in treatment to help men remain in therapy and prevent further use of IPV.

Instructional Coaching Cycles and Career and Technical Educators’ TPACK

Most professional development occurs in a large group format. In most cases, there is little to no application or continued support for teachers. All teachers, particularly those in career and technical schools, struggle to implement newly learned strategies related to technology, pedagogy, and content knowledge (TPACK) with this type of support. A review of the literature proves that through the support of instructional coaches, teachers can improve their practice through sustained professional learning with a coaching peer. The study followed six, secondary teachers from a comprehensive career and technical school who participated in instructional coaching cycles to improve technology, pedagogy, and content knowledge (TPACK) in their classrooms. Results from the study suggest the utility of instructional coaching as a means of helping educators develop enhanced TPACK.