Transdiagnostic Processes as Mediators of Change in an Internet-Delivered Intervention Based on the Unified Protocol

Background Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N = 129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In separate mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, the indirect effects through mindfulness and cognitive flexibility emerged as significant. Conclusion These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness and cognitive flexibility as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

Transdiagnostic Processes as Mediators of Change in an Internet-delivered Intervention based on the Unified Protocol

Background: Transdiagnostic treatments target shared mechanisms between disorders to facilitate change across diagnoses. The Unified Protocol (UP) aims at changing dysfunctional reactions towards emotions by increasing mindful emotion awareness and cognitive flexibility, as well as decreasing anxiety sensitivity and emotion avoidance. Method: We investigated whether these transdiagnostic processes were malleable by treatment and mediated the relationship between treatment and outcome in an internet-delivered adaptation of the UP. N=129 participants with mixed anxiety, depressive, and somatic symptom disorders were randomized to treatment or waitlist. Results: The treatment yielded significant changes in all transdiagnostic processes over time in comparison to a waitlist condition. In single mediator models, significant mediating effects were found for mindfulness, cognitive flexibility, behavioral activation, and experiential avoidance. When all mediators were combined in a multiple mediator model, only mindfulness emerged as a significant mediator. Conclusion: These findings add to the growing body of research on transdiagnostic processes as mediators of change and emphasize mindfulness as a transdiagnostic treatment target. However, these results should be interpreted cautiously, as temporal precedence could not be established.

Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis

ObjectivesExternal inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.MethodsWe performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.ResultsWe included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.ConclusionsExternal inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.

Exploring EFL Teachers’ Moral Identity: The Case of Iranian Teachers

Educating teachers for sustainability requires that teachers be considered as the mediators of change. To achieve this goal, a constructive teacher-learner relationship is essential where values and ethicality play a crucial role. Investigating language teachersí moral identity as an important aspect of teacher cognition can yield useful insights into the kind of relationship which is congenial to the desired whole-person development. The present qualitative study intended to explore the nature of moral dilemmas in language classes and teachersí criterial beliefs in responding to these dilemmatic situations. A systematic coding analysis of the recorded interviews with eight Iranian experienced EFL teachers revealed that they encountered moral dilemmas in both disciplinary and educational aspects of the teaching process. They referred to their knowledge, experience, intuitive sense as well as the teaching context and learnersí history as sources of their moral judgment. The findings on teachersí moral identity uphold implications for teacher education.