PubMed · 12608106
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Donald D Hensrud. 2003-02-17. When life really stinks.. https://pubmed.ncbi.nlm.nih.gov/12608106/
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PRIMARY OBJECTIVE: To examine the potential efficacy of a mindfulness-based stress reduction approach to improve quality of life in individuals who have suffered traumatic brain injuries. RESEARCH DESIGN: Pre-post design with drop-outs as controls. METHODS AND PROCEDURES: We recruited individuals with mild to moderate brain injuries, at least 1 year post-injury. We measured their quality of life, psychological status, and function. Results of 10 participants who completed the programme were compared to three drop-outs with complete data. EXPERIMENTAL INTERVENTION: The intervention was delivered in 12-weekly group sessions. The intervention relied on insight meditation, breathing exercises, guided visualization, and group discussion. We aimed to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs. MAIN OUTCOMES AND RESULTS: The treatment group mean quality of life (SF-36) improved by 15.40 (SD = 9.08) compared to - 1.67 (SD = 16.65; p = 0.036) for controls. Improvements on the cognitive-affective domain of the Beck Depression Inventory II (BDI-II) were reported (p = 0.029), while changes in the overall BDI-II (p = 0.059) and the Positive Symptom Distress Inventory of the SCL-90R (p = 0.054) approached statistical significance. CONCLUSIONS: The intervention was simple, and improved quality of life after other treatment avenues for these participants were exhausted.
This paper presents an experimental study of participants' response to the sudden appearance of a fire emergency in a virtual environment (VE) and of the adaptivity of their response pattern. A VE has been built in which participants meet two situations: first an explorative navigation and afterwards a hurried escape from the unexpected outbreak of fire. Fire intensity and participants' distance from the exit at the outbreak of fire have been varied as well, to create different degrees of danger and different degrees of difficulty in the task of leaving the premises. Participants' action has been collected automatically for quantitative analysis by registering each individual activation of the interaction devices (a triple button joystick). In addition, the movements in both virtual and real environment of additional groups of participants have been videorecorded for qualitative analysis. Results show that the appearance of the fire emergency triggers important changes in the way people move in the VE, and that such changes are all adaptive responses to an emergency situation. In conclusion, people show recognition of a dangerous situation in a VE and readily produce adaptive responses, making the VE suitable for emergency simulations and for use as an effective training tool.
CONTEXT: Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment. OBJECTIVE: To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI. DESIGN, SETTING, AND PATIENTS: Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention. INTERVENTION: Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks. MAIN OUTCOME MEASURES: Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months. RESULTS: Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients). CONCLUSIONS: The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.