Article

# Leveraging Mindfulness to Build Resilience and Professional Quality of Life in Human Service Professionals

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## Abstract

Mindfulness-based interventions (MBIs) have shown promise in cultivating resilience and are widely accepted as efficacious in the treatment of a range of psychological disorders. This paper explores the feasibility of a mindful-awareness and resilience skills training (MARST) program to enhance mindfulness and resilience, as a means of increasing psychological well-being and alleviating burnout and compassion fatigue in human service professionals. In this randomised control trial, 46 human service professionals were randomly allocated to either a MARST group or to a no intervention, control group. Multivariate analysis of covariance (MANCOVA), with pre-test scores as the covariates, revealed that the MARST intervention resulted in significant improvements in mindfulness, resilience, compassion satisfaction, and psychological well-being, and significant reductions in burnout and compassion fatigue; at post-intervention. These results were maintained at one month follow-up, with the exception of compassion satisfaction which was non-significant. Mediation analysis using a bootstrap resampling method indicated that mindfulness fully mediated changes in resilience and psychological well-being, as a result of the MARST intervention. Self-reported reductions in burnout following the intervention were mediated by mindfulness and resilience, and decreased compassion fatigue was mediated by resilience. The results of this study suggest that the MARST program may assist in developing resilience and reduce burnout and compassion fatigue in human service professionals. The study also provides evidence for the potential of mindfulness-based approaches to enhance resilience.

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... Studies that analyze the effects of mindfulness on social workers are still scarce (Trowbridge and Lawson, 2016), although they are currently on the rise. These investigations have found a significant relationship between the practice of mindfulness and the reduction of burnout (and its individual dimensions) in social workers in general (Crowder and Sears, 2017;Thomas, 2012;Thomas and Otis, 2010), in geriatric social workers (Pandya, 2019), and in human service professionals in general (Hanna and Pidgeon, 2018). Among these professionals, mindfulness practice has additionally been associated with lower levels of compassion fatigue (Thomas, 2012;Thomas and Otis, 2010), greater resilience (Hanna and Pidgeon, 2018), greater compassion satisfaction (Pandya, 2019), and a greater degree of mental well-being (Goodman and Shorling, 2012). ...
... These investigations have found a significant relationship between the practice of mindfulness and the reduction of burnout (and its individual dimensions) in social workers in general (Crowder and Sears, 2017;Thomas, 2012;Thomas and Otis, 2010), in geriatric social workers (Pandya, 2019), and in human service professionals in general (Hanna and Pidgeon, 2018). Among these professionals, mindfulness practice has additionally been associated with lower levels of compassion fatigue (Thomas, 2012;Thomas and Otis, 2010), greater resilience (Hanna and Pidgeon, 2018), greater compassion satisfaction (Pandya, 2019), and a greater degree of mental well-being (Goodman and Shorling, 2012). ...
... Moreover, a statistically significant relationship can be observed between the burnout construct along with two of its dimensions (exhaustion and depersonalization), on one hand, and the performance of meditative practices on the other, so that those who have carried out this type of practice present more exhaustion and depersonalization. These results are at odds with research that indicates the positive effects of different practices based on mindfulness in reducing burnout (Goodman and Shorling, 2012;Hanna and Pidgeon, 2018;Pandya, 2019;Thomas, 2012;Thomas and Otis, 2010). A similar situation occurs in the analysis of the mindfulness construct (MAAS), which again presents a statistically significant relationship with the fact of not having practiced meditative techniques at any time in life. ...
Article
Although the number of studies on burnout in social work has increased in recent years, research is still scarce. A similar situation occurs in the area of studies on the effects of mindfulness in this profession, although the research topic has increased exponentially. Based on a quantitative analysis, our study proposes a structural equation model that relates the constructs of burnout, areas of worklife, and dispositional mindfulness among social workers. Results suggest that high levels of mindfulness as well as consistency in the areas of worklife have predictive and preventive effects on the incidence of burnout in social work.
... Eastern [142,143,146,149,150,[152][153][154]156,159,181,182,187,189,191,193,233,239,250] 19 ( 59,60,63,67,69,70,79,80,84,94,101,108,110,117,124,[130][131][132]135,137,166,168,171,198,200,202,[213][214][215]225,244] 32 (14.5%) ...
... Western [42,[44][45][46]48,51,52,64,69,70,77,89,93,97,107,114,118,120,121,125,126, Western [41,63,66,68,74,75,78,81,[85][86][87][88]95,96,104,105,108,110,112,127,129,131, Western [39,40,43,[47][48][49][53][54][55][56][57][58][59][60]62,64,66,67,[71][72][73][74]76,79,[81][82][83][84][85]90,92,94,95,[98][99][100][101][102][103][104]106,109,111,[113][114][115][116][117][118][119]122,123,126,128,[130][131][132][133][135][136][137][138][139][140]162,[164][165][166] ...
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Previous research has demonstrated the efficacy of psychological interventions to foster resilience. However, little is known about whether the cultural context in which resilience interventions are implemented affects their efficacy on mental health. Studies performed in Western (k = 175) and Eastern countries (k = 46) regarding different aspects of interventions (setting, mode of delivery, target population, underlying theoretical approach, duration, control group design) and their efficacy on resilience, anxiety, depressive symptoms, quality of life, perceived stress, and social support were compared. Interventions in Eastern countries were longer in duration and tended to be more often conducted in group settings with a focus on family caregivers. We found evidence for larger effect sizes of resilience interventions in Eastern countries for improving resilience (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] 0.28 to 0.67; p < 0.0001; 43 studies; 6248 participants; I2 = 97.4%). Intercultural differences should receive more attention in resilience intervention research. Future studies could directly compare interventions in different cultural contexts to explain possible underlying causes for differences in their efficacy on mental health outcomes.
... Lindsay and Creswell (2017) argued that mindfulness is related to lower psychological distress during stressful life events. Hanna and Pidgeon (2018) introduced a mindfulness program which may assist in developing resilience and reduce burnout and compassion fatigue in human service professionals. Joyce et al. (2018) suggested that there is a greater level of resilience among employees after practicing a mindfulness-based resilience program. ...
... It would be particularly useful to develop resilience during helpers' initial training and measure it in order to identify helpers who may need more support to develop resilience and other mental health protection factors such as self-compassion, optimism, or hope. Resilience may be developed, for example, through mindfulnessbased practices [47,48], positive psychology interventions [49], or compassion-focused therapy. Furthermore, by increasing professional skills to help the client overcome such a situation, it may help to reduce empathic distress fatigue by increasing the orientation of the professional towards helping relieve other's suffering. ...
Article
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This study validated the French version of the Brief Resilience Scale (BRS-F) and tested the protective role of resilience in the context of vicarious trauma (22 March 2016 terrorist attacks in Brussels) regarding anxiety and depression symptoms. Confirmatory factor analyses indicated a single-factor structure of the BRS-F. Investigation of convergent validity showed that the BRS-F was positively correlated with usual outcomes such as subjective happiness, acceptance, and sense of coherence, and negatively correlated with anxiety and depression symptoms. Lastly, the results of the study showed that resilience protected against the effect of vicarious trauma in two ways. First, at the time of exposure, the more resilient individuals reported lower levels of anxiety and depression symptoms. Second, after three months, the more resilient individuals recovered from these symptoms, whereas no significant effect was found for less resilient individuals. Theoretical and clinical implications of the findings are discussed.
... Mindfulness meditation has been shown to have a positive impact on female teachers' mental health and wellbeing in the SARS-COV-2 outbreak in Italy [80]. Hanna and Pidgeon [81]and Behan [76] argue that of the many different forms of meditation and mindfulness, what have been evidenced in showing improvements in depression, panic, anxiety and pain is mindfulness-based stress reduction (MBSR). Having MBSR as a low-cost method to complement medical treatment in COVID-19 and post the pandemic is being of particular interest to healthcare professionals and in alternative medicine [57,76]. ...
Article
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The SARS-COV-2 virus has changed people’s lives and caused significant public health issues. The lockdown implemented by several governments across the globe has raised serious concerns on mental and physical wellbeing. Doctors, nurses and other COVID-19 frontline workers being put under extreme pressure to attend to patients’ health are being impacted by high stress levels which can result in burn-out and the inability to cope with the situation. This paper draws on multi-disciplinary research including complementary, traditional and integrative medicine, behavioral medicine, and social and environmental psychology to develop and propose a single integrative model of wellbeing encompassing dimensions of mental, physical and spiritual wellbeing in a pandemic context. The article discusses COVID-19 place confinement as a context to deliver body-mind medicine interventions in this challenging time. The aim is to provide the required support to promote behavior change for better public health outcomes. A range of cognitive behavioral therapies including psycho-social, psycho-educational, relaxation, meditation and nature therapies are discussed. Promoting alternative forms of traditional, complementary and integrative medicine in the local, global communities are discussed as preventive and sustainable measures to improve public health and wellbeing aligning with Global Health and the United Nations Sustainable Development Goals. This has important implications for people’s wellbeing and quality of life during and post the COVID-19 pandemic.
... The finding that mindfulness promotes resilience, which in turn improves QoL, is consistent with past literature confirming the positive relationships between mindfulness, resilience, and well-being [15,57,58]. Studies based in China have also reported on how mindfulness can improve academic functioning, a subsection of QoL [59], as well as buffer against the negative effects of phone addiction on depression and anxiety [60]. ...
Article
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Many social welfare programs focus on the provision of cash assistance and cash transfers to improve the quality of life (QoL) of those living in low-income households. While there is literature to support a positive relationship between income and QoL, studies have shown that QoL is impacted by non-income-related factors. This study examined the effects of income and mindfulness on QoL through a mediator, resilience, and attempts to answer the question of how important income is to QoL, relative to a non-income-based determinant, mindfulness. Using a sample of 905 emerging adults from the senior class of a secondary vocational high school based in an impoverished county of China, we studied two key determinants of QoL, income and mindfulness, as well as respective pathways, during a particularly critical stage of life. The results indicated that mindfulness had strong direct and indirect effects on QoL via resilience, while income had only limited indirect effects on QoL via resilience. Policy implications were discussed.
... Mindfulness training is also being explored to alleviate burnout and compassion fatigue in human service professionals. In a separate study by Hanna and Pidgeon [22], 46 human service professionals were randomly allocated to undergo a mindful-awareness and resilience skills training program or serve as controls. The study found significant improvements in mindfulness, resilience, compassion satisfaction, and psychological well-being, as well as significant reductions in burnout and compassion fatigue at post-intervention in the intervention group, compared to the control group. ...
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Mindfulness has emerged as one of the major strategies for the well-being of employees in the current corporate world. As the workspace continues to evolve due to technological and structural advancement, employees face difficulty coping and lack the desired agility. The present study is a systematic review of around a hundred scientific papers and various books and business research articles from the period of 2000–2021 focusing on mindfulness and employee wellness research from various journals such as Jama Psychiatry, Applied Psychology: Health and Well-being, journals from Frontier Psychology and Emerald Publications, and others. The study aims to explore mindfulness and its applications across various vocational sectors, with particular emphasis on its potential relevance to the Indian population. The study also discusses the evolution of mindfulness, its implications for improving work culture and leadership, and its application in various workplaces. As there are very few mindfulness-based studies conducted on the Indian working population, the present study helps to bridge the gap and recommends future studies to be conducted on the Indian population to establish concrete scientific evidence on the possible impact of mindfulness on employees' vocational lives. The paper makes a unique contribution by analyzing the potential for enhancement through mindfulness in various vocational sectors and also identifies a strong scope for research in the emerging areas of corporate agility and robot-assisted interventions.
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Purpose The aim is to investigate what relationships exist between resilience and mindfulness in undergraduate nurse training and how these might contribute to well‐being. Design and Methods One hundred and six students participated in this cross‐sectional study. Multivariate and bivariate procedures were utilized to assess the differences between students' demographics, academic resilience, and mindfulness. Findings The findings suggested that acceptance and attention within mindfulness were important for resilience. Students who had higher levels of academic resilience also had higher indexes of mindfulness. Practice Implications A key implication is that learning and practice areas should ensure that well‐being, mindfulness, and resilience literacy are key issues for students in training. This is at a time when mental health support and staff retention are foremost in policymakers’ minds.
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Previous meta-analyses on the effects of mindfulness meditation were predominantly concerned with clinical research. In contrast, the present study aims at giving a comprehensive overview of the effects of mindfulness meditation on various psychological variables, for meditators in nonclinical settings. Included are 39 studies that fulfilled our six selection criteria: (1) a mindfulness meditation treatment, (2) the existence of an inactive control group, (3) a population of nonclinical adults, (4) the investigation of psychological measures that were (5) assessed at temporal distance from a meditation session, and (6) the availability of sufficient data to calculate effect sizes. The dependent variables examined included, among others, attention, intelligence, self-attributed mindfulness, positive and negative emotions, emotion regulation, personality traits, self-concept, self-realization, stress, and well-being. We found an effect size of $\overline r = 0.27$ averaged across all studies and dependent variables. The effects differed widely across dependent variables. Moreover, we found large differences between the effect sizes reported for complete Mindfulness-based Stress Reduction (MBSR) programs vs. “pure” meditation. MBSR seems to have its most powerful effect on attaining higher psychological well-being, whereas pure mindfulness meditation studies reported the largest effects on variables associated with the concept of mindfulness. This raises the question if some effect sizes found for MBSR might be partly inflated by effects that are not attributable to its mindfulness meditation component. Future theorizing should address meditation-specific concepts more extensively to account for the changes in healthy practitioners.
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Empathy fatigue results from a state of emotional, mental, physical, and occupational exhaustion that occurs as the counselor's own wounds are continually revisited by the client's life stories of chronic illness, disability, trauma, grief, and loss. Fundamental to the emotional, physical, and spiritual well-being of professional counselors are the self-care strategies that promote resiliency for the prevention of empathy fatigue. This type of “fatigue reaction” and its consequences has been recognized as “counselor impairment” by the American Counseling Association's (ACA) Task Force on Counselor Wellness and Impairment. This article: (a) provides an analysis of empathy fatigue from a mind, body, and spiritual perspective, and (b) delineates variables that should be helpful in the prevention and self-care strategies for professional counselors.
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Resilience is normally sought in the child, family and the community. It is a complex term that needs to be understood in context. This paper seeks to locate and trace resilience in the practitioner. It also examines how practitioners foster resilient interventions. A number of practice examples, taken from the author's own practice experience, are interlaced throughout the text; it is hoped these examples may provide further illumination to the area of applying resilience to practice. It takes a paradoxical view of how failure is characterised in relation to resilience, and will examine the author's own failure to be resilient, as a way of extracting the hidden meanings of resilience. It examines global factors that are associated with building resilience and how these can be applied to practice. The influence of poverty as a determining factor in practice interventions is examined, in relation to building resilience in the worker, the child, the family and the community. The prescience of the “ordinary magic” of resilience and how this is related to everyday practice is also examined. The paper will conclude by outlining a number of key messages in relation to the connection between the concept of resilience and practice.
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The term compassion fatigue has come to be applied to a disengagement or lack of empathy on the part of care-giving professionals. Empathy and emotional investment have been seen as potentially costing the caregiver and putting them at risk. Compassion fatigue has been equated with burnout, secondary traumatic stress disorder, vicarious traumatization, secondary victimization or co-victimization, compassion stress, emotional contagion, and counter-transference. The results of a Canadian qualitative research project on nurses’ experience of compassion fatigue are presented. Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families. Time to help patients and families cope with suffering seemed unavailable, and many felt they were running on empty and, ultimately, impotent as nurses. Feelings of irritability, anger, and negativity arose, though participants described denying or ignoring these emotions as a way to try to survive their work day. Difficulties with work carried over into the nurses’ personal lives, affecting their relationships with family and friends. Such experiences invariably called into question the participants’ identity, causing them to reflect on the kind of nurse they were. The participants’ compassion fatigue created a sense of hopelessness regarding positive change, although some nurses described strategies that seemed to help alleviate their compassion fatigue.
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Baer's review (2003; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, (5) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.
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Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.
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Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.
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Failure is a familiar trauma in life, but its effects on people differ widely. Some reel, recover, and move on with their lives; others get bogged down by anxiety, depression, and fear of the future. Seligman, who is known as the father of positive psychology, has spent three decades researching failure, helplessness, and optimism. He created a program at the University of Pennsylvania to help young adults and children overcome anxiety and depression, and has worked with colleagues from around the world to develop a program for teaching resilience. That program is being tested by the U.S. Army, an organization of 1.1 million people where trauma is more common and more severe than in any corporate setting. Nevertheless, businesspeo-ple can draw lessons from resilience training, particularly in times of failure and stagnation. The program is called Comprehensive Soldier Fitness, and it has three components: the Global Assessment Tool, a test for psychological fitness (administered to more than 900,000 soldiers to date); self-improvement courses following the test; and "master resilience training" (MRT) for drill sergeants. MRT focuses on enhancing mental toughness, highlighting and honing strengths, and fostering strong relationships-core competencies for any successful manager.
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We describe causal mediation methods for analysing the mechanistic factors through which interventions act on outcomes. A number of different mediation approaches have been presented in the biomedical, social science and statistical literature with an emphasis on different aspects of mediation. We review the different sets of assumptions that allow identification and estimation of effects in the simple case of a single intervention, a temporally subsequent mediator and outcome. These assumptions include various no confounding assumptions including sequential ignorability assumptions and also interaction assumptions involving the treatment and mediator. The understanding of such assumptions is crucial since some can be assessed under certain conditions (e.g. treatment-mediator interactions), whereas others cannot (sequential ignorability). These issues become more complex with multiple mediators and longitudinal outcomes. In addressing these assumptions, we review several causal approaches to mediation analyses.
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Advocates of the concept of secondary traumatization propose that clinicians who provide trauma-focused treatment may be particularly at risk for experiencing secondary trauma symptoms. This specific symptom presentation purportedly develops following exposure to the traumatic experiences described by their clients. Consequently, these professionals have advocated for increases in resources devoted to the prevention and treatment of secondary trauma symptoms (e.g., enhanced clinician training, increase in availability of treatment options for affected trauma workers, etc.). A review of empirical literature examining prevalence and specificity of secondary trauma symptoms in trauma clinicians is provided. Findings are mixed and often indicate that trauma clinicians are not frequently experiencing "clinically significant" levels of symptoms and that these symptoms may not be uniquely associated with trauma-focused treatment. Finally, it is argued that additional clarification and research on the criterion, course, and associated impairment are needed. Recommendations for future research are provided.
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This article provides researchers with a guide to properly construe and conduct analyses of conditional indirect effects, commonly known as moderated mediation effects. We disentangle conflicting definitions of moderated mediation and describe approaches for estimating and testing a variety of hypotheses involving conditional indirect effects. We introduce standard errors for hypothesis testing and construction of confidence intervals in large samples but advocate that researchers use bootstrapping whenever possible. We also describe methods for probing significant conditional indirect effects by employing direct extensions of the simple slopes method and Johnson-Neyman technique for probing significant interactions. Finally, we provide an SPSS macro to facilitate the implementation of the recommended asymptotic and bootstrapping methods. We illustrate the application of these methods with an example drawn from the Michigan Study of Adolescent Life Transitions, showing that the indirect effect of intrinsic student interest on mathematics performance through teacher perceptions of talent is moderated by student math self-concept.
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Every individual experiences stressful life events. In some cases acute or chronic stress leads to depression and other psychiatric disorders, but most people are resilient to such effects. Recent research has begun to identify the environmental, genetic, epigenetic and neural mechanisms that underlie resilience, and has shown that resilience is mediated by adaptive changes in several neural circuits involving numerous neurotransmitter and molecular pathways. These changes shape the functioning of the neural circuits that regulate reward, fear, emotion reactivity and social behaviour, which together are thought to mediate successful coping with stress.
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The General Well-Being Schedule (GWB) is a brief, reliable, and valid instrument used in population studies to assess psychological well-being, although its validity with African-Americans has yet to be established. This study evaluated the reliability, validity, and factor structure of the GWB in a sample of 599 overweight African-American women who participated in multicenter weight loss trial. The results of the factor analysis indicate that the GWB is primarily unidimensional and that the existence of the six hypothesized subscales was not supported. The GWB demonstrated evidence of concurrent and construct validity when examined in association with measures of self-concept, depression, and several health behaviors. The results of this study suggest that the GWB is a reliable and valid measure of psychological well-being in African-American women.
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Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress.
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Over the past two decades, social workers have treated trauma survivors in a variety of settings. Interest has increased in the effect of this work on clinicians. Vicarious traumatization is a concept used to understand the impact of trauma work on clinicians. This article describes a study of social work clinicians working with two types of trauma: (1) the human-induced trauma, sexual abuse, and (2) the naturally caused trauma, cancer. The effect on clinician's cognitive schemas and the confounding variables of personal history of abuse and years' experience are described. Clinicians who worked primarily with clients who were sexually abused reported more disruptions in cognitive schemas than clinicians who worked with clients who had cancer. Implications for social practice and education are described.
Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.
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The purpose of this study, undertaken in 2003, was to explore the phenomenon of resilience as experienced by Australian crisis care mental health clinicians working in a highly demanding, complex, specialized and stressful environment. For the purpose of this research, the term 'resilience' was defined as the ability of an individual to bounce back from adversity and persevere through difficult times. The six participants for this study were drawn from Melbourne metropolitan mental health organizations - the disciplines of nursing, allied health and medicine. A number of themes were explicated from the participants' interview transcripts - Participants identified the experience of resilience through five exhaustive descriptions, which included: 'The team is a protective veneer to the stress of the work'; Sense of self; Faith and hope; Having insight; and Looking after yourself. These exhaustive descriptions were integrated into a fundamental structure of resilience for clinicians in this role. The study's findings have the potential to inform organizations in mental health to promote resilience in clinicians, with the potential to reduce the risk of burnout and hence staff attrition, and promote staff retention and occupational mental health.