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The front-line nurses are at risk of physical and psychological damage during an epidemic. This study aimed to investigate the level of nurses’ fear in COVID-19 Central Hospitals in Iran.
The study is cross-sectional. The questionnaire was designed in two parts (demographic and the level of fear). The sampling method was quota and random. The questionnaires were completed by the same nurses after four weeks.
A total of 345 questionnaires were distributed (the response rate was 89.27%). 121 nurses (39.3%) were female. Most participants were in the 26-30 years group. paired t-test showed the mean fear of COVID-19 in the first and the fourth weeks was significant (P <0.001). There was a statistical relationship between demographic variables of gender, age, marriage, number of working shifts, having children, and work experience of nurses with the level of fear.
Discussion & Conclusion:
Healthcare providers have shown resilience and a spirit of professional sacrifice to overcome problems. The nurses experienced a level of disease-related fear in close contact with COVID-19 patients. It is essential to apply strategies to optimize safe working conditions and minimize psychological harm and provide regular and intensive training to all health care providers to improve preparedness.
The session introduces a Trauma-Recall Protocol, which consists of a set of “tools” (for example, emotion regulation techniques) to be used when unwanted trauma recall occurs, and that help the patient to tolerate exposure. During the teaching of the protocols, be sure that the patient does the stretching and other motions, and, if the patient does not, encourage the patient to do so. The therapist should maintain a playful demeanor. At times, to ensure that a sense of relaxation is being conveyed, the therapist should purposefully slow and deepen the voice. (This creates a sense of shift in the session.)
In this session, applied stretching is taught, and the patient is led once more through the whole body muscle relaxation (with contract-release and stretch-release relaxation) with visualization. As in almost all lessons, there is a section on mindfulness and stretching. As indicated in the last session, the therapist should be sure that the patient does the stretching and other motions, and, if the patient does not, the therapist should encourage the patient to do so, all the while with a playful mien, a playful demeanor. This models a positive way of interacting and it also creates new positive associations to the topics being discussed. At times, to promote relaxation, the therapist should purposefully slow and deepen the voice. This also creates a sense of shift in the session: a shift in voice and emotional register.
In this session, again somatic symptoms and associated trauma networks and catastrophic cognitions are explored and addressed (on our model of how somatic symptoms are generated, see the Multiplex Model of Trauma-Related Disorder). The session also reviews key information such as emotion protocols (e.g., anxiety and anger protocol) and the applied stretching protocol.
Applied muscle relaxation” is traditionally used to describe the relaxation of muscles by contracting a muscle, holding the contraction, and then releasing tension. This might also be called “contract-release muscle relaxation.” Another method of muscle relaxation, such as that used in yoga, involves stretching a muscle by forced elongation and then holding the forced elongation a certain time, then releasing it. This might also be called “elongation-release relaxation” or “stretch-release relaxation.” CA Multiplex CBT teaches both applied muscle relaxation (i.e., “contract-release” relaxation) and applied muscle stretching (i.e., “elongation-release” relaxation), but emphasizes elongation-release relaxation, that is, yoga-type stretching. Traumatized patients have multiple symptoms induced by muscle tension. Examples of sensations caused by muscle tension include joint soreness, muscle soreness, and headache. Additionally, as discussed in the Introduction, applied muscle stretching allows for the introduction of phrases and images that promote a positive self-image of flexibility and prime to being flexible. These are embodied metaphors.
In this session, diaphragmatic breathing is taught to illustrate that normal breathing relieves anxiety, and hyperventilation is used to show that abnormal breathing can induce symptoms but that those symptoms are not dangerous. The patient is educated about breathing and educated about trauma associations to and catastrophic cognitions about symptoms caused by hyperventilation and chest breathing, such as chest tightness, dizziness, and cold extremities. The patient is made to hyperventilate to educate about breathing-induced symptoms, to create positive reassociations to dizziness and other sensations, to address trauma associations to the symptoms, to reduce fear of the hyperventilation-induced symptoms, and to act as interoceptive exposure that creates new nonthreating associations to the symptoms.
In this session, the patient is queried about worry episodes and resulting distress. Among ethnic minority and refugee patients, worry is common, and often triggers somatic symptoms, for example, dizziness and headache; triggers psychological symptoms (e.g., poor attention and concentration); and triggers panic. We have found worry to be a key psychopathological process in many minority and refugee populations. This session addresses worry in many ways, such as eliciting causes, symptoms, catastrophic cognitions, and trauma associations. Many treatments are used, such as modifying catastrophic cognitions and teaching mindfulness, including introducing a new form of mindfulness (tea/coffee mindfulness exercise). As a form of switching attentional focus, to treat worry, we introduce two forms of behavioral activation: encouraging exercise (for example, wall push-ups), and prescribing pleasurable activities.
Interoceptive exposure is introduced, focusing on dizziness sensations that are induced by head rolling. We use head rolling to educate about dizziness, to modify catastrophic cognitions about dizziness, to create positive reassociations to dizziness, to address trauma associations to dizziness (and other induced symptoms), and to act as interoceptive exposure that creates new nonthreatening associations to dizziness (and other induced symptoms). Interoceptive exposure also acts as behavioral activation and as a way to create an attitude of playfulness, a sort of flexibility. In the session there is also further training in emotion regulation (emotion flexibility) by practicing certain emotions.
In this session, somatic symptoms and associated trauma networks and catastrophic cognitions are explored and addressed (on our model of how somatic symptoms are generated, see the Multiplex Model of Trauma-Related Disorder). The session also reviews key information, such as emotion protocols (e.g., anxiety and anger protocol) and the applied stretching protocol.
In this session, metaphors for teaching about trauma-related symptomatology are presented to educate about PTSD and to help emotional processing: the “inner child watching DVDs” analogy and “two-television sets” analogy. Catastrophic cognitions about anxiety symptoms are addressed: the patient is taught about the physiology of fear. This Western model then is contrasted with the cultural group’s interpretation of anxiety-type somatic symptoms as indicated by dire events. Emotional distancing is taught.
This chapter is a theoretical introduction to the treatment. This includes introduction to the model that guides treatment (the multiplex model), aspects of efficacy, and a review of studies supporting the approach.
In this session, the patient is taught several emotion regulation techniques; diaphragmatic breathing for relaxation, emotion distancing, and the use of adaptive emotional states. Two forms of behavioral activation are taught: encouraging exercise and doing wall push-ups, and prescribing pleasurable activities. (Of note, throughout the treatment we have the patient do behavioral activation. We consider such actions as stretching and interoceptive exposure to be a form of behavioral activation in that they allow the patient to enter a new zone of experience and involve activity.)
In this session, cultural syndromes (e.g., the syndrome “thinking a lot”) are used as a means to explore catastrophic cognitions and trauma associations, and emotional protocols and other key treatment aspects are reviewed. The session ends by encouraging the patient to do a transitional ritual in that culture.
The goal of this session is to briefly describe the goals of the treatment, and to begin to educate the patient about trauma and its psychological effects. Culturally appropriate analogies promote the acceptance and recall of the core teaching principles. In this first session, the main metaphor utilized is that of the “inner child” who remembers everything and is easily frightened. This is used as a way to teach about trauma-recall triggers.
In this session, meditation and applied stretching are introduced. The therapist should be sure that the patient does the stretching and other motions, and, if the patient does not, should encourage the patient to do so with a playful mien. The therapist should maintain a playful demeanor whenever possible. At times, to ensure that a sense of relaxation is being conveyed, the therapist should purposefully slow and deepen the voice. This also creates a sense of shift in the session and so promotes flexibility.
With trauma-related disorder representing a major public health issue, and considering the increasingly diverse populations being treated for trauma, there is a great need for appropriate treatments. This manual provides detailed guidance for delivering culturally adapted Cognitive Behavioural Therapy (CBT) for the treatment of PTSD and other trauma-related disorders. Offering a unique approach that emphasises the somatic and sensorial aspects of experiencing and emotion regulation, this book is also appropriate for diverse populations with a varied range of education levels. This treatment is proven to be well received and effective for a wide range of groups, including Cambodian and Vietnamese refugees, Spanish-speaking populations, Afghan, Egyptian, Syrian, and Turkish populations, and even South African tribal groups. Written in a clear and accessible way to allow the treatment to be understood and utilised by a wide-range of mental health practitioners, students, and trainees working with multicultural populations, refugees and immigrants.
To successfully address large-scale public health threats such as the novel coronavirus outbreak, policymakers need to limit feelings of fear that threaten social order and political stability. We study how policy responses to an infectious disease affect mass fear using data from a survey experiment conducted on a representative sample of the adult population in the USA (N = 5,461). We find that fear is affected strongly by the final policy outcome, mildly by the severity of the initial outbreak, and minimally by policy response type and rapidity. These results hold across alternative measures of fear and various subgroups of individuals regardless of their level of exposure to coronavirus, knowledge of the virus, and several other theoretically relevant characteristics. Remarkably, despite accumulating evidence of intense partisan conflict over pandemic-related attitudes and behaviors, we show that effective government policy reduces fear among Democrats, Republicans, and Independents alike.
The aim of this study was to test the hypothesis that synthesis of nitric oxide (NO) and activation of CB1 receptors have opposite effects in a behavioural animal model of panic and anxiety.
To test the hypothesis, male Wistar rats were exposed to the elevated T-maze (ETM) model under the following treatments: L-Arginine (L-Arg) was administered before treatment with WIN55,212-2, a CB1 receptor agonist; AM251, a CB1 antagonist, was administered before treatment with L-Arg. All treatments were by intraperitoneal route.
The CB1 receptor agonist, WIN55,212-2 (1 mg/kg), induced an anxiolytic-like effect, which was prevented by pretreatment with an ineffective dose of L-Arg (1 mg/kg). Administration of AM251 (1 mg/kg), a CB1 antagonist before treatment with L-Arg (1 mg/kg) did not produce anxiogenic-like responses.
Altogether, this study suggests that the anxiolytic-like effect of cannabinoids may occur through modulation of NO signalling.