Google Scholar: ≥ 2020
A search strategy was developed by the research team that consisted of psychologists, physicians and other experienced researchers. The search consisted of associated terms and their keywords, according to the thesaurus of the underlying databases, for “occupational health management,” “stress” or “burnout” (indication), “health care professionals” and “digital component.” A detailed list of German and English search terms and Boolean operators is found in Table 2 . PubMed, Embase, PsycInfo, and Google Scholar were searched between 24th and 28th January 2022. A grey literature search on stress prevention projects in hospitals was conducted in parallel but will be published in a separate article due to the limited scope of this review.
Search strategy.
Occupational health management | Betriebliches Gesundheitsmanagement OR occupational health management OR occupational healthcare management OR corporate health management OR corporate healthcare management OR health care management [Emtree] OR Betriebliche Gesundheitsfoerderung OR workplace health promotion OR occupational health promotion OR occupational health [MESH Term] OR health promotion [MESH Term / Emtree] OR occupational health service [Emtree] |
AND | |
Indication | Stressreduktion OR stress reduction OR stress [APA Thesaurus of Psychological Index Terms] OR stress, psychological [MESH Term] OR occupational stress [MESH Term] OR physiological stress [MESH Term / Emtree] OR psychological stress [MESH Term / Emtree] OR mental stress [Emtree] OR emotional stress [Emtree] OR interpersonal stress [Emtree] OR job stress [Emtree] OR Stressprävention OR stress prevention OR Burnoutprävention OR burnout prevention |
AND | |
Health care professionals | Gesundheitsberufe OR health care professionals OR healthcare professionals OR Health Personnel [MESH Term] OR health care personnel [Emtree] OR Arzt OR medical doctor OR physician OR medical practitioner OR doctor OR physicians [MESH Term] OR doctor, physicians [Emtree] OR medical personnel [MESH Term / Emtree] OR practitioner [Emtree] OR private physician [Emtree] OR physician associate [Emtree] OR Krankenpflege OR nurse OR nursing [MESH Term] OR nurses [MESH Term] OR paramedical personnel [Emtree] OR paramedics [APA Thesaurus of Psychological Index Terms] |
AND | |
Digital component | Digital OR digital technology [MESH Term / Emtree] OR Digital Interventions [APA Thesaurus of Psychological Index Terms] OR Digital Health Resources [APA Thesaurus of Psychological Index Terms] OR app OR application OR Mobile Applications [MESH Term] OR mobile application [Emtree] OR mobile health application [Emtree] |
Identified publications were imported into EndNote (version 20.2.1), duplicates were removed. Two authors (JB & DA) independently reviewed the abstracts and titles. Then, full-text articles were screened (JB & DA). Two electronic spreadsheets were developed a priori for data extraction. The first form contained data on general study characteristics. The second form contained data on intervention characteristics. JB & DA independently extracted the data into these two spreadsheets. Discrepancies were resolved through discussion between JB, DA, and the rest of the research team. The results of the data extraction, particularly related to the topics of intervention group content/exercise and implications for future interventions, were summarized and discussed by the reviewers (JB & DA) and other members of the research team.
The search strategy identified 153 publications in medical databases. After the removal of duplicates, 143 publications remained. The search in Google Scholar revealed seven additional publications. In total 150 publications were screened by title and abstract. 136 did not meet the inclusion criteria. Fourteen full text articles were screened for inclusion. Seven articles met all inclusion criteria and were used for further data extraction ( Figure 1 ). All publications were original research articles ( 35 – 41 ). Reasons for exclusion of the other seven articles were: no digital component was involved ( n = 4) and no primary research article ( n = 2) or only a study protocol was published ( n = 1). One article described a process evaluation of a study with no results included ( 42 ). The primary research article was searched and included into the scoping review ( 37 ).
3.1.1. country.
General study details are presented in Table 3 . Two out of seven studies were conducted in the USA ( 35 , 39 ) and two were carried out in Spain ( 36 , 40 ). The others were conducted in the Netherlands, Poland, and Korea ( 37 , 38 ).
Study characteristics.
Author | Country | Year | Objective | Design | Sample size | Outcome measures | Points of measurement | Results |
---|---|---|---|---|---|---|---|---|
Coifman et al. ( ) | USA | 2021 | Test the efficacy of a brief online ambulatory intervention aimed at supporting psychological health and well-being during the COVID-19 pandemic | Randomized assigned, pre-post comparison | = 28 (assigned to low dose or high dose intervention) | Primary outcomes: PE (happiness, amusement, affection, contentment, relief) and NE (disgust, anger, sadness, fear, distress) | Before and after (1 week) each session participants rated intensity of specific NE and PE | Low dose and high dose intervention: sig. Decrease in NE by 44% and increase in PE by 13%; Higher dose condition: additional 9.4% increase in PE (pre- to post-session) + NE decrease by an additional 7.8% |
Fiol-DeRoque et al. ( ) | Spain | 2021 | Evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems during the COVID-19 pandemic | Blinded, individually randomized, parallel-group, controlled trial | Intervention group = 248; Control group = 234 | Primary outcomes: DASS-21; secondary outcome: DTS, MBI-HSS, ISI, GSE, Individual subscales of the DASS-21, Usability of PsyCovidApp | Baseline and at 2 weeks | Primary outcome: no sig. Differences between the groups at 2 weeks; subgroup analyses: sig. Improvements among HCW consuming psychotropic medications + receiving psychotherapy. |
Havermans et al. ( ) | Nether-lands | 2018 | Investigate the effectiveness of a digital platform-based implementation strategy regarding stress, determinants of work stress and the level of implementation among HCW | Cluster-controlled study design with 30 teams matched and assigned to either the experimental or control group | Intervention group = 252 (15 teams); control group = 221 (15 teams) | Primary outcome: stress: DASS-21; Secondary outcomes: psychosocial work factors (psychological demands, social support, autonomy) measured using sub-scales from the JCQ | Baseline, 6 month, 12 month | Stress: overall effect of the strategy statistically sig., control group showed higher stress scores than the intervention group over time. Separate analyses follow-up: statistically sig. Effect for stress at 6, but not at 12 months. |
Hwang and Jo ( ) | Korea | 2019 | Develop an app for mental health and assess its feasibility and effectiveness regarding stress management | Pretest-posttest design (mostly randomly assigned) | Intervention group = 26; control group = 30 | PSS-10; KOSS; PHQ-9; GAD-7; Korean Emotional Labor scale; WHO-5; Self-efficacy; level of satisfaction with the app | Before and after the intervention | Stress, depression, anxiety, and emotional labor improved; positive index of well-being and self-efficacy level increased. |
Mistretta et al. ( ) | USA | 2018 | Assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone delivered resiliency-based intervention improved stress, well-being, and burnout. | 3-armed RCT | Intervention group = 22; smartphone resilience intervention app = 23; control group = 15 | Primary outcome: DASS-21, WHO-5; secondary outcome: MBI-HSS, SCS, compassion for others scale, daily affect, relationship quality, valued action, sleep monitoring | Baseline, 6 weeks (after the end of the intervention), 3 months | MBRT group: sig. Reductions in stress at 6 weeks and 3 months + sig. Improvement in emotional exhaustion subscale (MBI). MBRT and smartphone resilience group: sig. Increases in well-being at 6 weeks and 3 months. |
Montero-Marin et al. ( ) | Spain | 2018 | Investigate if blended mindfulness-based program for GPs, without support or guidance, would improve well-being and if the construct of awareness would be a mediating factor for improvement | Open uncontrolled trial | = 290 | Primary outcome: PANAS-positive; secondary outcomes: PANAS-negative, MAAS, CDRISC, BCSQ-12 | Before and after the intervention | Participants completing “two or more weekly practices”: pre-post improvements for PANAS-positive + sig. Improvements in MAAS. Participants completing “one weekly practice”: no sig. Improvements in PANAS-positive. No sig. Improvements in PANAS-negative, CDRISC or BCSQ-12 in any group. |
Smoktunowicz et al. ( ) | Poland | 2019 | Test if a Med-Stress internet intervention reduces job stress, burnout, depression, and job-related secondary stress and increases work engagement through the enhancement of perceived social support and self-efficacy. | 4-arm parallel RCT | = 1,200 (300 participants per condition) | Primary outcomes: PSS-14, OLBI; secondary outcomes: PHQ-9, UWES-3, PCL-5 | Pre-intervention, post-intervention (6 weeks experimental groups; 3 weeks control groups), follow-ups: 6 month, 12 month | High dropout (loss to posttest 82.5%), Job stress: No sig. Effect of condition assignment (groups) on job stress for any between-group comparison, but sig. Effect of time for all comparisons (stress decreased with time). Burnout: no main effect of assignment on job burnout for all comparisons, but main effect of time for all comparisons (burnout decreased with time). |
BCSQ-12, burnout clinical subtype questionnaire; CDRISC, Connor-Davidson resilience scale; DASS-21, depression anxiety stress scale-21; DTS, Davidson trauma scale; GAD-7, generalized anxiety disorder; GP, general practitioner; GSE, general self-efficacy scale; HCW, health care workers; ISI, Insomnia severity index; JCQ, job content questionnaire; KOSS, Korean occupational stress scale; MAAS, mindful attention and awareness scale; MBI – HSS, Maslach burnout inventory – human services survey; MBRT, mindfulness-based resilience training; n , number of participants per group; N , total number of study participants; NE, negative emotions; OLBI, Oldenburg burnout inventory; PANAS, positive and negative affect schedule; PCL-5, posttraumatic stress disorder checklist 5; PE, positive emotions; PHQ-9, patient health questionnaire; PSS-10, perceived stress scale 10; PSS-14, perceived stress scale 14; RCT, randomized controlled trial; SCS, self-compassion scale; sig., significant; UWES-3, Utrecht work engagement scale; WHO-5, WHO-five well-being index.
All studies were published between 2018 and 2021. Four studies used a randomized study design ( 35 , 36 , 39 , 41 ). All studies but one had a control group ( 40 ). Six out of seven studies included one or more control groups ( 35 – 39 , 41 ). Two studies applied a waiting list design ( 37 , 38 ). Four studies compared the intervention to active control groups ( 35 , 36 , 39 , 41 ).
The sample size in the studies varied between n = 28 and n = 1,200 participants. Three studies had a rather small number of participants per group ≤30 ( 35 , 38 , 39 ). The four remaining studies included between n = 221 and n = 300 participants per group ( 36 , 37 , 40 , 41 ).
A wide range of outcome measures were used. For the primary outcome, three studies used the Depression Anxiety Stress Scale-21 ( 36 , 37 , 39 ), two examined positive and negative emotions with different questionnaires ( 35 , 40 ) and two focused on stress applying the Perceived Stress Scale ( 38 , 41 ). For secondary outcomes, two studies used the Maslach Burnout Inventory – Human Services Survey ( 36 , 39 ) and two made use of the Patient Health Questionnaire ( 38 , 41 ). Results varied across the different studies and outcome measures.
Results of the Depression Anxiety Stress Scale-21 varied across the studies but were overall positively directed. Fiol-DeRoque et al. ( 35 ) found no significant differences between the control and intervention groups but subgroup analyses showed significant improvements among health care workers consuming psychotropic medications and receiving psychotherapy. Havermans et al. ( 36 ) analysed a stress subscale of the Depression Anxiety Stress Scale and found that the control group showed higher stress scores than the intervention group over time. Mistretta et al. ( 39 ) found significant reductions in stress for the Mindfulness-based resilience training. Further results of the primary and secondary outcomes of the studies are displayed in Table 3 .
Details on the interventions are presented in Table 4 .
Intervention characteristics.
Author | Intervention | Control | Duration intervention | Intervals intervention | Target population | Digital component | Implications for future interventions |
---|---|---|---|---|---|---|---|
Coifman et al. ( ) | Expressive writing, adaptive emotion regulation activity, positive emotion-generation activities. An example of a prompt for positive emotions: “Think of a recent moment when you laughed and remember what was so funny” | Active control group: Equal to intervention only longer (“high dose” 4–6 min) | 3–6 min | 1 qd for 1 week | Medical and emergency personnel (hospital), personnel from police and fire departments | Smartphone app (intervention and control group) | Brief, daily, and ambulatory interventions are efficient. |
Fiol-DeRoque et al. ( ) | PsyCovidApp: Self-managed psychoeducational intervention, based on CBT and mindfulness: Written and audiovisual content targeting four areas: emotional skills, healthy lifestyle behavior, work stress and burnout, and social support (each with input to monitoring mental health status; education about psychological symptoms like anxiety; tips to manage pandemic-related stressors for example by relaxation and breathing techniques; healthy lifestyle and tips to promote it; organizational and individual strategies to promote resilience and reduce stress at work and burnout; and promotion of social support) | Active control group: General recommendations about mental health care (App) | Varied | Varied, app available for 2 weeks | HCW of COVID-19 patients’ | Smartphone app (intervention and control group) | Use of passive comparator + a longer intervention period may be recommended; a digital intervention only may not produce significant improvements. |
Havermans et al. ( ) | Stress Prevention@Work: Multifaceted, integral implementation strategy: Digital platform including information, screening, planning tools + a search engine for interventions to prevent work stress (ranging from written guidelines to tailor-made prevention projects) | Waiting list | Varied | Employees of a healthcare organization | Digital platform (intervention and control group) | Personnel shortage, turnover, and organizational restructuring hindered the use of the strategy. | |
Hwang and Jo ( ) | Waiting list | >10 min | More than twice per week, app available for 4 weeks | Nurses employed at hospitals | Smartphone app (intervention and control group) | Future research should include a wider sample, continuous counseling and health information provision via the app’s current functions, and the analysis of more factors. | |
Mistretta et al. ( ) | MBRT (aspects of MBSR + ACT): MBRT involves learning mindfulness skills to effectively deal with unpleasant or unwanted thoughts or experiences, and learning resilience skills to promote positive growth and behavior in alignment with one’s intentions and values. It incorporates aspects of mindfulness-based stress reduction (MBSR) and Acceptance and Commitment Therapy (ACT), while differing from the two approaches in shorter meditation exercises and a deeper exploration of the neurobiology of stress and resilience. Live sessions topics (including education, practice, discussion): resilience, mindfulness, coping difficult physical sensations / emotions / unwanted thoughts, self-compassion; audios for self-training provided | Active control group: Smartphone Resilience Training: monitoring sleep, emotions + prompts (every 7–10 days) to select training topics: sleep, happiness + productivity, energy, focus, productivity. Control group with no additional intervention. | 120 min | 1 weekly for 6 weeks | Clinic employees | Smartphone app (control groups only) | Utility in both in-person delivered and smartphone-delivered mindfulness interventions + broader benefits regarding stress and work-related burnout for in-person MBRT interventions. |
Montero-Marin et al. ( ) | Blended, abbreviated web-based MBI: Face-to-face meeting: mindfulness theoretical module (usefulness for GPs, implementation in personal practice, incorporation into daily life), practical module (e.g., raisin exercise, mindfulness of breathing, body scan, 3-min practice, values-based practice adapted from ACT). Online training: audio + video practices (handling thoughts and emotions, walking meditation, mindful movements, kindly awareness meditation) + extended theoretical descriptions (texts + articles) | Face-to-face meeting: 4 h, online training: 45 min | All together: 10 h over a 1 month period, face-to-face meeting: once only, online training: 2 times per week over 4 weeks | General practitioners | Blended learning: face-to-face meeting combined with online training | Adherence in online / digital components are important for program success, blended formats are feasible. | |
Smoktunowicz et al. ( ) | Med-Stress: Self-guided internet intervention, containing 2 main modules: SE and perceived SS. 3 CBT-framed exercises per module: consisting of psychoeducational animated clips + interactive tasks requiring both web-based and offline activities. SE exercises: mastery experience, vicarious experience, action planning. SS exercises: perceived support and cognitive distortions, social skills and peer support, action planning | Two active control groups: self-efficacy module only or perceived social support module only | 1.5 h | Weekly over 6 weeks | Physicians, nurses, midwives, physical therapists, paramedics | Internet-based Intervention (intervention and control group) | Job burnout did not depend on assignment to the study condition. However, allocation to study condition did have an effect on job stress. |
ACT, acceptance and commitment therapy; CBT, cognitive-behavioral therapy; HCW, health care workers; MBI, mindfulness-based intervention; MBRT, mindfulness-based resilience training; MBSR, mindfulness-based stress reduction; qd, daily; SE, self-efficacy; SS, social support.
The interventions were multifaceted and varied across the studies. One study investigated an intervention consisting of expressive writing, adaptive emotion regulation activity, and positive emotion-generation activities ( 35 ). Another study investigated a self-managed psychoeducational intervention based on Cognitive Behavioral Therapy (CBT) and mindfulness ( 36 ). One study evaluated a multifaceted, integral implementation strategy consisting of a digital platform including information, screening, planning tools and a search engine for interventions to prevent work stress ( 37 ). A further study evaluated aspects of mindfulness-based resilience training (MBRT) ( 39 ). One study investigated a blended, abbreviated web-based mindfulness-based intervention ( 40 ) and another study a self-guided internet intervention containing CBT-framed exercises like ( 41 ). One study did not provide details on the intervention used ( 38 ).
Duration and intervals of the intervention exercises varied from 3 min to 4 h and from daily to weekly intervals or intervals chosen by the participants.
Four studies worked with digital components for the intervention and/or control group ( 35 , 36 , 38 , 39 ). Two studies made use of a web-based platform in different ways: Havermans et al. ( 37 ) adopted it to give information on implantation strategies for work stress prevention programs on an organizational level. Smoktunowicz et al. ( 41 ) offered a self-guided intervention via the web-based platform. One study applied a blended learning format, which is a combination of face-to-face meetings and online trainings (web-based) ( 40 ).
4.1. summary of findings.
This scoping review shows that the topic of stress reduction and burnout prevention for health professionals is being addressed in recent workplace health management projects that include digital components. It provides information about the individual content, implementation, and evaluation for seven current programs published within the last 5 years with particular attention to the use of digital components, which is of increasing relevance considering the COVID-19 pandemic ( 31 ). Content, form of the digital component and the scientific evaluation of the interventions differed fundamentally ( 35 – 41 ). Regarding implementation, it is concluded that brief interventions can be effective, but higher effects might be achieved by higher dose interventions ( 35 , 37 , 39 ) and the behavior of the leader and the characteristics of the team ( 37 ) play an important role in project success. Given the scarcity of findings, it is difficult to provide more practical recommendations.
Although interventions for stress reduction and burnout prevention should combine individual and organizational interventions to be as successful as possible ( 29 ), this is only partially the case in the studies identified here ( 37 ). Individual interventions such as here positive emotion-generation activities ( 35 ), self-managed psychoeducational activities ( 36 ), MBRT ( 39 ) mindfulness ( 40 ) or CBT-framed exercises ( 41 ) are an important component in the field of stress reduction and burnout prevention, they can hardly bring about sustainable changes on their own. For this, supplementary action at the organizational level is necessary. This is because the main cause of burnout lies in the working conditions of the respective work environment ( 4 ). In healthcare professionals, a lack of individual coping mechanisms can promote burnout, but they are rarely the sole cause ( 4 ). The fact that stress reduction and burnout prevention still mainly takes place at the individual level, despite better knowledge, raises questions. One reason for this might be that such research and measures are rarely carried out by the most authoritative organizations ( 43 ). Research actors usually have no possibility to intervene in existing structures or processes and therefore start where they can: at the individual level. An institutional anchoring of stress reduction and burnout prevention with the backing of management is essential in order to be able to implement organizational measures successfully and sustainably ( 43 ).
The results of the evaluated interventions clearly show the challenges faced by program developers: Personnel shortage, turnover, and organizational restructuring hindered the use of the interventions ( 37 ) and may be reasons for high drop-out rates ( 40 ). Also fear regarding stigma related to mental health issues at work inhibits both treatment and disclosure in physicians ( 44 ). The best intervention is of no use if it cannot be implemented in everyday life due to external factors. This must be considered when developing interventions and must not be neglected – an intervention that does not have the support of the executives and management will have a hard time succeeding in the long term. Support from management is not only directly necessary for the success of prevention programs but is also directly related to employee satisfaction. Studies have shown that dissatisfaction with workplace physical health protections was significantly associated with higher levels of emotional exhaustion ( 45 ). These problems are also reflected in the high drop-out rates; in one study it was as high as 82.5% ( 41 ). Statistical dropout analyses showed that dropouts were related to intervention assignment and occupational and demographic characteristics. Intervention modules that required less time were more likely to be completed. Older workers who had been on the job longer were also more likely to complete the study. These also had higher initial expectancy and higher perceived credibility of the intervention. Interestingly, those who had participated in the intervention had lower baseline scores for work stress, job burnout, depression and work-related post-traumatic stress. This suggests that those who started the intervention already very stressed and with high levels of burnout did not find the time to complete it. Of course, it is those who would benefit the most. Here it is up to the employer, despite acute staff shortages, to create structures that enable participation – at best also in the interventions that take more time. Although high dropouts are not uncommon in non-supervised Internet interventions, this is a particularly high value. The main reasons given for this were initial enthusiasm and curiosity that diminished over time. This is a problem that generally confronts health interventions: How do we ensure that interventions have a lasting effect? Interventions for effective stress reduction and burnout prevention must not be developed detached from the actual context in which they are to be applied later ( 46 ). A detailed and comprehensive needs assessment a priori with a targeted view also on the environmental factors of the respective work context is indispensable to be able to develop effective interventions. In the best case, these hindering environmental factors are then immediately integrated into the intervention. These findings complement the calls for a combination of behavioral and situational prevention: for effective stress reduction and burnout prevention, one is not possible without the other ( 46 , 47 ). The health care system must meet these challenges in a timely manner. The consequences of burnout are severe, not only for healthcare providers but also for patients, as preventable medical errors become increasingly inevitable ( 10 – 13 , 15 , 16 ). A recent meta-analysis makes this point forcefully using data from 239.246 physicians ( 11 ): physician burnout undermines safe health care. Against the background of staff shortages in these important professions, this is once again a matter of urgency. Measures that are effective in practice are necessary and must no longer be regarded as nice-to-have. Without effective stress reduction and burnout prevention firmly anchored in occupational health management, our healthcare system is heading for disaster. The last few years, with the COVID-19 pandemic, have shown how quickly the demands on these professions can intensify again. Effective coping strategies are needed here, including effective stress reduction and burnout prevention programs.
While it is difficult to provide more practical recommendations given the scarcity of findings, the present scoping review illustrates that further research in this area is critically needed; especially regarding micro-interventions, wider samples, longer intervention periods including a passive comparator, interventions on organizational level and blended formats. For comprehensibility of the implementation of programs, they should be described as specific as possible in terms of methodical, didactical and content structure. Also, long-term acceptance (1–2 years perspective) is of importance.
A limitation of the present review is that the quality of the studies included was not assessed; however, this is not required or advised for scoping reviews ( 33 ). Also, only seven studies were evaluated in total and thus only five countries reflected. Furthermore, we included only studies from high-income countries in German or English language and only recent publications on clinical studies since the year 2017. However, the overall project included a search for grey literature. It focused on stress prevention projects in hospitals which have not been evaluated in a clinical trial and contains results of semi-structured interviews with project members which gain more insight into this “unpublished” area. The density of information exceeded the scope of this review. Results have been accepted for publication recently ( 48 ).
There is a high demand for comprehensive support of healthcare professionals in terms of long-time mental health ( 3 , 49 ). This review provides detailed information on the content of current international stress and burnout prevention programs with digital components for health professionals. Both potential barriers and potentially enabling factors related to program content and implementation are identified. The results of this scoping review can be used to inform prevention program development and research in this area. The fact that only seven recent interventions were identified in this scoping review, despite the acute health care burnout crisis, highlights the urgency of developing more programs that are effective, especially in real work settings.
DA, JuS, JB, WS, SR, CK, and GS: conceptualization. DA, JuS, and JB: formal analysis. GS and CK: funding acquisition. DA, JuS, SR, and JB: investigation. DA, WS, and JuS: methodology. DA, AK, MeS, WS, GS, and CK: project administration. DA, AK, GS, and CK: supervision. DA and JuS: writing – original draft. JB, MB, MeS, AK, MaS, JaS, SR, WS, CK, and GS: writing – review and editing. No one was financially compensated for their contribution. All authors contributed to the article and approved the submitted version.
We thank Thomas Holm, Nagi Salaz, Lisa Fleischmann, Martina Kringe, Cornelia Schmidt, Jessica Olschewski, Simone Prengel, Alexander Gratopp, Annika Eisermann, Kathrin Altricher, and Bianka Rösner for their valuable feedback. We thank Vanessa Bähr for her support of methodological preparatory work and conceptualization.
This review is part of a project funded by a German health insurance company (Techniker Krankenkasse) on burnout prevention among healthcare professionals at Charité – Universitätsmedizin Berlin. The funder has no influence on the contents and results of the present work.
1 https://osf.io/gsvcb
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Therapist and counsellor dr. dawn ferrara gives her perspective on a uptv client session.
We’ve got something a little different for you this time. As you know, often I like to describe therapeutic approaches in depth.
This piece describes one therapy session in detail, but it’s a little different because it’s not written by me but by an “outside pair of eyes.”
Dr. Dawn Ferrara is a Licensed Professional Counsellor and Licensed Marriage & Family Therapist specializing in Anxiety/Stress disorders.
Dawn looks at the session from the perspective of her understanding and experience. It’s so valuable to get a perspective other than your own so we asked Dawn, a skilled psychologist to write a case study for us.
What you have here is an overview of one session with Alice* an Uncommon Practitioners TV client who came for help with anxiety, stress and low self confidence. Please let me know in the comments section if you find this useful and whether you’d like more professional summations of these therapy sessions.
Here’s to improving psychological knowledge and emotional health,
Alice (age unspecified) is a female client who works in the Information Technology (IT) industry. She has been in the IT field for 25 years and has run her own business successfully for the last 10 years. She is married and she and her spouse work together.
Alice is seeking help for anxiety, stress and poor self-confidence.
Alice is married with one daughter. She reports a good personal and professional relationship with her spouse.
Alice’s parents divorced when she was young. She describes feeling “cheated” by that situation. Her father died in 1994 from cancer and never met her daughter. Alice expresses some regret that her father didn’t live to see her succeed as an adult or to meet his granddaughter. Alice’s mother is alive but Alice describes the relationship as strained.
Alice owns her own technology company. She reports that she learned her IT skills as an early adopter of emerging technology and built a career on those skills. She did not receive formal training.
Alice describes her job as quite stressful. She reports that she sometimes has difficulty dealing with demanding clients, especially when she is unable to help them in the ways they expect her to.
These situations evoke bothersome feelings of disappointment and anxiety, and worries about being criticized or judged. She states she becomes annoyed and that these feelings affect her wellbeing.
Alice reports that she has a history of anxiety and depression , for which she has received treatment. Past treatments have included antidepressant medication (unspecified) and diazepam for panic attacks. She is not currently taking medication.
Alice says that following her father’s death, her symptoms worsened.
Alice reports that she has previously used hypnosis for smoking cessation . It appears to have been only partially successful, as she continues to use an e-cigarette.
This video is a single therapy session. The first part of the session consists of information gathering and a number of suggestions and reframes to encourage relaxation and assist Alice in gaining insight into some of her issues. The latter part of the session is direct hypnosis. Throughout the session, Mark uses a relaxed, conversational approach .
Mark engages Alice in conversation to clarify and discuss her concerns. As she becomes more comfortable, Alice offers more information and insight into her issues.
She admits to having bursts of intense anxiety but has had a reduction in panic episodes. She attributes that to making better choices about managing situations that she finds provoke anxiety. She identifies criticism and self-doubt as particularly problematic triggers.
Because of her history, Mark asks Alice a series of questions to assess the risk of post-traumatic stress disorder (PTSD). It does not appear that PTSD is a diagnostic consideration at this time.
Mark then reframes anxiety symptoms as an “exercise response”. This is done in order to normalize the anxiety response and reduce the tendency to pathologize its symptoms.
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To create a visual representation of anxiety, Mark makes an analogy between unchecked anxiety and a mental bucket of water. Anxiety (water) pours into the bucket and, if left unchecked, eventually fills the bucket and overflows (panic). He equates regular relaxation to emptying the mental bucket so that it doesn’t overflow (anxiety/panic).
Throughout the session, Mark references water creating a sense of calm and flow: filling the bucket, anxiety response as a whirlpool, the surface of water calm and reflective, feelings of calm streaming over.
During this discussion, Alice is attentive and calm with a relaxed posture. She makes good eye contact and responds with ease.
Now Mark describes the biases of globalizing , internalizing negatives and externalizing positives using a number of examples and analogies. Alice is able to recognize some of those biases in herself. Mark frames Alice’s insight into her biases as “seeing through” them.
As Alice becomes more aware of her biases, she becomes less affected by them because she can recognize them for what they are: inaccurate. The purpose of this reframing is to help Alice to separate herself from her biases, and accept that they do not define who she is.
Because Alice is particularly sensitive to perceived criticism, Mark makes a similar distinction between complaint and criticism, framing them as separate and not reflective of who she is as a person.
Following a discussion of Alice’s physical anxiety symptoms, Mark explains the dynamics of tactical breathing and invites Alice to try the technique. She readily responds and is able to practise the technique successfully and feel the sensation of relaxing.
Using conversational strategies, Mark encourages Alice to visualize scenarios and notice her reactions, first recalling her feelings in the bothersome scenario then visualizing it from afar and noticing differences while breathing and remaining in the moment.
This therapeutic presupposition allows Alice to see that she can react differently to difficult situations and allows her to move towards the hypnotic state.
The hypnotic induction begins with Mark describing hypnosis. He references Alice’s enjoyment of mandala painting on stones as an anchor, a way to help her connect with the state of mind-body relaxation and its link to unconscious thought.
The focus of the induction is relaxation training and helping Alice learn to manage her anxiety response. Using a series of embedded commands and visualizations, Alice is able to recognize her anxiety without panic or heightened responses and gently reduce it or brush it aside. She is able to experience remaining in control of her physical and thought responses.
Mark then gives several suggestions for actions going forward. These actions empower Alice to continue to recognize and manage her anxiety response by remaining calm and in control.
“What I’d like you to do is just to notice in the coming weeks and months what you notice about yourself, maybe after the event… telling yourself perhaps that: “at one point this would have been a problem for me but I just didn’t feel anything. I just put it in perspective.”
“You can just notice those times in coming weeks and months and forever.”
Further strengthening the link between conscious and unconscious thought, the induction is completed with a final suggestion that her unconscious mind and body will continue to be accessible when needed.
Did you find this case study useful? Let us know in the comments below if you’d like to see more professional summations of therapy sessions from Uncommon Practitioners TV, and if there’s anything we can add to them to make them more useful to you.
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Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses .
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Read the story of a women who thought she was having a heart attack, but was instead diagnosed with panic disorder, panic attacks.
Although on the surface everything seemed fine, she felt that, "the wheels on my tricycle are about to fall off. I'm a mess." Over the past several months she had attacks of shortness of breath, heart palpitations, chest pains, dizziness, and tingling sensations in her fingers and toes. Filled with a sense of impending doom, she would become anxious to the point of panic. Every day she awoke with a dreaded feeling that an attack might strike without reason or warning.
On two occasions, she rushed to a nearby hospital emergency room fearing she was having a heart attack. The first episode followed an argument with her boyfriend about the future of their relationship. After studying her electrocardiogram, the emergency room doctor told her she was "just hyperventilating" and showed her how to breathe into a paper bag to handle the situation in the future. She felt foolish and went home embarrassed, angry and confused. She remained convinced that she had almost had a heart attack.
Her next severe attack occurred after a fight at work with her boss over a new marketing campaign. This time she insisted that she be hospitalized overnight for extensive diagnostic tests and that her internist be consulted. The results were the same--no heart attack. Her internist prescribed a tranquilizer to calm her down.
Convinced now that her own doctor was wrong, she sought the advice of a cardiologist, who conducted another battery of tests, again with no physical findings. The doctor concluded that stress was the primary cause of the panic attacks and "heart attack" symptoms. The doctor referred her to psychologist specializing in stress.
During her first visit, professionals administered stress tests and explained how stress could cause her physical symptoms. At her next visit, utilizing the tests results, they described to her the sources and nature of her health problems. The tests revealed that she was highly susceptible to stress, that she was enduring enormous stress from her family, her personal life, and her job, and that she was experiencing a number of stress-related symptoms in her emotional, sympathetic nervous, muscular and endocrine systems. She wasn't sleeping or eating well, didn't exercise, abused caffeine and alcohol, and lived on the edge financially.
The stress testing crystallized how susceptible she was to stress, what was causing her stress, and how stress was expressing itself in her "heart attack" and other symptoms. This newly found knowledge eliminated a lot of her confusion and separated her concerns into simpler, more manageable problems.
She realized that she was feeling tremendous pressure from her boyfriend, as well as her mother to settle down and get married; yet, she didn't feel ready. At the same time, work was overwhelming her as a new marketing campaign began. Any serious emotional incident--a quarrel with her boyfriend or her boss--sent her over the edge. Her body's response was hyperventilation, palpitations, chest pain, dizziness, anxiety, and a dreadful sense of doom. Stress, in short, was destroying her life.
Adapted from The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, Ph.D.
next: Terrorism Fear: What You Can Do To Alleviate It ~ anxiety-panic library articles ~ all anxiety disorders articles
APA Reference Staff, H. (2007, February 18). Stress: A Case Study, HealthyPlace. Retrieved on 2024, August 22 from https://www.healthyplace.com/anxiety-panic/articles/stress-a-case-study
Medically reviewed by Harry Croft, MD
Hanging tough during bad economic times, impact of anxiety disorders on seniors, steps to learning how to fly comfortably, helping teenagers with stress, spontaneous panic attacks, how to help your anxious child.
2024 HealthyPlace Inc. All Rights Reserved. Site last updated August 22, 2024
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Purpose: Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices.
Design: This study was a cross-sectional self-reported survey study.
Settings and sample: The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology.
Measures: The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals ( P < 0.001). Total wellness is significantly higher among professionals compared to students ( P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers ( P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout.
Conclusions: Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.
Keywords: burnout; health promotion; healthcare professionals; interventions; resilience; stress management; wellness.
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Chris came to counselling because he was experiencing increasing feelings of being stressed, overwhelmed and weighed down by his commitments in life. He has been particularly concerned about his negative thoughts and attitude at work and at home and would like to change this. Chris has been seeing a Professional Counsellor for three sessions and together they have been using an eclectic approach using Cognitive Behavioural Therapy, some Solution Focused Therapy and Gestalt techniques. For ease of writing the Professional Counsellor is abbreviated to “C”.
Background Information
Chris is a husband of three years to Michelle and father to 18-month-old James. He is 45 years of age and a nurse at a local hospital. He has also been studying part time for his Masters degree in Nursing for three years. His wife is also a nurse and together they work shift-work in order to look after James. Chris states he enjoys his job but it can be demanding and physically tiring at times. He has previously enjoyed his studies but is now finding it difficult to finish the work with the responsibilities of a small baby. For financial reasons he has not been able to complete his studies full-time.
Chris has recently found the demands of being a husband, a nurse, a father and a student to be taxing on his physical and emotional health and he has found himself to be snappy, irritable, exhausted and unmotivated at home and at work. He has noticed that his relationship with his wife Michelle has become strained and he has begun to resent her for asking him to complete even minor chores around the home. He is feeling unloved and taken for granted by his wife. He has started questioning whether he wants to finish his studies and whether he wants to stay in the marriage.
Chris was prompted to come to counselling at the suggestion of his doctor. Chris presented to his doctor’s surgery complaining of an itchy rash covering his arms and torso, and of throbbing headaches at night and in the morning. Chris stated that medical tests revealed no physical reason for these complaints and his doctor suggested that working through some of the demands and pressures Chris had in his life may relieve the symptoms, as they may be directly related to stress and tension. Chris was happy to do this as he stated he was unhappy with his reactions and attitude at this time, as he had always been a happy, positive sort of guy.
Previous Sessions
In the first three sessions, C worked through identifying the above issues and asked Chris what he felt was the most important issue requiring attention. Chris identified this as his negative thought patterns and pessimistic way of looking at each day in the morning.
C worked to immediately change this by using Ellis’ Rational Emotive Behaviour Therapy ABC model. Using this framework to identify the behavioural and emotional consequences of his thought patterns, Chris chose to work on his attitude to going to work everyday. Before using the ABC model, Chris’ thoughts and behaviours looked like this:
A – Alarm rings every morning at 7am B – Chris says to self “Oh, no. I hate my job. This is going to be another horrible day” C – The behavioural consequence here is that Chris is often late for work because he procrastinates about going and then is often reprimanded by his supervisor. D – The emotional consequences are that Chris has a sense of despair about his ability as a nurse
After applying the ABC model to change his irrational beliefs (in B), Chris has found the following pattern when his alarm rings in the morning:
A – Alarm rings every morning at 7am B – Chris says to self “I can do this. Every day is a new day. I will work well today” C – The behavioural consequence has meant that Chris has not been late for work and therefore not in trouble from his supervisor – in fact he has been praised for his promptness in front of other staff (thus reinforcing his behaviour to be on time!)
D – The emotional consequences for Chris have included a greater sense of satisfaction with his work, a feeling of being appreciated at work, and more importantly, the knowledge and evidence that he is in control of his own thoughts.
Current Session Content
After Chris had noticed some considerable improvements in his thought processes and felt more in charge of his meditating thoughts about work, he and C moved onto discussing the feelings he was having about his studies and his marriage.
Chris had noticed that his more positive attitude at work had certainly influenced his mood at home, but something was still not right. He also noted that his rash and headaches in the morning had somewhat subsided, although he was still suffering throbbing pain in his temples at night after work. C began asking questions:
Extract, Counsellor and Client
Counsellor: “Chris, you talked in our first session about wanting to leave your marriage and maybe not finish your Masters, how do you feel about this now we have worked on your positive thinking?”
Client: “You know, as much as the positive thinking has helped with getting up each day and getting through work, I don’t know if it has changed my other feelings. I dunno, I still don’t know whether I want to finish my Masters. I mean, I feel better about my marriage, but I still find myself lying awake at night wondering at the “why” of everything. Know what I mean?”
C: “Tell me more about the “why”. Just your marriage and studies?”
Client: “Well, not really just that. I mean, I’m 45 now. I have a son and a wife and a job, but something just doesn’t seem right. Like maybe something’s missing.”
C: “Chris, can I just ask a question for a moment?”
Client: “Sure”.
C: “If I could wave a magic wand and you could wake up tomorrow and everything was worked out, everything was the way you wanted, what would it be like?”
Client: “It would be great!”
C: “Great, how?”
Client: “Well, I guess I would be happy. Everyday.”
C: “So would your marriage be any different? Your studies?”
Client: “Probably not. I mean, Michelle isn’t really asking more of me than when we first got together. It just seems more. The studies stay the same no matter how I feel.”
C: “So..?”
Client: “Oh, I get it. It’s not really the stuff is it? It’s me. I’m the one who has changed.”
C: “Is that how you feel?”
C proceeded to show Chris that while some things at home and work were the same as when they first married, other factors had changed. C wanted to make sure that Chris was not going to be too hard upon himself for realising that much of his own thoughts and feelings were under his own control. C pointed out elements of stress and how it works, and again they surveyed Chris’ life to examine the external factors.
Counsellor: “Chris, I just want to go back a step to the work we did around your thoughts and taking control”
Client: “Mmmmm…”
C: “Are you familiar with the word stress?”
Client: “Sure”
C: “I don’t just mean the bad form of stress, where you want to rip your hair out, but other forms too”
Client: “I’m confused”
C: “So am I! What I mean is, anything in your life that causes a change, causes stress. So when you find your dream wife and get married, this is stress. When you break your leg, this is stress. There are different types of stress, but mostly it is a word that means any change in your life.”
Client: “Ok. Where are we going?”
C: “When we look at your life and you say that things are still basically the same as when you married, you might be right on the surface, but underneath lots of things have changed that may have caused forms of stress.”
Client: “Ok”
C: “What if we have a look at exactly what is going on in your life right now and see if it makes more sense?”
C showed Chris a copy of the Holmes Rahe Stress Scale (available easily on the Internet for use – try www.teachhealth.com ) and together they identified different things that were in his life over the past 12 months, which he may not necessarily have thought of as forms of stress.
Some examples from the Holmes Rahe Scale which Chris identified included: a mortgage, change in the health of a family member (Chris disclosed that his mother had recently been diagnosed with cancer and he hadn’t really thought of this as playing an active role in the physical symptoms he was having), changes in his responsibilities at work, chronic allergies, and a change in the number of family get togethers (these had decreased due to Chris and his wife’s work and study commitments).
C helped Chris realise that there was a great deal going on in his life and that someone else in the same position may feel just as overwhelmed. This exercise served to help Chris acknowledge the forms of stress, understand how they impacted upon him and avoid falling into the trap of believing that he was the only one who had changed and everything was his fault.
Satisfied with Chris’ grasp on these concepts, C moved back to the issue of Chris being unsatisfied in life generally and searching for answers to the “why” of it all. Together they examined more closely what Chris was feeling and he surprised himself by breaking down and crying in one of these sessions. Chris talked about his own upbringing and not feeling that he had ever been good enough for his father, who had since passed away.
He discussed that his father had been a Doctor and had wanted Chris to follow the same. Chris’ grades had prevented him from achieving this and so he had chosen nursing as the next best thing. Chris was surprised at this realisation as he and C explored this issue, and he then started to examine whether nursing was really his chosen profession. C used a visual technique to examine this and coupled it with the Gestalt technique of using an empty chair because Chris’ father had died, in order to give Chris a chance to express his thoughts and feelings.
Extracts include:
Client: “I think what it means is that somewhere I knew I was never going to be as good as him and nursing was a bit of a cop out too. Even though I didn’t get the grades to get into medicine.”
C: “Would it be possible that you may have subconsciously manipulated the situation to avoid the scrutiny or pressure of studying medicine and being a doctor?”
Client: “Yeah, you know I think that’s it. It all adds up. I mean, I like nursing, but I think I’ve always felt there was something more that I didn’t achieve, for some reason.”
C: “We call it self-sabotaging, where subconsciously a person might do the very thing they are avoiding or vice versa.”
Client: “How bizarre.”
C: ‘Would it be ok if we explored your choice of nursing further with a visual exercise?”
Client: “Sure. Whatever works.”
C asked Chris to close his eyes and using a brief relaxation technique they had employed in the earlier sessions using CBT, C asked Chris to imagine the first day he had started work as a Nurse, after graduating. C specifically asked Chris to watch the scenario as it unfolded, from an outsider’s point of view. C did not want Chris to be drawn into the scene, but wanted him to be able to note his own feelings and behaviours from a distance.
Client: “I can remember it like it was yesterday. It was such a busy day and I had no idea what I was doing.”
C: “Chris, can you imagine yourself somewhere in the middle of the day, with things happening around you?”
Client: “Yep, there was this patient who was crying in the waiting room and I went over to help.”
C: “You seem a little sad.”
Client: “Well, she was waiting for her child who was in emergency. I think there was an accident or something. It was so hard to sit there and just watch, waiting you know.”
C: “Run the scene before you until you get to the end of that situation. Watch yourself handle it.”
Client: “I know I look helpless but in the end, she came and thanked me for just being there. Her daughter was alright.”
C: “That’s a smile.”
Client: “Well, it was such a good feeling on that day because in the middle of all the chaos, I sat with her and just kinda talked about stuff, to take her mind off it, and she thanked me in the end. I really felt like I did nothing.”
C: “But as you watch now…”
Client: “I think it felt good. When I see myself now, I know I handled it ok, for the first day and all, and I guess I felt I could make it.”
Chris noted that in that moment of starting work after his studies, he felt okay as a nurse. This helped him clarify that while he was not a doctor, his work was appreciated and valued as a nurse. Together he and C explored the notion of still becoming a doctor, but Chris said he felt secure in his current role. He noticed over the next few sessions since this realisation, that his feelings at work continued to improve, and that he felt happier and more valued as a staff member; and that his patients benefited from this. Despite the progress Chris had made with these feelings, it still left the issue of his unresolved feelings towards his father.
Through more discussion, Chris came to realise that the unresolved childhood event of not feeling as though he had lived up to his Father’s expectations, was still having an impact on his feelings of emptiness and unfulfilment. C explained the concept of the Empty Chair technique to Chris and he agreed to give it a try, although he was finding it difficult to put his feelings towards his father into words. As a brief explanation, here the client is asked to put feelings or thoughts into action.
For example, C encouraged Chris to use a kind of role playing (in this case, speaking to an empty chair because Chris’ father was not present). He was encouraged to tell his father how he felt about the expectations he felt as a child. Enactment here is intended as a way of increasing awareness, not as a form of catharsis and in the case of Chris he had difficulty expressing his feelings into words in front of C. Instead of badgering Chris to continue, C took a step back and changed the angle slightly and tried some integrating and body techniques.
Integrating techniques bring together processes the patient doesn’t bring together or actively keeps apart (splitting). The client might be asked to put words to a negative process, such as tensing, crying or twitching. Or when the client verbally reports a feeling, that is, an emotion, they might be asked to locate it in their body.
Another example is asking a client to express positive and negative feelings about the same person. The body techniques include any technique that brings clients’ awareness to their body functioning or helps them to be aware of how they can use their bodies to support excitement, awareness and contact. In this case C observed Chris sitting tightly and rigidly in the chair after trying to express his feelings to his father in the Empty Chair technique.
C: “Would you be willing to try another experiment?”
Client: Nods
C: “Take some deep, deep breaths and each time you exhale, let your jaw loosely move down.”
Client: Breathes deeply, lets jaw drop on the exhale
C: “Stay with it”
Client: Starts melting, crying, then sobbing
At this point Chris was more able to speak about his feelings and loudly started to express how he hated his father, and how angry he was. C let Chris vent his feelings, which had been suppressed for many years. This was a huge breakthrough for Chris, even more so because this issue had not been foremost in his mind when he entered counselling.
This powerful technique involving role-playing may sound artificial and might make some people feel self-conscious as it did for Chris in the beginning, but it can be a powerful way to approach buried feelings and gain new insight into them. While Chris still had some way to go in working through these feelings, this session was useful for him to open to the idea of working on self-awareness.
Session Summary
In summary, Chris’ counselling focused on a number of issues:
The techniques of CBT helped Chris rapidly get a hold on his negative thought patterns and he was able to implement these in his life quite quickly. Visualisation techniques helped Chris explore his notion that perhaps he still wanted to be a doctor instead of a nurse. Finally, Gestalt techniques helped Chris begin to understand his unresolved feelings towards his father.
After the session involving the Gestalt technique of the empty chair, Chris opted to change his weekly sessions to fortnightly for 2 sessions, and then visited monthly for two more sessions. He stated at this time that life had settled back down to “normal”, meaning that he was coping well at work, had mapped out a timetable to finish his nursing studies and that his marriage was happy. He discussed that Michelle constantly pointed out the positive changes in him and this made him feel even more in control of his feelings, thoughts and behaviours.
Chris stated that the feelings of anger and resentment towards his father had subsided although he found himself pondering his childhood a little more now than he used too. He said that the counselling had worked to a degree with this issue, but because he had not realised it when he came into counselling, he was still coming to terms with his feelings.
He and C discussed this being a normal phenomenon, and the notion that if in the future the issue proved too difficult to handle, or started to again interfere in Chris’ life, then future sessions might be necessary. Chris described that he was particularly positive about his future, about spending more time with his son and wife, and felt more in control than he had ever been before.
Author: Peta Hartmann
Related Case Studies: A Case of Stressful Life Change , A Case of Low Self Esteem , A Case of Using a Person-Centred and Cognitive-Behavioural Approach to Burnout
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The problem.
The consumer science team of the home healthcare division of a leading consumer packaged goods company was considering developing a new line of stress management products for the consumer market. While they had conducted limited stress management research in the past, they needed to learn more about the causes, symptoms, and impacts of human stress. They were particularly interested in understanding the various non-pharmaceutical treatments for stress and current trends in stress management.
Introductory Overview Clinical and Non-Clinical Perspectives
Maven constructed an Electronic Survey targeting professionals who had conducted in-depth stress management research. Within hours, the consumer science team who commissioned the Survey had received detailed perspectives from healthcare providers, holistic healers, medical researchers, psychologists, and stress management specialists on the outcomes of their own stress management research, as well as their opinions on the areas of strongest interest for future stress management product development. The diverse insights provided by the Survey gave the team a strong foundation for the next phase of their research and ultimately the development of the new product offering.
“With Maven we were able to reach a broader audience than through our traditional challenges. The alternative perspectives provided through this Survey were critical to our work in this new area.” – Consumer Research Analyst
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Home >> Harvard Case Study Analysis Solutions >> Stress Management
Stress management.
A good stress management program will not only improve the mental health, but it will also improve the relationships with others. It will also help them to feel happier and more productive. It will also help to cope with the stresses of the life.
The first step is to identify the stressful situations in the life. They should be able to recognize the triggers of those situations and develop coping mechanisms. By doing this, they will be able to manage the stress and stay healthy. There is one way to reduce the symptoms of stress is to practice self-care, also known as managing stress because stress affects sleep. Getting quality sleep is a vital part of stress management. A proper sleep can improve the physical health and reduce the stress that experienced throughout the day.
Practicing meditation could also reduce the stress that the experience throughout the day. But long sessions are not as effective as short sessions. A five-minute session can calm the mind and body. The key is to be consistent.Exercising can reduce stress levels and improve overall health. Getting moving regularly will not only keep them in better shape, but it will also decrease the level of anxiety and improve the mood.
It is concluded that when all experience some stress, learning about these factors and how to manage them can help to reduce overall level of stress. Managing stress is an ongoing process that will help to maintain a healthy life. Learning how to manage the stress is important for the health and well-being. Effective stress management can help to enjoy a happier, healthier, and more productive life . In addition to this, it helps to become resilient and cope with pressure. Stress can be very harmful to the body and mind. It can cause a number of physical and mental symptoms. It is important to understand how to cope with stress. During stressful times, a healthy lifestyle can make a huge difference. They will feel better if they can deal with stress in a productive and balanced way. Fortunately, there are ways to manage the stress and get more rest. By following some basic tips, they can reduce the level of stress and improve health. They may find it useful to keep a stress diary. They can find a healthy way to handle the stress by focusing on the things that are in control.
It is recommended to use multiple methods because it is not necessary that one single method will work for everyone. Here, the key is to find the right combination of techniques that work for them. There is no set formula for how to do this; it may take several tries to find the right balance. Keeping a daily routine can help them to cope with stress. They may find it useful to keep a stress diary to track the types of stress they experience and make any necessary changes. This will help them to better understand their own unique needs and patterns.The first step in treating this disorder is to determine what kind of stress is causing the symptoms. A medical doctor can determine the severity of the condition by examining the patient's mental health and conducting a mental exam (Wang, 2020). They should try to avoid those people that are making them to feel stressed. If these people are the boss, they should talk to them to discuss the situation and how to deal with them. They might be able to find the solution for themselves, but they can still manage the stress in the long run by making changes. In addition to this, they can try to avoid stressful situations by letting themselves relax when they are feeling tense.............................
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Schematic representation of (SA/GL/PAm) hydrogel formation by gamma ray irradiation.
The specific conditions and parameters used for this hydrolysis process, as described in the previous work 7 , are critical in achieving this desired level of swelling and water absorbance. The choice of alkali (in this case, KOH), concentration, temperature, and reaction time all play a role in determining the final properties of the UAH. The hydrolysis of (SA/GL/PAm) was carried out by reaction with 10 wt% of KOH at a temperature of 90 °C for 90 min. The reaction rate is initially relatively high, and hydrolysis is rapid. This is attributed to the availability of many amide groups in the polymer chain that can readily react with the hydroxide ions. The hydrolysis of amide bond groups (–CONH 2 ) by KOH is outlined as the following Eq. 28 , 29 :
The chemical structure and surface morphology of the (SA/GL/PAm) hydrogels were analyzed using Fourier transform infrared spectrophotometry (FTIR) with an attenuated total reflectance (ATR) accessory on a Vertex 70 FTIR spectrometer equipped with a HYPERION ™ series microscope from Bruker Optik GmbH, Ettlingen, Germany. FTIR allowed for the identification of functional groups and chemical bonds in the hydrogel. Additionally, surface morphology was examined using a ZEISS EVO 15 scanning electron microscope (SEM) located in the United Kingdom (UK), providing high-resolution images that revealed surface topography, structural features, and the size and distribution of pores. These combined analyses offered comprehensive insights into the chemical and physical characteristics of the hydrogel, supporting its evaluation for various applications.
To measure the gel fraction (%) of the obtained (SA/GL/PAm) hydrogel, the initial weight ( W i ) after the prepared step was measured. Then, the (SA/GL/PAm) hydrogel was immersed in 100 ml of distilled water and on standby for 48 h at ambient temperature. The distilled water was refreshed twice every five hours. The swollen (SA/GL/PAm) hydrogel piece was placed in an oven at a temperature of 50 °C until completely dry. The dried weight was measured ( W d ), and the gel fraction (%) was calculated using Eq. ( 1 ).
To calculate the swelling degree and equilibrium swelling, the dried weight of the obtained (SA/GL/PAm) hydrogel was measured ( W d ) and immersed in distilled water to measure the swelling rate with time (t) to give the swelled weight ( W t ).
After 48 h, the water absorption equilibrium of the (SA/GL/PAm) hydrogel was reached ( W ES ), and the swelling equilibrium was calculated as Eq. ( 3 )
The water retention (%) was calculated by putting the weighted (SA/GL/PAm) hydrogel at maximum swelling in equilibrium ( W ES ) the weight of hydrogel at a given time ( W t ), and the weight of the dried hydrogel ( W o )
The trial optimum condition was repeated three times to achieve high confidence and reproducibility.
The study was done on sandy loam soil in El Gharbia, Egypt. The soil physiochemical analysis (analysis at Ain Shams University, Faculty of Agriculture, Cairo, Egypt, in the arid land research and services center) is displayed in Table 1 s. The experiment involved the application of 5 g of UAH (loaded with 5% urea) to each seed of wheat plants. The supplementary file details the treatment process (Table 2 s and Fig. 1 s).
Ftir analysis of (sa/gl/pam) before and after hydrolysis.
In Fig. 2 , the FTIR spectra revealed distinct features that shed light on these components' chemical identities and interactions. Sodium alginate, a natural polymer derived from brown algae, displayed a pronounced peak at 3335 cm −1 , a signature of OH stretching vibrations. Moreover, the spectra exhibited distinct absorption bands at 1595 cm −1 and 1408 cm −1 , which can be attributed to carboxylate groups' asymmetric and symmetric stretching vibrations 30 . This corroborates the presence of carboxylic groups within sodium alginate, an essential component in many hydrogel applications. Gelatin, another vital constituent in this hydrogel composite, presented a broad OH stretching peak at 3285 cm −1 , indicating its abundant hydroxyl groups. Notably, gelatin is a hydrolyzed form of collagen with distinctive bands at 1625 cm −1 , 1520 cm −1 , and 1248 cm −1 31 . These bands correspond to amide I, amide II, and amide III vibrations, reflecting the proteinaceous nature of gelatin. The rich spectrum of gelatin testifies to its vital role in contributing to the hydrogel's mechanical stability and protein-based structure. The SA/GL/PAm hydrogel, made up of sodium alginate, gelatin, and acrylamide, showed a spectrum that showed the unique properties of each of its polymers. Some changes were seen in the spectra, mainly in the bands' wavenumbers corresponding to sodium alginate and gelatin. However, the peaks from each component made it clear that they worked together and were connected without covalent bonds within the hydrogel. Additionally, the absence of a sharp band at 1662 cm −1 , indicative of the C = C bond of acrylamide, is compelling evidence of radiation-induced polymerization during the hydrogel’s synthesis.
FTIR of sodium alginate, gelatin, acrylamide, SA/GL/PAm hydrogel, and modified SA/GL/PAm hydrogel.
Interestingly, the FTIR analysis of the modified SA/GL/PAm (UAH) showed the big changes that were taking place in this advanced material. The spectra exhibited a noticeable shift in the (–NH 2 ) peak from 3184 cm −1 in the SA/GL/PAm hydrogel to 3367 cm −1 in the UAH. This change, along with a lower peak intensity and a wider peak, clearly showed that the amide bond groups in the modified hydrogel's structure were being broken down by water. This transformation is paramount, as it enhances the hydrogel’s water-absorbing capabilities, making it an efficient tool for water management, soil conditioning, and various agricultural applications.
SA and GL are critical building blocks in the (SA/GL/PAm) hydrogel, impacting its gel fraction and water-absorbing properties. The concentration of biopolymers, specifically the ratio of SA to GL, plays a pivotal role in shaping the characteristics of the resulting hydrogel 32 . The gel fraction shows how much the polymer chains have crossed-linked to form a network structure. It is an important parameter that shows how structurally stable the hydrogel is and how well it can absorb water. The SA-to-GL ratio within the hydrogel formulation can be optimized to achieve specific properties and characteristics. The choice of ratio can be tailored to meet the requirements of a particular application. For instance, a hydrogel with a balanced SA and GL ratio may offer a compromise between water-absorbing capacity and gelation percentage, suitable for various applications.
Figure 3 a shows that the ratio of sodium alginate to gelatin in the hydrogel composition influences the gel fraction percentage. A higher proportion of gelatin tends to result in a higher gel fraction, while a higher proportion of sodium alginate reduces the gel fraction. The ratio choice can be tailored for various applications to achieve specific properties and characteristics in the resulting hydrogel. At a 17/83 SA/GL ratio, the acrylamide content is 2.5%, and the gel fraction percentage is 86.4%. This indicates a relatively low acrylamide content and a significant gel fraction. At a 34/66 and 50/50 SA/GL ratio, the gel fraction percentages are 71% and 49.2%, respectively. At 66/34 and 83/17 SA/GL ratios, the acrylamide content is 2.5% and the gel fraction percentage is 0%. In this case, the gel fraction is minimal, indicating a lack of gel formation as SA content increases 33 . Gel fraction also increased from 76.8 to 90.3% with higher GL content, reflecting increased crosslinking (at 5% acrylamide content). At (17/83, 34/66, 50/50, 66/34, and 83/17 SA/GL) hydrogel with acrylamide content 10% Am, the gel fraction percentages are 92.9%, 90.9%, 90%, 89.9%, and 89.5%, respectively. At a 66/34 SA/GL ratio, the acrylamide content is 15%, and the gel fraction percentage is 92.1%. The acrylamide content has significantly increased, and the gel fraction remains high.
Effect of biopolymer (SA/GL) content on the gel fraction ( a ) and swelling degree ( b ) of SA/GL/PAm hydrogel, the effect of gamma radiation doses on the gel fraction ( c ) and swelling degree ( d ) of SA/GL/PAm hydrogel.
Figure 3 b reveals that the amount of biopolymer present, specifically the ratio of SA to GL, is a key factor in determining how the hydrogel swells. The swelling percentage, which quantifies the extent to which the hydrogel can absorb and retain water, is a crucial parameter reflecting the hydrogel’s performance in various applications. The SA/GL ratio can be carefully adjusted to achieve specific properties and characteristics tailored to the requirements of a particular application. For instance, a balanced SA and GL ratio may compromise water-absorbing capacity and gelation percentage, making it suitable for various applications. The pivotal role of biopolymers, namely SA and GL, in shaping the swelling behavior of (SA/GL/PAm) hydrogel underscores their significance in hydrogel engineering. These biopolymers contribute to the hydrogel's water-absorbing properties and influence its structural integrity and gelation percentage. The versatility of biopolymers allows for precise control over hydrogel properties, making them ideal candidates for a wide range of applications. Figure 3 b reveals the profound influence of the SA/GL ratio on the properties of the hydrogel. At a 17/83 SA/GL ratio, the acrylamide content is 2.5%, and the swelling degree is 81.3 (g/g). Transitioning to a 34/66 SA/GL ratio maintains the acrylamide content at 2.5% but significantly enhances the swelling to 144.6 g/g. As the SA and GL components approach a balanced 50/50 ratio at an acrylamide content of 5%, the swelling degree remains respectable at 98 g/g. Moving towards a 66/34 SA/GL ratio, the acrylamide content is 5%, and the swelling degree improves to 82.85%. At 5% acrylamide content, the (SA/GL 17/83) hydrogel exhibited a 61 (g/g) swelling degree, while increasing SA content resulted in higher swelling, peaking at 91.5 (g/g) for (SA/GL 83/17). Finally, at 10% acrylamide content, the (SA/GL 17/83) hydrogel exhibited a 40.03 (g/g) swelling degree, while increasing SA content resulted in higher swelling, peaking at 75.5 (g/g) for (SA/GL 83/17). The findings show that the balance between SA and GL is crucial for controlling the hydrogel's ability to absorb water and its acrylamide content. This information can make the hydrogel’s properties fit specific uses where water absorption is important.
Figure 3 c demonstrates the relationship between the irradiation dose (kGy) and the resulting gel fraction percentage of the (SA/GL/PAm) hydrogel. This relationship highlights the significant impact of irradiation on the gel fraction, an essential parameter reflecting the hydrogel’s structural integrity and water-absorbing capacity. At an irradiation dose of 10 kGy, the gel fraction percentage is 70.3%. This indicates that the hydrogel’s network structure has formed somewhat, but there is room for further improvement. A gel fraction of 70.3% suggests that the hydrogel may have a moderate water-absorbing capacity. At an irradiation dose of 20 kGy, the gel fraction percentage significantly increases to 89.7%. This higher irradiation dose produces a much denser network structure 34 , indicating enhanced structural integrity and water-absorbing capacity. The hydrogel is now better suited for applications requiring efficient water retention. The gel fraction percentage rises at an irradiation dose of 30 kGy, reaching 96%. This dose further optimizes the hydrogel’s network structure, maximizing its structural integrity and water-absorbing capacity.
A gel fraction of 96% signifies that the hydrogel is well-suited for applications demanding high water retention. At an irradiation dose of 40 kGy, the gel fraction percentage reaches 96.5%, indicating a minor increase in structural integrity compared to the 30 kGy dose. The network structure is nearly fully developed, and the hydrogel possesses exceptional water-absorbing capabilities. The slight increase in the gel fraction suggests that further irradiation may have diminishing returns regarding structural improvement. These results underscore the pivotal role of irradiation dose in shaping the structural characteristics and water-absorbing properties of (SA/GL/PAm) hydrogel. The data shows that a higher irradiation dose makes the network structure denser and better at retaining water. The 30 kGy dose best balances irradiation intensity and structural integrity. This information is invaluable for tailoring hydrogel properties to meet the requirements of specific applications, whether in agriculture, medicine, or environmental management. Figure 3 d illustrates the impact of irradiation dose (measured in kGy) on the swelling percentage of the (SA/GL/PAm) hydrogel. These findings reveal a significant relationship between the irradiation dose and the hydrogel's water-absorbing capacity. At an irradiation dose of 10 kGy, the hydrogel exhibits a substantial swelling percentage of 139.7%, indicating its ability to efficiently absorb and retain water. As the irradiation dose is increased to 20 kGy, the swelling percentage decreases to 104.8%. This suggests a higher irradiation dose can reduce the hydrogel's water-absorbing capacity, indicating a denser network structure. Further increasing the irradiation dose to 30 kGy results in a decreased swelling percentage of 86.68%. This trend continues to emphasize the impact of irradiation on the hydrogel’s water-absorbing properties. Finally, when the irradiation dose is raised to 40 kGy, the swelling percentage drops even more to 71.5%. This shows that a higher irradiation dose makes the network structure denser and lowers its ability to absorb water 35 . These findings underscore the critical role of irradiation dose in shaping the swelling behavior of the (SA/GL/PAm) hydrogel. The data suggests that the irradiation dose can be carefully adjusted to achieve specific water-absorbing properties tailored to the requirements of different applications, particularly in fields where controlled water absorption is crucial.
The hydrolysis of the (SA/GL/PAm) hydrogel is a critical process that can significantly impact its swelling behavior and water-absorbing capacity. In this part, we’ll look at how cycling hydrolysis affects the amount of swelling and how fast it happens. This will help us understand how the hydrogel changes when it's broken down in different ways. The hydrolysis process of the (SA/GL/PAm) hydrogel involves subjecting it to an aqueous potassium hydroxide (KOH) solution under controlled conditions, explicitly utilizing a 10 wt% KOH solution, maintaining a temperature of 90 °C, and allowing the reaction to proceed for 90 min. The aim is to examine how multiple hydrolysis cycles impact the hydrogel's water-absorbing capacity. The relationship between the hydrolysis cycles and the water-absorbing capacity of the hydrogel is presented in Fig. 4 a. The data reveals a clear correlation between the number of cycles and the swelling percentage (g/g). As shown, absorbency increases with an increase in the hydrolysis cycle.
The equilibrium swelling degree (g/g) ( a ) and photograph ( b ) of the UAH at different modification cycles (0–4).
The initial swelling degree is recorded at 77.5 (g/g), and with the first hydrolysis cycle, it increases substantially to 402.3 (g/g). The swelling percentage rises in the second cycle, reaching 969 (g/g). However, the third cycle demonstrates the most remarkable increase, achieving a swelling degree of 1293 (g/g). In contrast, the fourth cycle experiences a reduction in swelling, dropping to 290 (g/g). This intriguing pattern suggests an optimal range of hydrolysis cycles where the hydrogel’s water-absorbing capacity is maximized. The corresponding photographs in Fig. 4 b illustrate the hydrogel’s appearance after undergoing different hydrolysis processes. Despite its expansion, the hydrogel maintains its initial cylindrical form when swollen. The photographs also reflect the variations in size and swelling behavior with each cycle, with the third cycle displaying the most significant increase in height and diameter. Figure 5 a, b show how the swelling rate changes for the SA/GL/PAm hydrogel and the UAH. It is evident that, with increasing time, the swelling rate experiences a steady increase until it reaches a point of stability, which occurs after approximately 20 h for both hydrogels. This suggests a specific equilibrium state is achieved, where the hydrogel's water-absorbing capacity remains relatively constant. The analysis of the diffusion mechanism for both hydrogels indicates that the swelling follows a non-Fickian diffusion mechanism (Fig. 5 c). The non-Fickian diffusion mechanism is characterized by a combination of diffusion and relaxation processes, implying that the swelling behavior is not solely dependent on the concentration gradient but also on the relaxation of the polymer network. The SA/GL/PAm hydrogel and the UAH’s diffusion parameters are shown in Table 1 , along with their n-values, which show that the diffusion mechanism is non-Fickian. These values, which are less than 1 and more than 0.5, further support the idea that the swelling is influenced by a combination of diffusion and relaxation processes rather than purely Fickian 36 .
Rate of swelling ( a , b ) and swelling kinetics ( c ) of SA/GL/PAm hydrogel and UAH, respectively.
The cross-sectional shape of the swollen SA/GL/PAm hydrogel before and after chemical modification, as shown in Fig. 6 , gives us interesting information about how this material is put together. The hydrogel exhibits a distinctive surface morphology characterized by three-dimensional pores (Fig. 6 a). Notably, these pores appear relatively uniform, boasting a diameter of approximately 10 µm. This regularity in pore size contributes to the hydrogel’s consistent and efficient water-absorbing capacity. In contrast, the UAH displays notable deviations in morphology compared to the original SA/GL/PAm hydrogel (Fig. 6 b). Two distinctive features are readily apparent. Firstly, the modified hydrogel showcases differences in the diameter of its macropores. This variation in pore size is a significant structural alteration resulting from the hydrolysis process, contributing to its enhanced water-absorbing capabilities. Secondly, the surface of the modified hydrogel is notably less smooth when compared to the original SA/GL/PAm hydrogel. This textured surface serves as an advantageous attribute for increased water absorption. The irregularities and microstructures on the hydrogel’s surface provide more sites for water molecules to interact with and be retained, ultimately enhancing the hydrogel’s ability to absorb and retain water efficiently. The SA/GL/PAm hydrogel and the UAH have different shapes, showing the hydrolysis process’s effect. This change in structure, along with the changes seen in the pores’ size and the surface’s texture, makes the modified hydrogel better at absorbing water. These insights are invaluable in understanding the underlying mechanisms that drive the hydrogel's enhanced performance and its potential applications in fields where efficient water management is essential. Also, Figure 6 c shows the network structure of UAH after hydrolysis modification. The ability to retain a porous structure is crucial for the hydrogel’s effectiveness in applications such as soil moisture retention, indicating its potential for prolonged and efficient water management in agricultural settings.
SEM of SA/GL/PAm hydrogel ( a ) and UAH after hydrolysis ( b , c ).
Figure 7 shows an analysis of water retention that clearly shows how the SA/GL/PAm hydrogel and the UAH are very different in how well they can absorb water. This critical information is pivotal in understanding the hydrogel’s potential in various applications where efficient water management is essential. For the SA/GL/PAm hydrogel, the water retention percentage (WR%) reveals a significant decrease over time. After just 5 days, there is an approximately 50% reduction in WR%, which further decreases to 75% of the initial water weight after 6 days. Notably, within 11 days, the SA/GL/PAm hydrogel loses all its water content, highlighting its limited water-retaining capacity. This is a crucial factor in applications requiring prolonged water retention. In stark contrast, the UAH demonstrates extraordinary water-retaining capabilities. Even after 9 days, there is only a 50% reduction in WR%, a rate much slower than that of the unmodified hydrogel. Remarkably, the modified hydrogel maintains its water content for an extended period, retaining water for up to 36 days. This substantial difference in water retention can be attributed to the high hydrophilic nature of the modified hydrogel, which is characterized by numerous hydrophilic groups that can readily form hydrogen bonds with water molecules. Its effective porosity and substantial surface area further contribute to its ability to absorb and retain a significant volume of water. These findings underscore the considerable impact of the hydrolysis process on the hydrogel’s water-absorbing properties. The UAH’s ability to retain water for an extended duration makes it an ideal candidate for applications where sustained water retention is crucial, such as agriculture in arid regions, horticulture, and environmental management. The ability to efficiently manage water resources through such advanced materials represents a critical step towards addressing water scarcity and enhancing sustainability in various sectors.
Water retention of SA/GL/PAm hydrogel and UAH at 30 °C.
Drought stress is a condition in which plants lack water or dehydration, negatively affecting their growth, development and overall health 37 . Hydrogels can increase biomass production in wheat plants, resulting in taller plants with more leaves 38 . The data presented in Fig. 8 illustrates the positive impact of ultra-absorbent hydrogel (UAH) on shoot length (g) under varying stress conditions. In the first stage (after 45 days), UAH demonstrated a notable enhancement in shoot length by 0%, 6%, 7%, and 18% at stress levels of 0%, 25%, 50%, and 100%, respectively (Fig. 8 a). Similarly, in the second stage (after 85 days) (Fig. 8 b), UAH exhibited a positive effect on shoot length with enhancements of 15%, 11%, 13%, and 12% at stress levels of 0%, 25%, 50%, and 100%, respectively, compared to control groups. This data underscores the capacity of hydrogels, such as UAH, to positively influence root growth and development by ensuring a consistent water supply, particularly under varying stress conditions 39 . The observed positive impact of UAH on shoot length also extends to root development, fostering healthier root systems with increased strength and extensiveness. As depicted in the data presented in Fig. 8 c, UAH exhibits a substantial enhancement in root length by 42%, 26%, 12%, and 43% under stress levels of 0%, 25%, 50%, and 100%, respectively. Furthermore, at stage two (Fig. 8 d), UAH demonstrates a significant difference in root length with enhancements of 12%, 13%, 11%, and 12%, respectively. This consistent improvement in root length underscores the beneficial influence of UAH on the overall health and development of wheat plants, contributing to taller and more robust growth 40 , 41 , As depicted in Fig. 8 e–h the application of UAH to wheat plants resulted in a notable enhancement in shoot fresh weight. The data illustrates that the use of UAH positively influences the overall weight of the shoots, indicating a potential for increased biomass and healthier plant development. The precise values and details provided in the figure can offer a more comprehensive understanding of the extent of this enhancement in shoot fresh weight attributed to the application of UAH 42 . The positive impact of the hydrogel on wheat plants is evident in the data presented in Fig. 9 a, b showcasing the enhancement in wheat dry weight shoots and roots. Particularly noteworthy is the positive influence observed in shoot dry weight. In stage one, the hydrogel application increased by 51%, 34%, 34%, and 45% at stress levels of 0%, 25%, 50%, and 100%, respectively. Similarly, in stage two, the hydrogel demonstrated a positive effect on shoot dry weight with enhancements of 25%, 11%, 24%, and 18% at stress levels of 0%, 25%, 50%, and 100%, respectively. These findings emphasize the hydrogel’s potential to significantly improve fresh and dry weight in wheat plants, particularly in adverse stress conditions. Hydrogels can protect wheat crops from the detrimental effects of drought 43 . Acting as a water reservoir, hydrogels give plants access to moisture during dry periods, effectively minimizing yield losses caused by drought-induced stress 44 . Also, dry weight of roots as shown in Fig. 9 c, d in stage one, the hydrogel application increased by 45%, 43%, 41%, and 37% at stress levels of 0%, 25%, 50%, and 100%, respectively. Similarly, in stage two, the hydrogel demonstrated a positive effect on roots dry weight with enhancements of 25%, 23%, 19%, and 13% at stress levels of 0%, 25%, 50%, and 100%, respectively. Figure 9 e, f show the positive impact of UAH on number of leaves under varying stress conditions. In the first stage, UAH demonstrated a notable enhancement in number of leaves by 43%, 46%, 47%, and 31% at different stress levels. In second stage, the hydrogel demonstrated a positive effect on number of leaves with enhancements of 28%, 28%, 18%, and 25% at stress levels of 0%, 25%, 50%, and 100%, respectively. As displayed in Fig. 10 , it is clear that UAH had superiority of all yield parameters; the number of grains in Fig. 10 a increased by using UAH; there was also an improvement in grain weight in Fig. 10 b by 50, 32, 21, and 37% at 0, 25, 50, and 100% stress, respectively; the 100-grain weight in Fig. 10 c increased at all stress levels of UAH treatments; and the number of spikes increased in the presence of UAH (Fig. 10 d). Photographs of wheat spikes, as depicted in Fig. 10 e, f provide visual evidence confirming the disparity between wheat plants cultivated with and without UAH presence. Also, Fig. 2 s show the size and shape of the spike of wheat for four groups samples.
The effect of UAH and controlled (H and C) samples on ( a , b ) shoot length ( c , d ) root length ( e , f ) fresh weight of shoots, and ( g , h ) fresh weight of roots at stages (1, 2), respectively.
The effect of UAH and controlled (H and C) samples on ( a , b ) the dry weight of shoots, ( c , d ) the dry weight of roots, and ( e , f ) the number of leaves at stages (1, 2), respectively.
The effect of UAH and controlled (H and C) samples on the number of grains, grain weight, 100-grain weight, and number of spikes ( a – d ), respectively. Photographs of wheat spikes C and H ( e , f ), respectively.
As evident in Fig. 11 a, b UAH demonstrated promising effects on wheat plants subjected to varying drought stress levels. The considerable increase in shoot protein content by 18%, 26%, 32%, and 26% at stress levels of 0%, 25%, 50%, and 100%, respectively, along with the corresponding increment in grain protein content by 16%, 11%, 21%, and 10%, directly supports the notion that UAH positively influences the nitrogen content of the plant. This impact is crucial for synthesizing proteins, underscoring the potential benefits of UAH in promoting healthier plant growth under stress conditions. These findings corroborate earlier research 45 , which also recognized the benefits of hydrogels in enhancing plant protein content. Hydrogels contribute to overall plant health and stimulate photosynthesis 46 , a fundamental process in which plants transform carbon dioxide and water into carbohydrates. As illustrated in Fig. 11 c, d there is a notable increase in shoot carbohydrate content by 14%, 17%, 15%, and 19% at stress levels of 0%, 25%, 50%, and 100%, respectively. Similarly, the grain carbohydrate content experiences increment of 24%, 23%, 19%, and 13%. These findings suggest that ultra-absorbent hydrogel (UAH) has the potential to enhance photosynthesis, aligning with previous research. The observed surge in carbohydrate content further supports the idea that UAH positively influences the plant’s metabolic processes, contributing to improved overall plant health and resilience under varying stress conditions 46 . Moreover, plants often accumulate proline under drought stress conditions as a defensive mechanism to maintain cellular stress and osmotic balance 47 . The consistent water supply provided by hydrogels can alleviate drought stress and reduce the need for proline accumulation, which acts as an osmoprotectant in cells under biotic stress. The reduction in shoot proline content by 38%, 31%, 18%, and 9% and the decrease in grain proline content by 30%, 26%, 26%, and 35%, as evident in Fig. 11e, f underscore the effectiveness of UAH in mitigating drought stress. This is consistent with previous research 48 , which also demonstrated a decrease in proline content in sunflower plants by applying hydrogels. Phenolic compounds, known for their various functions in plants, such as defense mechanisms, stress responses, and antioxidant activities, were also impacted by UAH. Contrary to some previous findings 49 , the data in Fig. 11g, h revealed an increase in phenolic compounds at all stress levels compared to control treatments. This variation could be elucidated by allocating more resources towards secondary metabolites, specifically phenolic compounds when plants undergo mild drought stress. Such resource allocation may enhance the plant's stress response and defense mechanisms. This discrepancy emphasizes the complexity of plant responses to stress conditions, where factors such as stress severity and the specific metabolic pathways activated can lead to varied outcomes in secondary metabolite production.
The effect of UAH and controlled (H and C) samples on ( a , b ) protein (mg/ml), ( c , d ) carbohydrate (mg/ml), ( e , f ) proline (mg/ml), and ( g , h ) phenol (mg/100 g).
Chlorophyll is an essential chemical found in the chloroplasts of plant cells and other photosynthetic organisms, such as algae and some bacteria 50 . Hydrogels play a crucial role in maintaining consistent soil moisture levels, a factor essential for photosynthesis, and preserving adequate chlorophyll levels. This aligns with the outcomes presented in Fig. 3 s, where UAH positively impacted chlorophyll content. In Fig. 3 s (a, b) UAH enhanced chlorophyll a during stage 1 by 29%, 20%, 10%, and 14%, and during stage 2 by 24%, 15%, 9%, and 7% at stress levels of 0%, 25%, 50%, and 100%, respectively. Similarly, in Fig. 3 s (c, d), UAH increased chlorophyll b during stage 1 by 38%, 28%, 15%, and 37% and during stage 2 by 15%, 21%, 12%, and 31% at stress levels of 0%, 25%, 50%, and 100%, respectively. Moreover, in Fig. 3 s (e, f), UAH demonstrated superiority in total Chlorophyll during stage 1 by 31%, 22%, 11%, and 20% and during stage 2 by 21%, 17%, 10%, and 14%, at stress levels of 0%, 25%, 50%, and 100%, respectively. Lastly, in Fig. 3 s (g, h), UAH enhanced carotenoid content during stage 1 by 27%, 14%, 26%, and 25% and during stage 2 by 24%, 14%, 24%, and 27% at stress levels of 0%, 25%, 50%, and 100%, respectively. These findings underscore the positive influence of UAH on the photosynthetic pigments crucial for plant growth and stress resilience. These results align with 51 , which revealed that superabsorbent hydrogel enhanced the chlorophyll and carotenoid content of sunflowers.
Catalase is an enzyme involved in the detoxification of reactive oxygen species (ROS) produced under stress conditions 52 . Hydrogel can reduce catalase enzyme content in plants by maintaining soil moisture and reducing drought stress. In line with this, the results displayed in Fig. 4s (a, b) showed that UAH reduced catalase enzyme stage (1) by 29, 22, 29, and 38%, and stage (2) by 26, 32, 19, and 16%, at 0, 25, 50, and 100%, respectively. These results were verified by previous research on sunflowers 13 . The Peroxidase enzyme is involved in a variety of physiological processes in plants, including creating defenses against oxidative stress 53 . Hydrogel can reduce peroxidase enzyme content by improving water retention in the root zone and reducing oxidative stress in plants. This goes with the results displayed in Fig. 4s (c, d), where UAH decreased peroxidase enzyme stage (1) by 19, 22, 25, and 24% and stage (2) by 31, 18, 16, and 30% at 0, 25, 50, and 100%, respectively. Polyphenol oxidase (PPO) is an enzyme found in plants that helps turn fruits and vegetables brown when they are cut or damaged 54 . Hydrogel can indirectly reduce PPO activity by limiting the occurrence of tissue damage and minimize physical damage to plant tissues by preventing excessive drying and wilting. The results displayed in Fig. 4s (e, f) revealed that UAH reduced polyphenol oxidase enzyme stage (1) by 9, 6, 10, and 12% and stage (2) by 15, 13, 23, and 25% at 0, 25, 50, and 100%, respectively. In line with these results 48 , hydrogels decrease the polyphenol oxidase enzyme in sunflower plants, One well-known function of hydrogen peroxide in plants is its role in responses to biological and abiotic stresses 55 . Hydrogels can reduce H 2 O 2 by mitigating drought stress; the data displayed in Fig. 5 s (a, b) showed that UAH reduced H 2 O 2 stage (1) by 16, 10, 11, and 17%, and stage (2) by 25, 16, 21, and 22% at 0, 25, 50, and 100%, respectively. This results goes with the previous research on maize plant 7 which indicated that UAH reduce hydrogen peroxide in maize plant, malondialdehyde (MDA) is a marker of lipid peroxidation and oxidative stress in plant cells 56 , MDA can accumulate in plant tissues when the cells undergo oxidative damage 57 , hydrogel can reduce MDA by regulating temperature in the root zone of plants which plays a role in the rate of oxidative reactions, the results displayed in Fig. 5s (c and d) indicated that UAH reduced MDA stage (1) by 45, 23, 34 and 38% and stage (2) by 21, 22, 18 and 36% at 0, 25, 50 and 100% respectively, in line with the results 58 revealed that hydrogel reduced MDA content under stress condition.
The study developed an ultra-absorbent biopolymer hydrogel using sodium alginate, gelatin, and polyacrylamide for efficient water management and nitrogen regulation in wheat under drought stress. The hydrogel was synthesized by gamma irradiation and modified through hydrolysis to achieve remarkably high water absorption (1293% swelling) and extended water retention (36 days). Characterization confirmed chemical transformations enabling enhanced moisture retention. Application to wheat crops revealed significantly improved growth metrics, grain yield, protein, and carbohydrates under extreme 100% drought conditions compared to controls. Chlorophyll levels increased up to 31% with hydrogel treatment, while antioxidant enzyme activity declined, reducing oxidative damage. The biopolymer hydrogel demonstrated outstanding potential for water conservation and controlled nutrient release to enhance wheat yield and nutrition under moisture limitations. The technology could be extended to various water-intensive crops and optimized for diverse agro-climates. Further analysis of nutrient release kinetics and soil health impacts is warranted.
All data generated or analyzed during this study available from the corresponding author on request.
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Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). This work is funded by the Academy of Scientific Research and Technology (ASRT), Egypt. entitled “Water Rationalization Initiative”, project number 9952.
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Mahmoud A. El-diehy, Ibrahim I. Farghal, Mohamed A. Amin & Abdelatti I. Nowwar
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Mahmoud A. El-diehy, Ibrahim I. Farghal1 and Mohamed A. Amin prepared figures. Mohamed mohamady Ghobashy and Abdelatti I. Nowwar H. M. Gayed wrote the main manuscript text. All authors reviewed the manuscript.
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El-diehy, M.A., Farghal, I.I., Amin, M.A. et al. Radiation synthesis of sodium alginate/gelatin based ultra-absorbent hydrogel for efficient water and nitrogen management in wheat under drought stress. Sci Rep 14 , 19463 (2024). https://doi.org/10.1038/s41598-024-69333-3
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The World Health Organization (WHO) Global Tuberculosis Programme is launching a call for case studies and best practices on addressing tuberculosis (TB) in prisons. This includes provision of services for communicable diseases, with a focus on TB prevention and care provided within prisons, as well as on addressing TB in the context of mobility of people between police holding cells, prisons and the community.
An estimated 10.6 million people developed TB in 2022. Despite being preventable and curable, TB remains one of the world’s top infectious killers, accounting for over one million deaths annually. Prisons and other places of detention can be high risk environments for TB transmission due to overcrowding, inadequate infection prevention and control measures, and other determinants such as undernutrition, substance use disorders and inadequate access to health services. The burden of TB disease in prison populations is about 10 times higher than in the general population. In 2019, an estimated 125,105 people in prisons fell ill with TB worldwide, representing about 1% of the global incidence, and only about half of these detected, leaving a large gap of incarcerated people with undiagnosed or unreported TB.
The provision of high-quality health care in prisons, including TB prevention and care, is essential. People in prisons should access health care in the same conditions and of a similar quality as any other person living in the community, throughout their life course. Protecting the human right to health and ensuring universal health coverage are particularly critical in prison settings, where the provision of health services is not always prioritised.
WHO recommendations on TB (prevention, screening, diagnosis, treatment, testing for HIV and comorbidities, treatment support, and infection prevention and control) are applicable to all settings, including prisons. In addition, WHO has specific recommendations on systematic screening for TB disease in prisons and penitentiary institutions, for both prisoners and prison staff as well as systematic testing and treatment for TB infection, which may be considered for people in prisons as well as other at-risk groups including health workers, immigrants from countries with a high TB burden, homeless people and people who use drugs.
WHO has previously issued guidance on the management of TB in prisons, however there have been significant advances in TB prevention and care since this guidance was issued. The WHO Global Tuberculosis Programme is in the process of updating its guidance on TB in prisons. The purpose of the guidance will be to provide operational guidance on the prevention, management and care of TB in prisons, including when people are transferred between police holding cells, prisons and communities. The new WHO guidance on TB in prisons will also feature several case studies illustrating experiences and best practices in addressing TB in prisons.
These case studies may include examples of interventions that are provided within prisons and police holding cells, such as:
· TB screening and active TB case finding for people in prisons as well as prison staff;
· Short course TB preventive treatment and effective management and treatment of TB;
· Screening, diagnosis and care for co-morbidities or other health related risk factors, such as mental health conditions, substance use disorders, HIV, among other conditions;
· Contact investigation, outbreak management and TB infection prevention and control;
· Policies and practices that aim to address the social determinants of TB among people in prisons (such as employment, housing and linkages with social protection services);
· Collaboration between ministries of health and the ministries responsible for prisons and penitentiary institutions;
· Policies and practices on promotion of human rights and the human right to health;
· Building the capacity of prison health staff and inmates to effectively prevent and manage TB;
· Recording and reporting systems on TB in prison settings, and their linkages to the national TB surveillance system, and
· Policies or practices that ensure continuity of care when people with TB are transferred between prisons or from prisons to the community.
Through this call, WHO invites country officials, UN agencies, technical partners, and other governmental and non-governmental stakeholders within and beyond the health sector involved in the provision of health services within prison settings to submit examples of relevant case studies and best practices to this email address: [email protected] .
These case studies and best practices should be no longer than 500 words, should feature current examples implemented in the last ten years and should be structured as follows:
· Background
· Policy or practice implemented
· Results achieved as a result of this policy or practice
· Challenges identified during implementation (and solutions)
· Way forward/ next steps (as a conclusion)
The deadline for submission of case studies and best practices is Friday 30 September, 2024 .
All contributors to the selected case studies will be appropriately acknowledged in the WHO guidance on TB in prisons. We thank you in advance for your collaboration, and please do not hesitate to contact us in case of any questions.
COMMENTS
negative stress indulges a person into depression, trauma, causes upsetness, and leads to. negativities. This is the case study of a domestic help, a ten year old girl named Jyoti who was ...
Case Study 1: The Physical Toll of Chronic Stress and Anxiety John, a middle-aged executive, experienced chronic stress due to work and family pressure, leading to a range of health issues. Having never learned good stress management skills, John overate, drank too much coffee in the daytime and alcohol in the evening, and made no time for ...
1. Introduction. Stress constitutes a complex process that is activated by a physical or mental threat to the individuals' homeostasis, comprising a set of diverse psychological, physiological and behavioral responses [].Although it is usually considered a negative response, stress actually constitutes a key process for ensuring our survival.
This straightforward case study requires little in the way of facilitation but mingle with the groups and be on hand to answer any questions or prompt discussion. It could be used as part of a stress management workshop or stress awareness campaign. It would work best with groups of up to six participants. Allow just over an hour for completion.
Accept - Choose - Take action. Acceptance and Commitment Therapy (ACT) has proven valuable for clients learning to manage anxiety and stress; it encourages (Forsyth & Eifert, 2016): Letting go of the struggles that keep them stuck. Cultivating peace of mind. Accepting what is, and doing what works.
Counselling Case Study: Managing Anxiety. Leah is a 24 year old woman who was recently discharged from the Army on medical grounds. During her four years in the Army, Leah experienced high levels of stress and anxiety which she coped with by drinking heavily. When she presented for counselling, Leah had been sober for 55 days and was seeking ...
This releases more cortisol, the stress hormone, making you feel more anxious and stressed. Eating a balanced diet has a variety of health benefits, including mitigating the effects of stress. 3. Practice mindfulness. Mindfulness practices such as meditation are proven to be effective stress management techniques.
Case Study on Stress Management Policies of TCS and Infosys. International Journal of Case Studies in Business, IT, and Education (IJCSBE), 6 (1), 401-4 13 .
Why Stress Management Is Important for Students . A study by the American Psychological Association (APA) found that teens report stress levels similar to adults. This means teens are experiencing significant levels of chronic stress and feel their stress levels generally exceed their ability to cope effectively.
Work stress is a generic term that refers to work-related stimuli (aka job stressors) that may lead to physical, behavioral, or psychological consequences (i.e., strains) that affect both the health and well-being of the employee and the organization. Not all stressors lead to strains, but all strains are a result of stressors, actual or perceived.
Conclusions suggest that individual and organizational solutions are ideally combined to obtain greater improvements in well-being, ... for "occupational health management," "stress" or "burnout" (indication), "health care professionals" and "digital component." ... An analysis of 19 international case studies of stress ...
Throughout the session, Mark references water creating a sense of calm and flow: filling the bucket, anxiety response as a whirlpool, the surface of water calm and reflective, feelings of calm streaming over. During this discussion, Alice is attentive and calm with a relaxed posture. She makes good eye contact and responds with ease.
Stress can damage different parts of human body from muscles and tissues to organs and blood vessels. It can speed up pulse rate and respiration. It can raise blood pressure and body temperature. It can also interfere with the body metabolism, digestion, appetite, sleep, sexuality and even fertility.
In this case, short-term goal setting and small wins strategy can solve this problem. The purpose of this strategy is to eliminate the stress by establishing a focus and direction for activity. The anxiety associated with uncertainty and potentially negative events is dissipated when mental and physical energy is concentrated on purposeful ...
2022, Vol. 6, No. 6, 9621 - 9628. Stress Management and Stress: A Review on Case Studies with. Special Reference on India. 1 Kajal Srivastava, 2 Dr. Mitu Mandal. 1 Junior Research Fellow ...
Stress Management at Work Place - A Case Study on Wipro - Free download as Word Doc (.doc / .docx), PDF File (.pdf), Text File (.txt) or read online for free. Stress is a major concern for modern employees and can harm their health and job performance. Organizations need to recognize workplace stress. The document discusses various causes of stress, such as demanding work, lack of control, and ...
Stress: A Case Study. Read the story of a women who thought she was having a heart attack, but was instead diagnosed with panic disorder, panic attacks. A young woman sought psychological services after her cardiologist referred her for stress management and treatment of "heart attack" symptoms. This 36 year old woman had the world by the tail.
Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce. ... The study included students (N = 242) and ...
Chris came to counselling because he was experiencing increasing feelings of being stressed, overwhelmed and weighed down by his commitments in life. He has been particularly concerned about his negative thoughts and attitude at work and at home and would like to change this. Chris has been seeing a Professional Counsellor for three sessions ...
Stress management policies and procedures are then explained and specified for each significant type of a stressor. This is done using a practical case study of an organization, where it shows how this firm deals with each kind of different stressors. Keywords: stress, productivity, time management, conflict management, workplace diversity. 1.
Case Study: Don't Stress (Stress Management Research) ... The Solution. Maven constructed an Electronic Survey targeting professionals who had conducted in-depth stress management research. Within hours, the consumer science team who commissioned the Survey had received detailed perspectives from healthcare providers, holistic healers ...
This study had been carried out to examine the stress management among 288 respondents of student's UiTM Kedah. Among the selected program which are DPA, DIA, DIB, DIM, DBS, DCS, DQS and DIDE. The research has been conduct in UiTM Kedah. A proportionate stratified random sampling of 288 respondents mainly the UiTM's students has been ...
Dr. Sameera, Dr. Shakir Shaik, Sk. C. Firoz, A study on stress management among the bpo employees in chennai city, The International Journal Of Business & Management (ISSN 2321-8916). Jan 2014 ...
Stress Management Case Solution Stress Management. A good stress management program will not only improve the mental health, but it will also improve the relationships with others. It will also help them to feel happier and more productive. It will also help to cope with the stresses of the life. Stress Management Techniques
The study developed an ultra-absorbent biopolymer hydrogel using sodium alginate, gelatin, and polyacrylamide for efficient water management and nitrogen regulation in wheat under drought stress.
The World Health Organization (WHO) Global Tuberculosis Programme is launching a call for case studies and best practices on addressing tuberculosis (TB) in prisons. This includes provision of services for communicable diseases, with a focus on TB prevention and care provided within prisons, as well as on addressing TB in the context of mobility of people between police holding cells, prisons ...