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Bridging Body and Mind: Considerations for Trauma-Informed Yoga

Lauren Justice, Christiane Brems, Karrie Ehlers
2018 International Journal of Yoga Therapy  
Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the
more » ... adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphas i ze beneficial practices (e.g., diaphragmatic breath and re s t o r a t i ve postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender-and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice. Justice, Brems, & Ehlers. Int J Yo g a Therapy 2018(28).
doi:10.17761/2018-00017r2 pmid:29419338 fatcat:yvzay3bzb5fejevg7vbropuegq

When Providers and Patients Come from Different Backgrounds: Perceived Value of Additional Training on Ethical Care Practices

Laura Weiss Roberts, Mark E. Johnson, Christiane Brems, Teddy D. Warner
2008 Transcultural Psychiatry  
doi:10.1177/1363461508100782 pmid:19091725 pmcid:PMC3851332 fatcat:eul62d6ui5bi3ooljbyrtvrjga

Ethical Disparities: Challenges Encountered by Multidisciplinary Providers in Fulfilling Ethical Standards in the Care of Rural and Minority People

Laura Weiss Roberts, Mark E. Johnson, Christiane Brems, Teddy D. Warner
2007 Journal of Rural Health  
Context-Health care disparities and well documented for people living in rural areas and for people who are members of ethnic minorities. Purpose-Our goal was to determine whether providers report greater difficulty in providing care for rural than urban residents and for ethnic minorities than patients/clients in general in 4 practice areas of ethical relevance attaining treatment adherence, assuring confidentiality, establishing therapeutic alliance, and engaging in informed consent
more » ... d consent processes. Methods-We received survey responses from 1,558 multidisciplinary medical and behavioral providers across rural and non-rural areas of New Mexico and Alaska in 2004 to assess a wide range of issues in providing health care. Findings-Providers reported some difficulties in fulfilling various ethical practices for all types of patients, but not more difficulty when caring for minority compared to nonminority patients/ clients. However, they do report more frequent additional problems related to the practice issues of treatment adherence, therapeutic alliance, informed consent, and confidentiality with minority patients than others. Difficulties and more frequent additional problems are greater for providers in rural than in non-rural areas. Results generalize across both Alaska and New Mexico with few differences. Conclusions-We obtained evidence for disparity in care for patients/clients who were minority group members, and clear evidence of disparity for people residing in rural compared to non-rural areas of 2 states with large rural areas. Illness burden and health-related resources are unevenly distributed across the United States. 1-3 A pattern of greater burden and lessened resources exists among certain populations, such as rural and frontier residents and ethnic minority people, creating significant inequities or disparities in health for these groups. 4,5 Over time, with our country comprised of nearly 60 million rural persons 6 and more than 50 million ethnic minority persons, 6 health disparities among these populations have been recognized increasingly as serious concerns for our society.
doi:10.1111/j.1748-0361.2007.00130.x pmid:18237331 pmcid:PMC2386414 fatcat:i64pc7x55re7nerr43d6tm4kha

Psychiatric symptomatology among individuals in alcohol detoxification treatment

Mark E. Johnson, Christiane Brems, Michael E. Mills, Dennis G. Fisher
2007 Addictive Behaviours  
The coexistence of psychiatric symptomatology among individuals receiving longer-term treatment for alcohol use disorders has been well-established; however, less is known about comorbidity among individuals receiving alcohol detoxification. Using the Brief Symptom Inventory [BSI; Derogatis, L. R. (1992). BSI: Administration, scoring, and procedures manual-II. Towson, MD: Clinical Psychometric Research], we compared psychiatric symptomatology among 815 individuals receiving short-term
more » ... hort-term detoxification services with normative data from non-patients, psychiatric patients, and out-of-treatment individuals using street drugs. Findings revealed that individuals in the current sample reported a wide range of psychiatric symptoms with over 80% meeting BSI criteria for diagnosable mental illness. These BSI scores were significantly more severe than those reported by out-of-treatment individuals using street drugs and most closely resembled BSI scores reported for adult psychiatric inpatients. Findings suggest that routine screening for severe mental health symptoms appears warranted in detoxification units. Such screening would greatly increase the chance that coexistence of substance use and other psychiatric disorders would be properly addressed in ongoing treatment.
doi:10.1016/j.addbeh.2006.12.007 pmid:17239548 pmcid:PMC2232900 fatcat:w2q6zgqhcjaqpfj5cbvd4vj3yu

Ethical Challenges in Conducting Psychiatric or Mental Health Research in Correctional Settings

Gloria D. Eldridge, Mark E. Johnson, Christiane Brems, Staci L. Corey
2011 AJOB Primary Research  
We explored ethical challenges in conducting psychiatric or mental health research with incarcerated people. Methods: Semistructured interviews were conducted with 87 people who were researchers; institutional review board (IRB) chairs, members, and prisoner representatives; research ethicists; and prison administrators with experience in and knowledge about the conduct of research in correctional settings. NVivo 9.0 was used to conduct grounded theory analysis of responses to the question:
more » ... o the question: "What would you say are the top three ethical challenges to conducting psychiatric or mental health research with incarcerated people?" Results: Key informants identified autonomy and consent, balancing the potential for direct benefit with the risk for harm, and access to and standards of psychiatric care in correctional facilities as the three most important ethical challenges. The characteristics of incarcerated individuals, the nature of correctional systems, and federal regulations for oversight of prisoner research provided the contextual framework for these challenges. Conclusions: Findings from this study provide insights into ethical challenges affecting the conduct of psychiatric and mental health research with incarcerated individuals. Given the potential benefit to incarcerated people from access to participation in research, these ethical challenges should be addressed.
doi:10.1080/21507716.2011.631964 fatcat:yvyhoji2djgutf2s5ld2s56rxi

Rates and sequelae of the coexistence of substance use and other psychiatric disorders

Christiane Brems, Mark E. Johnson, Rebecca S. Wells, Randall Burns, Nicholas Kletti
2002 International Journal of Circumpolar Health  
Objectives: Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals. Method: A retrospective population based study was performed on the entire population of psychiatric patients
more » ... c patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated. Results: The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990's. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients. Conclusions: 1.) Individual patient level -Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level -Educators must better prepare providers to deal with this challenging clientele. (Int J Circumpolar Health 2002; 61: 224-244)
doi:10.3402/ijch.v61i3.17456 pmid:12369112 fatcat:cd4nkaep45ehjgqzfkrmdwq5re

Moderating Effects of Control on the Relationship Between Stress and Change

Mark E. Johnson, Christiane Brems, Michael E. Mills, David B. Neal, Joan L. Houlihan
2005 Administration and Policy in Mental Health  
Given the well-documented impact of stress on employees, it is important to understand moderating factors, especially in behavioral health treatment settings, where constant change occurs. Staff members at four mental health (n=663) and four substance abuse (n=256) treatment agencies completed questionnaires inquiring about perceptions of direct and indirect agency changes, stress experienced due to changes, and control and input into the changes. Results revealed that as direct and indirect
more » ... ect and indirect change increased, stress increased; as level of control and input into changes increased, stress decreased. Control and input served as a moderating variable between stress and direct change, but not for indirect change.
doi:10.1007/s10488-005-0002-6 pmid:16220241 fatcat:6tcvfch2zrgd5bogabv6m7mhhy

Community-Based Participatory Research for Improved Mental Health

Jane Smikowski, Sarah Dewane, Mark E. Johnson, Christiane Brems, Catherine Bruss, Laura Weiss Roberts
2009 Ethics & behavior  
Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This paper describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course
more » ... perts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations, and narrow the parity gap in effective mental health treatment and services delivery.
doi:10.1080/10508420903274971 pmid:20186257 pmcid:PMC2825708 fatcat:qshsrcvzznaqlahgy2xgogybni

Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities

Mark E. Johnson, Karli K. Kondo, Christiane Brems, Erica F. Ironside, Gloria D. Eldridge
2015 Ethics & behavior  
With over half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, IRB members, and IRB prisoner representatives to assess their perceptions of risks associated with
more » ... s associated with mental health research conducted in correctional settings. Highest-ranked risks were related to privacy, stigma, and confidentiality; lowest-ranked risks were related to prisoners' loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being over age of 60, being a minority, and being pregnant were the lowest-ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike.
doi:10.1080/10508422.2015.1011327 pmid:27092025 pmcid:PMC4833090 fatcat:b2dk7jigwbgndjcgn4z54oeiha

Adaptations to Health Care Barriers as Reported by Rural and Urban Providers

Cody L. Chipp, Mark E. Johnson, Christiane Brems, Teddy D. Warner, Laura W. Roberts
2008 Journal of health care for the poor and underserved  
Barriers to ethical and effective health care in rural communities have been well-documented; however, less is known about strategies rural providers use to overcome such barriers. is study compared adaptations by rural and urban health care providers. Physical and behavioral health care providers were randomly selected from licensure lists for eight groups to complete a survey; 1,546 (52%) responded. Replies indicated that health care providers from small rural and rural communities were more
more » ... munities were more likely to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, seek out additional expertise, and adjust treatment styles than were providers from small urban and urban communities. Behavioral health care providers were more likely than physical health care providers to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, and adjust their treatment styles; physical health care providers were more likely than behavioral health care providers to make attempts or have options to seek out additional expertise. Keywords Adaptations; rural; ethics; health care barriers Recent research has shown that rural residents and health care providers face a number of barriers associated with the provision of ethical and effective health care service, 1 related to rural resource limitations, challenges to confidentiality, overlapping roles for patients and providers, travel and geographic complications, service access restrictions, and limitations in training and education. Some barriers are clearly related to the special circumstances of rural life, some are unique to the nature of rural residents, and some are closely tied to the experiences and backgrounds of rural health care providers. Combined, these challenges represent and lead to health and health care disparities 2,3 that perpetuate lower health-related quality of life for rural residents, 4 especially rural residents in racial/ethnic minority groups. 5 For example, as a result of rural health care barriers, rural areas struggle with inadequate disease prevention, delayed detection of illness, mis-diagnosis and late diagnosis, inadequate referral, and ineffective treatment. 6-9 Not surprisingly, repeated calls have been made for systemic interventions and training interventions that will address NIH Public Access
doi:10.1353/hpu.0.0002 pmid:18469424 pmcid:PMC2561996 fatcat:wzyeiolc25gz5ixzkgkeokh7zi

Knowledge of Federal Regulations for Mental Health Research Involving Prisoners

Mark E. Johnson, Christiane Brems, Aaron L. Bergman, Michael E. Mills, Gloria D. Eldridge
2014 AJOB Empirical Bioethics  
Background-Given their vulnerability to coercion and exploitation, prisoners who participate in research are protected by Office for Human Research Protections (OHRP) regulations designed to ensure their safety and wellbeing. Knowledge of these regulations is essential for researchers who conduct and institutional review boards (IRBs) that oversee mental health research in correctional settings. Methods-We explored depth of knowledge of OHRP regulations by surveying a nationwide sample of: (1)
more » ... ide sample of: (1) mental health researchers who have conducted research in correctional settings; (2) mental health researchers who have conducted research in non-correctional settings; (3) IRB members who have overseen mental health research in correctional settings; (4) IRB members who have overseen mental health research in in non-correctional settings; and (5) IRB prisoner representatives. Participants responded to a 10-item knowledge questionnaire based on OHRP regulations. Results-1,256 participants provided usable data (44.9% response rate). Results revealed limited knowledge of OHRP regulations, with a mean across groups of 44.1% correct answers. IRB Prisoner representatives, IRB members, and researchers with correctional experience OR 97123, Phone: 503-352-7232, AUTHOR CONTRIBUTIONS: All authors: (1) made substantial contributions to the conception or design of the work, or to the acquisition, analysis, or interpretation of data for the work; (2) were actively involved in drafting and revising the work; (3) gave final approval of the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. demonstrated the highest levels of knowledge; however, even these participants were able to correctly answer only approximately 50% of the items. Conclusions-Although awareness that prisoners are a protected population and that different regulatory procedures apply to research with them is likely to be universal among researchers and IRB members, our findings reveal limited mastery of the specific OHRP regulations that are essential knowledge for researchers who conduct and IRB members who oversee mental health research in correctional settings. Given well-documented health and healthcare disparities, prisoners could potentially benefit greatly from mental health research; increasing knowledge of the OHRP regulations among researchers and IRB members is a crucial step toward meeting this important public health goal.
doi:10.1080/23294515.2014.995837 pmid:26495325 pmcid:PMC4610195 fatcat:hchekr425zbqvctlzut755nsra

HIV/AIDS Research in Correctional Settings: Perspectives on Training Needs From Researchers and IRB Members

Karli K. Kondo, Mark E. Johnson, Erica F. Ironside, Christiane Brems, Gloria D. Eldridge
2014 AIDS Education and Prevention  
Being disproportionately represented by individuals living with HIV/AIDS, correctional facilities are an important venue for potentially invaluable HIV/AIDS epidemiological and intervention research. However, unique ethical, regulatory, and environmental challenges exist in these settings that have limited the amount and scope of research. We surveyed 760 HIV/AIDS researchers, and IRB chairs, members, and prisoner representatives to identify areas in which additional training might ameliorate
more » ... might ameliorate these challenges. Most commonly identified training needs related to federal regulations, ethics (confidentiality, protection for participants/researchers, coercion, privacy, informed consent, and general ethics), and issues specific to the environment (culture of the correctional setting; general knowledge of correctional systems; and correctional environments, policies, and procedures). Bolstering availability of training on the challenges of conducting HIV/ AIDS research in correctional settings is a crucial step toward increasing research that will yield significant benefits to incarcerated individuals and society as a whole.
doi:10.1521/aeap.2014.26.6.565 pmid:25490736 pmcid:PMC4469272 fatcat:iqtcocbetza3vd6exjbgootqra

Mindfulness-based Wellness and Resilience intervention among interdisciplinary primary care teams: a mixed-methods feasibility and acceptability trial

Dana Dharmakaya Colgan, Michael Christopher, Sarah Bowen, Christiane Brems, Mathew Hunsinger, Brian Tucker, Eli Dapolonia
2019 Primary Health Care Research and Development  
Aims: The primary objective of this study was to evaluate feasibility and acceptability of Mindfulness-based Wellness and Resilience (MBWR): a brief mindfulness-based intervention designed to enhance resilience and is delivered to interdisciplinary primary care teams. Background: Burnout is a pervasive, international problem affecting the healthcare workforce, characterized by emotional exhaustion, depersonalization, and decreased professional effectiveness. Delivery models of mindfulness-based
more » ... f mindfulness-based resilience interventions that enhance feasibility for onsite delivery, consider cultural considerations specific to primary care, and utilize team processes that are integral to primary care are now needed. Methods: We conducted a mixed-methods feasibility and acceptability trial of MBWR. Primary feasibility and acceptability outcomes were assessed by number of participants recruited, percent of MBWR treatment completer, and attrition rate during the 8-week intervention, and four items on a Likert-type scale. Secondary outcomes of perceived effects were measured by focus groups, an online survey, and self-reported questionnaires, including the Brief Resilience Scale, the Five Facet Mindfulness Questionnaire-Short Form, and the Self-Compassion Scale-Short Form. Participants included 31 healthcare providers on interdisciplinary primary care teams employed a safety-net medical center. In the MBWR group, 68% identified as Latinx, compared to 64% in the control group. Findings: All criteria for feasibility were met and participants endorsed high levels of satisfaction and acceptability. The results of this study suggest that MBWR provides multiple perceived benefits to the individual healthcare provider, cohesion of the healthcare team, and enhanced patient care. MBWR may be a feasible and acceptable method to integrate mindfulness, resilience, and teamwork training into the primary care setting.
doi:10.1017/s1463423619000173 pmid:32799970 fatcat:pku33zcx7zepvn73sg2touibqq

"If Only Someone Had Told Me …": Lessons From Rural Providers

Cody Chipp, Sarah Dewane, Christiane Brems, Mark E. Johnson, Teddy D. Warner, Laura W. Roberts
2011 Journal of Rural Health  
Purpose-Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers' knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance
more » ... which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. Methods-Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, "What are the 3 things you wish someone would have told you about delivering health care in rural areas?" were thematically coded. Findings-Emergent themes coalesced into 3 overarching themes addressing practice-related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. Conclusion-Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.
doi:10.1111/j.1748-0361.2010.00314.x pmid:21204979 pmcid:PMC3057882 fatcat:d2xaa5rl5vgb5iiuoe5kpmekpy

Conducting ethical research with correctional populations: Do researchers and IRB members know the federal regulations?

Mark E Johnson, Christiane Brems, Bridget L Hanson, Staci L Corey, Gloria D Eldridge, Kristen Mitchell
2013 Research Ethics Review  
Conducting or overseeing research in correctional settings requires knowledge of specific federal rules and regulations designed to protect the rights of individuals in incarceration. To investigate the extent to which relevant groups possess this knowledge, using a 10-item questionnaire, we surveyed 885 IRB prisoner representatives, IRB members and chairs with and without experience reviewing HIV/AIDS correctional protocols, and researchers with and without correctional HIV/ AIDS research
more » ... AIDS research experience. Across all groups, respondents answered 4.5 of the items correctly. Individuals who have overseen or conducted correctional research had the highest scores; however, even these groups responded correctly only to slightly more than half of the items. These findings emphasize the need for ongoing training in federal guidelines governing correctional research, particularly for those individuals who are embarking on this type of research.
doi:10.1177/1747016113494652 pmid:26097498 pmcid:PMC4474229 fatcat:w2wac6vnazfzxoztyururz63fu
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