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      Frozen moments: flashback memories of critical incidents in emergency personnel

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          Abstract

          Background

          Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion.

          Methods

          Emergency nurses ( N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires.

          Results

          A majority ( =  59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion.

          Conclusions

          The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.

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          Most cited references25

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          Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

          Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (c) 2006 APA, All Rights Reserved.
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            Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians.

            Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce. To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Delta], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Delta = -6.8; 95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; Delta = -2.5; 95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; Delta = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Delta = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Delta = -4.1; 95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; Delta = -17.1; 95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; Delta = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Delta = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = -0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = -0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001). Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.
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              The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis.

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                Author and article information

                Journal
                Brain Behav
                Brain Behav
                brb3
                Brain and Behavior
                John Wiley & Sons, Ltd (Chichester, UK )
                2162-3279
                2162-3279
                July 2015
                13 May 2015
                : 5
                : 7
                Affiliations
                [1 ]Department of Experimental Psychotherapy, University of Zurich Zurich, Switzerland
                [2 ]Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Zurich Zurich, Switzerland
                [3 ]Department of Emergency Medicine, University Hospital Basel Basel, Switzerland
                [4 ]Department of Psychology, Pace University Pleasantville, New York
                [5 ]New York State Psychiatric Institute, Columbia University New York, New York
                Author notes
                Correspondence Birgit Kleim, University of Zurich, Department of Experimental Psychotherapy, Binzmühles-trasse 14, Box 26, 8050 Zürich, Switzerland., Tel: +41 44 635 7377; Fax: 41 44 635 73 59; E-mail: b.kleim@ 123456psychologie.uzh.ch

                Funding Information This research was funded by grants PZ00P1_126597, PZ00P1_150812 awarded to Birgit Kleim, Department of Psychology, University of Zurich, by the Swiss National Science Foundation.

                Article
                10.1002/brb3.325
                4511283
                b8fd6e9d-07e2-437d-8e47-49e8adaeed34
                © 2015 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Research

                Neurosciences
                anxiety,burnout,depression,emergency department,emotional memory,flashback,intrusion
                Neurosciences
                anxiety, burnout, depression, emergency department, emotional memory, flashback, intrusion

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