Aims and objectives: (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID‐19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.Background: Nurses were at increased risk for burnout and low fulfilment prior to the COVID‐19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.Methods: Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non‐clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self‐report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.Results: Both at baseline and across the 5 months, nurses working during the COVID‐19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.Conclusions: Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.Relevance to clinical practice: Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, M_age = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.

Despite the high death toll of the COVID-19 pandemic, reported rates of adherence to adaptive preventive health behaviours during the early wave of the pandemic were suboptimal for reducing the risk of disease spread. Additionally, some have adopted practices with the intention of preventing infection that have harmful consequences. Protection Motivation Theory (PMT), consisting of perceived vulnerability, severity, response efficacy, and self-efficacy, has been used to predict intentions to engage in behaviours in past pandemics, and can be extended to the COVID-19 outbreak. Three hundred and thirty-three American adults completed a survey in May 2020 through Amazon’s Mechanical Turk. Ten behaviours recommended by the CDC and WHO and two ‘maladaptive’ behaviours presented in the media were selected for investigation. Binary logistic regressions were conducted to assess the impacts of demographic variables and PMT constructs on behaviour frequency. Perceived severity and vulnerability were not significant predictors of behaviour frequency. Behaviour specific response efficacy and self-efficacy were significant predictors of 11/12 (odds ratios: 2.70–6.22) and 10/12 (odds ratios: 2.59–4.64) behaviours, respectively. Age, gender, education, political ideology, perceived severity, and perceived vulnerability were generally unimportant predictors. Beliefs about the effectiveness of the behaviour and one’s ability to carry out that behaviour consistently seem to be more important in predicting how often someone engages in that behaviour than the perceived dangerousness of COVID-19 and one’s believed susceptibility to infection. These results suggest that interventions trying to modulate the likelihood of engaging in preventive behaviours should focus on the effectiveness of these behaviours in reducing risk of spread and the individual’s ability to engage in these behaviours frequently rather than the dangerousness of the COVID-19 pandemic and the individual’s risk of becoming infected.

The COVID-19 pandemic has caused increased psychological distress and decreased quality of life (QoL), but limited research has evaluated cognitive appraisals of COVID-19. This study aimed to exami...

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed. Key learning aims: (1) How can training of CBT techniques such as exposure occur prior to graduate education? (2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals? (3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?