Sixteen skills training intervention studies were directed at improving self-efficacy. These studies included 11 RCTs, two observational studies, and three single-group studies. A total of 3, participants received skills training interventions, with sample sizes ranging from 33 to The frequency of the skills training interventions was rarely reported. The interventions were delivered most often in a group format and the control groups were generally usual care and wait-list control conditions. Eight of the 11 RCTs 14 , 15 , 26 , 27 , 35 , 42 — 46 reported significant improvements in self-efficacy; three of the significant studies used CDSMP 15 , 42 , Four of the five non-RCT studies 15 , 20 , 24 , 32 also demonstrated significant improvements in self-efficacy.
All but Smith et al. The expert panel did not find sufficient evidence for either exercise or social support interventions to improve emotional health. The expert panel found insufficient evidence for 20 other skills training interventions that focused on other emotional health outcomes such as mood and stress. Most of these pairings were of at least fair quality. There was insufficient evidence of effectiveness for most of these intervention—outcome pairings and the panel rated most of the pairings as at least fair quality.
The expert panel did not reach consensus for several physical activity and exercise intervention—outcome pairings. First, the panel was split between ratings of sufficient and insufficient for stretching, flexibility, balance, or agility interventions to decrease fear of falling. Second, panel members did not agree on whether there was sufficient evidence that stretching, flexibility, balance or agility interventions improved self-efficacy, mastery, or locus of control. Panel members raised concerns about limited numbers of studies for any single outcome and about mixed results observed across the study outcomes.
Finally, the expert panelists were split between evidence ratings of sufficient and insufficient for walking interventions that targeted anxiety or stress. Insufficient evidence was found for all other exercise and physical activity interventions. The expert panel found insufficient evidence that the reviewed social support interventions improved emotional health. Among the interventions rated as having at least fair quality and sufficient evidence, we found that skills training interventions reduced anxiety; enhanced self-efficacy; and improved vitality, role functioning related to emotional limitations, and emotional health as measured in quality of life subscales.
Skills training interventions are theorized to promote positive domains of emotional health through cognitive reframing, strengthening coping resources, and increasing the amount of support or quality of support. We acknowledge that skills training may improve emotional health through improved self-efficacy, though the panel chose to view self-efficacy as its own emotional health domain. These interventions are designed for older adults with chronic conditions e.
These populations were targeted by these interventions because chronic conditions or caregiving responsibilities increase the need for skills training, support, information, and resources. The CDSMP was used as an intervention in seven of the skills training studies that showed sufficient evidence for improving quality of life or self-efficacy or decreasing anxiety.
CDSMP has been shown to enhance stress management techniques, improve communication with physicians, increase confidence in ability to manage the condition, and improve role function 32 , 42 , — This review is limited by its end date of June We found two review papers , that reported similar findings as we report above, namely, sufficient evidence for skills training interventions impact on self-efficacy and quality of life and insufficient evidence for other emotional health outcomes.
We also searched for intervention studies for those areas where sufficient evidence was found. Our search yielded 10 recently published articles — , none of which reported different findings than reported above. Insufficient evidence did not mean that interventions were clearly ineffective. Very few intervention—outcome pairings were rated as at least fair quality. The expert panel identified the following common quality limitations: lack of descriptive information about the interventions, limited information about the statistical methods and analyses, and small sample sizes or underpowered studies.
Additionally, features of some of the study designs made it difficult to detect changes in emotional health. Our review included a wide range of emotional health constructs. Some outcomes were entirely emotional e. In addition, some studies included emotional health outcomes as their primary outcomes, whereas others included emotional health as intermediate outcomes or mediators of other health outcomes. In particular, positive constructs were underrepresented in the available literature.
We were not surprised that there was limited evidence on interventions to promote emotional health, and particularly any studies lacking in positive emotional health constructs given the tendency up until recently to focus on disease prevention over health promotion. We anticipate that more research will include emotional health outcomes as models such as the socio-ecological model 67 , and guidelines such as the Public Health Action Plan to Integrate Mental Health Promotion and Mental Illness Prevention with Chronic Disease Prevention, — 74 emphasize the importance of emotional health in the larger public health goals.
Future research needs to address these quality concerns by attending to limitations with both internal and external validity. RE-AIM stands for reach, effectiveness, adoption, implementation fidelity, and maintenance — five areas, which, if addressed, ensure that essential program goals are retained during the implementation process, resulting in greater external validity. More research is also needed to investigate the longer term, maintenance effects of interventions to promote positive emotional health, and address illness-related domains in older adults as most of the studies here were of short-term effectiveness.
Despite the gaps in the current research, our systematic review provides important information about interventions that can promote emotional health outcomes in community-dwelling older adults. Specifically, we found that skills training interventions resulted in improvements in both illness-related anxiety and positive quality of life and self-efficacy domains of emotional health. Given that more than one in four Americans lives with two or more concurrent chronic conditions, the challenges of managing multiple chronic conditions among the growing numbers of older persons are significant One of the overarching goals of the U.
Given the expanding proportion of older adults in the US and globally, we hope this review will help in addressing some of challenges identified in this important area of study. 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.
Review Editors were independent of named authors on any given article published in this volume. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Biotechnology Information , U. Journal List Front Public Health v. Front Public Health. Published online Apr Mark B. Snowden , 1 Lesley E. Carlson , 1 Kara N. Mochan , 3, 4 Ana F. Abraido-Lanza , 5 Lucinda L. Bryant , 6 Michael Duffy , 7 Bob G. Knight , 8 Dilip V. Jeste , 9 Katherine H. Leith , 10 Eric J.
Lenze , 11 Rebecca G. Logsdon , 12 William A. Satariano , 13 Damita J.
Zweiback , 14, 15 and Lynda A. Anderson 16, Lesley E. Whitney L. Kara N. Ana F. Lucinda L.
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Bob G. Dilip V. Katherine H. Eric J. Rebecca G. William A. Damita J. Lynda A. Author information Article notes Copyright and License information Disclaimer. Received Jun 19; Accepted Oct The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. This article has been cited by other articles in PMC.
Methods A national panel of health services and mental health researchers guided the review. Results In all, articles met inclusion criteria.
Conclusion Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. Keywords: mental health, aged, health promotion, review. Introduction Emotional health is increasingly viewed as a multidimensional construct that includes both positive and illness-related dimensions.
Open in a separate window. Figure 1. Table 1 Search terms used in electronic searches. Expert panel and review methods This review was guided by an eight-member expert panel of health services and mental health researchers from around the United States representing psychology, psychiatry, geriatrics, public health, and social work. Table 2 Indicators of quality and effectiveness for rating the evidence. Figure 2. NC, no consensus. Intervention—outcome pairings with sufficient evidence Skills training Sufficient evidence was found for effectiveness of skills training interventions to reduce anxiety and to promote quality of life and self-efficacy from a total of 38 studies.
Exercise and social support The expert panel did not find sufficient evidence for either exercise or social support interventions to improve emotional health. Other intervention—outcome pairings Skills training The expert panel found insufficient evidence for 20 other skills training interventions that focused on other emotional health outcomes such as mood and stress.
Exercise and physical activity The expert panel did not reach consensus for several physical activity and exercise intervention—outcome pairings. Social support The expert panel found insufficient evidence that the reviewed social support interventions improved emotional health. Conflict of Interest Statement 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. References 1. The NIH cognitive and emotional health project: report of the critical evaluation study committee.
Alzheimers Dement 2 — National Association of Chronic Disease Directors; Atlanta, GA: U. Measurement of leisure time satisfaction in family caregivers. Aging Ment Health 8 —9. Int J Ment Health Promot 6 2 — J Consult Clin Psychol 64 —9. Developing an evidence-based guide to community preventive services-methods. Am J Prev Med 18 1S — The effectiveness of disease and case management for people with diabetes: a systematic review.
Am J Prev Med 22 4S — Community-based treatment of late life depression—an expert panel informed literature review. Am J Prev Med 33 3 — Conceptual framework and item selection. Med Care 30 — Effectiveness of a stress management program for family caregivers of the elderly at home.
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J Med Dent Sci 46 4 — Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist 43 5 — Steffen AM. Anger management for dementia caregivers: a preliminary study using video and telephone interventions. Behav Ther 31 2 — Assessment of the efficacy of a stress management program for informal caregivers of dependent older adults. Gerontologist 47 2 — Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial.
Heart 86 3 — A randomized controlled study of the arthritis self-management programme in the UK. Health Educ Res 15 6 — The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Appl Nurs Res 18 3 — A randomised comparative trial of yoga and relaxation to reduce stress and anxiety.
Complement Ther Med 15 2 — Cognitive behavioral therapy of minor depressive symptoms in elderly Chinese Americans: a pilot study. Community Ment Health J 35 6 — Management of urinary incontinence in older women using videoconferencing versus conventional management: a randomized controlled trial. J Telemed Telecare 12 7 —7. Ethn Dis 17 4 —8. Self-management training for people with chronic disease: an exploratory study.
Br J Health Psychol 8 Pt 4 — Therapeutic psychosocial intervention for elderly subjects with very mild Alzheimer disease in a community: the tajiri project.
Alzheimer Dis Assoc Disord 16 4 —9. Self-management of age-related macular degeneration and quality of life: a randomized controlled trial. Arch Ophthalmol 11 — Cunningham AJ. Integrating spirituality into a group psychological therapy program for cancer patients. Integr Cancer Ther 4 2 — Evcik D, Sonel B. Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee. Rheumatol Int 22 3 —6. Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. J Pain Symptom Manage 33 3 — The use of supportive-educative and mutual goal-setting strategies to improve self-management for patients with heart failure.
Home Healthc Nurse 25 8 — The effects of nursing interventions to enhance mental health and quality of life among individuals with heart failure. Appl Nurs Res 17 4 — Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 37 1 :5— Davis LL. Telephone-based interventions with family caregivers: a feasibility study. J Fam Nurs 4 3 — Family support for stroke: one year follow up of a randomised controlled trial. J Neurol Neurosurg Psychiatry 76 7 —8. Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning.
Heart Lung 32 3 — Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke 33 8 —5. Implementation and effectiveness of a community-based health promotion program for older adults. Health promotion for frail older home care clients. J Adv Nurs 54 3 — Stress self-management: an intervention for women with physical disabilities.
Womens Health Issues 16 6 — Eur J Heart Fail 9 9 — Effects of a peer-led senior health education program. Patient Educ Couns 34 1 — A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns 64 1—3 —8. Two of our Brothers, Br. Keith Nelson and Br. John Braught, share the theological lessons they have taken away from their time up at Emery House. Grafton House Interns, as they meditate on the gifts and graces they have reaped from their internship experience.
God has blessed us richly, in times of joy and times of grief, and the beautiful land at Emery House has provided a backdrop of consolation and grace in both. Most notably we grieved and continue to grieve the loss of our Brother Tom Shaw, who died last October. It was a time when we, like any family, needed to gather together — and we did so at Emery House.
We have been immeasurably enriched as a community by the presence of Sarah, David, James, Dave, and Rachael over the past year, and we are excited now to welcome eight new interns this fall: four at the Monastery, and four at Emery House. We hope that, if you know of any young people who might benefit from a period of intentional formation in community, you will share word of this opportunity with them.
In this kind of advocacy and in so many other ways, we know that we depend upon you, our Friends. We are also most grateful to all you who volunteer your wisdom and counsel: our financial advisors, investment advisors, buildings and grounds advisors, stewardship advisors. Above all, we know that you pray for us. We feel it every day. It is a constant source of strength, encouragement, and hope.
That mission to which we believe we have been called is only possible because of all our Friends and supporters who share our life. Notes from A Letter from theRetreatants Superior Our ministry of hopsitality is at the heart of our life as a community. The stories of their sufferings and achievements and their experience of God stir and challenge us.
If we are attentive, each guest will be a word and gift of God to us. We invite you to consider a retreat with us in the coming year. I had never been on a retreat before and was a little anxious that I might do something wrong — sneeze resoundingly during the service or hiccup during the silent meal! The hermitages nestled in the countryside were perfect, attractive, and very comfortable accommodations.
Meals prepared at the Monastery were gourmet presentations, and I came to appreciate the silence as we ate. When I returned home, it was strange to leap back into that life. I missed the days of prayer and silence, and now am trying to instill quiet moments for prayer and reflection into my home life.
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I hope I return some day. Despite very limited talking, we fellow retreatants developed a sense of community and connection. With an initial goal of only rest and quieting the mind, new revelatory feelings and insights percolated up from deep inside. My room was comfortable, the food healthy and tasty, and the community rooms and worship spaces inspiring. Now, I cannot imagine going through a year without taking a retreat at the Monastery. This was my first such retreat experience, and I was grateful for the opportunity to be so warmly welcomed in the process of restoration for myself.
Gregory, PhD. Notes from A Letter from theRetreatants Superior I want to thank the Brothers for a meaningful weekend of deep prayer and meditation facilitated by your godly, unintrusive hospitality. The thought and care and prayer that went into making our time at Emery Farm deeply nourishing to the soul was gently conveyed in every aspect of our time with you. Ample simple silence at meals and in your brotherly example of life in community was heartening and soothing to a weary soul.
Being included in all the offices of prayer promoted a profound sense of connection to God and Christ. The wings of my soul were rejuvenated by the holiness of place, your practices in maintaining the farm, your care for us, each other, and the world. Delicious food at meal times was food to spirit and body. Thank you for inviting us to share the Peace of God at Emery Farm.
I hope to return — Barbara Filleul some day soon. And for a bit longer, next time! For more information on these programs, visit SSJE. What my friend said is funny, because it goes without saying. There is a lot more to the early mornings at Emery House than the gradual light of the sunrise and the frenetic clamor of birdsong.
Daily, when I look at the grass, observe the breeze blowing the leaves of the birch trees, see the wildlife scamper and the birds soar, I reconfirm my own communion with nature. As a result, I have come to realize, to believe, that no human is or ever will be the Creator. God has graciously crowned us with glory and majesty; the capability and the glory belong to God. And therein lies the problem with dawn simulators and other artificial re-creations of nature which continue to pop up all around us in shopping malls, natural history museums, video games, theme parks, science fiction, and other representations.
We have taken nature out of context. We no longer view it as a Masterly flow; instead, we think of nature as an easy selection from sundry conditions that we can turn on or off, just as one presses the control button on the dawn simulator. In taking nature out of context, we do the same to ourselves. Our sense of being one with the process, progression, and pattern of our natural world is lost, and the illusion of personal control is given.
The human urge to control nature is no surprise. God gave human beings stewardship of the environment. But rather than try and adapt it for our own purposes, to satisfy personal comforts and individual needs, we have a responsibility to work assiduously to live in harmony and joy with nature. The natural world is more than the sum of its parts: Each part is splendid and necessary in and of itself, but when combined within the context of our earthly life, creation gives meaning, dimension, and flavor to daily living.
It directly points us toward the reality of a divine and excellent Creator. Once we discover or reconfirm the existence of our Creator, it is instinctive that we want to pray. Our chapels, churches, and cathedrals, when done right, are man-made 7. Sky, earth, seasons, and a celestial energy pervade worship-done-well. We see the statues, crosses, and pictures; the light and shadows of the naves, transepts, and buttresses; the sounds of the clergy, choir, and congregation working in accord to praise and thank God.
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At Emery House, the Chapel and nature are one. Large windows let an abundance of light inward, yet perpetually draw the eye outward toward the meadow and the river beyond. This worship experience de-centers me; it takes me out of self-absorption and pride and guides me toward reflection and prayer. I am glad to remind myself that this is true. Our world is a complex place. More and more people are living in situations where their contact with 8.
Just take a walk down a major avenue in a city on any continent. The honking of car horns, whirring of fire or police alarms, clanging of industrial machinery — they overwhelm the ear and sometimes the mind, body, and spirit, as well. That is why many city dwellers leave town to go hiking or kayaking on the weekend. It is why they grow herbs on their window sills or install a table-top fountain in their entry areas. It is why they purchase the dawn simulator alarm clock with recorded birdsong.
Humans adapt and find ways to bring nature in some makeshift form into their lives. But that is not the same as living with nature. I like living up here; I like praying here; I like rediscovering God here. I have no need for the dawn simulator alarm clock with recorded birdsong. Emery House is as close to nature as you can get. Emery House brings me closer to God, too. Here are some reflections on my experience of prayer and life here as this season of my formation draws to a close.
Physical space is another such vocation-shaping frame. For example, the central location of the cloister garden and fountain in Cistercian monasteries is meant to recall Eden, a Paradise in miniature at the heart of the monastery. While we are not Cistercians, our Cloister Garden and fountain at the Monastery in Cambridge also occupy a prominent place, nestled between our Enclosure and the footand-car traffic of Memorial Drive, and spanning the Cloister walk between the Chapel and the Refectory.
The sound of the fountain, audible from our cells, refreshes the ear. The colors in blossom beckon the eye outdoors. In place of a central fountain, the Artichoke and Merrimack bound us on two sides. The holy water stoop outside the Chapel is little sister to the living river below the bluff; the iris in the vase by the Tabernacle remembers its roots in the flowerbed out front; the white fair linen on the. Even the quacks of our domesticated ducks seem to pay homage to their wild brethren beyond the barnyard.
We human creatures and our dwellings here are striving to honor the dance between domestic and wild, with the latter partner leading. Simple Gifts. I experience this in a poignant, personal way in the simple goodness of our eggs. I am a student iconographer and use egg tempera paint — raw mineral pigments mixed in a solution of egg yolk and white wine.
Gathering and using our chicken eggs whilst getting to know our chickens has blessed me with new gratitude for this process. And this is exactly what an iconographer is meant to feel. I can say I am well-acquainted with silence — it has been a central language of prayer for me for the past ten years. Mike and Carla divorced in Although she began intending to write a book, she published it in installments starting in as she wrote it, as if it were a newsletter. The first complete book was finished in March By the end of she had sold 13, copies.
Around that time the book was listed in the Guinness Book of Records as the "largest mimeographed volume in general circulation" pages and was listed as having sold the most copies of a self-published guide: 45, mimeographed copies as of The author believed that it might set a record for the most typographical errors in a book of its size, but reported that she did not have time to count them. Emery's book did not find a commercial publisher until the 7th edition when it was published by Bantam in The most recent edition of the Encyclopedia, the "updated 10th edition," was published by Sasquatch Books in The Encyclopedia of Country Living presents an exhaustive overview of virtually every topic relevant to homesteading and self-sufficiency.
During the s Emery researched somnambulism , hypnosis , and mind control. Because of a personal history as a victim of hypnotism abuse, she wrote a second book, Secret, Don't Tell: The Encyclopedia of Hypnotism.