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Gonzalez-Ibarra F, Cruz-Ruiz M, Llanes JM, Achem SR, Fass R. The Role of Psychological Factors in Noncardiac Chest Pain of Esophageal Origin. J Neurogastroenterol Motil 2024; 30:272-280. [PMID: 38972864 PMCID: PMC11238108 DOI: 10.5056/jnm23166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 07/09/2024] Open
Abstract
Background/Aims Noncardiac chest pain (NCCP) of esophageal origin is a challenging clinical problem of diverse etiology that affects more than 80 million Americans yearly. We assess the prevalence and impact of psychological disorders on NCCP of esophageal origin, describe possible mechanisms associated with this condition, and review psychological therapy options. Methods Online search using PubMed and Medline from January 1, 1966, to April 30, 2023. Results Psychological disorders have been reported in up to 79% of patients with NCCP of esophageal origin. Several psychological disturbances have been identified with this condition, including depression, anxiety, panic disorder, phobias, and obsessive-compulsive and somatoform disorders. It is unclear whether the psychological disorders trigger the chest pain or vice versa. Multiple psychological mechanisms have been linked to chest pain and may contribute to its pathogenesis and severity. These mechanisms include cardiophobia, poor coping strategies, negative social problem solving, stress and perceived control, hypervigilance to cardiopulmonary sensations, altered pain perception, and alexithymia. Psychological therapies for NCCP of esophageal origin include cognitive behavioral therapy, hypnotherapy, physical and relaxation training, breathing retraining, and alternative medicine. Among the therapeutic options, cognitive behavioral therapy has been shown to be an effective treatment for NCCP of esophageal origin. Conclusion This review raises awareness about the high prevalence of psychological disorders in NCCP of esophageal origin and highlights the need for clinical trials and trained therapists to address the management of this taxing clinical problem.
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Affiliation(s)
| | | | - Joel Murillo Llanes
- Department of Research, Sinaloa Health Services, Women’s Hospital, Sinaloa, Mexico
| | - Sami R Achem
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ronnie Fass
- Digestive Health Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Cleveland, OH, USA
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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Eriksson-Liebon M, Westas M, Johansson P, Mourad G. Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial. BMC Psychiatry 2024; 24:216. [PMID: 38504157 PMCID: PMC10953164 DOI: 10.1186/s12888-024-05661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain. AIMS To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress. METHODS A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety. RESULTS A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up. CONCLUSIONS Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high tendency to avoid activities or situations that they believe could trigger cardiac symptoms may benefit more from psychological interventions targeting cardiac anxiety. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov NCT03336112 on 08/11/2017.
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Affiliation(s)
- Magda Eriksson-Liebon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Department of Emergency Medicine in Norrköping, and, Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine in Norrköping, and, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Thesen T, Himle JA, Pripp AH, Sunde T, Walseth LT, Thorup F, Gallefoss F, Jonsbu E. Patients with depression symptoms are more likely to experience improvements of internet-based cognitive behavioral therapy: a secondary analysis of effect modifiers in patients with non-cardiac chest pain in a randomized controlled trial. BMC Psychiatry 2023; 23:751. [PMID: 37838653 PMCID: PMC10576305 DOI: 10.1186/s12888-023-05238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Non-cardiac chest pain is common and associated with increased anxiety and reduced health-related quality of life. Randomized controlled trials on psychological interventions for patients with non-cardiac chest pain have reported mixed results. Patients with non-cardiac chest pain are a heterogeneous group. Identifying sub-groups that could potentially benefit more (or less) from an intervention would be valuable knowledge. We have conducted a randomized controlled trial where internet-based cognitive behavioural therapy (iCBT) had effect on reducing cardiac anxiety and increasing health-related quality of life at 12-month follow-up. The aim of the present study was to explore potential effect modifiers of iCBT in patients with non-cardiac chest pain on cardiac anxiety and/or health related quality of life at 12-month follow-up. METHODS We analysed data from our randomized, controlled trial where 161 patients with non-cardiac chest pain were included and randomized to either iCBT or a treatment as usual (control). Cardiac anxiety measured by the Cardiac Anxiety Questionnaire and health-related quality of life measured by the EuroQol Visual Analog Scale at 12 month follow-up were the primary outcomes. Four potential baseline characteristics where identified as potential effect modifiers by a theory-based approach: (1) depression measured by the Patient Health Questionnaire; (2) anxiety measured by the Body Sensations Questionnaire; (3) prior healthcare contacts measured by a self-developed question; and (4) chest pain frequency measured by a self-developed question. Each potential effect modifier was analysed in a linear regression model where cardiac anxiety and EQ-VAS scores at 12-month follow-up, separately, were used as dependent variables. The potential differential treatment effect for each effect modifier was assessed by the interaction term: effect modifier x treatment group. RESULTS Depression symptoms at baseline predicted a differential treatment effect at 12-month follow-up on health-related quality of life in favor of the iCBT group (regression coefficient of the interaction term: -1.85 (CI -3.28 to -0.41), p = 0.01), but not on cardiac anxiety at 12-month follow-up. Fear of bodily symptoms, chest pain frequency and prior health care contacts at baseline did not predict a treatment effect on either health-related quality of life or cardiac anxiety. CONCLUSIONS Depression symptoms at baseline predicted a positive treatment effect of iCBT on health-related quality of life in patients suffering from non-cardiac chest pain. This indicates that it is important to identify patients with non-cardiac chest pain and co-occurring depression symptoms given that they are particularly likely to benefit from iCBT. TRIAL REGISTRATION ClinicalTrials.gov NCT03096925 .
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Affiliation(s)
- Terje Thesen
- DPS Solvang, Sørlandet Hospital, SSHF, Servicebox 416, Kristiansand, 4604, Norway.
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Joseph A Himle
- School of Social Work and School of Medicine-Psychiatry, University of Michigan, Ann Arbor, USA
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tor Sunde
- DPS Solvang, Sørlandet Hospital, SSHF, Servicebox 416, Kristiansand, 4604, Norway
| | - Liv T Walseth
- Department of Clinical Research, Sørlandet Hospital, SSHF, Kristiansand, Norway
| | - Frode Thorup
- Department of Cardiology, Sørlandet Hospital, SSHF, Kristiansand, Norway
| | - Frode Gallefoss
- Department of Clinical Research, Sørlandet Hospital, SSHF, Kristiansand, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Egil Jonsbu
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Molde, Norway
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Huzmeli I, Ozer AY. Effectiveness of a training program for a patient with non-cardiac chest pain that combines intervention to improve quality of life, psychological state, and functional capacity: a case report. Biopsychosoc Med 2023; 17:27. [PMID: 37496057 PMCID: PMC10369802 DOI: 10.1186/s13030-023-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Noncardiac chest pain (NCCP) is persistent angina-like chest pain without cardiac origin that affects the patient's health related quality of life (HrQoL), although it does not affect mortality. The effect of a comprehensive training program for NCCP focused on quality of life, psychological state, peripheral muscle strength, physical activity, and quality of life has not been previously established or published. Therefore, this study aimed to show the effectiveness of our combined training program that focuses on functional capacity, physical activity, pulmonary function, respiratory and peripheral muscle strength, dyspnea, fatigue, anxiety, and depression perception in NCCP patients with dyspnea. CASE PRESENTATION A 38-year-old man with shortness of breath and NCCP was referred to to us for cardiopulmonary rehabilitation. Respiratory muscle strength (mouth pressure device), functional capacity (6 min walking test, 6-MWT), peripheral muscle strength (dynamometer), pulmonary function (spirometry), fatigue (fatigue severity scale), shortness of breath (MMRC, Modified Medical Council Research, Modified Borg Scale-MBS), physical activity (International Physical Activity Questionnaire, IPAQ), health related quality of life (SF-36, Short Form-36), and depression and anxiety (Hospital Depression and Anxiety scale, HADs) were assessed. Aerobic training combined with inspiratory muscle training (loading 30% maximal inspiratory pressure (MIP)) was administered at least 5 days/week for 6 weeks. Functional capacity, physical activity, pulmonary function, and respiratory and peripheral muscle strength improved, and dyspnea, fatigue, anxiety, and depression perception were decreased after the management. CONCLUSIONS This combined training program was effective for patients with NCCP and shortness of breath. Future studies should be conducted to find the most effective biopsychosocial training protocol for NCCP patients.
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Affiliation(s)
- Irem Huzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hatay Mustafa Kemal University, Hatay, Turkey.
| | - Aysel Yildiz Ozer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Røysland IØ, Patel H. Experiences of unexplained chest pain and physical activity: A Meta-Ethnography. J Clin Nurs 2022. [PMID: 36028954 DOI: 10.1111/jocn.16496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim was to examine the experiences of physical activity in the patients with unexplained chest pain. BACKGROUND Previous qualitative studies have compiled data on the physical activity experiences of people with unexplained chest pain. Nevertheless, no meta-synthesis exists on this topic to advance the theoretical development of future-related studies. DESIGN A meta-ethnographic synthesis of qualitative studies was conducted. Original qualitative studies on the physical activity experiences of people with unexplained chest pain were identified and systematically synthesised using a meta-ethnographic approach. METHODS Seven databases were searched for relevant full-text articles in English, Danish, Norwegian and Swedish. There were no limitations concerning year of publication. Articles were first screened against inclusion criteria for eligibility and then assessed for quality and analysed using Noblit and Hare's seven-step meta-ethnography process. The ENTREQ checklist for systematic reviews was used. RESULTS Nine qualitative studies were included in the analysis. The physical activity experiences of people with unexplained chest pain illuminates the metaphor: "Physical activity means balancing uncertainty" with four themes: looking for possible explanations, feeling vulnerable, feeling uncertain of consequences and being physically active may mean becoming more capable. CONCLUSION For people with unexplained chest pain, being physically active meant moving toward being more capable. The participants felt vulnerable and physical activity helped in balancing uncertainty. A comprehensive model illustrates the antecedents and succedent for the physical activity experiences of individuals with unexplained chest pains. RELEVANCE TO CLINICAL PRACTICE An approach to care which considers the patient's experience might be applicable; however, it needs to be accompanied with a biomedical perspective. Nurses and other health professionals need to provide a bridge between the patient's experiences and health professionals' advice and recommendations.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Harshida Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Madva EN, Celano CM, Kim S, Bell M, Radfar A, Ibrahim NE, Dar T, Albanese A, Tawakol A, Huffman JC. A Care Management Intervention for Noncardiac Chest Pain: Treatment Development and Feasibility Assessment. Prim Care Companion CNS Disord 2022; 24:21m03045. [PMID: 35452569 PMCID: PMC9979015 DOI: 10.4088/pcc.21m03045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT. Objective: Noncardiac chest pain is common and can cause distress, impair quality of life, and lead to recurrent evaluation. It is often multifactorial in etiology and influenced by psychological factors. The objective of this study was to describe the development, implementation, and preliminary feasibility of an 8-week multicomponent care management intervention. Methods: Participants with noncardiac chest pain were recruited from primary care clinics, ambulatory cardiac stress testing, and the emergency department (ED) at an urban academic hospital from March 2019 to November 2019. The care management team consisted of a nurse, cardiologist, and psychiatrist. Following a 1-time consultation visit with the cardiologist and nurse, evaluation and treatment recommendations were conveyed to the participant's primary care physician. The nurse completed 8 weekly phone calls with the participant to provide support, introduce therapeutic principles, and assist with care coordination under the supervision of a psychiatrist. Intervention feasibility was assessed on 7 domains. To examine preliminary efficacy, the number of ED visits was recorded, and participants completed pre-post measures of psychological health and health-related quality of life and Likert scales of chest pain symptom severity, frequency, and impact. Results: The intervention was developed and implemented in 3 patients who completed 100% of the consultation visits and a mean of 95.8% of study phone calls. There were no adverse events or ED visits. Mean scores for chest pain severity, chest pain frequency, chest pain impact, depression, anxiety, and somatization all improved. No other trends were observed. Conclusions: The findings suggest that a care management intervention may be feasible with potential to improve chest pain symptoms and psychological outcomes. A larger, randomized trial is needed to explore the efficacy of this intervention. Trial Registration: ClinicalTrials.gov identifier: NCT04904198.
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Affiliation(s)
- Elizabeth N. Madva
- Harvard Medical School, Boston, Massachusetts,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts,Corresponding author: Elizabeth N. Madva, MD, Massachusetts General Hospital, Warren 6, Boston, MA 02114 ()
| | - Christopher M. Celano
- Harvard Medical School, Boston, Massachusetts,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Sonia Kim
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Margaret Bell
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Azar Radfar
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Tawseef Dar
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ariana Albanese
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Ahmed Tawakol
- Harvard Medical School, Boston, Massachusetts,Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeff C. Huffman
- Harvard Medical School, Boston, Massachusetts,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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systematic review on role of hypnotherapeutic intervention in promoting positive psychological health. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns2.6123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this world of fast moving day to day activities, it is of utmost importance that every individual is aware of their personal well- being and take steps towards improving these over the course of time (Al-Asmi et al., 2015; Amato et al., 2001). The state of well – being can be described as understanding the quality of life led by various individuals (Statham & Chase, 2010). The concept of well- being in humans is broadly classified into two aspects - the first one is associated with having life satisfaction and a positive effect in one’s life.the study here is only focused towards the use of hypnotherapeutic interventions in the process of promoting a positive psychological heath scenario all across. The study undertakes a systematic review approach with 51 articles and aims to put forward a summarised version of the literature in the aspect of hypnotherapeutic interventions.The result of the study identifies a total of three themes from the systematic literature review conducted. It is found that the three identified themes have been put forward by researchers as the most effective impact of hypnotherapeutic interventions.
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Thesen T, Himle JA, Martinsen EW, Walseth LT, Thorup F, Gallefoss F, Jonsbu E. Effectiveness of Internet-Based Cognitive Behavioral Therapy With Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial. J Med Internet Res 2022; 24:e33631. [PMID: 35072641 PMCID: PMC8822426 DOI: 10.2196/33631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain. Trial Registration ClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925
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Affiliation(s)
- Terje Thesen
- Distriktspsykiatrisk senter Solvang, Sørlandet Hospital, Sørlandet sykehus Helse Foretak, Kristiansand, Norway
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Joseph A Himle
- School of Social Work and School of Medicine-Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Egil W Martinsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv T Walseth
- Distriktspsykiatrisk senter Solvang, Sørlandet Hospital, Sørlandet sykehus Helse Foretak, Kristiansand, Norway
| | - Frode Thorup
- Department of Cardiology, Sørlandet Hospital, Sørlandet sykehus Helse Foretak, Kristiansand, Norway
| | - Frode Gallefoss
- Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Clinical Research, Sørlandet Hospital, Sørlandet sykehus Helse Foretak, Kristiansand, Norway
| | - Egil Jonsbu
- Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Molde, Norway
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10
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Hamel S, Denis I, Turcotte S, Fleet R, Archambault P, Dionne CE, Foldes-Busque G. Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health Qual Life Outcomes 2022; 20:7. [PMID: 35012545 PMCID: PMC8751105 DOI: 10.1186/s12955-021-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life. METHODS A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points. RESULTS Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up. CONCLUSIONS Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
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Affiliation(s)
- Stéphanie Hamel
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Centre de Recherche Universitaire Sur Les Jeunes Et Les Familles (CRUJeF), 2915 avenue du Bourg-Royal, Quebec, QC G1C 3S2 Canada
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Patrick Archambault
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Clermont E. Dionne
- CHU de Quebec Research Centre, Saint-Sacrement Hospital, 1050, Chemin Sainte-Foy, Quebec, QC G1S 4L8 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Quebec Heart and Lung Institute Research Centre, 2725 chemin Sainte-Foy, Quebec, QC G1V 4G5 Canada
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11
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Sun J, Zheng YB, Liu L, Li SQ, Zhao YM, Zhu XM, Que JY, Li MZ, Liu WJ, Yuan K, Yan W, Liu XG, Chang SH, Chen X, Gao N, Shi J, Bao YP, Lu L. The Impact of Quarantine on Pain Sensation among the General Population in China during the COVID-19 Pandemic. Brain Sci 2022; 12:brainsci12010079. [PMID: 35053822 PMCID: PMC8773642 DOI: 10.3390/brainsci12010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
During the pandemic era, quarantines might potentially have negative effects and disproportionately exacerbate health condition problems. We conducted this cross-sectional, national study to ascertain the prevalence of constant pain symptoms and how quarantines impacted the pain symptoms and identify the factors associated with constant pain to further guide reducing the prevalence of chronic pain for vulnerable people under the pandemic. The sociodemographic data, quarantine conditions, mental health situations and pain symptoms of the general population were collected. After adjusting for potential confounders, long-term quarantine (≥15 days) exposures were associated with an increased risk of constant pain complaints compared to those not under a quarantine (Odds Ratio (OR): 1.26; 95% Confidence Interval (CI): 1.03, 1.54; p = 0.026). Risk factors including unemployment (OR: 1.55), chronic disease history (OR: 2.38) and infection with COVID-19 (OR: 2.15), and any of mental health symptoms including depression, anxiety, insomnia and PTSD (OR: 5.44) were identified by a multivariable logistic regression. Additionally, mediation analysis revealed that the effects of the quarantine duration on pain symptoms were mediated by mental health symptoms (indirect effects: 0.075, p < 0.001). These results advocated that long-term quarantine measures were associated with an increased risk of experiencing pain, especially for vulnerable groups with COVID-19 infection and with mental health symptoms. The findings also suggest that reducing mental distress during the pandemic might contribute to reducing the burden of pain symptoms and prioritizing interventions for those experiencing a long-term quarantine.
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Affiliation(s)
- Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Shui-Qing Li
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
| | - Yi-Miao Zhao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- School of Public Health, Peking University, Beijing 100191, China
| | - Xi-Mei Zhu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Jian-Yu Que
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Ming-Zhe Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
| | - Wei-Jian Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Xiao-Guang Liu
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (J.S.); (S.-Q.L.); (X.-G.L.)
| | - Su-Hua Chang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Xuan Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Nan Gao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (Y.-P.B.); (L.L.)
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China; (Y.-B.Z.); (L.L.); (X.-M.Z.); (J.-Y.Q.); (M.-Z.L.); (W.-J.L.); (K.Y.); (W.Y.); (S.-H.C.); (X.C.); (N.G.)
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Beijing 100191, China
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; (Y.-M.Z.); (J.S.)
- Correspondence: (Y.-P.B.); (L.L.)
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12
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Internet-assisted cognitive behavioural therapy for non-cardiac chest pain: a pilot and feasibility study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted.
Key learning aims
(1)
Feasibility of internet-assisted cognitive behavioural therapy (I-CBT) for non-cardiac chest pain (NCCP).
(2)
How NCCP patients experience I-CBT.
(3)
Possible effects of I-CBT.
(4)
How I-CBT can be delivered at the Cardiac Department.
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13
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Rogers J, Collins G, Husain M, Docherty M. Identifying and managing functional cardiac symptoms. Clin Med (Lond) 2021; 21:37-43. [PMID: 33479066 DOI: 10.7861/clinmed.2020-0934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recurring chest pain and other cardiac symptoms that cannot be adequately explained by organic pathology are common and can be associated with substantial disability, distress and high healthcare costs. Common mental disorders such as depression and anxiety frequently co-occur with these symptoms and, in some cases, account for their presentation, although they are not universally present. Due to the frequency of functional cardiac presentations and risks of iatrogenic harm, physicians should be familiar with strategies to identify, assess and communicate with patients about these symptoms. A systematic and multidisciplinary approach to diagnosis and management is often needed. Health beliefs, concerns and any associated behaviours should be elicited and addressed throughout. Psychiatric comorbidities should be concurrently identified and treated. For those with persistent symptoms, psychosocial outcomes can be poor, highlighting the need for further research and investment in diagnostic and therapeutic approaches and multidisciplinary service models.
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Affiliation(s)
- Jonathan Rogers
- University College London, London, UK and specialty registrar in general adult and old age psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - George Collins
- University College London, London, UK and specialty registrar in cardiology, Barts Health NHS Trust, London, UK
| | - Mujtaba Husain
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mary Docherty
- South London and Maudsley NHS Foundation Trust, London, UK
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14
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Namgung E, Kim J, Jeong H, Ma J, Hong G, Kang I, Kim J, Joo Y, Kim RY, Lyoo IK. Changes in Prefrontal Gamma-Aminobutyric Acid and Perfusion After the Computerized Relaxation Training in Women With Psychological Distress: A Preliminary Report. Front Psychol 2021; 12:569113. [PMID: 33927662 PMCID: PMC8076529 DOI: 10.3389/fpsyg.2021.569113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Computerized relaxation training has been suggested as an effective and easily accessible intervention for individuals with psychological distress. To better elucidate the neural mechanism that underpins the effects of relaxation training, we investigated whether a 10-session computerized relaxation training program changed prefrontal gamma-aminobutyric acid (GABA) levels and cerebral blood flow (CBF) in women with psychological distress. We specifically focused on women since they were reported to be more vulnerable to develop stress-related disorders than men. Nineteen women with psychological distress but without a diagnosis of psychiatric disorders received the 10-day computerized relaxation training program that consisted of 30-min cognitive-relaxation training and 10-min breathing-relaxation training per day. At baseline and post-intervention, perceived stress levels, anxiety, fatigue, and sleep quality were assessed by self-report questionnaires. Brain magnetic resonance spectroscopy and arterial spin labeling scans were also performed before and after the intervention to evaluate GABA levels and relative CBF in the prefrontal region. Levels of perceived stress (t = 4.02, P < 0.001), anxiety (z = 2.33, P = 0.02), fatigue (t = 3.35, P = 0.004), and sleep quality (t = 4.14, P < 0.001) improved following 10 sessions of computerized relaxation training, resulting in a significant relief in composite scores of stress-related symptoms (t = -5.25, P < 0.001). The prefrontal GABA levels decreased (t = 2.53, P = 0.02), while relative CBF increased (t = -3.32, P = 0.004) after the intervention. In addition, a greater increase in relative prefrontal CBF was associated with better composite scores of stress-related symptoms following the intervention (t = 2.22, P = 0.04). The current findings suggest that computerized relaxation training may improve stress-related symptoms through modulating the prefrontal GABA levels and CBF in women with psychological distress.
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Affiliation(s)
- Eun Namgung
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Hyeonseok Jeong
- Department of Radiology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jiyoung Ma
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Gahae Hong
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Ilhyang Kang
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Jinsol Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Yoonji Joo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Rye Young Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, United States.,Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
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15
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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16
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Pietrabissa G, Rozzoni F, Liguori F, Cerruto A, Giusti EM, Malfatto G, Munforti C, De Martin M, Giglio A, Facchini M, Castelnuovo G. The Brief Strategic Treatment of Cardiophobia: A Clinical Case Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractMany individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a case of cardiophobia treated in an outpatient cardiac rehabilitation unit and, for the first time, describes the application of brief strategic therapy for the treatment of this condition. In the case reported, the first therapeutic encounter and the key elements of the strategic approach are described in detail with the aim to explain how brief strategic therapy works and how it can be used to identify and address cardiophobia-related behaviors. A 64-year-old male presented to cardiac rehabilitation reporting intense anxiety-provoking heart palpitations, and believing he was at risk of dying from a heart attack. After 3 sessions, an overall improvement in heart-related bodily sensations followed a decrease in the patient’s continuous checking of his heartbeat and seeking reassurance—factors that were largely responsible for the persistence of the problem. Moreover, quantitative evaluation showed increased scores of mood state at the end of treatment. This improvement persisted at the 18-month follow-up. This case is an interesting example of how brief strategic therapy can contribute to the development of a new conceptual model for the diagnosis and treatment of cardiophobia. Still, more systematic research in the field is needed to prove the efficacy and effectiveness of this therapeutic approach on symptoms of heart-focused anxiety.
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17
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Ambartsumyan L, Khlevner J, Nurko S, Rosen R, Kaul A, Pandolfino JE, Ratcliffe E, Yacob D, Li BU, Punati J, Sood M, Rao SSC, Levitt MA, Cocjin J, Rodriguez L, Flores A, Rosen JM, Belkind-Gerson J, Saps M, Garza JM, Fortunato J, Schroedl RL, Keefer L, Friedlander J, Heuckeroth RO, Rao M, El-Chammas K, Vaz K, Chumpitazi BP, Sanghavi R, Matta S, Danialifar T, Di Lorenzo C, Darbari A. Proceedings of the 2018 Advances In Motility and In NeuroGastroenterology: AIMING for the Future Single Topic Symposium. J Pediatr Gastroenterol Nutr 2020; 71:e59-e67. [PMID: 32287151 PMCID: PMC8451965 DOI: 10.1097/mpg.0000000000002720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Motility and functional disorders are common in children and often debilitating, yet these disorders remain challenging to treat effectively. At the 2018 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the Neurogastroenterology and Motility Committee held a full day symposium entitled, 2018 Advances In Motility and In NeuroGastroenterology - AIMING for the future. The symposium aimed to explore clinical paradigms in pediatric gastrointestinal motility disorders and provided a foundation for advancing new scientific and therapeutic research strategies. METHODS The symposium brought together leading experts throughout North America to review the state of the art in the diagnosis and management of motility and functional disorders in children. Presentations were divided into esophageal, antral duodenal, and colorectal modules. Each module included oral presentations by experts in the respective fields, leading to thought-provoking discussions. There were 2 breakout sessions with small group discussions on select topics, focusing on defining scientific insights into the diagnosis and management of pediatric functional gastrointestinal and motility disorders in a systematic, segment-based approach. CONCLUSIONS The field of neurogastroenterology has made remarkable progress in the last decade. The current report summarizes the major learning points from the symposium highlighting the diagnosis and promising therapies on the horizon for pediatric neurogastrointestinal and motility disorders.
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Affiliation(s)
| | - Julie Khlevner
- Division of Gastroenterology, Hepatology and Nutrition, Columbia University College of Physicians and Surgeons, New York, NY
| | - Samuel Nurko
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Ajay Kaul
- Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - John E. Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | | | - Desale Yacob
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - B U.K. Li
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Jaya Punati
- Division of Gastroenterology, Children’s Hospital of Los Angeles, Los Angeles, CA
| | - Manu Sood
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Satish SC Rao
- Division of Gastroenterology, Department of Medicine, Augusta University Medical Center, Augusta, GA
| | - Marc A Levitt
- Division of Colorectal Surgery, Children’s National Hospital, Washington, DC
| | - Jose Cocjin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO
| | - Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale School of Medicine, New Haven, CT
| | - Alejandro Flores
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO
| | - Jaime Belkind-Gerson
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Colorado, Aurora, CO
| | - Miguel Saps
- Division of Pediatric Gastroenterology and Nutrition, University of Miami, Miami, FL
| | - Jose M Garza
- Children’s Center for Digestive Health Care, Atlanta, GA
| | - John Fortunato
- Division of Gastroenterology, Ann & Robert H Lurie Children’s Hospital, Chicago, IL
| | - Rose L Schroedl
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joel Friedlander
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale School of Medicine, New Haven, CT
| | - Robert O. Heuckeroth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia - Research Institute, Philadelphia, PA
| | - Meenakshi Rao
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Khalil El-Chammas
- Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Karla Vaz
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | | | - Rina Sanghavi
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center Dallas, TX
| | - Sravan Matta
- Pediatric Gastroenterology and Nutrition, Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Tanaz Danialifar
- Division of Gastroenterology, Children’s Hospital of Los Angeles, Los Angeles, CA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - Anil Darbari
- Division of Pediatric Gastroenterology and Nutrition, Children’s National Hospital, Washington, DC
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Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Australia
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19
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Kisely S. Moving beyond the descriptive in psychotherapy research. Australas Psychiatry 2020:1039856220936140. [PMID: 32586114 DOI: 10.1177/1039856220936140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are challenges to conducting randomised controlled trials in psychotherapy. This article therefore discusses methodological advances in applying this design to the field. The application of evidence-based practice to psychotherapy means that people with psychological problems, clinicians, health services and any third-party payers can confidently choose from a range of effective treatments that are best suited to an individual's needs.
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Affiliation(s)
- Steve Kisely
- Metro South Mental Health and Addiction Services, Australia
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
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20
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Henningsen P, Zipfel S, Sattel H, Creed F. Management of Functional Somatic Syndromes and Bodily Distress. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:12-31. [PMID: 29306954 DOI: 10.1159/000484413] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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21
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Bjørnnes AK, Parry M, Leegaard M, Ayala AP, Lenton E, Harvey P, McFetridge-Durdle J, McGillion MH, Price J, Stinson J, Watt-Watson J. Self-Management of Cardiac Pain in Women: A Meta-Summary of the Qualitative Literature. QUALITATIVE HEALTH RESEARCH 2018; 28:1769-1787. [PMID: 29916769 DOI: 10.1177/1049732318780683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Symptom recognition and self-management is instrumental in reducing the number of deaths related to coronary artery disease (CAD) in women. The purpose of this study was to synthesize qualitative research evidence on the self-management of cardiac pain and associated symptoms in women. Seven databases were systematically searched, and the concepts of the Individual and Family Self-Management Theory were used as the framework for data extraction and analysis. Search strategies yielded 22,402 citations, from which 35 qualitative studies were included in a final meta-summary, comprising data from 769 participants, including 437 (57%) women. The available literature focused cardiac pain self-management from a binary sex and gender perspective. Ethnicity was indicated in 19 (54%) studies. Results support individualized intervention strategies that promote goal setting and action planning, management of physical and emotional responses, and social facilitation provided through social support.
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Affiliation(s)
- Ann Kristin Bjørnnes
- 1 University of Toronto, Toronto, Ontario, Canada
- 2 Oslo Metropolitan University, Oslo, Norway
| | - Monica Parry
- 1 University of Toronto, Toronto, Ontario, Canada
| | | | | | - Erica Lenton
- 1 University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- 3 Women's College Hospital, Toronto, Ontario, Canada
| | | | | | | | - Jennifer Stinson
- 1 University of Toronto, Toronto, Ontario, Canada
- 6 The Hospital for Sick Children, Toronto, Ontario, Canada
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Markozannes G, Aretouli E, Rintou E, Dragioti E, Damigos D, Ntzani E, Evangelou E, Tsilidis KK. An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction. BMC Psychol 2017; 5:31. [PMID: 28859685 PMCID: PMC5580223 DOI: 10.1186/s40359-017-0200-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias. METHODS We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias. RESULTS Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence. CONCLUSIONS The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Evangelia Rintou
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Elena Dragioti
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Dimitrios Damigos
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, 02903, USA
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
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23
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Tyrer P, Tyrer H, Morriss R, Crawford M, Cooper S, Yang M, Guo B, Mulder RT, Kemp S, Barrett B. Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial. Open Heart 2017; 4:e000582. [PMID: 28674627 PMCID: PMC5471860 DOI: 10.1136/openhrt-2016-000582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/18/2017] [Accepted: 02/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. METHODS We tested the effectiveness and cost-effectiveness of a modified form of CBT for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months. The primary outcome was the change in the Health Anxiety Inventory Score at 6 months. Other clinical measures, social functioning, quality of life and costs of services were also recorded. RESULTS Sixty-eight patients were randomised with low attrition rates at 6 months and 12 months with 81% of all possible assessments completed at 6 months and 12 months. Although there were no significant group differences between any of the outcome measures at either 6 months or 12 months, patients receiving CBT-CP had between two and three times fewer hospital bed days, outpatient appointments, and A&E attendances than those allocated to standard care and total costs per patient were £1496.49 lower, though the differences in costs were not significant. There was a small non-significant gain in quality adjusted life years in those allocated to CBT-CP compared with standard care (0.76 vs 0.74). CONCLUSIONS It is concluded that CBT-CP in the context of current hospital structures is not a viable treatment, but is worthy of further research as a potentially cost-effective treatment for non-cardiac chest pain. TRIAL REGISTRATION NUMBER ISRCTN 14711101.
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Affiliation(s)
- Peter Tyrer
- Centre of Psychiatry, Imperial College London, London, UK
| | - Helen Tyrer
- Centre of Psychiatry, Imperial College London, London, UK
| | - Richard Morriss
- Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Sylvia Cooper
- Centre of Psychiatry, Imperial College London, London, UK
| | - Min Yang
- School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Boliang Guo
- Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Samuel Kemp
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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24
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Hayek SS, Ko YA, Awad M, Del Mar Soto A, Ahmed H, Patel K, Yuan M, Maddox S, Gray B, Hajjari J, Sperling L, Shah A, Vaccarino V, Quyyumi AA. Depression and chest pain in patients with coronary artery disease. Int J Cardiol 2017; 230:420-426. [PMID: 28041701 PMCID: PMC5881400 DOI: 10.1016/j.ijcard.2016.12.091] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression. METHODS AND RESULTS 5158 patients (mean age 63±12years, 65% male, 20% African American) undergoing cardiac catheterization completed the Seattle Angina Questionnaire (SAQ) and Patient Health Questionnaire-8 (PHQ-8) to assess angina severity and screen for depression, respectively, both at baseline and between 6 and 24months of follow-up. We found significant correlations between PHQ-8 scores and angina frequency (SAQ-AF, r=-0.28), physical limitation (SAQ-PL, r=-0.32) and disease perception (SAQ-DS r=-0.37, all P<0.001), which remained significant after adjustment for clinical characteristics, CAD severity, and anti-depressant use. Improvement in depressive symptoms at follow-up was associated with improvement in angina subscales (SAQ-AF β 1.34, P<0.001), SAQ-PL β 1.85, P<0.001), and SAQ-DS (β 2.12, P<0.001), independently of CAD severity or revascularization. Patients with depression who underwent revascularization had less improvement in chest pain frequency than those without depressive symptoms. CONCLUSIONS Depression is associated with angina, independently of CAD severity. Patients with depression may not derive as adequate symptomatic benefit from revascularization as those without. Whether treatment of underlying depression improves chest pain needs to be further studied.
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Affiliation(s)
- Salim S Hayek
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Yi-An Ko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mosaab Awad
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrea Del Mar Soto
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Hina Ahmed
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Keyur Patel
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Spencer Maddox
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Brandon Gray
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamal Hajjari
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Laurence Sperling
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Amit Shah
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Viola Vaccarino
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
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25
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Established and Emerging Treatment Options for Functional Heartburn and Chest Pain. ACTA ACUST UNITED AC 2016; 14:19-27. [DOI: 10.1007/s11938-016-0081-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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