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Wijnen J, Geijselaers MWH, Pont ML, Van't Hullenaar G, Van Oosterwijck J, de Jong J. An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders. Psychosom Med 2024; 86:603-614. [PMID: 38718168 DOI: 10.1097/psy.0000000000001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders. METHODS Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time. RESULTS The 20-week treatment period yielded significant improvements in both mental ( B = 0.44, t (943) = 19.42, p < .001) and physical component summary scores ( B = 0.45, t (943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score ( B = -0.77, t (943) = -26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program. CONCLUSIONS An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.
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Affiliation(s)
- Jaap Wijnen
- From the Intergrin Academy, Geleen, The Netherlands (Wijnen, Geijselaers, van 't Hullenaar, de Jong), Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Wijnen, Van Oosterwijck), Pain in Motion Internationl Research Group, (Wijnen, Van Oosterwijck), Center for InterProfessional Collaboration in Education Research and Practice (IPC-ERP UGent), Faculty of Medicine and Health Sciences (Van Oosterwijck), and Reakira Recovery College, Sittard, the Netherlands (de Jong)
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Epp S, Walker A, Boudes E, Bray S, Noel M, Rayner L, Rasic N, Miller JV. Brain Function and Pain Interference After Pediatric Intensive Interdisciplinary Pain Treatment. Clin J Pain 2024; 40:393-399. [PMID: 38606879 DOI: 10.1097/ajp.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Intensive interdisciplinary pain treatments (IIPTs) are programs that aim to improve functioning in youth with severe chronic pain. Little is known about how the brain changes after IIPT; however, decreased brain responses to emotional stimuli have been identified previously in pediatric chronic pain relative to healthy controls. We examined whether IIPT increased brain responses to emotional stimuli, and whether this change was associated with a reduction in pain interference. PATIENTS AND METHODS Twenty youths with chronic pain aged 14 to 18 years were scanned using functional magnetic resonance imaging, pre and post-IIPT. During the functional magnetic resonance imaging, patients were presented with emotional stimuli (ie, faces expressing happiness/fear), neutral expressions, and control (ie, scrambled) images. Patients completed a measure of pain interference pre and post-IIPT. Paired t tests were used to examine differences in brain activation in response to emotional versus neutral stimuli, pre to post-IIPT. Data from significant brain clusters were entered into linear mixed models to examine the relationships between brain activation and impairment pre and post-IIPT. RESULTS Patients demonstrated a decrease in middle frontal gyrus (MFG) activation in response to emotional stimuli (happy + fear) relative to scrambled images, between pre and post-IIPT ( P < 0.05). Lower MFG activation was associated with lower pain interference, pre and post-IIPT ( P < 0.05). CONCLUSION Contrary to our hypothesis, IIPT was associated with a reduction in MFG activation to emotional stimuli, and this change was associated with reduced pain interference. The MFG is a highly interconnected brain area involved in both pain chronification and antinociception. With further validation of these results, the MFG may represent an important biomarker for evaluating patient treatment response and target for future pain interventions.
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Affiliation(s)
- Spencer Epp
- Department of Anesthesiology, Perioperative and Pain Medicine
| | - Andrew Walker
- Department of Anesthesiology, Perioperative and Pain Medicine
| | | | - Signe Bray
- Department of Radiology, Cumming School of Medicine
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
| | - Melanie Noel
- Department of Radiology, Psychology
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
| | - Laura Rayner
- Department of Anesthesiology, Perioperative and Pain Medicine
| | - Nivez Rasic
- Department of Anesthesiology, Perioperative and Pain Medicine
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jillian Vinall Miller
- Department of Anesthesiology, Perioperative and Pain Medicine
- Department of Radiology, Psychology
- O'Brien Institute for Public Health, University of Calgary
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
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Bateman S, Caes L, Eccleston C, Noel M, Jordan A. Co-occurring chronic pain and primary psychological disorders in adolescents: A scoping review. PAEDIATRIC & NEONATAL PAIN 2023; 5:57-65. [PMID: 37744281 PMCID: PMC10514777 DOI: 10.1002/pne2.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 09/26/2023]
Abstract
Long-term health conditions, whether mental or physical, often co-occur in adolescents. For instance, adolescents with chronic pain may experience co-occurring primary psychological disorders. In this scoping review, we determine the influence of co-occurring chronic pain and primary psychological disorders on adolescents' functioning. A systematic search of six databases was conducted to identify articles if they were: (1) peer-reviewed; (2) reported original findings; (3) included participants aged 11-19 years, who experienced chronic pain (i.e., pain lasting 3 months or more) and had a co-occurring diagnosis of a primary psychological disorder; and (4) assessed functioning. Searches returned 9864 articles after the removal of duplicates. A two-phase abstract and full-text screening process identified two eligible articles which compared emotional functioning (n = 1) and social functioning (n = 2) between groups of adolescents with co-occurring chronic pain and primary psychological disorders with adolescents only reporting chronic pain. Overall findings revealed no differences in social functioning, but adolescents with co-occurring chronic pain and a primary psychological disorder (depression and anxiety) reported worse emotional functioning compared with adolescents with chronic pain alone. This review confirms the limited research on the co-occurrence of primary psychological disorders and chronic pain in adolescents by only identifying two eligible articles exploring the co-occurrence of chronic pain with depression, anxiety, and/or attentional disorders.
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Affiliation(s)
- Sharon Bateman
- Department of PsychologyUniversity of BathBathUK
- Centre for Pain ResearchUniversity of BathBathUK
| | - Line Caes
- Division of Psychology, Faculty of Natural SciencesUniversity of StirlingStirlingUK
| | | | - Melanie Noel
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Abbie Jordan
- Department of PsychologyUniversity of BathBathUK
- Centre for Pain ResearchUniversity of BathBathUK
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ÖZDEMİR E, HACIÖMEROĞLU AB. Transdiagnostic Approach and Obsessive Compulsive Disorder. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1110989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.
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BATMAZ S. Transdiagnostic Cognitive Behavioral Psychotherapy: Unified Protocol as an Example. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1064590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The fact that there are many limitations of the current classification systems led to the emergence of transdiagnostic approaches (TA) that focus on the common psychopathological processes underlying disorders rather than categorical diagnoses. TA focuses on the underlying common psychopathological processes in the emergence and persistence of mental disorders. Thus, even if the disorders are categorically diagnosed differently, it can be determined how they overlap or separate with each other. TA aims to treat mental disorders using these aspects. TA has a flexible and modular structure that can be easily integrated into cognitive behavioral therapies. The rest of this review will focus on the Unified Protocol (UP), one of the most popular TA examples. The main purpose of the UP is to enable patients to recognize their feelings and give more adaptive reactions to their negative emotions. Accordingly, UP consists of eight modules. The modules can usually be completed in a total of 11 - 17 weeks. Each 50 to 60-minute individual session is held once a week. If necessary, changes can be made to the number or the frequency of sessions allocated to modules. The goals of each module of the UP and the treatment approaches towards these goals allow a very clearly defined approach. For this reason, there is a need for a detailed evaluation, conceptualization and treatment plan before the UP is put into practice. We hope that mental health professionals from Turkey will contribute to the developments in the UP.
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Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain. THE JOURNAL OF PAIN 2022; 24:655-666. [PMID: 36442816 DOI: 10.1016/j.jpain.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk. PERSPECTIVE: This article identifies reward drive as a potentially important factor increasing the effects of depression-related cognitive mechanisms on risk of prescription opioid misuse in those with CNCP. These findings could assist in personalizing clinical CNCP management to reduce the risks associated with opioid misuse.
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Lackner JM, Jaccard J, Quigley BM, Ablove TS, Danforth TL, Firth RS, Gudleski GD, Krasner SS, Radziwon CD, Vargovich AM, Clemens JQ, Naliboff BD. Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS). Trials 2022; 23:651. [PMID: 35964133 PMCID: PMC9375413 DOI: 10.1186/s13063-022-06554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief. Discussion Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine. Trial Registration Clinicaltrials.gov NCT05127616. Registered on 9/19/21. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06554-9.
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Affiliation(s)
- Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA.
| | - James Jaccard
- School of Social Work, New York University, New York, NY, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brian M Quigley
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Tova S Ablove
- Department of Obstetrics and Gynecology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Teresa L Danforth
- Department of Urology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Rebecca S Firth
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Gregory D Gudleski
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Susan S Krasner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Christopher D Radziwon
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Alison M Vargovich
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Bruce D Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
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Duru YB, Gunal V, Agaoglu CY, Tatlı C. The role of covid‐19 anxiety and intolerance of uncertainty in predicting resilience. Scand J Psychol 2022; 63:522-529. [PMID: 35398920 PMCID: PMC9115403 DOI: 10.1111/sjop.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Resilience is one of the protective factors for mental health. The aim of this study is to reveal the role of COVID‐19 anxiety and intolerance of uncertainty in predicting resilience in adulthood. To this end, data were collected from 533 adults (359 women‐174 men). A hierarchical regression analysis was performed, controlling for the effects of gender and presence of a chronic disease on the prediction of resilience. Results showed that intolerance of uncertainty and COVID‐19 anxiety were statistically significant predictors of resilience. Gender and presence of a chronic disease were not statistically significant in predicting resilience. These results indicate that intolerance of uncertainty plays an important role in explaining resilience.
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Affiliation(s)
- Yagmur Benian Duru
- Ministry of Education, School Counselor Master Student in Hasan Kalyoncu University Gaziantep Turkey
| | - Vuslat Gunal
- Master Student in Hasan Kalyoncu University Gaziantep Turkey
| | - Ceyda Yalcin Agaoglu
- Ministry of Education School Counselor, PhD Student in Hasan Kalyoncu University Kahramanmaras Turkey
| | - Cemre Tatlı
- Faculty of Education Hasan Kalyoncu University Gaziantep Turkey
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Caiado B, Canavarro MC, Moreira H. The Bifactor Structure of the Emotion Expression Scale for Children in a Sample of School-Aged Portuguese Children. Assessment 2022; 30:1065-1079. [PMID: 35272501 PMCID: PMC10152220 DOI: 10.1177/10731911221082038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Emotion Expression Scale for Children (EESC) is a 16-item self-report questionnaire assessing children's difficulties in emotion expression (i.e., poor emotion awareness and reluctance to express emotions). Considering the inconsistent findings regarding its factorial structure and dimensionality, this study aims to explore the factor structure and psychometric properties of the EESC in a sample of 286 Portuguese children (8-12 years). Three competing models were analyzed through confirmatory factor analysis (correlated two-factor model, one-factor model, and bifactor model). The bifactor model provided a better fit than the competing models, and the results suggested a strong general factor of "difficulties in emotion expression." The validity of the EESC was also indicated by its positive correlations with variables assessing child anxiety, depression, and behavioral avoidance and its negative correlation with mindfulness skills. The EESC is a valid measure of children's difficulties in emotion expression and the use of its total score is recommended.
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Cheng AL, Brady BK, Bradley EC, Calfee RP, Klesges LM, Colditz GA, Prather H. Opioid use and social disadvantage in patients with chronic musculoskeletal pain. PM R 2022; 14:309-319. [PMID: 33773068 PMCID: PMC8464618 DOI: 10.1002/pmrj.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Historically, marginalized patients were prescribed less opioid medication than affluent, white patients. However, because of persistent differential access to nonopioid pain treatments, this direction of disparity in opioid prescribing may have reversed. OBJECTIVE To compare social disadvantage and health in patients with chronic pain who were managed with versus without chronic opioid therapy. It was hypothesized that patients routinely prescribed opioids would be more likely to live in socially disadvantaged communities and report worse health. DESIGN Cross-sectional analysis of a retrospective cohort defined from medical records from 2000 to 2019. SETTING Single tertiary safety net medical center. PATIENTS Adult patients with chronic musculoskeletal pain who were managed longitudinally by a physiatric group practice from at least 2011 to 2015 (n = 1173), subgrouped by chronic (≥4 years) adherent opioid usage (n = 356) versus no chronic opioid usage (n = 817). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The primary outcome was the unadjusted between-group difference in social disadvantage, defined by living in the worst national quartile of the Area Deprivation Index (ADI). An adjusted effect size was also calculated using logistic regression, with age, sex, race, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function scores as covariates. Secondary outcomes included adjusted differences in health by chronic opioid use (measured by PROMIS). RESULTS Patients managed with chronic opioid therapy were more likely to live in a zip code within the most socially disadvantaged national quartile (34.9%; 95% confidence interval [CI] 29.9-39.9%; vs. 24.9%; 95% CI 21.9-28.0%; P < .001), and social disadvantage was independently associated with chronic opioid use (odds ratio [OR] 1.01 per ADI percentile [1.01-1.02]). Opioid use was also associated with meaningfully worse PROMIS Depression (3.8 points [2.4-5.1]), Anxiety (3.0 [1.4-4.5]), and Pain Interference (2.6 [1.7-3.5]) scores. CONCLUSIONS Patients prescribed chronic opioid treatment were more likely to live in socially disadvantaged neighborhoods, and chronic opioid use was independently associated with worse behavioral health. Improving access to multidisciplinary, nonopioid treatments for chronic pain may be key to successfully overcoming the opioid crisis.
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Affiliation(s)
- Abby L Cheng
- Department of Orthopaedic Surgery, Division of Physical
Medicine and Rehabilitation, Washington University in St. Louis School of Medicine,
St. Louis, Missouri
| | - Brian K Brady
- Washington University in St. Louis School of Medicine, St.
Louis, Missouri
| | - Ethan C Bradley
- The Brown School of Social Work, Washington University in
St. Louis, St. Louis, Missouri
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Division of Hand and
Microsurgery, Washington University in St. Louis School of Medicine, St. Louis,
Missouri
| | - Lisa M Klesges
- Department of Surgery, Division of Public Health Sciences,
Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences,
Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Heidi Prather
- Department of Orthopaedic Surgery, Division of Physical
Medicine and Rehabilitation, Washington University in St. Louis School of Medicine,
St. Louis, Missouri
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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Portugal: Feasibility Study Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031782. [PMID: 35162806 PMCID: PMC8835210 DOI: 10.3390/ijerph19031782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023]
Abstract
The Unified Protocol for Children (UP-C) is a transdiagnostic Cognitive-Behavioral Therapy group intervention for children and caregivers targeting the treatment of children’s emotional disorders (EDs). The present study aims to assess the feasibility and acceptability of the UP-C in the Portuguese population using a single-armed design. The participants were 32 children (6–12 years of age) with an ED (anxiety and/or depressive disorder) as a main diagnosis and their parents. All participants received the UP-C intervention and were assessed at pretreatment, midtreatment, posttreatment, and 3 months posttreatment. Children, parents, the clinicians, and an external observer completed questionnaires to assess the feasibility and acceptability of the UP-C (e.g., satisfaction, motivation, and adherence). Children and parents also completed self-report measures assessing the children’s anxiety and depression and its interference and severity. The results of the present study support the feasibility and acceptability of the UP-C in Portugal; low dropout rates, high adherence rates, and high levels of child and parent satisfaction and motivation were observed. Moreover, significant reductions over time in children’s levels of anxiety and/or depression and of its interference and severity were found and were maintained after 3 months of follow-up. These results are promising and warrant a subsequent randomized controlled trial (RCT).
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Osma J, Martínez-García L, Quilez-Orden A, Peris-Baquero Ó. Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Medical Conditions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5077. [PMID: 34064898 PMCID: PMC8151777 DOI: 10.3390/ijerph18105077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/04/2023]
Abstract
Emotional disorders are those that most commonly present comorbidly with medical conditions. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral emotion-based intervention, has proven efficacy and versatility. The aim of this systematic review is to know the current (research studies) and future research interest (study protocols) in using the UP for the transdiagnostic treatment of emotional symptoms or disorders (EDs) in people with a medical condition. Using the PRISMA guidelines, a literature search was conducted in Web of Science, PubMed, Medline, and Dialnet. The nine research studies included in this review indicated that the UP is effective in treating emotional symptomatology in a population with a medical condition (effect sizes ranging from d = -3.34 to d = 2.16). The three included study protocols suggest interest in the future UP application to different medical conditions, and also in distinct application formats. Our review results are encouraging, and conducting more controlled studies is advised to recommend the UP to treat and/or prevent EDs in medical conditions, especially in children and youths.
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Affiliation(s)
- Jorge Osma
- Department of Psychology and Sociology, Universidad de Zaragoza, C/Atarazanas, 4, 44003 Teruel, Spain; (L.M.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, C/San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Laura Martínez-García
- Department of Psychology and Sociology, Universidad de Zaragoza, C/Atarazanas, 4, 44003 Teruel, Spain; (L.M.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, C/San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Alba Quilez-Orden
- Department of Psychology and Sociology, Universidad de Zaragoza, C/Atarazanas, 4, 44003 Teruel, Spain; (L.M.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, C/San Juan Bosco, 13, 50009 Zaragoza, Spain
- Mental Health Unit of Tarazona, C/Plaza Joaquín Zamora, 2, 50500 Tarazona, Spain
| | - Óscar Peris-Baquero
- Department of Psychology and Sociology, Universidad de Zaragoza, C/Atarazanas, 4, 44003 Teruel, Spain; (L.M.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, C/San Juan Bosco, 13, 50009 Zaragoza, Spain
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Caes L, Dick B, Duncan C, Allan J. The Cyclical Relation Between Chronic Pain, Executive Functioning, Emotional Regulation, and Self-Management. J Pediatr Psychol 2021; 46:286-292. [PMID: 33249502 DOI: 10.1093/jpepsy/jsaa114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To propose a new model outlining a hypothesized cyclical relation between executive functioning, emotional regulation, and chronic pain in adolescence and to highlight the likely importance of such a relation for self-management behavior and pain-related disability. METHODS A review of the existing literature that critically explores the role of executive functioning in understanding chronic pain experiences and self-management in adolescence in order to develop the Cyclical model Of Pain, Executive function, emotion regulation, and Self-management (COPES). RESULTS Growing evidence points towards a potential cyclical relation between chronic pain and impaired executive functioning, which forms the basis of COPES. The COPES model proposes that the relative immaturity of executive functioning in adolescence negatively influences their ability to engage with self-management, which in turn increases adolescents' disability due to pain and contributes to the maintenance of chronic pain, which perpetuates the reduced capacity of executive functioning. The moderating influence of flexible parental support is hypothesized to offset some of these influences. However, the available evidence is limited due to methodological shortcomings such as large variety in executive functioning operationalization, reliance on self-report and cross-sectional designs. CONCLUSIONS It is anticipated that the COPES model will stimulate more systematic, theory-driven research to further our understanding of the links between executive functioning, chronic pain, self-management, and wellbeing. Such enhanced understanding has the potential to drive forward intervention development and refinement aimed at improving self-management uptake and adherence amongst adolescents with chronic pain.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling
| | - Bruce Dick
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine & Dentistry, University of Alberta
| | | | - Julia Allan
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen
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Rogers AH, Garey L, Allan NP, Zvolensky MJ. Exploring transdiagnostic processes for chronic pain and opioid misuse among two studies of adults with chronic pain. Behav Res Ther 2020; 136:103786. [PMID: 33316580 DOI: 10.1016/j.brat.2020.103786] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
Chronic pain is a significant public health problem associated with functional impairment, increased medical expenditures, and opioid misuse. Recent work has suggested that certain transdiagnostic psychosocial factors may be more important than pain intensity to better understand pain and opioid outcomes. Specifically, pain-related anxiety, anxiety sensitivity, emotion dysregulation, and distress tolerance have all been uniquely associated with both pain and opioid outcomes across a range of samples. Yet, no work has examined how these transdiagnostic constructs relate to pain and opioid misuse when accounting for the other constructs. Therefore, the current study employed two independent sample of adults with chronic pain to examine (1) the construct independence of each of these factors using exploratory structural equation modelling (ESEM) and (2) how each of these constructs relates to pain and opioid outcomes in latent structural models. Results from Study 1 provided empirical support for construct independence of the transdiagnostic constructs. Findings from Study 2 indicated that pain-related anxiety was most strongly related to pain intensity, interference, and pain-related negative affect, anxiety sensitivity with opioid misuse, and emotion dysregulation with all studied criterion variables. The current results highlight the importance of assessing and targeting transdiagnostic constructs among adults with pain.
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Affiliation(s)
| | - Lorra Garey
- Department of Psychology, University of Houston, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA.
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Nazari N, Sadeghi M, Ghadampour E, Mirzaeefar D. Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial. BMC Psychol 2020; 8:114. [PMID: 33129356 PMCID: PMC7603744 DOI: 10.1186/s40359-020-00480-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder. METHODS Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity. RESULTS The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen's d = 1.9), anxiety symptoms (Cohen's d = 2.16), worry symptoms (Cohen's d = 1.27), emotion dysregulation (Cohen's d = 0.44), positive affect (Cohen's d = 1.51), and negative affect (Cohen's d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001). CONCLUSION The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view .
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | - Masood Sadeghi
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Ezatolah Ghadampour
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Davod Mirzaeefar
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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16
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Nazari N, Aligholipour A, Sadeghi M. Transdiagnostic treatment of emotional disorders for women with multiple sclerosis: a randomized controlled trial. BMC Womens Health 2020; 20:245. [PMID: 33129298 PMCID: PMC7603725 DOI: 10.1186/s12905-020-01109-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/25/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, unpredictable, neurodegenerative disease, significantly associated with psychological, behavioral, cognitive, and emotional consequences. MS is more common in females than males and frequently affects women during their reproductive years. Despite the frequent mental disorders, comorbidities, and emotional problems in People with MS (PwMS), these conditions are too often underdiagnosed and undertreated. OBJECTIVE This study aimed to examine the efficacy of a group format of the Unified Protocol (UP) for the Transdiagnostic treatment of depression and anxiety disorders in females with MS. METHODS In the present study, Sixty-four adult females diagnosed with MS were randomized to either the UP (n = 32) or treatment-as-usual conditions. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional regulation, and affectivity. RESULTS Repeated measure analysis of variance (ANOVA) revealed that the UP significantly improved depression scores [Cohen's d = - 2.11, 95% CI (- 2.72, - 1.50)], anxiety scores [Cohen's d = - 3.34, 95% CI (- 4.01, - 2.58)], positive and negative affect scale (PANAS)-positive affect scores [Cohen's d = 1.46, 95% CI (1.46, 2.01)], PANAS-negative affect scores [Coen's d = - 2.21, 95% CI (- 2.84, - 1.60)], difficulties emotion regulation scale scores [Cohen's d = 1.40, 95% CI (- 0.87, - 0.03)], and Worry scale scores [Cohen's d = - 0.45, 95% CI (- 0.95, - 0.04)] at the end of treatment relative to compared to the control condition. Also, treatment gains were maintained at the three-month follow-up (p < 0.001). CONCLUSION The findings provide the support that the UP could be an additional efficient psychological treatment for females with MS. ISRCTN Number: ISRCTN95459505.
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | - Akram Aligholipour
- Department of Psychology, Islamic Azad University, Hamadan Branch, Hamadan, Iran
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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Nazari N, Sadeghi M, Ghadampour E, Mirzaeefar D. Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial. BMC Psychol 2020. [DOI: doi.org/10.1186/s40359-020-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.
Methods
Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.
Results
The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).
Conclusion
The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS.
Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.
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18
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Pain prevention and management must begin in childhood: the key role of psychological interventions. Pain 2020; 161 Suppl 1:S114-S121. [DOI: 10.1097/j.pain.0000000000001862] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Nasiri F, Mashhadi A, Bigdeli I, Chamanabad AG, Ellard KK. Augmenting the unified protocol for transdiagnostic treatment of emotional disorders with transcranial direct current stimulation in individuals with generalized anxiety disorder and comorbid depression: A randomized controlled trial. J Affect Disord 2020; 262:405-413. [PMID: 31740106 DOI: 10.1016/j.jad.2019.11.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/27/2019] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the current study was to compare the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) with and without transcranial direct current stimulation (tDCS) in individuals suffering from generalized anxiety disorder (GAD) and comorbid depression. METHODS A total of 43 individuals diagnosed with GAD and comorbid depression enrolled in a randomized controlled trial (IRCT20140929019334N1). Participants were randomly assigned to three groups including UP with tDCS (UP+tDCS; n = 15), UP alone (UP; n = 13) or wait-list control (n = 15). GAD and depression symptoms, worry severity, anxiety sensitivity, and intolerance of uncertainty were assessed at baseline, post-treatment and 3-month follow-up. RESULTS Treatment with both UP+tDCS and UP alone resulted in significant lower ratings across all measures relative to wait-list controls at post-treatment and 3-month follow-up (all p-values <0.001). UP+tDCS showed significantly greater reductions in anxiety (p = 0.001 post-treatment; p = 0.003 follow-up), worry (p = 0.001 post-treatment; p = 0.002 follow-up), and anxiety sensitivity (p = 0.003 post-treatment; p = 0.002 follow-up) relative to UP alone. LIMITATIONS The present study had some limitations. First, the sample size was low. Another limitation was the use of a short-term follow-up. CONCLUSIONS These results suggest augmenting UP treatment with tDCS may be an efficacious strategy to improve treatment outcomes in GAD with comorbid depression. Trial registration reference is IRCT20140929019334N1 (see https://irct.ir/trial/27988).
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Affiliation(s)
- Farzad Nasiri
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Mashhadi
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Imanollah Bigdeli
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Ghanaei Chamanabad
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital /Harvard Medical School, Boston, United States
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20
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Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis. J Clin Psychol Med Settings 2019; 28:40-52. [DOI: 10.1007/s10880-019-09685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Sakiris N, Berle D. A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clin Psychol Rev 2019; 72:101751. [DOI: 10.1016/j.cpr.2019.101751] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 01/19/2023]
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Mohammadi A, Soleimani M, Mohammadi MR, Abasi I, Foroughi AA. Unified Protocol for Transdiagnostic Prevention of Depression and Anxiety in Iranian Adolescents: Protocol Development and Initial Outcome Data. IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:171-178. [PMID: 31440299 PMCID: PMC6702274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Cognitive-behavioral interventions have been used as effective approaches for the treatment and prevention of depression and anxiety. However, to date, no anxiety and depression prevention guidelines package has been developed for Iranian adolescents. Thus, the purpose of this study was to develop transdiagnostic prevention program of anxiety and depression for Iranian adolescents and to assess the effectiveness of this program in a sample of adolescents. Method : Based on evidence-based literatures on CBT interventions, transdiagnostic prevention program was developed and its content and face validity was assessed and established by three clinical psychologies (Ph.D.) and a psychiatrist (child and adolescent postdoctoral). Then, in a semi-experimental design, 62 students were recruited from a school in Tehran by purposive sampling method and were randomly assigned in to experimental (n = 40) and control (n = 22) groups. They participated in 8 sessions of intervention based on the developed program. Revised Child Anxiety and Depression Scale (RCADS)- Child Version and Parent Version- were used to gather the data before, after, and 3 months after intervention. Results: Results of ANCOVA, controlling for the effect of pretest score, showed no significant differences (P>0.05) between experimental and control groups in SAD, panic, MDD, separation anxiety, GAD, OCD, total anxiety, and total anxiety-depression for parent and child in pretest and posttest. Conclusion: Transdiagnostic prevention package for anxiety and depression had no significant effect on reducing anxiety and depression of adolescents. Using an inappropriate measure, difficulties with timing of assessment, and lower severity of pre-intervention anxiety and depression due to universal prevention and sample recruited, might have affected the present findings. Discussion would be clearer and more complete by analyzing follow-up results and education performance in the future.
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Affiliation(s)
- Abolfazl Mohammadi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Soleimani
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran. Postal Code:1333715914, Tel: 98-2155419151, Fax: 98-2155419151,
| | - Mohammad Reza Mohammadi
- Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Imaneh Abasi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Akbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Defence response mobilization in response to provocation or imagery of interoceptive sensations in adolescents with chronic pain: a study protocol. Pain Rep 2018; 3:e680. [PMID: 30324172 PMCID: PMC6172822 DOI: 10.1097/pr9.0000000000000680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/01/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Fear of pain seems to be a key factor in the development and maintenance of chronic pain and pain-related disability. Interoceptive fear conditioning is assumed to constitute an important mechanism in the origins and maintenance of fear of pain. If conditioned stimuli such as internal bodily sensations are repeatedly paired with pain (unconditioned stimulus), they in turn elicit a conditioned fear response, including defence mobilization such as startle modulation and changes in heart rate and electrodermal activity. Research into emotional imagery suggests that defensive responses can also be elicited through imagery of fear scripts. Objectives We present 2 novel paradigms adapted from research on anxiety disorders, which allow to test, if perceived or imagined sensations locally proximal to the main pain location trigger heightened defence response mobilization in adolescents with chronic headaches and abdominal pain. Methods The provocation paradigm includes the anticipation and provocation of locally proximal and locally distal interoceptive sensations through disorder-specific muscle tensing tasks (tightening the neck or the abdominal muscles). The imagery paradigm includes 3 imagery scripts (standard neutral, standard fear, and disorder-specific). Startle probes are presented in both paradigms. Defence response mobilization is assessed using psychophysiological measures (startle response modulation, skin conductance level, and heart rate), as well as self-reported measures of fear. Perspective The paradigms will give insight into the defence response of adolescents with chronic pain, when confronted with or imagining interoceptive sensations. Results may inform the improvement of clinical interventions aimed to decrease fear of bodily sensations such as interoceptive exposure or interoceptive imagery exposure.
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Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: A systematic literature review. J Psychosom Res 2018; 107:38-45. [PMID: 29502762 DOI: 10.1016/j.jpsychores.2018.02.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Emotion regulation (ER) includes a set of cognitive and attentional processes used to change or maintain emotional state. A small but growing body of research suggests that maladaptive ER might be a risk factor for the development of chronic pain. This review aims to summarize existing literature on the association between ER and chronic pain, and to determine whether the construct of ER may further enhance our understanding of the risk and protective factors that may contribute to the onset and maintenance of chronic pain. METHODS A systematic search was conducted using the search terms "chronic pain" and "emotion regulation." Studies that measured both constructs across all age groups were included. RESULTS We found 15 studies that met our inclusion criteria. Nine studies were completed within the last five years, suggesting that the evaluation of ER as it relates to pain is a new line of research. Studies that measured "response-focused" ER found associations between maladaptive ER and pain. Studies that measured "antecedent-focused" ER strategies were less likely to show a direct association with pain. CONCLUSION Maladaptive response-focused ER may be an important risk factor in the development and maintenance of chronic pain, as it is associated with pain and psychological comorbidities. Adding ER to chronic pain investigations may help to further explain individual differences in the risk and protective mechanisms that are known to influence chronic pain. Importantly, this line of research has potential to directly inform future interventions for patients with chronic pain.
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Affiliation(s)
- Helen Koechlin
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Rachael Coakley
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Neil Schechter
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | | | - Joe Kossowsky
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
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Neville A, Soltani S, Pavlova M, Noel M. Unravelling the Relationship Between Parent and Child PTSD and Pediatric Chronic Pain: the Mediating Role of Pain Catastrophizing. THE JOURNAL OF PAIN 2018; 19:196-206. [DOI: 10.1016/j.jpain.2017.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/07/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
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Wurm M, Klein Strandberg E, Lorenz C, Tillfors M, Buhrman M, Holländare F, Boersma K. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interv 2017; 10:54-64. [PMID: 30135753 PMCID: PMC6084869 DOI: 10.1016/j.invent.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/06/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimal treatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarching aim of this study was to test an internet delivered therapist guided transdiagnostic treatment with telephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of Emotional Disorders was used as an intervention for pain patients with residual pain problems and comorbid emotional problems after having received a multimodal pain rehabilitation. The study used a replicated AB single case experimental design (N = 5; 3 females). Outcome measures were depressive and general anxiety symptoms, pain intensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) and patient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety for three participants and a decrease of depression for four participants. Decreases were small and did not always reach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two out of four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnostic criteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patient satisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support may be a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, the effects are unclear. The gap between high patient satisfaction and small changes in symptomatology should be explored further.
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Affiliation(s)
- Matilda Wurm
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Caroline Lorenz
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | - Maria Tillfors
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Fredrik Holländare
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
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Dudeney J, Sharpe L, Jaffe A, Jones EB, Hunt C. Anxiety in youth with asthma: A meta-analysis. Pediatr Pulmonol 2017; 52:1121-1129. [PMID: 28749088 DOI: 10.1002/ppul.23689] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/19/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Anxiety often presents comorbidly with asthma in youth under 18; however, prevalence rates are unclear. The aim of this review was to provide an up-to-date analysis of the literature investigating the prevalence of anxiety disorders, and comparisons of anxiety disorders and symptomatology in youth with asthma, compared to those without. METHODS A systematic search was conducted using the databases PsycINFO, MEDLINE, EMBASE, and CINAHL. RESULTS The search process produced 15 studies (n = 7443) reporting data on youth with asthma and anxiety disorders, 11 studies (n = 10 332) reporting data on youth with and without asthma and anxiety disorders, and 28 studies (n = 5848) reporting data on youth with and without asthma and anxiety symptomatology. Youth with asthma had an anxiety disorder prevalence rate of 22.7%. Youth with asthma also had a greater number of anxiety disorders, compared to those without asthma (d = 0.37, 95%CI: 0.24-0.50, P < 0.001), and higher levels of anxiety symptomatology than youth without asthma (d = 0.29, 95%CI: 0.19-0.39, P < 0.001). CONCLUSIONS Youth with asthma display a prevalence rate for anxiety disorders that is more than three times higher than the prevalence in healthy youth. For the specific anxiety disorders investigated, elevated prevalence rates for youth with asthma were also found. Future research needs to focus on the factors that mediate or predict the development and maintenance of anxiety in youth with asthma and the development of clinically efficacious treatments.
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Affiliation(s)
- Joanne Dudeney
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Emma B Jones
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Naylor B, Boag S, Gustin SM. New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scand J Pain 2017; 17:58-67. [PMID: 28850375 DOI: 10.1016/j.sjpain.2017.07.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Personality traits may influence development and adjustment to ongoing pain. Over the past 120 years, there has been considerable research into the relationship between pain and personality. This paper presents new evidence for common personality traits found amongst chronic pain sufferers. In particular, it evaluates evidence for Cloninger's biopsychosocial model of personality in distinguishing typical personality features of chronic pain sufferers. It evaluates this evidence in the context of the past 120 years of research including psychodynamic formulations, MMPI studies, personality disorder investigations, and the influence of neuroticism on chronic pain. METHODS A literature search was conducted using PubMed, Medline, PsycINFO, SCOPUS and Cochrane library. Search terms included chronic pain, pain, personality, neuroticism, harm avoidance, self-directedness, attachment, Temperament and Character Inventory (TCI-R), MMPI, MMPI-2, NEO-PI, EPI, Millon Clinical Multiaxial Inventory, Millon Behavioral Health Inventory, Millon Behavioral Medicine Diagnostic, the Personality Assessment Inventory, the Locus of Control Construct and different combinations of these terms. CONCLUSIONS Recent descriptive studies using Cloninger's Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic, sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of 'a pain personality'. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support 'a pain personality' and may be confounded by somatic items in the instrument. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples. CLINICAL IMPLICATIONS Because harm avoidance reflects a tendency to developed conditioned fear responses, we suggest that higher harm avoidance may create more vulnerability to developing a fear-avoidance response to chronic pain. Furthermore, lower self-directedness may contribute to keeping a sufferer within this vicious cycle of fear, avoidance and suffering. Moreover, we suggest that harm avoidance and self-directedness are broader and more complex constructs than current clinical targets of CBT such as fear-avoidance and self-efficacy. Thus, assessing such personality traits may help to address the complexity of chronic pain presentations. For example, it may help to identify and treat sufferers more resistant to treatment, more prone to comorbidity and more vulnerable to entering the vicious cycle of chronic pain, suffering and disability.
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Affiliation(s)
- Brooke Naylor
- Neuroscience Research Australia, Australia; School of Psychology, Macquarie University, Australia
| | - Simon Boag
- School of Psychology, Macquarie University, Australia
| | - Sylvia Maria Gustin
- Neuroscience Research Australia, Australia; School of Psychology, University of New South Wales, Australia.
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Zemestani M, Imani M, Ottaviani C. A Preliminary Investigation on the Effectiveness of Unified and Transdiagnostic Cognitive Behavior Therapy for Patients With Comorbid Depression and Anxiety. Int J Cogn Ther 2017. [DOI: 10.1521/ijct.2017.10.2.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mehdi Zemestani
- Department of Clinical Psychology, University of Kurdistan, Sanandaj, Iran
| | - Mahdi Imani
- Department of Clinical Psychology, University of Shiraz, Fars, Iran
| | - Cristina Ottaviani
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Italy
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Sharma P, Mehta M, Sagar R. Efficacy of transdiagnostic cognitive-behavioral group therapy for anxiety disorders and headache in adolescents. J Anxiety Disord 2017; 46:78-84. [PMID: 27856068 DOI: 10.1016/j.janxdis.2016.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 08/06/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Abstract
Anxiety disorders and headache are both among the most prevalent disorders among adolescents. Although cognitive behavioral therapy (CBT) has proved its efficacy with each of these disorders individually, there are several barriers to its utilization, including cost, gaps in knowledge about treatment delivery and modes, and its utility with comorbid disorders. The current study examined the comparative efficacy of a 12 week TCBT Group treatment (n=32) versus treatment as usual group (n=31) (TAU) in adolescents with anxiety disorders and headache in a north Indian hospital based setting. Results from 63 adolescents suggested while both conditions improved significantly on the Headache Impact Test and Children's Global Assessment Scale, those receiving TCBT showed significantly greater improvement than those in the TAU condition. Participants receiving TCBT, but not those in the TAU condition, showed significant improvement on the State Trait Anxiety Inventory. The study provides evidence supporting the efficacy of TCBT in adolescents with anxiety disorders and headache. Further, group TCBT has the benefits of easy dissemination and increased access to evidence-based treatment, thus, lowering costs and therapist time.
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Affiliation(s)
- Pragya Sharma
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, Delhi 110029, India.
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, Delhi 110029, India.
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, Delhi 110029, India.
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31
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Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment. CHILDREN-BASEL 2016; 3:children3040040. [PMID: 27918444 PMCID: PMC5184815 DOI: 10.3390/children3040040] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent-child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.
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32
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Mazaheri M, Roohafza HR, Mohammadi M, Afshar H. The structural model of pain, cognitive strategies, and negative emotions in functional gastrointestinal disorders. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:107. [PMID: 28250784 PMCID: PMC5322688 DOI: 10.4103/1735-1995.193179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/10/2016] [Accepted: 07/18/2016] [Indexed: 11/12/2022]
Abstract
Background: Patients with functional gastrointestinal disorders (FGIDs) may use specific coping strategies. We intend to provide a mediating role of the relationship between pain (intensity and acceptance), cognitive emotion regulation strategies, and negative emotions in patients with FGIDs. Materials and Methods: Participants were 176 inpatients, all experiencing significant FGIDs symptomatology as confirmed by gastroenterologists. Patients completed data on cognitive emotion regulation questionnaire, short form of depression, anxiety, stress scale, chronic pain acceptance questionnaire-revised, and pain intensity scale. Data were analyzed using structural equation modeling method. Results: The pain intensity had significantly direct effect on cognitive emotion regulation strategies and indirect effect on negative emotions. Besides, the mediating role of negative emotions in the relationship between the strategies and pain acceptance were supported, whereas indirect relationships between pain intensity and acceptance through cognitive strategies were not confirmed. Conclusion: The results of the study emphasize the role of pain intensity in the development of negative emotions through cognitive strategies and the role of the strategies in pain acceptance through negative emotions. In fact, cognitive strategies to be related to pain and emotions.
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Affiliation(s)
- Mina Mazaheri
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Roohafza
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mohammadi
- Department of Statistic, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Department of Psychiatry, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Flink IK, Sfyrkou C, Persson B. Customized CBT via internet for adolescents with pain and emotional distress: A pilot study. Internet Interv 2016; 4:43-50. [PMID: 30135789 PMCID: PMC6096266 DOI: 10.1016/j.invent.2016.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/07/2016] [Accepted: 03/13/2016] [Indexed: 12/18/2022] Open
Abstract
The aim of this pilot study was to explore the effects of an early and customized CBT intervention, mainly delivered via internet, for adolescents with coexisting recurrent pain and emotional distress (low mood, worry, and/or distress). The intervention was based on a transdiagnostic approach, to concurrently target pain and emotional distress. A single case experimental design (SCED) was employed with six participants, 17-21 years old, who were recruited via school health care professionals at the student health care team at an upper secondary school in a small town in Sweden. The intervention consisted of 5-9 modules of CBT, delivered via internet in combination with personal contacts and face to face sessions. The content and length of the program was customized depending on needs. The effects of the program were evaluated based on self-report inventories, which the participants filled out before and after the intervention and at a six month follow-up. They did also fill out a diary where they rated symptoms on a daily basis. The results were promising, at least when considering changes during the intervention as well as pre- and posttest ratings. However, the results were more modest when calculating the reliable change index (RCI), and most of the treatment effects were not sustained at the follow-up assessment, which raises questions about the durability of the effects. Taken together, this study indicates that this type of program is promising as an early intervention for adolescents with pain and concurrent emotional distress, although the outcomes need to be explored further, especially in terms of long-term effects.
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Affiliation(s)
- Ida K. Flink
- Corresponding author at: Institution of Law, Psychology, and Social Work, 70182 Örebro, Sweden.
| | - Christina Sfyrkou
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Bob Persson
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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Mazaheri M. Difficulties in Emotion Regulation and Mindfulness in Psychological and Somatic Symptoms of Functional Gastrointestinal Disorders. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e954. [PMID: 26834811 PMCID: PMC4733315 DOI: 10.17795/ijpbs-954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/28/2015] [Accepted: 09/16/2015] [Indexed: 12/14/2022]
Abstract
Background: Negative emotions are the best predictors for psychological and physical health. Objectives: We aimed to investigate the role of difficulties in emotion regulation and mindfulness on psychological and somatic symptoms of patients with functional gastrointestinal disorders (FGID). Patients and Methods: In this cross-sectional study, the studied sample was selected using census method. A total of 167 patients with FGID completed a demographic questionnaire, difficulties in emotion regulation scale (DERS), mindful attention awareness scale (MAAS), depression, anxiety and stress scale (DASS), and gastrointestinal symptom rating scale (GSRS). To examine the relationship between studied variables, Pearson correlation coefficients and multiple regression analyses were used. Results: The findings of the study indicate that difficulties in emotion regulation and mindfulness are significantly correlated to both increased psychological and somatic symptoms. Some factors of difficulties in emotion regulation positively predicted those symptoms. Among these factors, only lack of awareness was not significantly correlated with both symptoms as well as decreased mindfulness. Conclusions: The findings suggest some potential targets to reduce symptoms. Patients with FGID may benefit from treatments that facilitate emotional experience, functional status, and ability to control impulsive behaviors and behave according to the goals when experiencing negative emotions.
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Affiliation(s)
- Mina Mazaheri
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
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35
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Individualized Guided Internet-delivered Cognitive-Behavior Therapy for Chronic Pain Patients With Comorbid Depression and Anxiety. Clin J Pain 2015; 31:504-16. [DOI: 10.1097/ajp.0000000000000176] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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36
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The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation. Clin J Pain 2015; 31:375-83. [DOI: 10.1097/ajp.0000000000000127] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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37
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Weisberg RB, Magidson JF. Integrating cognitive behavioral therapy into primary care settings. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:247-251. [PMID: 27471370 PMCID: PMC4961302 DOI: 10.1016/j.cbpra.2014.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Risa B Weisberg
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Department of Family Medicine
| | - Jessica F Magidson
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, Behavioral Medicine Service, The Chester M. Pierce, MD Division of Global Psychiatry
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38
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Experimental pain responses in children with chronic pain and in healthy children: how do they differ? Pain Res Manag 2012; 17:103-9. [PMID: 22518373 DOI: 10.1155/2012/592108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extant research comparing laboratory pain responses of children with chronic pain with healthy controls is mixed, with some studies indicating lower pain responsivity for controls and others showing no differences. Few studies have included different pain modalities or assessment protocols. OBJECTIVES To compare pain responses among 26 children (18 girls) with chronic pain and matched controls (mean age 14.8 years), to laboratory tasks involving thermal heat, pressure and cold pain. Responses to cold pain were assessed using two different protocols: an initial trial of unspecified duration and a second trial of specified duration. METHODS Four trials of pressure pain and of thermal heat pain stimuli, all of unspecified duration, were administered, as well as the two cold pain trials. Heart rate and blood pressure were assessed at baseline and after completion of the pain tasks. RESULTS Pain tolerance and pain intensity did not differ between children with chronic pain and controls for the unspecified trials. For the specified cold pressor trial, 92% of children with chronic pain completed the entire trial compared with only 61.5% of controls. Children with chronic pain exhibited a trend toward higher baseline and postsession heart rate and reported more anxiety and depression symptoms compared with control children. CONCLUSIONS Contextual factors related to the fixed trial may have exerted a greater influence on pain tolerance in children with chronic pain relative to controls. Children with chronic pain demonstrated a tendency toward increased arousal in anticipation of and following pain induction compared with controls.
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39
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Chu BC. Translating Transdiagnostic Approaches to Children and Adolescents. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Rohde P. Applying Transdiagnostic Approaches to Treatments With Children and Adolescents: Innovative Models That Are Ready for More Systematic Evaluation. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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