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Paschali M, Thompson GS, Mehta S, Howard PM, Yamin JB, Edwards RR, Donnino MW. Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale. FRONTIERS IN PAIN RESEARCH 2024; 5:1328495. [PMID: 39091382 PMCID: PMC11291320 DOI: 10.3389/fpain.2024.1328495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/24/2024] [Indexed: 08/04/2024] Open
Abstract
Chronic pain syndromes affect over one-third of the US adult population and often lead to significant disability and a reduced quality of life. Despite their high prevalence, causal links between chronic pain syndromes and anatomic abnormalities are often not apparent. Most current chronic pain treatments provide modest, if any, relief. Thus, there is a pressing need to understand the causal mechanisms implicated in chronic pain as a means to develop more targeted interventions for improvement in clinical outcomes and reduction in morbidity and financial burden. In the present manuscript, we summarize the current literature on treatment for chronic pain, and hypothesize that non-specific chronic back pain (without a clear organic etiology, such as tumors, infections or fractures) is of psychophysiologic origin. Based on this hypothesis, we developed Psychophysiologic Symptom Relief Therapy (PSRT), a novel pain reduction intervention for understanding and treating chronic pain. In this manuscript, we provide the rationale for PSRT, which we have tested in a pilot trial with a subsequent larger randomized trial underway. In the proposed trial, we will evaluate whether non-specific chronic back pain can be treated by addressing the underlying stressors and psychological underpinnings without specific physical interventions.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Garrett S. Thompson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shivani Mehta
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia M. Howard
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jolin B. Yamin
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Lanzara R, Conti C, Lalli V, Cannizzaro P, Affaitati GP, Giamberardino MA, Williams A, Porcelli P. Emotions in search of words: Does alexithymia predict treatment outcome in chronic musculoskeletal pain? Stress Health 2024:e3436. [PMID: 38896506 DOI: 10.1002/smi.3436] [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: 08/28/2023] [Revised: 05/22/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Chronic pain, with its complex and multidimensional nature, poses significant challenges in identifying effective long-term treatments. There is growing scientific interest in how psychopathological and personality dimensions may influence the maintenance and development of chronic pain. This longitudinal study aimed to investigate whether alexithymia can predict the improvement of pain severity following a treatment-as-usual programme for chronic musculoskeletal pain over and above psychological cofactors (emotional distress, catastrophizing, and self-efficacy). A consecutive sample of 129 patients with diagnosed chronic musculoskeletal pain referred to two tertiary care centres was recruited and treated for 16 weeks. Clinical pain, psychological distress, self-efficacy, catastrophizing, and alexithymia were assessed with validated self-report measures at the first medical visit (T0) and at 16-week follow-up (T1). Compared with non-responder patients (n = 72, 55.8%), those who responded (i.e., reduction of >30% in pain severity; n = 57, 44.2%) reported an overall improvement in psychological variables except alexithymia. Alexithymia showed relative stability between baseline and follow-up within the entire sample and remained a significant predictor of treatment outcome even when other predictive cofactors (i.e., pain interference, depressive symptoms, and catastrophizing) were considered simultaneously. Our results suggest that identifying patients with a co-occurrence between alexithymia, depressive symptoms, catastrophizing, and the stressful experience of chronic pain can be clinically relevant in pain prevention and intervention programs.
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Affiliation(s)
- Roberta Lanzara
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Vittorio Lalli
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Paolo Cannizzaro
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Gianna Pia Affaitati
- Department of Innovative Technologies in Medicine & Dentistry, University "Gabriele d'Annunzio", Chieti, Italy
| | - Maria Adele Giamberardino
- Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alison Williams
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415842. [PMID: 38869899 PMCID: PMC11177167 DOI: 10.1001/jamanetworkopen.2024.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
Importance Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. Objectives To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Interventions Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. Main Outcomes and Measures The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Results Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. Conclusions and Relevance The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. Trial Registration ClinicalTrials.gov Identifier: NCT03918642.
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Affiliation(s)
- Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Nicholas J. Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alexander Alas
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
| | - Rebecca J. Melrose
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - David L. Sultzer
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine
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Smith R, Persich MR, Chuning AE, Cloonan S, Woods-Lubert R, Skalamera J, Berryhill SM, Weihs KL, Lane RD, Allen JJB, Dailey NS, Alkozei A, Vanuk JR, Killgore WDS. Improvements in mindfulness, interoceptive and emotional awareness, emotion regulation, and interpersonal emotion management following completion of an online emotional skills training program. Emotion 2024; 24:431-450. [PMID: 37535567 PMCID: PMC10837318 DOI: 10.1037/emo0001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Socioemotional skills, such as the ability to recognize, understand, and regulate the emotions of self and others, are associated with both physical and emotional health. The present study tested the effectiveness of a recently validated online training program for increasing these emotional skills in adults. In this study, 448 participants (323 female) were randomly assigned to complete this training program or a placebo control program. Among those who completed the training program or placebo (N = 326), the training program led to improved scores post-training on measures of interoceptive and emotional awareness, mindfulness, emotion recognition, and emotion regulation strategies (e.g., reduced emotion suppression and greater impulse control) relative to placebo. In a smaller group of participants who also completed a 6-month follow-up visit (N = 94), sustained improvements were observed on several measures in those who completed the training program, while the placebo group instead showed decreased performance. This suggested a potentially protective effect against emotional challenges associated with the COVID-19 pandemic occurring during this time. These results suggest that this online training program shows promise in improving emotional skills relevant to adaptive social and emotional functioning, and that it might be useful as an intervention within at-risk populations and those with emotional disorders associated with reduced application of these skills. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Ryan Smith
- University of Arizona
- Laureate Institute for Brain Research
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5
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Beals K, Torregrossa LJ, Smith R, Lane RD, Sheffield JM. Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia. Front Psychiatry 2024; 14:1325617. [PMID: 38283891 PMCID: PMC10811959 DOI: 10.3389/fpsyt.2023.1325617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives Evidence suggests that emotional awareness-the ability to identify and label emotions-may be impaired in schizophrenia and related to positive symptom severity. Exposure to childhood maltreatment is a risk factor for both low emotional awareness and positive symptoms. Methods The current investigation examines associations between a performance-based measure of emotional awareness, positive symptom severity, and childhood maltreatment exposure in 44 individuals with a schizophrenia-spectrum disorder and 48 healthy comparison participants using the electronic Levels of Emotional Awareness Scale (eLEAS), Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire (CTQ). Results Patients demonstrated significant deficits in emotional awareness overall, which was true for both self and others. In patients, lower emotional awareness was significantly associated with more severe positive symptoms. Emotional awareness was significantly impaired in patients with schizophrenia with self-reported maltreatment exposure, relative to other groups. Severity of maltreatment was not significantly associated with emotional awareness or positive symptoms when looking continuously, and there was no significant indirect effect. Conclusion These data suggest that emotional awareness impairments observed in schizophrenia may be exacerbated by exposure to childhood maltreatment, possibly putting individuals at greater risk for experiencing positive symptoms of psychosis.
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Affiliation(s)
- Kendall Beals
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Social Cognition and Recovery in Schizophrenia Lab, Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Lénie J. Torregrossa
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Richard David Lane
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Julia M. Sheffield
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Yarns BC, Molaie AM, Lumley MA, Zhu TA, Jazi AN, Ganz DA, Melrose RJ. Video telehealth emotional awareness and expression therapy for older U.S. military veterans with chronic pain: A pilot study. Clin Gerontol 2024; 47:136-148. [PMID: 36541672 DOI: 10.1080/07317115.2022.2159909] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Emotional Awareness and Expression Therapy (EAET) targets trauma and emotional conflict to reduce or eliminate chronic pain, but video telehealth administration is untested. This uncontrolled pilot assessed acceptability, feasibility, and preliminary efficacy of group-based video telehealth EAET (vEAET) for older veterans with chronic musculoskeletal pain. METHODS Twenty veterans were screened, and 16 initiated vEAET, delivered as one 60-minute individual session and eight 90-minute group sessions. Veterans completed posttreatment satisfaction ratings and pain severity (primary outcome), pain interference, anxiety, depression, functioning, social connectedness, shame, and anger questionnaires at baseline, posttreatment, and 2-month follow-up. RESULTS Satisfaction was high, and veterans attended 7.4 (SD = 0.6) of 8 group sessions; none discontinued treatment. Veterans attained significant, large reductions in pain severity from baseline to posttreatment (p < .001, Hedges' g = -1.54) and follow-up (p < .001, g = -1.20); 14 of 16 achieved clinically significant (≥ 30%) pain reduction, and 3 achieved 90-100% pain reduction. Secondary outcomes demonstrated significant, medium-to-large improvements. CONCLUSIONS In this small sample, vEAET produced better attendance, similar benefits, and fewer dropouts than in-person EAET in prior studies. Larger, controlled trials are needed. CLINICAL IMPLICATIONS Group vEAET appears feasible and highly effective for older veterans with chronic pain.
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Affiliation(s)
- Brandon C Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali M Molaie
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tongtong A Zhu
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Ali Najafian Jazi
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David A Ganz
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rebecca J Melrose
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Silveira S, Godara M, Faschinger A, Singer T. Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice. J Affect Disord 2023; 341:162-169. [PMID: 37598721 DOI: 10.1016/j.jad.2023.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. METHODS This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. RESULTS Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LIMITATIONS Given the subclinical study sample, findings are limited in their generalizability to clinical samples. CONCLUSIONS Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.
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Affiliation(s)
- Sarita Silveira
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany.
| | - Malvika Godara
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Anna Faschinger
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
| | - Tania Singer
- Social Neuroscience Lab, Max Planck Society, Berlin, Germany
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Krohner S, Yamin JB, Ziadni MS, Carty McIntosh JN, Schubiner H, Lumley MA. Emotional Awareness and Expression Interview: Examining Interview Content and Patient Experiences in Two Medical Samples. J Clin Psychol Med Settings 2023; 30:520-530. [PMID: 36190608 PMCID: PMC10122833 DOI: 10.1007/s10880-022-09913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
A single session of Emotional Awareness and Expression Therapy (EAET)-the EAET Interview-was previously shown to lead to clinical benefits for patients with centralized somatic conditions in primary care (Ziadni et al. in Health Psychol 37(3):282-290, 2018) and tertiary care (Carty et al. in Pain Med 20(7):1321-1329, 2019) settings. There has yet to be an examination of patients' experiences of and reactions to the EAET Interview, which is crucial in evaluating possible clinical implementation of the interview. We conducted secondary analyses on 88 patients (M age = 41.32, 90.9% women) from the two prior trials (primary care N = 51; tertiary care N = 37). Analyses examined interview processes (stress disclosure themes, working alliance, and emotional processing) and patients' reactions to the interview (interview credibility and perceived value of the interview), comparing the two samples and examining correlations among these variables. All patients disclosed at least one stressful life experience, commonly interpersonal problems (89.2%) and childhood adversity (51.5%). Patients had moderately high levels of working alliance and emotional processing during the interview and reported high interview credibility and perceived value of the interview. More extensive emotional processing of stressors was associated with more positive patient reactions to the interview, including higher interview credibility (r = .23) and perceived value (r = .32). We conclude that the single-session EAET Interview was valued by most patients, and patients' emotional processing is particularly beneficial. Addressing the trauma and emotional conflicts of patients with centralized somatic conditions is both feasible and valuable in front-line medical settings.
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Affiliation(s)
- Shoshana Krohner
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Jolin B Yamin
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Maisa S Ziadni
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | | | - Howard Schubiner
- Department of Internal Medicine, Ascension Health/Providence Park Hospital, Michigan State University, Southfield, MI, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA.
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Zamir O, Yarns BC, Lagman-Bartolome AM, Jobanputra L, Lawler V, Lay C. Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review. Headache 2023; 63:1031-1039. [PMID: 37638484 DOI: 10.1111/head.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments. BACKGROUND Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes. METHODS We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing. RESULTS Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment. CONCLUSION There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.
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Affiliation(s)
- Orit Zamir
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Wasser Pain Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ana Marissa Lagman-Bartolome
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Lina Jobanputra
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Lawler
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Lay
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Junghaenel DU, Schneider S, Lucas G, Boberg J, Weinstein FM, Richeimer SH, Stone AA, Lumley MA. Virtual Human-Delivered Interviews for Patients With Chronic Pain: Feasibility, Acceptability, and a Pilot Randomized Trial of Standard Medical, Psychosocial, and Educational Interviews. Psychosom Med 2023; 85:627-638. [PMID: 37363989 PMCID: PMC10527278 DOI: 10.1097/psy.0000000000001228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Seminal advances in virtual human (VH) technology have introduced highly interactive, computer-animated VH interviewers. Their utility for aiding in chronic pain care is unknown. We developed three interactive telehealth VH interviews-a standard pain-focused, a psychosocial risk factor, and a pain psychology and neuroscience educational interview. We then conducted a preliminary investigation of their feasibility, acceptability, and efficacy. We also experimentally compared a human and a computer-generated VH voice. METHODS Patients ( N = 94, age = 22-78 years) with chronic musculoskeletal pain were randomly assigned to the standard ( n = 31), psychosocial ( n = 34), or educational ( n = 29) VH interview and one of the two VH voices. Acceptability ratings included patient satisfaction and expectations/evaluations of the VH interview. Outcomes assessed at baseline and about 1-month postinterview were pain intensity, interference, emotional distress, pain catastrophizing, and readiness for pain self-management. Linear mixed-effects models were used to test between- and within-condition effects. RESULTS Acceptability ratings showed that satisfaction with the VH and telehealth format was generally high, with no condition differences. Study attrition was low ( n = 5). Intent-to-treat-analyses showed that, compared with the standard interview, the psychosocial interview yielded a significantly greater reduction in pain interference ( p = .049, d = 0.43) and a marginally greater reduction in pain intensity ( p = .054, d = 0.36), whereas the educational interview led to a marginally greater yet nonsignificant increase in readiness for change ( p = .095, d = 0.24), as well as several significant improvements within-condition. Results did not differ by VH voice. CONCLUSIONS Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education.
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Affiliation(s)
- Doerte U. Junghaenel
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, CA, USA
| | - Stefan Schneider
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, CA, USA
| | - Gale Lucas
- Institute for Creative Technologies, University of Southern California, CA, USA
- Viterbi School of Engineering, University of Southern California, CA, USA
| | - Jill Boberg
- Institute for Creative Technologies, University of Southern California, CA, USA
| | - Faye M. Weinstein
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, CA, USA
| | - Steven H. Richeimer
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, CA, USA
| | - Arthur A. Stone
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, MI, USA
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11
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Elyoseph Z, Hadar-Shoval D, Asraf K, Lvovsky M. ChatGPT outperforms humans in emotional awareness evaluations. Front Psychol 2023; 14:1199058. [PMID: 37303897 PMCID: PMC10254409 DOI: 10.3389/fpsyg.2023.1199058] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
The artificial intelligence chatbot, ChatGPT, has gained widespread attention for its ability to perform natural language processing tasks and has the fastest-growing user base in history. Although ChatGPT has successfully generated theoretical information in multiple fields, its ability to identify and describe emotions is still unknown. Emotional awareness (EA), the ability to conceptualize one's own and others' emotions, is considered a transdiagnostic mechanism for psychopathology. This study utilized the Levels of Emotional Awareness Scale (LEAS) as an objective, performance-based test to analyze ChatGPT's responses to twenty scenarios and compared its EA performance with that of the general population norms, as reported by a previous study. A second examination was performed one month later to measure EA improvement over time. Finally, two independent licensed psychologists evaluated the fit-to-context of ChatGPT's EA responses. In the first examination, ChatGPT demonstrated significantly higher performance than the general population on all the LEAS scales (Z score = 2.84). In the second examination, ChatGPT's performance significantly improved, almost reaching the maximum possible LEAS score (Z score = 4.26). Its accuracy levels were also extremely high (9.7/10). The study demonstrated that ChatGPT can generate appropriate EA responses, and that its performance may improve significantly over time. The study has theoretical and clinical implications, as ChatGPT can be used as part of cognitive training for clinical populations with EA impairments. In addition, ChatGPT's EA-like abilities may facilitate psychiatric diagnosis and assessment and be used to enhance emotional language. Further research is warranted to better understand the potential benefits and risks of ChatGPT and refine it to promote mental health.
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Affiliation(s)
- Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, England
| | - Dorit Hadar-Shoval
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Kfir Asraf
- Psychology Department, Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Maya Lvovsky
- Psychology Department, Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
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12
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Aaron RV, McGill LS, Finan PH, Wegener ST, Campbell CM, Mun CJ. Determining Profiles of Pain-Specific and General Emotion Regulation Skills and Their Relation to 12-Month Outcomes Among People With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:667-678. [PMID: 36503109 PMCID: PMC10079591 DOI: 10.1016/j.jpain.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Difficulties with pain-specific emotion regulation (ER; eg, pain catastrophizing, pain acceptance) are associated with poor pain outcomes. Less is known about how general ER relates to pain outcomes, or the extent to which pain-specific and general ER interact. In a sample (N = 1,453) of adults with chronic pain, the current study used latent profile analysis to identify subgroups of people with distinct pain-specific and general ER profiles, and determined how subgroup membership at baseline related to pain severity, pain interference, depression and anxiety symptoms at 12-month follow-up. Four groups were identified: 1) general ER difficulties only (29.6%); 2) pain-specific and general ER difficulties (26.3%); 3) skillful pain-specific and general ER (24.6%); 4) pain-specific ER difficulties only (19.4%). Controlling for auto-correlation and demographic covariates, those with pain-specific and general ER difficulties had the worst outcomes in all domains. Membership to other groups did not differentiate between pain severity or interference outcomes; those skillful in pain-specific and general ER had the lowest depression and anxiety symptoms at 12 months. General ER difficulties are common among adults with chronic pain and raise relative risk when paired with pain-specific ER difficulties. Findings offer potential directions for individualizing pain psychology treatment. PERSPECTIVE: This article shows that people with chronic pain have different sets of strengths and difficulties when it comes to regulating emotions related and/or unrelated to the experience of pain itself. Understanding an individual's unique constellation of emotion regulation skills and difficulties might help personalize the psychological treatment of pain.
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Affiliation(s)
- Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Edson College of Nursing and Health Innovation, Arizona State University, Pheonix, Arizona
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13
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Gower C, Trevitt J, Cherry BJ, Zettel-Watson L. Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia. Front Med (Lausanne) 2022; 9:1033936. [PMID: 36590966 PMCID: PMC9794591 DOI: 10.3389/fmed.2022.1033936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age. Methods The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale. Results It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors. Discussion Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.
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Affiliation(s)
- Caitlin Gower
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States
| | - Jennifer Trevitt
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States
| | - Barbara J. Cherry
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States,Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, United States
| | - Laura Zettel-Watson
- Fibromyalgia and Chronic Pain Center, California State University, Fullerton, Fullerton, CA, United States,Department of Psychology, California State University, Fullerton, Fullerton, CA, United States,Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, United States,*Correspondence: Laura Zettel-Watson,
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14
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Maroti D, Lumley MA, Schubiner H, Lilliengren P, Bileviciute-Ljungar I, Ljótsson B, Johansson R. Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial. J Psychosom Res 2022; 163:111068. [PMID: 36327532 DOI: 10.1016/j.jpsychores.2022.111068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/11/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Somatic symptom disorder (SSD) is commonly encountered in health care settings. Cognitive-behavioural treatments have been most extensively studied, but they tend to have small effects of temporary duration. Emotional awareness and expression therapy (EAET) is a newly developed treatment for SSD, targeting emotional processing of trauma and conflict as a mechanism of symptom change. In an earlier uncontrolled study of self-guided, internet-administrated EAET (I-EAET), we found substantial reductions in somatic symptoms, prompting the need for a randomized controlled trial of I-EAET. METHODS We conducted a 2-arm RCT, comparing 10-week I-EAET (n = 37) to a waitlist control (WL; n = 37). Primary outcomes were reductions of somatic symptoms (PHQ-15) and pain intensity (BPI-4) at post-treatment, with a 4-month evaluation of effect duration. We also analysed emotional processing (EPS-25) and depression (PHQ-9) as possible mediators of I-EAET's effects. RESULTS Compared to controls, I-EAET significantly reduced somatic symptoms at both post-treatment and follow-up. I-EAET also reduced pain, depression, insomnia, and anxiety at post-treatment, but these effects were not retained at follow-up. As hypothesized, a facet of emotional processing partially mediated the treatment effect on somatic symptoms, even when controlling for depression. CONCLUSIONS Although treatment effects were smaller than in the previous uncontrolled trial, I-EAET is a promising treatment for SSD, with a minority of patients (around 20%) experiencing substantial clinical improvement. The benefits of I-EAET are partially mediated by improved emotional processing. Future research should identify and target patients who respond best to I-EAET and develop tailored treatment to enhance treatment effects. (Preregistered at clinicaltrials.gov: NCT04751825.).
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA..
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden..
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Robert Johansson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden..
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15
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Ziadni MS, Sturgeon JA, Lumley MA. "Pain, Stress, and Emotions": Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1028561. [PMID: 36466215 PMCID: PMC9715975 DOI: 10.3389/fpain.2022.1028561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
Objectives Trauma- and emotion-focused chronic pain interventions, particularly Emotional Awareness and Expression Therapy (EAET), show much promise for reducing pain and improving functioning. We developed a novel, single-session, telehealth-delivered EAET class ("Pain, Stress, and Emotions"; PSE) and tested it on adults with chronic pain of mixed etiology. Methods After an initial developmental phase, we conducted an uncontrolled trial, providing PSE to 74 individuals with chronic pain (63.5% female; 64.9% White; 60.8% with pain duration >5 years) in four class administrations. Participants completed self-report measures (primary outcomes: pain intensity and pain interference) at baseline and multiple follow-ups to 12 weeks. Linear mixed-models examined changes over time, and effect sizes were calculated on change from baseline to 4-week (primary endpoint) and 12-week follow-ups. The trial was registered with clinicaltrials.gov (NCT05014126). Results Participants reported high satisfaction with the PSE class. Pain intensity showed a significant, medium reduction across time (p < .001; d = 0.60 at 4 weeks); one-quarter of participants had clinically meaningful pain reduction (≥30%). Pain interference had a large reduction (p < .001; d = 0.74). There were significant but smaller improvements in most secondary outcomes (ds = 0.15 to 0.55; ps < .01). Effects were generally maintained or increased at 12-week follow-up. Higher education and baseline ambivalence over emotional expression predicted greater pain reductions. Conclusions People taking this EAET class had reduced pain severity and interference and improvements in other pain-related outcomes. The single-session, telehealth class holds promise as an easily delivered, efficient, and potentially impactful intervention for some patients with chronic pain, although controlled trials are needed.
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Affiliation(s)
- Maisa S. Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,Correspondence: Maisa Ziadni
| | - John A. Sturgeon
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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16
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Nicola M, Correia H, Ditchburn G, Drummond PD. Defining pain-validation: The importance of validation in reducing the stresses of chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:884335. [PMID: 36313220 PMCID: PMC9614309 DOI: 10.3389/fpain.2022.884335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Purpose To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.
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17
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Do alexithymia and negative affect predict poor sleep quality? The moderating role of interoceptive sensibility. PLoS One 2022; 17:e0275359. [PMID: 36191028 PMCID: PMC9529110 DOI: 10.1371/journal.pone.0275359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Emotion-related hyperarousal is an important core pathology of poor sleep. Studies investigating the interplay of alexithymia and affective experiences in determining sleep quality have yielded mixed results. To disentangle the inconsistency, this study examined the concurrent predictive power of alexithymia, and negative and positive affect, while incorporating interoceptive sensibility (IS) as a possible moderator. METHODS A sample of 224 (70.10% were female) participants completed the Toronto Alexithymia Scale, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Interoceptive Awareness (MAIA), and Marlowe-Crowne Social Desirability Scale (for controlling response bias) using paper and pencil. A two-stage cluster analysis of the MAIA was used to capture IS characteristics. Stepwise regression was conducted separately for each IS cluster. RESULTS A three-group structure for IS characteristics was found. Higher alexithymia was predictive of poor sleep quality in the low IS group, while higher negative affect predicted poor sleep quality in the moderate and high IS groups. Additionally, alexithymia and positive affect were significantly different in the three IS groups, while negative affect and sleep quality were not. CONCLUSIONS Emotion and cognitive arousal may impact sleep quality differently in individuals with different levels of internal focusing ability, depending on physiological versus emotional self-conceptualization. The implications on pathological research, clinical intervention, study limitations and future directions are discussed.
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18
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Li J, Gao X, Qiu Y, Ling Y. Aging-friendly cities: Investigating the effects of street usage on the psychological satisfaction of older adults in megacities. Front Psychol 2022; 13:942301. [PMID: 36204773 PMCID: PMC9531757 DOI: 10.3389/fpsyg.2022.942301] [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: 05/12/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
The psychological satisfaction of older adults is an important evaluation standard for the construction of elder-friendly cities. Meanwhile, as important space carriers carrying the travel activities and social participation of older adults, streets are also of great significance to improve psychological wellbeing. However, few studies pay attention to the street usage of aging population, especially in the context of megacities. Moreover, the previous literature rarely distinguishes the types of streets. Thus, employing a mixed approach, we investigate the relationships between street usage and psychological satisfaction for older adults. Based on the survey in Shanghai, we find that a clear role for different usage indicators in the determination of subjective psychological satisfaction of older adults. More specially, the street usage and psychological satisfaction for older adults are strongly correlated, especially for living streets. Psychological satisfaction for older adults in different types of streets is not always positively related to the positive perception of street usage. The psychological satisfaction of different streets depends on different factors. By focusing on the case of a megacity, our study emphasizes the differences between different types of streets, which will be conducive to the proposal of practical planning policies. In addition, employing mixed research methods not only explains how different street usage affects the psychological welfare of older adults on a macro scale, but also emphasizes the inner world of respondents.
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Affiliation(s)
- Jian Li
- School of Humanities and Social Sciences, Beijing Institute of Technology, Beijing, China
| | - Xing Gao
- School of Humanities and Social Sciences, Beijing Institute of Technology, Beijing, China
- Beijing Institute of Technology, Beijing, China
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
- *Correspondence: Xing Gao,
| | - Yue Qiu
- School of English Language, Literature and Culture, Beijing International Studies University, Beijing, China
| | - Yantao Ling
- School of Economics and Finance, Chongqing University of Technology, Chongqing, China
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19
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Nicola M, Correia H, Ditchburn G, Drummond PD. The Pain-Invalidation Scale: Measuring Patient Perceptions of Invalidation Toward Chronic Pain. THE JOURNAL OF PAIN 2022; 23:1912-1922. [PMID: 35842088 DOI: 10.1016/j.jpain.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023]
Abstract
Increasing evidence reveals the damaging impact of having one's chronic pain symptoms invalidated through disbelief, discrediting, and critical judgement. In other instances, a caregiver's over-attentiveness to the daily tasks of individuals with pain can be problematic, potentially undermining rehabilitation. The aim of this study was to develop an instrument to measure different aspects of invalidation perceived by people with chronic pain. Item generation was informed through literature review and a thematic analysis of narratives from 431 peer-reviewed articles. The crowdsourcing platform Prolific was used to distribute survey items to participants. In Study 1A, Principal Component Analysis was performed on data from 302 respondents, giving rise to 4 subscales, including: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Invalidation by Over-attentive Others. Confirmatory Factor Analysis of data collected from aonther 308 individuals in Study 1B supported the 4-factor model of the Pain-Invalidation Scale (Pain-IS) and identified a best-fit model with 24 items. The Pain-IS was further validated in another 300 individuals in Study 2. The Pain-IS demonstrates sound psychometric properties and may serve as a valuable tool for use by clinicians in the detection of pain-invalidation issues, as a first step in patient pain management. Perspective. Links between pain-invalidation and pain levels, as well as functional detriment, highlight the importance of having one's chronic pain experience heard, believed and accepted. The Pain-Invalidation Scale is designed to identify domains where invalidation of the patient's pain should be addressed to promote emotional processing, treatment adherence and improved outcomes.
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Affiliation(s)
- Melinda Nicola
- College of Science, Health, Engineering, and Education, Murdoch University, Western Australia
| | - Helen Correia
- College of Science, Health, Engineering, and Education, Murdoch University, Western Australia
| | - Graeme Ditchburn
- College of Science, Health, Engineering, and Education, Murdoch University, Western Australia
| | - Peter D Drummond
- College of Science, Health, Engineering, and Education, Murdoch University, Western Australia.
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20
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Aaron RV, Mun CJ, McGill LS, Finan PH, Campbell CM. The Longitudinal Relationship Between Emotion Regulation and Pain-Related Outcomes: Results From a Large, Online Prospective Study. THE JOURNAL OF PAIN 2022; 23:981-994. [PMID: 34974172 PMCID: PMC9232929 DOI: 10.1016/j.jpain.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
People with chronic pain engage in various strategies, such as pain catastrophizing and pain acceptance, to regulate the difficult emotional aspects of living with pain. Engagement in these strategies is known to influence pain severity and pain interference. However, less research has examined the extent to which general emotion regulation, the ability to identify emotions and engage in strategies to alter emotions, relates to pain-related outcomes. The current study, a large (N = 1453) online prospective study of adults with chronic pain, employed theory-driven assessment of emotion regulation to determine the extent to which general difficulties with emotion regulation at baseline relate to pain severity and pain interference at three-month follow-up, above and beyond pain catastrophizing and pain acceptance. We conducted a series of path models, controlling for demographic covariates and baseline pain severity and pain interference. Pain catastrophizing and pain acceptance at baseline significantly predicted pain interference at three-month follow-up. However, when indices of general emotion regulation were entered into the model, the associations between pain catastrophizing and pain interference (B = .009, P = .153) were no longer statistically significant. Alexithymia emerged as a significant predictor of pain severity (B = .012, P = .032) and pain interference (B = .026, P < .001). These findings highlight the value of considering the role of general emotion regulation (particularly identifying and describing emotions), in addition to pain-specific experiences, in understanding risk for poor pain-related outcomes. PERSPECTIVE: In addition to pain catastrophizing and pain acceptance, difficulties regulating emotions in general (particularly elevated alexithymia) relates to pain outcomes three months later. These findings shed light on risk for poor pain outcomes and point to general emotion regulation as a potentially important target of chronic pain intervention.
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Affiliation(s)
- Rachel V Aaron
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland.
| | - Chung Jung Mun
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, AZ; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Lakeya S McGill
- Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland
| | - Patrick H Finan
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
| | - Claudia M Campbell
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Science, Baltimore, Maryland
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21
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Lumley MA, Yamin JB, Pester BD, Krohner S, Urbanik CP. Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain. Pain 2022; 163:599-603. [PMID: 34338244 PMCID: PMC8799778 DOI: 10.1097/j.pain.0000000000002425] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
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22
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Morie KP, Crowley MJ, Mayes LC, Potenza MN. The process of emotion identification: Considerations for psychiatric disorders. J Psychiatr Res 2022; 148:264-274. [PMID: 35151218 PMCID: PMC8969204 DOI: 10.1016/j.jpsychires.2022.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.
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Affiliation(s)
- Kristen P Morie
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Michael J Crowley
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Linda C Mayes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, 06510, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; Connecticut Mental Health Center, New Haven, CT, 06519, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, 06510, USA
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Higher emotional awareness is associated with greater domain-general reflective tendencies. Sci Rep 2022; 12:3123. [PMID: 35210517 PMCID: PMC8873306 DOI: 10.1038/s41598-022-07141-3] [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: 07/14/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
The tendency to reflect on the emotions of self and others is a key aspect of emotional awareness (EA)—a trait widely recognized as relevant to mental health. However, the degree to which EA draws on general reflective cognition vs. specialized socio-emotional mechanisms remains unclear. Based on a synthesis of work in neuroscience and psychology, we recently proposed that EA is best understood as a learned application of domain-general cognitive processes to socio-emotional information. In this paper, we report a study in which we tested this hypothesis in 448 (125 male) individuals who completed measures of EA and both general reflective cognition and socio-emotional performance. As predicted, we observed a significant relationship between EA measures and both general reflectiveness and socio-emotional measures, with the strongest contribution from measures of the general tendency to engage in effortful, reflective cognition. This is consistent with the hypothesis that EA corresponds to the application of general reflective cognitive processes to socio-emotional signals.
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Park J, Zhan X, Gainey KN. Meta-Analysis of the Associations Among Constructs of Intrapersonal Emotion Knowledge. EMOTION REVIEW 2022. [DOI: 10.1177/17540739211068036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To better define the boundaries of conceptually overlapping constructs of intrapersonal emotion knowledge (EK), we examined meta-analytic correlations among five intrapersonal EK-related constructs (affect labelling, alexithymia, emotional awareness, emotional clarity, emotion differentiation) and attention to emotion. Affect labelling, alexithymia, and emotional clarity were strongly associated, and they were moderately associated with attention to emotion. Alexithymia and emotional awareness were weakly associated, and emotion differentiation was unrelated with emotional clarity. Sample characteristics and measures moderated some of the associations. Publication bias was not found, except for the alexithymia-emotional awareness association. This study helped to clarify the extent to which similarly defined constructs overlap or are distinct, which can inform our decision to adequately label important constructs and employ corresponding measures.
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Affiliation(s)
- Juhyun Park
- Department of Psychology, University at Buffalo, The State University of New York, USA
| | - Xinyi Zhan
- Department of Psychology, University at Buffalo, The State University of New York, USA
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Senger K, Rubel JA, Kleinstäuber M, Schröder A, Köck K, Lambert MJ, Lutz W, Heider J. Symptom change trajectories in patients with persistent somatic symptoms and their association to long-term treatment outcome. Psychother Res 2021; 32:624-639. [PMID: 34711141 DOI: 10.1080/10503307.2021.1993376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. METHODS Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with PSS and treated either with conventional cognitive behavioral therapy (CBT) or CBT enriched with emotion regulation training (ENCERT). RESULTS We identified three subgroups of patients with similar symptom change patterns over the course of treatment (a "no change," "strong response," and "slow change" subgroup). Higher initial anxiety symptoms were significantly associated with the no change and strong response subgroups; symptom-related disability in daily routine with no changes. Patients with a strong response had the highest proportion of reliable improvement at termination and at six-month-follow-up. CONCLUSION Our results indicate that, instead of one common change pattern, patients with PSS respond differently to treatment. Due to the high association of symptom curves with long-term outcome, the identification and prediction of an individual's trajectory could provide important information for clinicians to identify non-responding patients that are at risk for failure. Selecting personalized treatment interventions could increase the effectiveness of psychotherapy.Trial registration: ClinicalTrials.gov identifier: NCT01908855..
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Affiliation(s)
- Katharina Senger
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Julian A Rubel
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Health Services, Utah State University, Logan, UT, USA
| | - Annette Schröder
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Katharina Köck
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Jens Heider
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
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“I can’t describe it and they can’t see the rain.” an interpretative phenomenological analysis of the experience of self-harm in young adults who report difficulties identifying and describing their feelings. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02273-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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Donnino MW, Thompson GS, Mehta S, Paschali M, Howard P, Antonsen SB, Balaji L, Bertisch SM, Edwards R, Ngo LH, Grossestreuer AV. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Rep 2021; 6:e959. [PMID: 34589642 PMCID: PMC8476063 DOI: 10.1097/pr9.0000000000000959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Chronic back pain is the leading cause of disability in the United States. Based on the hypothesis that nonspecific back pain may be rooted in a psychophysiologic etiology, we propose a new approach to chronic back pain. OBJECTIVES A pilot study was conducted to assess whether psychophysiologic symptom relief therapy (PSRT) can reduce disability and back pain bothersomeness for patients with chronic back pain. METHODS This was a three-armed, randomized trial for adults with nonspecific chronic back pain that compared PSRT with usual care and an active comparator (mindfulness-based stress reduction [MBSR]). Psychophysiologic symptom relief therapy-randomized participants received a 12-week (36 hours) course based on the psychophysiological model of pain. All groups were administered validated questionnaires at baseline and at 4, 8, 13, and 26 weeks. The primary outcome was the reduction in pain disability measured by the Roland-Morris Disability Questionnaire. RESULTS The mean Roland-Morris Disability Questionnaire score for the PSRT group (n = 11) decreased from 9.5 (±4.3 SDs) to 3.3 (±5.1) after 26 weeks which was statistically significant compared with both MBSR (n = 12) (P = 0.04) and usual care (n = 12) (P = 0.03). Pain bothersomeness scores and pain-related anxiety decreased significantly over 26 weeks in PSRT compared with MBSR and usual care (data in manuscript). At 26 weeks, 63.6% of the PSRT arm reported being pain free (0/10 pain) compared with 25.0% and 16.7% in MBSR and usual care arms, respectively. Psychophysiologic symptom relief therapy attendance was 76%, and there was 100% follow-up of all groups. CONCLUSION Psychophysiologic symptom relief therapy is a feasible and potentially highly beneficial treatment for patients with nonspecific back pain.
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Affiliation(s)
- Michael W. Donnino
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Garrett S. Thompson
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shivani Mehta
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Myrella Paschali
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Patricia Howard
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sofie B. Antonsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Lakshman Balaji
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne M. Bertisch
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Long H. Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Anne V. Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lane RD, Smith R. Levels of Emotional Awareness: Theory and Measurement of a Socio-Emotional Skill. J Intell 2021; 9:42. [PMID: 34449662 PMCID: PMC8395748 DOI: 10.3390/jintelligence9030042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Emotional awareness is the ability to conceptualize and describe one's own emotions and those of others. Over thirty years ago, a cognitive-developmental theory of emotional awareness patterned after Piaget's theory of cognitive development was created as well as a performance measure of this ability called the Levels of Emotional Awareness Scale (LEAS). Since then, a large number of studies have been completed in healthy volunteers and clinical populations including those with mental health or systemic medical disorders. Along the way, there have also been further refinements and adaptations of the LEAS such as the creation of a digital version in addition to further advances in the theory itself. This review aims to provide a comprehensive summary of the evolving theoretical background, measurement methods, and empirical findings with the LEAS. The LEAS is a reliable and valid measure of emotional awareness. Evidence suggests that emotional awareness facilitates better emotion self-regulation, better ability to navigate complex social situations and enjoy relationships, and better physical and mental health. This is a relatively new but promising area of research in the domain of socio-emotional skills. The paper concludes with some recommendations for future research.
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Affiliation(s)
- Richard D. Lane
- Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA;
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Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects. J Psychosom Res 2021; 145:110473. [PMID: 33814192 DOI: 10.1016/j.jpsychores.2021.110473] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment. METHODS Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables. RESULTS We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = -1.07), which was maintained at long-term follow-up (SMD = -0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = -0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders. CONCLUSIONS STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines.
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Senger K, Schröder A, Kleinstäuber M, Rubel JA, Rief W, Heider J. Predicting optimal treatment outcomes using the Personalized Advantage Index for patients with persistent somatic symptoms. Psychother Res 2021; 32:165-178. [PMID: 33910487 DOI: 10.1080/10503307.2021.1916120] [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: 10/21/2022] Open
Abstract
Because individual patients with persistent somatic symptoms (PSS) respond differently to treatments, a better understanding of the factors that predict therapy outcomes are of high importance. Aggregating a wide selection of information into the treatment-decision process is a challenge for clinicians. Using the Personalized Advantage Index (PAI) this study aims to deal with this. Methods: Data from a multicentre RCT comparing CBT (N = 128) versus CBT enriched with emotion regulation training (ENCERT) (N = 126) for patients diagnosed with somatic symptom disorder were used to identify based on two machine learning approaches predictors of therapy outcomes. The identified predictors were used to calculate the PAI. Results: Five treatment unspecific predictors (pre-treatment somatic symptom severity, depression, symptom disability, health-related quality of life, age) and five treatment specific moderators (global functioning, early childhood traumatic events, gender, health anxiety, emotion regulation skills) were identified. Individuals assigned to their PAI-indicated optimal treatment had significantly lower somatic symptom severity at the end of therapy compared to those randomised to their non-optimal condition. Conclusion: Allowing patients to choose a personalised treatment seems to be meaningful. This could help to improve outcomes for PSS and reduce its high costs to the health care system.
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Affiliation(s)
- Katharina Senger
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Annette Schröder
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julian A Rubel
- Department of Psychology, University of Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany
| | - Jens Heider
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
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Nunes da Silva A. Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines. Psychopathology 2021; 54:282-290. [PMID: 34749373 DOI: 10.1159/000519786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022]
Abstract
Despite being a longstanding and well-established concept, alexithymia is unfamiliar for many clinicians. This article aimed to address the alexithymia concept from a clinical perspective based on a review of the research on alexithymia intervention. Several strategies are proposed to help clinicians better work with alexithymic clients in psychotherapy. Alexithymia assessment, its impact on the therapeutic alliance, and the difficulties in emotional tasks are highlighted points. Considering alexithymia will inform clinicians' current diagnosis and conceptualization and provide specific targets and venues for intervention, increasing the effectiveness of psychotherapy.
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Smith R, Badcock P, Friston KJ. Recent advances in the application of predictive coding and active inference models within clinical neuroscience. Psychiatry Clin Neurosci 2021; 75:3-13. [PMID: 32860285 DOI: 10.1111/pcn.13138] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/01/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022]
Abstract
Research in clinical neuroscience is founded on the idea that a better understanding of brain (dys)function will improve our ability to diagnose and treat neurological and psychiatric disorders. In recent years, neuroscience has converged on the notion that the brain is a 'prediction machine,' in that it actively predicts the sensory input that it will receive if one or another course of action is chosen. These predictions are used to select actions that will (most often, and in the long run) maintain the body within the narrow range of physiological states consistent with survival. This insight has given rise to an area of clinical computational neuroscience research that focuses on characterizing neural circuit architectures that can accomplish these predictive functions, and on how the associated processes may break down or become aberrant within clinical conditions. Here, we provide a brief review of examples of recent work on the application of predictive processing models of brain function to study clinical (psychiatric) disorders, with the aim of highlighting current directions and their potential clinical utility. We offer examples of recent conceptual models, formal mathematical models, and applications of such models in empirical research in clinical populations, with a focus on making this material accessible to clinicians without expertise in computational neuroscience. In doing so, we aim to highlight the potential insights and opportunities that understanding the brain as a prediction machine may offer to clinical research and practice.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, Oklahoma, USA
| | - Paul Badcock
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia.,Orygen, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, UK
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Baskan E, Yagci N, Cavlak U. Factors affecting body awareness in older adults with chronic musculoskeletal pain. Arch Med Sci 2021; 17:934-939. [PMID: 34336023 PMCID: PMC8314400 DOI: 10.5114/aoms.2019.86614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/08/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain (CMP) and cognitive impairment (CI) may reduce body awareness in older adults. The first aim of this study was to determine the impact of CMP and CI on body awareness in older adults. The second was to search for the factors most affecting body awareness using logistic regression analysis. MATERIAL AND METHODS Two hundred and 65 older adults (males: 138 and females: 127) aged 65 and over (mean age; 72.27 ±6.42 years) living in their own homes were included. We used the following evaluation methods: CMP intensity (Visual Analog Scale - VAS), cognitive status (Hodkinson's Abbreviated Mental Test - HAMT), and body awareness (Body Awareness Questionnaire - BAQ). Logistic regression analysis was used to determine the factor most affecting the BAQ score. RESULTS Eighty-five point two percent of participants (n = 265) reported CMP (lower extremity pain: 74.6%; spinal pain: 66.6%; upper extremities pain: 44.4%). CMP intensity was higher in lower extremities (mean VAS: 5.73 ±1.86 cm). Gender differences in terms of CMP were found in favor of males (p = 0.0001). Mean HAMT score was 8.16±1.65. Gender difference in favor of males was significant (p = 0.0001). Mean BAQ score was 77.61±20.90; there was no significant difference between the gender (p = 0.142). There was a significant moderate positive correlation between body awareness and cognitive status (r = 0.382, p = 0.0001). However, a weak negative correlation was found between body awareness and pain intensity (r = -0.234, p = 0.0001). Regression analysis showed that living environment (rural area), low education level, low cognition level and increased CMP intensity significantly predicted body awareness. CONCLUSIONS The results obtained from this study indicate that cognitive impairment and pain should be reduced by improving body awareness among older adults. That is why health professionals should evaluate all related factors affecting body awareness before planning the most suitable rehabilitation program.
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Affiliation(s)
- Emre Baskan
- Kinikli Campus, School of Physical Therapy, Pamukkale University, Denizli, Turkey
| | - Nesrin Yagci
- Kinikli Campus, School of Physical Therapy, Pamukkale University, Denizli, Turkey
| | - Ugur Cavlak
- Kinikli Campus, School of Physical Therapy, Pamukkale University, Denizli, Turkey
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Pahlevan M, Besharat MA, Borjali A, Naghipoor M. How can the Alexithymia and Behavioural Inhibition predict the perceived pain intensity in patients with chronic pain? ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Pahlevan M, Besharat MA, Borjali A, Farahani H. A hypothetical model of pain perception in patients with chronic pain: The predictive role of unconscious, emotional, behavioral and meta-cognitive factors. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ghavidel-Parsa B, Bidari A. Two sides on the fibromyalgia coin: physical pain and social pain (invalidation). Clin Rheumatol 2020; 40:841-848. [PMID: 32772267 DOI: 10.1007/s10067-020-05304-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
Although fibromyalgia (FM) has been traditionally defined by the extent of physical pain sites alongside other non-pain symptoms, recent evidence has highlighted the importance of social dimension in definition of pain perception. Social pain or invalidation, which denotes painful feeling following social conflicts or misunderstanding about illness legitimacy, is an important but ignored issue in the FM lexicon. While physical and social pain seem to be different and separate entities, we hypothesize that they are completely intertwined with indistinct borders in FM. Accumulating emergent neuroscience and behavioral evidence highlights the overlapping of physical and social pain in different painful conditions. However, this overlapping seems to reach its maximum in FM. This review sheds more light on the tight interconnectivity between physical and social pain in FM from the perspective of intuitional commonalities, clinical aspects, and shared neural pathways. The conceptualization of FM as an integrative physical-social pain paradigm will move us closer to necessitating the incorporation of social pain in future models of FM diagnosis and management. Key Points • Considering of social pain as one key concept is relatively mute in FM literature. • Overlapping of physical and social pain seems to be unique in FM due to its nature. • Acknowledging social pain in the FM lexicon could shift the paradigm of diagnosis and management of FM patients.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Hazarat Rasoul Medical Complex, Sattarkhan Ave, Tehran, Iran.
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Carty JN, Ziadni MS, Holmes HJ, Tomakowsky J, Peters K, Schubiner H, Lumley MA. The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial. PAIN MEDICINE 2020; 20:1321-1329. [PMID: 30252113 DOI: 10.1093/pm/pny182] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms. METHODS In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up. RESULTS Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms. CONCLUSIONS An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.
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Affiliation(s)
- Jennifer N Carty
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Maisa S Ziadni
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - Hannah J Holmes
- Department of Psychology, Wayne State University, Detroit, Michigan
| | | | - Kenneth Peters
- Women's Urology, Beaumont Health System, Royal Oak, Michigan
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Health / Providence-Providence Park Hospital, Michigan State University College of Human Medicine, Southfield, Michigan
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
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Lane RD. The construction of emotional experience: State‐related emotional awareness and its application to psychotherapy research and practice. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Richard D. Lane
- Department of Psychiatry University of Arizona Tucson AZ USA
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Smith R, Steklis HD, Steklis NG, Weihs KL, Lane RD. The evolution and development of the uniquely human capacity for emotional awareness: A synthesis of comparative anatomical, cognitive, neurocomputational, and evolutionary psychological perspectives. Biol Psychol 2020; 154:107925. [DOI: 10.1016/j.biopsycho.2020.107925] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023]
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Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial. PAIN MEDICINE 2020; 21:2811-2822. [DOI: 10.1093/pm/pnaa145] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Objective
Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain.
Design
Randomized comparison trial.
Setting
Outpatient clinics at the West Los Angeles VA Medical Center.
Subjects
Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain.
Methods
Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up.
Results
EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance.
Conclusions
This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.
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Perceived Injustice Mediates the Relationship Between Perceived Childhood Neglect and Current Function in Patients with Chronic Pain: A Preliminary Pilot Study. J Clin Psychol Med Settings 2020; 28:349-360. [PMID: 32382872 DOI: 10.1007/s10880-020-09722-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cumulative evidence supports the association between perceived childhood neglect and adulthood psychological and physical health. To date, pathways mediating this association remain largely unknown, though other evidence suggests that negative patterns of appraisal, including injustice perception related to pain, may be shaped by prior adverse social experiences. Consequently, the current study examined perceived injustice about chronic pain as a possible factor connecting childhood neglect and pain-related outcomes, given its relevance for both adaptation to chronic pain and to prior adverse life experiences. Patients (n = 742) visiting a tertiary pain clinic completed a survey administered via the Collaborative Health Outcomes Information Registry. Path modeling analyses were used to examine perceived injustice as a mediator of the relationships between childhood neglect and affective distress and physical function, after controlling for pain intensity and pain catastrophizing. Patients endorsing childhood neglect reported higher levels of perceived injustice and worse affective distress and physical function. Further, inclusion of perceived injustice as a mediator fully accounted for the relationship between neglect and current levels of physical function, and accounted for a significant proportion of the relationship between neglect and current levels of affective distress. These preliminary findings suggest that perceived injustice appears to be a more proximal factor by which prior experiences of neglect may adversely affect adaptation to chronic pain. Given the single-item assessment of childhood neglect and cross-sectional nature of the current findings, further research may focus on replicating these findings in longitudinal studies with validated measures and examining other adverse social experiences (e.g., abuse, social disparities) that may contribute to injustice perception and poor pain-related outcomes.
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Abstract
OBJECTIVE Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. METHODS We briefly review the leading evidence-based psychological therapies for chronic pain-cognitive-behavioral and acceptance/mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. RESULTS Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. CONCLUSIONS This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.
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Affiliation(s)
- Mark A Lumley
- From the Department of Psychology (Lumley), Wayne State University, Detroit, Michigan; and Department of Internal Medicine (Schubiner), Providence-Providence Park Hospital, Ascension Health, and Michigan State University College of Human Medicine, Southfield, Michigan
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43
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Prangnell A, Shoveller J, Voon P, Shulha H, Grant C, Milloy MJ, Kerr T, Hayashi K. The Impact of Childhood Emotional Abuse on Pain Interference Among People with Chronic Pain who Inject Drugs in Vancouver, Canada. PAIN MEDICINE 2020; 21:704-713. [PMID: 32266945 DOI: 10.1093/pm/pnz233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE High levels of chronic pain interference with daily activities are known to negatively impact quality of life. Although mental health conditions have been associated with pain interference and child abuse, research has been mixed regarding it acting as a mediator, with even less known among people who inject drugs. Therefore, we sought to explore childhood emotional abuse and pain interference among this population. METHODS Data were derived from two prospective cohort studies of community-recruited people who inject drugs in Vancouver, Canada, between June 2014 and November 2016. We employed multivariable generalized estimating equations to examine the relationship between childhood emotional abuse and pain interference in the past six months. We also conducted a mediation analysis to examine whether mental health disorder diagnoses mediated this association. RESULTS Among 822 eligible participants, 341 (41.5%) reported childhood emotional abuse. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with pain interference (adjusted odds ratio = 1.33, 95% confidence interval [CI] = 1.05-1.70) after adjusting for a range of confounders. Results from the mediation analysis yielded a statistically significant positive average causal mediation effect (β = 0.01, 95% CI = 0.001-0.02). Approximately 12% of the effect was due to mediation. CONCLUSIONS Our results demonstrate among people who inject drugs with chronic pain, those who experienced childhood emotional abuse were more likely to report pain interference, which was partially mediated by mental health disorder diagnosis history. These findings highlight the importance of incorporating screening and appropriate treatment for mental illness into chronic pain treatment.
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Affiliation(s)
- Amy Prangnell
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jean Shoveller
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Pauline Voon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hennady Shulha
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Cameron Grant
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis. Pain 2020; 160:994-1006. [PMID: 31009416 DOI: 10.1097/j.pain.0000000000001487] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non-self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
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Aaron RV, Blain SD, Snodgress MA, Park S. Quadratic Relationship Between Alexithymia and Interoceptive Accuracy, and Results From a Pilot Mindfulness Intervention. Front Psychiatry 2020; 11:132. [PMID: 32210852 PMCID: PMC7076086 DOI: 10.3389/fpsyt.2020.00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022] Open
Abstract
Alexithymia, or a reduced ability to label and describe one's emotions, is a transdiagnostic construct associated with poor psychosocial outcomes. Currently, the mechanisms underlying affective deficits associated with alexithymia are unclear, hindering targeted treatment delivery. Recent research suggests deficient interoceptive awareness, or reduced awareness of one's internal bodily state, may be key in the etiology of alexithymia. It has long been demonstrated that mindfulness meditation can alter perceptions of one's own emotions and bodily cues. Therefore, it is possible that mindfulness meditation may reduce affective deficits associated with alexithymia by improving interoceptive awareness. In this study, we aimed to (1) elucidate the role of interoceptive accuracy and sensibility, two dimensions of interoceptive awareness, in alexithymia, and (2) test the efficacy of a brief mindfulness meditation for improving interoceptive accuracy, interoceptive sensibility, and emotional awareness. Seventy six young adults completed a baseline heartbeat detection task, to assess interoceptive accuracy and sensibility, and the Toronto Alexithymia Scale-20 item. They were randomly assigned to a brief mindfulness-based body scan meditation intervention or control condition. Afterwards, participants completed tasks assessing emotional awareness (i.e., affect labeling, emotional granularity) and follow-up heartbeat detection task. Relationships between alexithymia and interoceptive accuracy and sensibility were best described as quadratic (p = 0.002) and linear (p = 0.040), respectively. Participants in both conditions showed robust improvements in interoceptive accuracy from baseline to follow-up (p < 0.001; η p 2 = 0.15); however, there were no group (meditation or control) differences in degree of improvement. Similarly, there were no group differences in affect labeling or emotional granularity. These preliminary results suggest that heightened alexithymia may be associated with either relatively high or low interoceptive accuracy. The meditation condition did not result in improved interoceptive accuracy or sensibility above and beyond that of a control group. Improvements in interoceptive accuracy, interoceptive sensibility, and emotional awareness may require longer or more interactive intervention approaches. More research is needed to parse the potentially complex relationship between alexithymia and interoceptive awareness, and to develop targeted treatment approaches to ameliorating associated affective deficits.
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Affiliation(s)
- Rachel V Aaron
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| | - Scott D Blain
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Matthew A Snodgress
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
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46
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Smith R, Parr T, Friston KJ. Simulating Emotions: An Active Inference Model of Emotional State Inference and Emotion Concept Learning. Front Psychol 2019; 10:2844. [PMID: 31920873 PMCID: PMC6931387 DOI: 10.3389/fpsyg.2019.02844] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/02/2019] [Indexed: 01/08/2023] Open
Abstract
The ability to conceptualize and understand one's own affective states and responses - or "Emotional awareness" (EA) - is reduced in multiple psychiatric populations; it is also positively correlated with a range of adaptive cognitive and emotional traits. While a growing body of work has investigated the neurocognitive basis of EA, the neurocomputational processes underlying this ability have received limited attention. Here, we present a formal Active Inference (AI) model of emotion conceptualization that can simulate the neurocomputational (Bayesian) processes associated with learning about emotion concepts and inferring the emotions one is feeling in a given moment. We validate the model and inherent constructs by showing (i) it can successfully acquire a repertoire of emotion concepts in its "childhood", as well as (ii) acquire new emotion concepts in synthetic "adulthood," and (iii) that these learning processes depend on early experiences, environmental stability, and habitual patterns of selective attention. These results offer a proof of principle that cognitive-emotional processes can be modeled formally, and highlight the potential for both theoretical and empirical extensions of this line of research on emotion and emotional disorders.
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Affiliation(s)
- Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Thomas Parr
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - Karl J. Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
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47
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Yarns BC, Wells KB, Fan D, Mtume N, Bromley E. The Physical and the Emotional: Case Report, Mixed-Methods Development, and Discussion. Psychodyn Psychiatry 2019; 46:549-574. [PMID: 31750018 DOI: 10.1521/pdps.2018.46.4.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is a growing recognition that emotional problems are important to physical health outcomes. In response, primary care clinics have introduced self-report checklists to identify patients with emotional disorders such as depression or anxiety. Yet psychodynamic theory posits that certain emotional problems may be unconscious and unspoken, and thus not discernible on self-report checklists, and studies show that checklists do not identify every patient who needs treatment. New clinical tools are needed to identify subtle and complex presentations. We aimed to develop an innovative mixed-methods approach characterizing different types of verbal expression of feelings, drawing on psychodynamic theory and empirical research. We outline the development of the mixed-methods approach, including our theoretical framework and use of semi-structured interview data from Partners in Care (PIC), a randomized controlled trial of quality improvement for depression. We then illustrate the approach with one case: an older female PIC participant who screened positive for depression on all study self-reports. The approach delineates three qualitatively different categories of words-specific feeling words, vague feeling words, and physical words-that were quantified to define a measurable pattern for our participant. Clinicians could be trained to identify these categories of words in the context of a discussion of feelings to better detect and understand subtle emotional problems in patients who have difficulty talking openly about their feelings. Next steps include furthering face and construct validity and test-retest reliability, examining the prevalence of these patterns in a larger sample, and assessing correlates of patterns.
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Affiliation(s)
- Brandon C Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kenneth B Wells
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Denise Fan
- National Clinician Scholars Program, David Geffen School of Medicine, University of California, Los Angeles
| | - Norma Mtume
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Elizabeth Bromley
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Pahlevan M, Besharat MA, Borjali A, Farahani H. A hypothetical model of pain perception in patients with chronic pain: The predictive role of unconscious, emotional, behavioral and meta-cognitive factors. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2019.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Aaron RV, Fisher EA, Palermo TM. Alexithymia in adolescents with and without chronic pain. Rehabil Psychol 2019; 64:469-474. [PMID: 31393153 DOI: 10.1037/rep0000287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE/OBJECTIVE Alexithymia refers to reduced emotional awareness and is associated with higher levels of burden and disability in adults with chronic pain. Limited research has examined alexithymia in adolescents with chronic pain. The current study aimed to (a) determine whether alexithymia was higher in adolescents with (vs. without) chronic pain and (b) examine the relationship between alexithymia and pain experiences in youth. Research Method/Design: We assessed alexithymia in 22 adolescents with chronic pain and in 22 adolescents without chronic pain (otherwise healthy), and its relation to pain experiences (i.e., self-reported pain intensity, pain bothersomeness, and pain interference), while controlling for the concomitant effects of psychological distress (i.e., depressive and anxiety symptoms). RESULTS After controlling for psychological distress, adolescents with versus without chronic pain had higher total alexithymia scores (p = .042; η2 = .10), and specifically, greater difficulty identifying feelings (p = .001; η2 = .23). Difficulty identifying feelings was related to worse pain interference (r = .55; p = .015) and pain bothersomeness (r = .55; p = .015). CONCLUSIONS/IMPLICATIONS These preliminary findings suggest that adolescents with chronic pain may have greater difficulty identifying their emotions, and that this might be related to increased pain interference and pain bothersomeness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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50
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Reflections on hybrid transdiagnostic treatment, pain reduction, and emotion regulation. Pain 2019; 160:1689-1690. [DOI: 10.1097/j.pain.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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