The Future of Health Psychology Interventions

Predicting the Effectiveness of Work-Focused CBT for Common Mental Disorders: The Influence of Baseline Self-Efficacy, Depression and Anxiety

Purpose This study examined who benefits most from a cognitive behavioural therapy (CBT)-based intervention that aims to enhance return to work (RTW) among employees who are absent due to common mental disorders (CMDs) (e.g., depression, anxiety, or adjustment disorder). We researched the influence of baseline work-related self-efficacy and mental health (depressive complaints and anxiety) on treatment outcomes of two psychotherapeutic interventions. Methods Using a quasi-experimental design, 12-month follow-up data of 168 employees were collected. Participants either received work-focused cognitive behavioural therapy (W-CBT) that integrated work aspects early into the treatment (n = 89) or regular cognitive behavioural therapy (R-CBT) without a focus on work (n = 79). Results Compared with R-CBT, W-CBT resulted in a faster partial RTW, irrespective of baseline self-efficacy. Among individuals with high self-efficacy, W-CBT also resulted in faster full RTW. The effectiveness of W-CBT on RTW did not depend on baseline depressive complaints or anxiety. The decline of mental health complaints did not differ between the two interventions, nor depended on baseline self-efficacy or mental health. Conclusions Considering the benefits of W-CBT for partial RTW, we recommend this intervention as a preferred method for employees with CMDs, irrespective of baseline self-efficacy, depression and anxiety. For individuals with high baseline self-efficacy, this intervention also results in higher full RTW. For those with low self-efficacy, extra exercises or components may be needed to promote full RTW.

Apoio social a pacientes coronarianos: efeitos de intervenção comportamental com um familiar

O estudo teve por objetivo aplicar um procedimento de intervenção comportamental em cuidadores de pacientes coronarianos e verificar seus efeitos mediante a percepção do paciente sobre a disponibilidade e satisfação com o apoio social antes (Linha de Base), imediatamente (Momento 2) e três meses após intervenção específica (Momento 3). Uma entrevista semiestruturada e uma escala validada para avaliar o suporte social foram utilizados em três pacientes com diagnóstico de angina instável. As intervenções com os três cuidadores consistiram de quatro sessões semanais, em que técnicas de reforçamento diferencial e automonitoramento foram as principais estratégias comportamentais utilizadas. Os resultados mostraram que, após a intervenção, houve um aumento dos escores dessa variável para os três pacientes (p≤0,05), se comparados à linha de base. Os resultados indicaram a possibilidade de aplicação de técnicas comportamentais para melhorar o apoio social de cuidadores a pacientes coronarianos.

As contribuições da ciência do desenvolvimento para a psicologia da saúde

A ciência do desenvolvimento humano vem estimulando uma nova visão sobre a pesquisa em saúde, destacando variáveis contextuais e ecológicas que influenciam o processo de desenvolvimento e condicionam o diagnóstico, o tratamento e o prognóstico de indivíduos e grupos. O objetivo deste artigo é discutir as implicações da ciência do desenvolvimento humano à psicologia da saúde, área de intervenção educacional voltada aos diversos contextos de tratamento de saúde. Pretende-se, ainda, analisar criticamente alguns aspectos metodológicos dos estudos da área e apontar tendências atuais e futuras para uma análise mais funcional do processo saúde-doença. Espera-se que os profissionais de saúde se beneficiem dos argumentos e modelos propostos pela ciência do desenvolvimento humano, construindo ambientes de cuidados mais adequados às necessidades psicossociais de pacientes e familiares.

A further investigation of the importance of pain cognition and behaviour in pain rehabilitation: longitudinal data suggest disability and fear of movement are most important

BACKGROUND

Tailored treatments are topical in pain rehabilitation. One key issue for correlational studies is the identification of factors having a potential causal impact on essential treatment outcomes.

OBJECTIVE

To study associations between pain beliefs and disability with regard to the amount and time-frame of available data.

DESIGN

A prospective, correlational design.

SUBJECTS AND SETTING

Ninety-two patients consulting physical therapists in primary care for persistent musculoskeletal pain.

MAIN MEASURES

The Pain Disability Index, the Self-Efficacy Scale and the Tampa Scale of Kinesiophobia.

RESULTS

Functional self-efficacy and fear of movement/(re)injury explained variance in pain-related disability pretreatment (adj R(2) = 0.41). Self-efficacy was the most salient predictor. Adding data from immediately post treatment decreased explained variance (adj R(2) = 0.25). Functional self-efficacy and fear of movement/ (re)injury lost their significant contribution in favour of pain-related disability at baseline. Change scores in functional self-efficacy and fear of movement/(re)injury accounted for a modest share of explained variance in change scores of disability (adj R(2) = 0.11). Fear of movement/(re)injury but not functional self-efficacy was related to a reliable change in pain-related disability.

CONCLUSIONS

Longitudinal data suggest that pretreatment levels of pain-related disability and changes in fear of movement/(re)injury are most important to immediate treatment outcomes and individual reliable change. Disability and elevated fear of movement/(re)injury should therefore be addressed in tailored pain treatments.

Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. According to per-protocol analyses, short-term effects were maintained in both groups for the primary outcome, pain-related disability. The TBT-group reported lower disability levels compared with the EBT-group. Intention-to-treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self-efficacy were maintained over the 2-year post-treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period.

Adaptive coping with rheumatoid arthritis: the transforming nature of response shift

OBJECTIVE

Qualitative investigations of patients' perspectives of coping can offer insights into a wide array of adaptive coping patterns selectively used to deal with illness-related challenges. The purpose of this qualitative study was to examine adaptive coping patterns reported by a sample of women with rheumatoid arthritis (RA).

METHODS

Using thematic analysis, interviews from 19 participants were analysed until theoretical saturation was achieved. The interviews were coded, with narrative excerpts collated within each code, sorted by codes into potential themes, and then collated within identified themes. These themes were then further defined, providing specific adaptive coping strategies for each major theme.

RESULTS

Major themes included accepting role limitations, reclaiming control, reframing their situation, and bolstering courage. Women described accepting more realistic performance standards, accepting their limitations and dependence on others, and altering their basis of self-worth. They reclaimed control of their lives by changing priorities, pacing themselves, being flexible, delegating to others, and setting appropriate boundaries. Reframing their situation enabled them to change their perspective, minimize threats from RA, re-prioritize their values, and find meaning and positive changes associated with their suffering. To bolster courage, they turned to a variety of sources for encouragement, including confidence from past successes, inspiring role models, and social support.

CONCLUSIONS

The data reflect adaptive strategies similar to response shift processes. A link between response shift processes and higher levels of perceived control is discussed.

Psicologia da saúde e psicologia positiva: perspectivas e desafios

O presente artigo visa a discutir a interface entre Psicologia da saúde e Psicologia positiva, destacando a relevância dos aspectos positivos do desenvolvimento humano como foco de pesquisas e intervenções. Salienta-se a necessidade de avanços nos estudos relacionados aos fatores protetores e de manutenção do desenvolvimento humano saudável. Na discussão em foco neste artigo, a Psicologia da saúde e a Psicologia positiva têm importante papel na compreensão dos aspectos envolvidos no enfrentamento da doença bem como na manutenção da saúde da pessoa, e apontam a relevância do investimento científico na investigação dos fatores de proteção da saúde.

Psicologia pediátrica: a atenção à criança e ao adolescente com problemas de saúde

O presente trabalho examina algumas questões referentes ao modelo psicossocial, à Psicologia da saúde e à Psicologia pediátrica. A Psicologia pediátrica é o campo que aplica os conhecimentos da Psicologia da saúde às crianças e adolescentes com problemas de saúde e tem como objetivo prevenir, compreender e tratar os problemas psicológicos causados pelos transtornos físicos. A autora discute as origens da Psicologia pediátrica, os conhecimentos básicos para trabalhar nesse campo e questões referentes à atuação prática e à pesquisa com crianças e adolescentes com problemas de saúde e suas famílias.

Feasibility and induced cognitive-emotional change of an emotional disclosure intervention adapted for home application

OBJECTIVE

Emotional engagement, cognitive restructuring, and positive future directedness are considered core elements to induce change in emotional disclosure interventions. Our aim was to examine the induction of these elements and the feasibility of an emotional disclosure intervention adapted for home application.

METHODS

The intervention emphasized expression of negative and positive emotions (session 1-4), search for meaning (session 3), and a positive future-oriented ending (session 4). A randomized clinical trial in patients with rheumatoid arthritis compared the adapted intervention (n=40) with a time management control condition (n=28). Feasibility was evaluated regarding adherence, compliance with instructions, perceived viability, and clinical safety. Induction of core elements was evaluated by analysis of change in immediate affective responses and by computerized text analysis of word use.

RESULTS

Feasibility criteria were successfully met. The disclosure condition produced higher immediate negative affect and use of emotion, insight, and optimism words compared to control, and induced the elements of change within sessions as intended.

CONCLUSION

The adapted intervention is feasible for home application and induces change in variables that indicate emotional engagement, cognitive restructuring, and positive future directedness.

PRACTICE IMPLICATIONS

Empirical support of health benefits of this emotional disclosure intervention will extend its applicability in patient self-care.

Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain

Although cognitive-behavioral therapies (CBT) have been demonstrated to be effective for a variety of chronic pain problems, patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects. Furthermore, although cognitive-behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes, little research has systematically tested this. Therefore, we examined mediators, moderators, and predictors of treatment effects in a randomized controlled trial of CBT for chronic temporomandibular disorder (TMD) pain. Pre- to post-treatment changes in pain beliefs (control over pain, disability, and pain signals harm), catastrophizing, and self-efficacy for managing pain mediated the effects of CBT on pain, activity interference, and jaw use limitations at one year. In individual mediator analyses, change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome. Analyzing the mediators as a group, self-efficacy had unique mediating effects beyond those of control and the other mediators. Patients who reported more pain sites, depressive symptoms, non-specific physical problems, rumination, catastrophizing, and stress before treatment had higher activity interference at one year. The effects of CBT generally did not vary according to patient baseline characteristics, suggesting that all patients potentially may be helped by this therapy. The results provide further support for cognitive-behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain-related beliefs in CBT and in other health care encounters.

Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age

Meta-analyses support the effectiveness of behavioral interventions for the treatment of insomnia, although few have systematically evaluated the relative efficacy of different treatment modalities or the relation of old age to sleep outcomes. In this meta-analysis of randomized controlled trials (k = 23), moderate to large effects of behavioral treatments on subjective sleep outcomes were found. Evaluation of the moderating effects of behavioral intervention type (i.e., cognitive-behavioral treatment, relaxation, behavioral only) revealed similar effects for the 3 treatment modalities. Both middle-aged adults and persons older than 55 years of age showed similar robust improvements in sleep quality, sleep latency, and wakening after sleep onset. A research agenda is recommended to examine the mechanisms of action of behavioral treatments on sleep with increased attention to the high prevalence of insomnia in older individuals.

Negatively oriented personality and perceived negative job characteristics as predictors of future psychological and physical symptoms: a meta-analytic structural modelling approach

OBJECTIVES

There is evidence that perceptions of negative job characteristics (e.g., lack of control) and negatively oriented personality (e.g., negative affect) both predict symptom reporting. However, the relative contribution of these factors is rarely examined. This paper uses meta-analytic structural equation modelling (MA-SEM) to explore their relative contribution.

METHODS

A meta-analysis of recent longitudinal studies was conducted. Eight studies covering 10 separate samples met the inclusion criteria (N=2104) and were used in the MA-SEM. Meta-correlations were used to construct structural equations models in which perceived negative job characteristics (PNJC) and negatively oriented personality (NOP) at baseline were used to predict concurrent and future symptom reporting, controlling for symptom reporting at baseline.

RESULTS

The results indicated that a model based solely on NOP offered a more parsimonious account for baseline and future symptom reporting than did PNJC.

CONCLUSIONS

The evidence indicates interventions should focus on both individuals and organizations, and not just organizational-level interventions.

How Changes in Population Demographics Will Impact Health Psychology: Incorporating a Broader Notion of Cultural Competence Into the Field

U.S. population demographics are undergoing striking changes that will impact health care and the research and practice of health psychology. An increase in the number of people who are older; belong to an ethnic minority group; have disabilities; identify as lesbian, gay, bisexual, or transgendered; or live in poverty will influence definitions of aging, health, and illness, and will challenge current psychological and medical treatment models. The authors argue that health psychologists need to become context competent for the field to be relevant and viable over the course of this new century. Health psychologists need to become aware of the multiple, overlapping contexts in which people live and apply this knowledge on a regular basis to research, practice, education and training, and policy in health psychology.

Health Psychology: What Will the Future Bring?

This commentary highlights several important themes and trends in this series of articles focusing on the future of health psychology. First, the challenges posed by changes in populations will only be met if health psychologists can develop a contextual competency. Second, with increasing evidence for the efficacy of health psychology interventions comes heightened interest in testing the effectiveness of these interventions. Third, issues of cost-effectiveness of health psychology will become increasingly important. Fourth, the growing integration of technological advances (e.g., telehealth, the Internet) into health psychology has major implications. Finally, the numerous changes outlined in this series of articles will demand that health psychologists extend and refine their theoretical models including the biopsychosocial model.

Introduction to the Special Section on the Future of Health Psychology

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy.