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Paul AE, Juncos DG, Winter D. Acceptance and commitment coaching for music performance anxiety in adolescent singers. Front Psychol 2024; 15:1386559. [PMID: 39228872 PMCID: PMC11370724 DOI: 10.3389/fpsyg.2024.1386559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/24/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development. Methods The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires. Results When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes. Discussion This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.
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Affiliation(s)
- Anupa Elizabeth Paul
- Independent Researcher, Esslingen, Germany
- Voice Study Centre, University of Wales Trinity St David, East Bergholt, United Kingdom
| | - David G. Juncos
- Independent Researcher, Philadelphia, PA, United States
- Voice Study Centre, Associate College of Essex University and Collaborative Partner of University of Wales Trinity St David, East Bergholt, United Kingdom
| | - Debbie Winter
- Voice Study Centre, Associate College of Essex University and Collaborative Partner of University of Wales Trinity St David, East Bergholt, United Kingdom
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Greenough MJ, Jibb L, Lewis KB, Bucknall T, Lamontagne C, Demery Varin M, Sokalski A, Squires JE. A systematic review of the biopsychosocial dimensions affected by chronic pain in children and adolescents: identifying reliable and valid pediatric multidimensional chronic pain assessment tools. Pain Rep 2023; 8:e1099. [PMID: 38033716 PMCID: PMC10686605 DOI: 10.1097/pr9.0000000000001099] [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: 12/20/2022] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 12/02/2023] Open
Abstract
Pediatric chronic pain is a complex experience that is often challenging to describe and measure. Multidimensional tools that evaluate the biopsychosocial impact of chronic pain in pediatric patients can help clinicians to prioritize and tailor interdisciplinary pain care; yet, the psychometric value and clinical utility of such tools has not yet been systematically studied in the literature. The purpose of this review was to identify multidimensional biopsychosocial tools used in pediatric chronic pain, synthesize their reliability and validity evidence, and draw on this evidence to describe the relationships between chronic pain and biopsychosocial domains. The search involved 2 phases to (1) identify eligible tools and (2) conduct a measured forward citation search of tool development articles. Tool eligibility was guided by the Multidimensional Biobehavioral Model of Pediatric Pain and study eligibility was focused on primary chronic pain diagnoses unrelated to disease. Data extraction was focused on reliability and validity evidence of eligible tools, guided by the Standards for Educational and Psychological Testing. Results yielded 6 tools that included 64 eligible studies, highlighting 84 significant relationships between pain and functional interference across 11 biopsychosocial variables. All tools were shown to have good internal consistency and evidence of validity, primarily through relationships to other variables. Of the 6 tools, the most brief and easy to use were the most under studied. Further psychometric research is warranted for these tools to investigate their clinical utility and psychometric properties in guiding and prioritizing pain care for children and adolescents.
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Affiliation(s)
- Megan J. Greenough
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lindsay Jibb
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Pediatric Nursing Research, SickKids Hospital, Toronto, ON, Canada
| | | | - Tracey Bucknall
- School of Nursing, Deakin University, Burwood Victoria, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, Australia
| | - Christine Lamontagne
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Ashley Sokalski
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Janet Elaine Squires
- University Research Chair in Health Evidence Implementation & School of Nursing, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Girardet RG, Shellman AB, Llorens A, Nguyen L, Ellsworth M, Rennie K, Ha C. Evaluation of an Intensive Program for Children With Co-occurring Medical and Emotional Disorders. Clin Pediatr (Phila) 2022; 61:605-614. [PMID: 35677990 DOI: 10.1177/00099228221091429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period. Children had more than 30 medical diagnoses including chronic pain, dysautonomia, neurologic disorders, and diabetes. Complete utilization data were available for 118 patients, and demonstrated decreased hospitalizations and increased behavioral health visits during the 12 months post program compared with 12 months prior. Private insurance and female sex were associated with reduced utilization costs after program participation. Estimated avoided cost for the 118 children was $1 111 485. Patients reported significant improvements in somatic symptoms, sleep problems, inattention, depression, anger, and anxiety. Limited data indicated improvements in school attendance. Additional research addressing other outcomes, such as school-related symptoms, would be helpful.
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Affiliation(s)
- Rebecca G Girardet
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Department of Pediatrics, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Alison B Shellman
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ashlie Llorens
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Anew Psychological Services, Houston, TX, USA
| | - Linh Nguyen
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Misti Ellsworth
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kimberly Rennie
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,NeuroBehavioral Health, Milwaukee, WI, USA
| | - Carolyn Ha
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Katy Psychological Services, Katy, TX, USA
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Peacefull: A French mindfulness-based intervention for adolescents with chronic pain a feasibility study. Arch Pediatr 2022; 29:581-587. [PMID: 36109288 DOI: 10.1016/j.arcped.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/26/2022] [Accepted: 06/18/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric chronic pain can lead to serious consequences in terms of daily functioning and global quality of life. Mindfulness-based intervention (MBI) approaches that emphasize accepting rather than controlling pain have gained increasing attention in adults with chronic pain. The effectiveness of MBIs for chronic pain in the pediatric population remains unknown. The aim of the Peacefull program was to study the feasibility in France of a mindfulness program for adolescents with chronic pain, based on a program especially developed in Canada and Belgium. METHOD An MBI for adolescents consisting of eight 90-min sessions was provided. It focused on building skills and incorporated mindfulness meditation, exercises, and activities especially adapted to teenagers with chronic pain. RESULTS A total of 27 adolescents aged 12-17 years who were diagnosed with a chronic pain condition were enrolled in five cohorts from April 2018 to June 2021. The completion rate of the Peacefull program was 88.89 with no dropouts and good completion of outcome measures. Secondary outcomes were assessed before the program, at the end, and 3 months later. A trend toward an improvement was observed on the mean average score for the Visual Analog Scale (VAS), but it was not statistically significant. Scores increased significantly over time on the Functional Disability Inventory (FDI), and pain catastrophizing also improved. CONCLUSIONS Although the findings regarding the effectiveness of Peacefull programs were inconsistent and insufficient, they can be indicative of the benefits of mindfulness as an adjuvant treatment for adolescents with chronic pain.
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Shear D, Harrison LE, O'Brien S, Khazendar Z, Lyons S, Morgan JJ, Chan SK, Feinstein AB, Simons LE. Rapid Transition to Virtual Assessment and Treatment in an Interdisciplinary Randomized Clinical Trial for Youth With Chronic Pain: Adaptations and Implications for Future Trials. Clin J Pain 2022; 38:459-469. [PMID: 35686576 PMCID: PMC9199594 DOI: 10.1097/ajp.0000000000001040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES COVID-19 abruptly halted in-person clinical care and research requiring a shift to virtual assessment and treatment. This unexpected transition of a 2-arm randomized controlled trial (RCT) examining interdisciplinary graded exposure treatment (GET Living) compared with multidisciplinary pain management for youth with chronic pain provided an opportunity to implement the first remotely delivered exposure treatment and remotely delivered biomechanical assessment for pediatric chronic pain. Here we describe these new approaches and provide lessons learned to inform future efforts in digital health care. METHODS A total of 68 youth (M=14.2 y; 80.9% female) were enrolled in the RCT (n=31 in-person, n=5 hybrid, n=32 virtual, n=9 withdrew). Of those withdrawn, n=3 withdrew due to COVID-19 related reasons. Some RCT elements required slight modification (eg, e-consent, actigraphy deployment, recruitment, and screening), while others were significantly altered (eg, session format and lab-based biomechanical assessment). Data from exit interviews were also examined to assess perspectives on the virtual format transition. RESULTS Results showed an increased enrollment rate when virtual care was an option (70.7%) compared with in-person (44.3%). Equivalent rates of completion for daily assessment (in-person, 72.8%; virtual, 73.3) were also observed, and participants described enhanced experience when able to complete exercises and exposures in their home environment during session (vs. a rehabilitation gym) allowing for genuine in vivo exposures (eg, household chores, riding bicycles). DISCUSSION Overall, our data demonstrate acceptability, feasibility, and equivalent patient engagement to virtual treatment. Novel methods implemented in this RCT can inform trial design and measures of clinical endpoints for future digital health interventions.
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Affiliation(s)
- Deborah Shear
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
| | - Shannon O'Brien
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
| | - Zeena Khazendar
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
| | - Samuel Lyons
- Motion and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Sunnyvale, CA
| | - Jeffery J Morgan
- Motion and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Sunnyvale, CA
| | - Salinda K Chan
- Motion and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Sunnyvale, CA
| | - Amanda B Feinstein
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto
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Jain A, Gee S, Malayala SV, Laboe CW. Chronic Pediatric Pain and Mental Illness During the COVID-19 Era: A Case Series From Inpatient Child Psychiatry Unit. Cureus 2021; 13:e20032. [PMID: 34987917 PMCID: PMC8716159 DOI: 10.7759/cureus.20032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic pain is defined as pain that persists following tissue injury or disease processes and is believed to have taken place after healing. It is a functional impairment that causes discomfort and leads to the inability to perform various essential daily activities. Chronic pain in pediatrics can be of various types, the most commonly prevalent types being headaches, abdominal pain, and limb pain. Adolescents with chronic pain have been found to have generalized anxiety scores twice that of the average population, along with significant impairment of family dynamics. Some forms of chronic pain respond effectively to medication and psychotherapy, and recurrence is common when stress is triggered by external or environmental factors, most recently in the form of COVID-19. In this case series, we discuss three cases of worsening mental health presentations and chronic pain exacerbation in the context of the COVID-19 pandemic. We talk about the unique perspective of chronic pain in the pediatric population and comorbid mental illnesses and their management from a psychiatric standpoint.
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Affiliation(s)
- Ankit Jain
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
| | - Sage Gee
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
| | | | - Christopher W Laboe
- Psychiatry & Behavioral Health, Penn State College of Medicine, Hershey, USA
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Khera T, Rangasamy V. Cognition and Pain: A Review. Front Psychol 2021; 12:673962. [PMID: 34093370 PMCID: PMC8175647 DOI: 10.3389/fpsyg.2021.673962] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cognition is defined as the brain's ability to acquire, process, store, and retrieve information. Pain has been described as an unpleasant sensory or emotional experience, and for experiencing pain consciously, cognitive processing becomes imperative. Moreover, evaluation of pain strongly depends on cognition as it requires learning and recall of previous experiences. There could be a possible close link between neural systems involved in cognition and pain processing, and studies have reported an association between pain and cognitive impairment. In this narrative review, we explore the available evidence that has investigated cognitive changes associated with pain. We also examine the anatomical, biochemical, and molecular association of pain and neuro-cognition. Additionally, we focus on the cognitive impairment caused by analgesic medications. There is a need to improve our understanding of pathophysiology and cognitive impairment mechanisms associated with chronic pain and its treatment. This area provides a diverse opportunity for grounding future research, aiding institution of timely interventions to prevent chronic pain and associated cognitive decline, ultimately improving patient care.
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Affiliation(s)
- Tanvi Khera
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Valluvan Rangasamy
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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