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Yoshino A, Maekawa T, Kato M, Chan HL, Otsuru N, Yamawaki S. Changes in Resting-State Brain Activity After Cognitive Behavioral Therapy for Chronic Pain: A Magnetoencephalography Study. THE JOURNAL OF PAIN 2024; 25:104523. [PMID: 38582288 DOI: 10.1016/j.jpain.2024.104523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
Cognitive behavioral therapy (CBT) is believed to be an effective treatment for chronic pain due to its association with cognitive and emotional factors. Nevertheless, there is a paucity of magnetoencephalography (MEG) investigations elucidating its underlying mechanisms. This study investigated the neurophysiological effects of CBT employing MEG and analytical techniques. We administered resting-state MEG scans to 30 patients with chronic pain and 31 age-matched healthy controls. Patients engaged in a 12-session group CBT program. We conducted pretreatment (T1) and post-treatment (T2) MEG and clinical assessments. MEG data were examined within predefined regions of interest, guided by the authors' and others' prior magnetic resonance imaging studies. Initially, we selected regions displaying significant changes in power spectral density and multiscale entropy between patients at T1 and healthy controls. Then, we examined the changes within these regions after conducting CBT. Furthermore, we applied support vector machine analysis to MEG data to assess the potential for classifying treatment effects. We observed normalization of power in the gamma2 band (61-90 Hz) within the right inferior frontal gyrus (IFG) and multiscale entropy within the right dorsolateral prefrontal cortex (DLPFC) of patients with chronic pain after CBT. Notably, changes in pain intensity before and after CBT positively correlated with the alterations of multiscale entropy. Importantly, responders predicted by the support vector machine classifier had significantly higher treatment improvement rates than nonresponders. These findings underscore the pivotal role of the right IFG and DLPFC in ameliorating pain intensity through CBT. Further accumulation of evidence is essential for future applications. PERSPECTIVE: We conducted MEG scans on 30 patients with chronic pain before and after a CBT program, comparing results with 31 healthy individuals. There were CBT-related changes in the right IFG and DLPFC. These results highlight the importance of specific brain regions in pain reduction through CBT.
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Affiliation(s)
- Atsuo Yoshino
- Health Service Center, Hiroshima University, Minami-Ku, Hiroshima, Japan; Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Toru Maekawa
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Miyuki Kato
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan
| | - Hui-Ling Chan
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan; Department of Computer Science and Information Engineering, Institute of Medical Informatics, National Cheng Kung University, Tainan City, Taiwan
| | - Naofumi Otsuru
- Department of Physical Therapy, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan
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Yokoyama S, Adachi T, Yoshino A. Unraveling pain experience and catastrophizing after cognitive behavioral therapy. Sci Rep 2024; 14:17176. [PMID: 39060508 PMCID: PMC11282057 DOI: 10.1038/s41598-024-68334-6] [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] [Received: 02/20/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
Pain experiences are often complex with catastrophic cognitions, emotions, and behaviors. Cognitive behavioral therapists share the work of unraveling these complex experiences with their patients. However, the change process underlying the unraveling of the pain experience have not yet been quantified. We used an interrelationship-focused network model to examine the way an undifferentiated conceptualization between cognition and pain experience changed via group cognitive-behavioral therapy (CBT). Overall, 65 participants (77.4% of all patients who entered the intervention) were included in the analysis; they attended the total of 12 weekly group CBT and filled the Short-Form McGill Pain Questionnaire and the pain catastrophizing questionnaire. Before treatment, there were no edges in the partial correlation-based network because of large covariation across items. After treatment, many edges appeared and, particularly strong couplings were found between items within the same subscale. The formative shift from a non-edged pre-treatment network to a mature post-treatment network may indicate that patients were able to conceptualize these symbolic constructs better. These results are probably of interest to clinicians and would be consistent with the fundamental monitoring process of CBT.
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Affiliation(s)
- Satoshi Yokoyama
- Faculty of Humanities, Niigata University, Niigata, Japan.
- Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan.
| | - Tomonori Adachi
- Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan
- Health Service Center, Hiroshima University, Hiroshima, Japan
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
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Yoshino A, Yokoyama S, Kurata A, Nakamura R, Nagami T, Taguchi S, Yamawaki S. Clinical effects of online cognitive behavioral group therapy for chronic pain patients and developing a therapeutic alliance: A pre-post pilot trial. Health Sci Rep 2024; 7:e2141. [PMID: 38784247 PMCID: PMC11112632 DOI: 10.1002/hsr2.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Background and Aims Research suggests that various psychosocial factors influence chronic pain, with psychotherapies like cognitive behavioral therapy proving effective. However, the limited availability and accessibility have prolonged suffering among patients with chronic pain. This challenge has led to a growing demand for accessible online interventions. We developed an online cognitive behavioral group therapy (CBGT) program, building upon our existing face-to-face CBGT program. We compared the scores obtained by patients during the treatment-as-usual (TAU) period with those collected at the beginning and at the end of the intervention. Methods Patients with chronic pain (N = 22) agreed to participate in the online CBGT program, which was conducted once a week for 12 sessions. The sample size was decided based on the effect sizes of our past face-to-face CBGT. We assessed pain intensity [Visual Analogue Scale (VAS)], pain catastrophizing [pain catastrophizing scale (PCS)] and psychiatric assessment [Beck Depression Inventory-Second Edition (BDI)-II], State-Trait-Anxiety Inventory (STAI), and Short Form Health Survey (SF-36) at three points: entry, pretreatment, and posttreatment. We also evaluated the participants' therapeutic alliance with the treatment staff [short-form version of the Working Alliance Inventory (WAI-S)]. We utilized analyses of variance, Friedman test, paired t-tests, Wilcoxon signed-rank test, and Pearson correlation analysis for data evaluation. Results Results indicated a significant posttreatment improvement in VAS, PCS, and BDI-II scores compared to the TAU period. Furthermore, posttreatment WAI-S scores increased significantly compared to pretreatment scores. Also, positive correlations were observed among pre- and posttreatment changes in WAI-S, pain intensity, and pain catastrophizing scores. Conclusion There is a possibility that a therapeutic alliance can be established, and therapeutic effects achieved through an online CBGT intervention; however, additional research is required to substantiate this potential. We have registered this clinical trial in UMIN-CTR on 04/21/2021 with the number UMIN000043982.
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Affiliation(s)
- Atsuo Yoshino
- Health Service CenterHiroshima UniversityHiroshimaJapan
- Center for Brain, Mind and KANSEI Sciences ResearchHiroshima UniversityHiroshimaJapan
| | | | - Akiko Kurata
- Department of Psychiatry and NeurosciencesHiroshima UniversityHiroshimaJapan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical CareHiroshima UniversityHiroshimaJapan
| | | | - Shima Taguchi
- Department of Anesthesiology and Critical CareHiroshima UniversityHiroshimaJapan
- Department of AnesthesiologyShimura HospitalHiroshimaJapan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences ResearchHiroshima UniversityHiroshimaJapan
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Schubach A, Quigley BM, Lackner JM, Gudleski GD. Somatization Mediates the Relationship Between Childhood Trauma and Pain Ratings in Patients with Irritable Bowel Syndrome. J Clin Gastroenterol 2024:00004836-990000000-00259. [PMID: 38266076 DOI: 10.1097/mcg.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024]
Abstract
GOALS To identify potential mechanisms by which childhood trauma may lead to the adult development of abdominal symptoms in patients with irritable bowel syndrome (IBS). BACKGROUND Patients with IBS frequently report a history of childhood trauma. The pathophysiology by which abdominal pain arises in patients with IBS is multidimensional, consisting of both peripheral factors, such as altered motility, inflammation, and bacterial overgrowth, as well as central factors, such as psychological distress and neuro-hormonal dysregulation. STUDY Adult psychological factors (anxiety, depression, and somatization) were examined to determine if they mediate the relationship between retrospective reports of childhood trauma and current adult IBS abdominal symptoms in a study of 436 patients (M age=41.6, 79% F) meeting Rome III diagnosis criteria. Childhood trauma was measured using retrospective questions assessing physical and sexual abuse. Psychological factors in adulthood were measured with the subscales of the Brief Symptom Inventory-18. Outcome variables included adult IBS symptoms of abdominal pain, bloating, and satisfaction with bowel habits from the IBS Symptoms Severity Scale. RESULTS Results indicated that somatization mediated the relationship between childhood abuse and abdominal pain and bloating but not bowel satisfaction. CONCLUSIONS This study provides insight into the multifactorial nature of IBS-associated abdominal pain in patients with a history of childhood trauma, elucidating the need for a trauma-informed treatment approach for patients with histories of abuse.
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Affiliation(s)
- Abigail Schubach
- Department of Medicine, Division of Behavioral Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY
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Sato A, Itagaki S, Matsumto T, Ise Y, Yokokura S, Wada T, Hayashi K, Kakamu T, Fukushima T, Nikaido T, Konno S, Yabe H. Prediction of the prognosis of somatoform disorders using the Minnesota Multiphasic Personality Inventory. Fukushima J Med Sci 2023; 69:105-113. [PMID: 37164766 PMCID: PMC10480515 DOI: 10.5387/fms.2022-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/06/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Somatoform disorders are frequently resistant to treatment. This study aimed to determine the utility of the Minnesota Multifaceted Personality Inventory (MMPI) in predicting the prognosis of somatoform disorders. METHODS Overall, 125 patients diagnosed with somatoform disorders between January 1, 2013 and December 31, 2017 in the psychiatric department of Fukushima Medical University Hospital were included. Patients with positive outcomes were identified based on a subjective estimation regarding (1) pain and (2) social functions, including activities of daily living. They were divided into the improved group (IG) and the non-improved group (NIG). Each factor was then descriptively compared between the two groups, and the sensitivity and specificity were determined. RESULTS The NIG had significantly higher scores but only on the Hy scale. Thus, the optimal Hy scale cutoff score was calculated. The cutoff point was 73.5, with a sensitivity of 55.7% and a specificity of 71.7%. CONCLUSION An MMPI Hy scale score higher than a cutoff value of 73.5 predicts a poor response to conventional supportive psychotherapy or drug therapy in patients with somatoform disorders. This cutoff point may be used as an important index for selecting treatment for somatoform disorders.
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Affiliation(s)
- Akiko Sato
- Department of Neuro Psychiatry, Fukushima Medical University
| | | | | | - Yoko Ise
- Department of Neuro Psychiatry, Fukushima Medical University
| | - Shunya Yokokura
- Department of Neuro Psychiatry, Fukushima Medical University
| | - Tomohiro Wada
- Department of Neuro Psychiatry, Fukushima Medical University
| | - Kaoru Hayashi
- Department of Neuro Psychiatry, Fukushima Medical University
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University
| | | | - Takuya Nikaido
- Department of Orthopedic Surgery, Fukushima Medical University
| | - Shinichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University
| | - Hirooki Yabe
- Department of Neuro Psychiatry, Fukushima Medical University
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Yoshino A, Otsuru N, Doi M, Maekawa T, Sasaoka T, Yamawaki S. Interoceptive accuracy is related to the psychological mechanisms of the burning mouth syndrome: a cross-sectional study. BMC Oral Health 2022; 22:297. [PMID: 35854344 PMCID: PMC9295371 DOI: 10.1186/s12903-022-02316-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Different perspectives are needed to understand the pathophysiology of burning mouth syndrome (BMS), including physiological and psychological standpoints. The significance of interoception in chronic pain has been suggested. However, few studies have investigated this relationship in BMS. Therefore, we examined the role of interoception in BMS. Methods This is a cross-sectional study. BMS patients (N = 64) participated in the study. We used interoceptive accuracy (IAc) based on the heartbeat counting task. Then, participants were divided into high and low IAc groups, and their scores on clinical assessment including pain and psychological evaluation were compared. Results The Visual Analogue Scale scores indicating pain in low IAc patients, but not high IAc patients, were positively correlated with the Beck Depression Inventory-Second Edition (BDI-II) and the State-Trait Anxiety Inventory-State (STAI-S) Scores. Conclusions Interoception might play a role in the pathophysiology of BMS.
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Affiliation(s)
- Atsuo Yoshino
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan. .,Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashi-Hiroshima, 739-8514, Japan.
| | - Naofumi Otsuru
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimamichou, Kita-Ku, Niigata, 950-3198, Japan
| | - Mitsuru Doi
- Department of Dental Anesthesiology, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Toru Maekawa
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takafumi Sasaoka
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Řiháček T, Čevelíček M, Boehnke JR, Pourová M, Roubal J. Mechanisms of change in multicomponent group-based treatment for patients suffering from medically unexplained physical symptoms. Psychother Res 2022; 32:1016-1033. [PMID: 35436163 DOI: 10.1080/10503307.2022.2061874] [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: 01/17/2023] Open
Abstract
Understanding psychological mechanisms of change is essential to advance treatments for patients suffering from medically unexplained physical symptoms (MUPS). This study aimed to test the role of selected change mechanisms (incl. interoceptive awareness, emotional regulation skills, symptom acceptance, relational needs satisfaction, clarification of meaning, working alliance, and group cohesion) in the modification of patients' somatic symptom intensity and well-being. N = 290 patients suffering from MUPS participated in a multi-component group-based treatment at seven clinical sites. Data were collected weekly. Multi-level modeling was used to test cross-lagged relationships between the hypothesized mechanisms and outcomes in terms of Granger causality (with lags of 1, 2, and 3 weeks). None of the mechanisms predicted a time-lagged change in outcomes in the expected direction. In fact, there was a consistent pattern of negative time-lagged relationships (i.e., an increase in a mechanism predicted worsening of the outcome). Findings consistent with the hypothesized role of the mechanisms were found only in concurrent relationships between mechanisms and outcomes. This study did not support time-lagged relationships under the condition of weekly measurement and many methodological factors remain to be considered (e.g., a finer time resolution).
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Affiliation(s)
- Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Martina Pourová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan Roubal
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Ishikawa S, Chen J, Fujisawa D, Tanaka T. The development, progress, and current status of cognitive behaviour therapy in Japan. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Junwen Chen
- School of Psychology, Research School of Psychology, The Australian National University, Canberra, Australia,
| | - Daisuke Fujisawa
- Keio University School of Medicine, Division of Patient Safety, Department of Neuropsychiatry, Tokyo, Japan,
| | - Tsunehiko Tanaka
- Faculty of Education Specialized Courses Educational Psychology, Niigata University, Niigata, Japan,
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Pan X, Ding W, Sun X, Ji C, Zhou Q, Yan C, Zhou Y, Luo Y. Gray Matter Density of the Dorsomedial Prefrontal Cortex Mediates the Relationship Between Catastrophizing and Anxiety in Somatic Symptom Disorder. Neuropsychiatr Dis Treat 2021; 17:757-764. [PMID: 33727819 PMCID: PMC7955750 DOI: 10.2147/ndt.s296462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Catastrophizing is commonly co-occurrence with anxiety in somatic symptom disorder (SSD). However, the quantitative relationship between catastrophizing and anxiety in SSD and its underlying neuropsychopathology remains unclear. METHODS To address the issue, twenty-eight SSD patients and twenty-nine healthy controls (HCs) completed the Hamilton anxiety scale and the catastrophizing subscale of the cognitive emotion regulation questionnaire. Then they underwent structural magnetic resonance imaging and voxel-based morphometry analysis was performed to obtain gray matter density (GMD) of the dorsomedial prefrontal cortex (dmPFC). RESULTS Independent samples t-tests showed no significance between SSD patients and HCs in the scores on the catastrophizing subscale and GMD of the dmPFC. However, correlation analysis found that catastrophizing was significantly positively associated with anxiety in SSD. Further, mediation analyses revealed that GMD of the dmPFC (bilateral medial Brodmann area 8) mediated the relationship between catastrophizing and anxiety in SSD. CONCLUSION These findings support Kirmayer's disease model of SSD that catastrophic interpretations of somatic symptoms resulted in increased anxiety and demonstrate that the dmPFC may be a potential neural site linking catastrophizing and anxiety in SSD.
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Affiliation(s)
- Xiandi Pan
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Weina Ding
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xia Sun
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chenfeng Ji
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qian Zhou
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Ikemoto T, Shiro Y, Ikemoto K, Hayashi K, Arai YC, Deie M, Beeston L, Wood B, Nicholas M. Feasibility of Imported Self-Management Program for Elderly People with Chronic Pain: A Single-Arm Confirmatory Trial. Pain Ther 2020; 9:583-599. [PMID: 32844366 PMCID: PMC7648817 DOI: 10.1007/s40122-020-00192-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Multidisciplinary pain management programs incorporating a cognitive-behavioral therapy (CBT) approach have been reported to be helpful for elderly people with chronic pain. However, it is unclear whether the same program for elderly people with chronic pain would translate to different cultures. This study investigated whether a multidisciplinary program based on that of Nicholas et al. (Pain 154(6):824-835, 2013) in Australia would be effective for elderly people with chronic pain in Japan. METHODS Twenty-seven community-dwelling elderly people with chronic pain were enrolled to confirm changes (effect size d = 0.5) in pain disability, which were previously reported by Nicholas et al. The multidisciplinary program consisted of eight sessions (2 sessions a week for 4 weeks). Pain disability was assessed using the Pain Disability Assessment Scale (PDAS) as the primary outcome at the baseline, the beginning and the end of the program, and the 1- and 3-month (final) follow-up. We also assessed the pain severity, catastrophizing, pain self-efficacy, and physical function with the Timed Up and Go test (TUG) and the two-step test as secondary outcomes. RESULTS PDAS, pain catastrophizing, and pain self-efficacy were significantly improved immediately after the program compared with baseline, and these effects were maintained at 3-month follow-up. The effect size (d) for the PDAS score was a medium size (0.54) from baseline to 3-month follow-up. Those who showed improvements in TUG immediately after the program tended to report improved psychometric measures at 3-month follow-up. CONCLUSION These results suggest that the Japanese multidisciplinary program has a similar effect on pain disability as that reported by Nicholas et al. This finding has important implications for the development of pain services in community-dwelling elderly Japanese.
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Affiliation(s)
- Tatsunori Ikemoto
- Department of Orthopaedics, Aichi Medical University, Aichi, Japan
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
- Research of Pain Science, Non-Profit Organization, Nagoya, Japan
| | | | - Kayo Ikemoto
- Research of Pain Science, Non-Profit Organization, Nagoya, Japan
| | - Kazuhiro Hayashi
- Research of Pain Science, Non-Profit Organization, Nagoya, Japan
| | - Young-Chang Arai
- Research of Pain Science, Non-Profit Organization, Nagoya, Japan
| | - Masataka Deie
- Department of Orthopaedics, Aichi Medical University, Aichi, Japan
| | - Lee Beeston
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
| | - Bradley Wood
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
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Hosogoshi H, Iwasa K, Fukumori T, Takagishi Y, Takebayashi Y, Adachi T, Oe Y, Tairako Y, Takao Y, Nishie H, Kanie A, Kitahara M, Enomoto K, Ishii H, Shinmei I, Horikoshi M, Shibata M. Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan. Biopsychosoc Med 2020; 14:6. [PMID: 32175003 PMCID: PMC7063808 DOI: 10.1186/s13030-020-00176-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. Methods Our study was an open-labeled before–after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20–80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. Results Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge’s g = − 0.72, 90% confidence interval = − 1.38 to − 0.05) and up to the 3-month follow-up (g = − 0.60, CI = − 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. Conclusion The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880. Registered on 04 February 2016.
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Affiliation(s)
- Hiroki Hosogoshi
- 1Department of Sociology, Faculty of Sociology, Kansai University, 3-3-35 Yamate-cho, Suita-shi, Osaka, 564-8680 Japan.,2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Kazunori Iwasa
- 3Faculty of Education, Shujitsu University, 1-6-1 Nishigawara, Naka-ku, Okayama-shi, Okayama, 703-8516 Japan
| | - Takaki Fukumori
- 4Graduate School of Integrated Arts and Sciences, Tokushima University, 1-1 Minamijosanjima-cho, Tokushima-shi, Tokushima, 770-8502 Japan
| | - Yuriko Takagishi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,5Department of Psychology, Surugadai University, 698 Azu, Hanno-shi, Saitama, 357-8555 Japan
| | - Yoshitake Takebayashi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,6Department of Health Risk Communication, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, 960-1295 Japan
| | - Tomonori Adachi
- 7Pain Management Clinic, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu-shi, Shiga 520-2192 Japan
| | - Yuki Oe
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,8Department of Neuropsychiatry, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611 Japan
| | - Yukino Tairako
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan.,9Department of Psychology, Meiji Gakuin University, 1-2-37 Shirokanedai, Minato-ku, Tokyo, 108-8636 Japan
| | - Yumiko Takao
- 10Department of Pain Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501 Japan
| | - Hiroyuki Nishie
- 11Anesthesiology and Intensive Care 2, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama, 701-0192 Japan
| | - Ayako Kanie
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masaki Kitahara
- 12Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama-shi, Kanagawa 232-0024 Japan
| | - Kiyoka Enomoto
- 13Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita-shi, Osaka, 565-0871 Japan
| | - Hirono Ishii
- 14Counseling Office, Japan Women's University, 1-1-1 Nishiikuta, Tama-ku, Kawasaki-shi, Kanagawa 214-8565 Japan
| | - Issei Shinmei
- 15Department of Neurology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8553 Japan.,TCBT Counseling Office, Cosmos Kichijoji Building 2F, 2-8-4 Kichijojihoncho, Musashino-shi, Tokyo, 180-0004 Japan
| | - Masaru Horikoshi
- 2National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551 Japan
| | - Masahiko Shibata
- 17Department of Health Science, Naragakuen University, 3-15-1 Nakatomigaoka, Nara-shi, Nara, 631-8524 Japan
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12
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Yoshino A, Okamoto Y, Jinnin R, Takagaki K, Mori A, Yamawaki S. Role of coping with negative emotions in cognitive behavioral therapy for persistent somatoform pain disorder: Is it more important than pain catastrophizing? Psychiatry Clin Neurosci 2019; 73:560-565. [PMID: 31102312 DOI: 10.1111/pcn.12866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/11/2019] [Accepted: 05/13/2019] [Indexed: 01/04/2023]
Abstract
AIM Cognitive behavioral therapy (CBT) is known to be effective for patients with persistent somatoform pain disorder (PSPD). Improvement of negative emotions in interpersonal stressful situations has been reported to reduce PSPD-related clinical pain. However, these associations in CBT remain unclear. Therefore, we examined the relation between changes in negative emotions and clinical pain symptoms after CBT by using a multiple regression analysis that included pain catastrophizing. METHODS We analyzed negative emotional intensity scores in stressful situations of 38 patients with PSPD who had completed CBT treatment and all the daily worksheets. Negative emotional intensity scores were recorded in daily worksheets during 12 weekly CBT sessions. Scores for the Pain Catastrophizing Scale (PCS), Visual Analogue Scale (VAS) as clinical pain intensity, Beck Depression Inventory - Second Edition (BDI-II), and State-Trait Anxiety Inventory (STAI) were also obtained at pre- and post-treatment. A multiple regression analysis was conducted using changes in VAS scores after CBT as the dependent variable, and changes in negative emotional intensity, PCS, BDI-II, and STAI scores after CBT, age, and sex as independent variables. RESULTS Negative emotional intensity scores decreased after CBT. In a multiple regression analysis, the emotional changes resulting from CBT depicted a modest positive relation with changes in VAS scores (β = 0.37; P < 0.05); however, there was no relation between changes in PCS scores after CBT and changes in VAS scores after CBT (β = 0.03). CONCLUSION The results show that negative emotions play an important role in the treatment effects of CBT for PSPD.
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Affiliation(s)
- Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Ran Jinnin
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Koki Takagaki
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Asako Mori
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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13
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Yoshino A, Okamoto Y, Okada G, Takamura M, Ichikawa N, Shibasaki C, Yokoyama S, Doi M, Jinnin R, Yamashita H, Horikoshi M, Yamawaki S. Changes in resting-state brain networks after cognitive-behavioral therapy for chronic pain. Psychol Med 2018; 48:1148-1156. [PMID: 28893330 DOI: 10.1017/s0033291717002598] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is thought to be useful for chronic pain, with the pathology of the latter being closely associated with cognitive-emotional components. However, there are few resting-state functional magnetic resonance imaging (R-fMRI) studies. We used the independent component analysis method to examine neural changes after CBT and to assess whether brain regions predict treatment response. METHODS We performed R-fMRI on a group of 29 chronic pain (somatoform pain disorder) patients and 30 age-matched healthy controls (T1). Patients were enrolled in a weekly 12-session group CBT (T2). We assessed selected regions of interest that exhibited differences in intrinsic connectivity network (ICN) connectivity strength between the patients and controls at T1, and compared T1 and T2. We also examined the correlations between treatment effects and rs-fMRI data. RESULTS Abnormal ICN connectivity of the orbitofrontal cortex (OFC) and inferior parietal lobule within the dorsal attention network (DAN) and of the paracentral lobule within the sensorimotor network in patients with chronic pain normalized after CBT. Higher ICN connectivity strength in the OFC indicated greater improvements in pain intensity. Furthermore, ICN connectivity strength in the dorsal posterior cingulate cortex (PCC) within the DAN at T1 was negatively correlated with CBT-related clinical improvements. CONCLUSIONS We conclude that the OFC is crucial for CBT-related improvement of pain intensity, and that the dorsal PCC activation at pretreatment also plays an important role in improvement of clinical symptoms via CBT.
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Affiliation(s)
- A Yoshino
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - Y Okamoto
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - G Okada
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - M Takamura
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - N Ichikawa
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - C Shibasaki
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - S Yokoyama
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - M Doi
- Department of Dental Anesthesiology,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - R Jinnin
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - H Yamashita
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
| | - M Horikoshi
- National Center for Cognitive Behavior Therapy and Research,National Center of Neurology and Psychiatry (NCNP),4-1-1, Ogawahigashicho,Kodaira,Tokyo 187-0031,Japan
| | - S Yamawaki
- Department of Psychiatry and Neurosciences,Division of Frontier Graduate School of Biomedical Sciences,Hiroshima University,1-2-3 Kasumi,Minami-ku,Hiroshima 734-8551,Japan
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14
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Carlier IVE, Andree Wiltens DH, van Rood YR, van Veen T, Dekker J, van Hemert AM. Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care. Clin Psychol Psychother 2018; 25:550-564. [PMID: 29573030 DOI: 10.1002/cpp.2191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/27/2022]
Abstract
AIM Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. METHOD The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). RESULTS The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). CONCLUSION Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.
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Affiliation(s)
- I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - T van Veen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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