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Carney LM, Schnur JB, Morgan O, Hyun C, Magin ZE, Martin L, Montgomery GH. Psychosocial interventions to improve sexual functioning in women with cancer: a systematic review of randomized controlled trials. Sex Med Rev 2024; 12:142-153. [PMID: 38185918 PMCID: PMC10986159 DOI: 10.1093/sxmrev/qead052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.
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Affiliation(s)
- Lauren M Carney
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Julie B Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Orly Morgan
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL 33101, United States
| | - Christine Hyun
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Zachary E Magin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, United States
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Guy H Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Marshall DC, Carney LM, Hsieh K, Dickstein DR, Downes M, Chaudhari A, McVorran S, Montgomery GH, Schnur JB. Effects of trauma history on cancer-related screening, diagnosis, and treatment. Lancet Oncol 2023; 24:e426-e437. [PMID: 37922933 PMCID: PMC10754479 DOI: 10.1016/s1470-2045(23)00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lauren M Carney
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Shauna McVorran
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth Cancer Center, Hanover, NH, USA
| | - Guy H Montgomery
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie B Schnur
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Head KJ, Harrington NG, Schnur JB, Margolies L, Montgomery GH. Examining gain- and loss-framed messages in a novel breast cancer screening/cardiovascular context: Does framing matter? PEC Innov 2022; 1:100007. [PMID: 37364030 PMCID: PMC10194377 DOI: 10.1016/j.pecinn.2021.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 06/28/2023]
Abstract
Objective Digital mammography can reveal not only breast cancer but also breast arterial calcification (BAC), which can indicate potential coronary artery disease. To explore ways to inform women of their BAC status in the context of a standard mammography results letter, we conducted a preliminary study comparing gain- and loss-framed messages to encourage follow-up cardiovascular care. Methods U.S. women over age 40 with no heart disease history (N = 227) were randomly assigned to view a mammography letter including BAC information in one of seven ways (three gain-framed messages, three loss-framed messages, one comparison message). Results Post-test measures indicated no significant differences on BAC knowledge, recall of test results and recommendations, perceived message effectiveness, or behavioral intentions for follow-up. Conclusion Despite showing no significant differences between message conditions, results supported the messages' ability to clearly convey BAC information and encourage intention for follow-up cardiovascular care. Innovation This experimental study represents the first published report examining the inclusion of BAC screening results within the mammography letter. It also explored the use of message framing in a dual detection-prevention context and suggests that future work should test the effects of including both framing tactics in messages designed to target dual-focus contexts.
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Affiliation(s)
- Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, USA
| | | | - Julie B. Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, USA
| | - Laurie Margolies
- Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, USA
| | - Guy H. Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, USA
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Marshall D, Green S, Jones BM, Starrs C, Montgomery GH, Minassian K, Wunder B, Force J, Schnur JB. Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer. J Am Coll Radiol 2022; 19:1236-1243. [PMID: 36126825 PMCID: PMC10354668 DOI: 10.1016/j.jacr.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.
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Affiliation(s)
- Deborah Marshall
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York.
| | - Sheryl Green
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Medical Director, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Brianna M Jones
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Clodagh Starrs
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Guy H Montgomery
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin Minassian
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Bruce Wunder
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - James Force
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie B Schnur
- Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Co-Director of the Integrative Behavioral Medicine Program, Icahn School of Medicine at Mount Sinai, New York, New York
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Montgomery GH, Schnur JB, Erblich J, Narula J, Benck K, Margolies L. Breast Arterial Calcification Rates in a Diverse, Urban Group of Screening Mammography Patients. Ann Epidemiol 2022; 75:16-20. [PMID: 36031094 DOI: 10.1016/j.annepidem.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Breast arterial calcifications (BAC), detected by digital mammography are a potential marker of coronary artery disease (CAD). Past BAC research has been limited by having primarily racially and ethnically homogeneous samples, samples at higher risk for CAD, and neglecting to explore the influence of women's health factors. The purpose of this study was to evaluate the prevalence of, and factors associated with, BAC in an ethnically and racially diverse group. METHODS We conducted a retrospective chart review on 17,237 screening mammography patients. Mammography results and patient responses to a demographic and medical history questionnaire were abstracted. Logistic regression was used. RESULTS BAC prevalence was 12.3%. Age was a significant risk factor, with the odds of BAC approximately doubling every decade. Age-adjusted analyses showed: 1) higher BAC prevalence among Hispanic, Black, and Ashkenazi women; 2) lower BAC prevalence among nulliparous and pre-menopausal women, those with dense breasts and breast implants, and those currently using HRT; and 3) no association between BAC prevalence and BMI or age at menarche. CONCLUSIONS BAC prevalence differs according to age, ethnicity, race, women's health, and breast-specific factors. Communication of BAC information in clinical settings could potentially prompt women to engage in preventive care.
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Affiliation(s)
- Guy H Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Julie B Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joel Erblich
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Jagat Narula
- Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelley Benck
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laurie Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Platt S, Montgomery GH, Schnur JH, Margolies L. BI-RADS 0 Screening Mammography: Risk Factors That Prevent or Delay Follow-Up Time to Diagnostic Evaluation. J Am Coll Radiol 2022; 19:1262-1268. [PMID: 35985631 DOI: 10.1016/j.jacr.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE BI-RADS 0 screening mammograms require follow-up diagnostic imaging, optimally within 60 days. Our study aims to identify risk factors for delayed follow-up. METHODS We conducted a retrospective case-control study of individuals who had a nondiagnostic BI-RADS 0 screening mammogram between March 19, 2018, and March 19, 2020. Sociodemographic information was collected from self-reported questionnaire. We aimed to identify factors associated with <60-day follow-up, >60-day follow-up, or no follow-up outcomes. The χ2 test and univariate logistic regressions were performed. Significant variables were included in multinomial logistic regression. We also aimed to identify risk factors that lead to delayed follow-up times among individuals with follow-up. Spearman's correlation and Mann-Whitney Wilcoxon tests and Kruskal-Wallis tests were performed. RESULTS Review returned 5,034 screening mammograms. Of 4,552 individuals included, 904 (19.9%) had no follow-up. Of the 3,648 (80.1%) with follow-up, 2,797 (76.7%) had a follow-up <60 days (median 20 days) and 851 (23.3%) had follow-up >60 days (median 176 days). Multinomial regression found that Asian (P = .022), Black (P < .0001), and individuals who identified their race as other (P < .0001) were independently more likely to have no or >60-day follow-up. Individuals who did not report their race (P = .001) or completed the questionnaire in Spanish (P = .025) were more likely to have no or >60-day follow-up. Amongst individuals with follow-up, Black individuals (P < .0001), those who identified their race as other (P < .0001), Hispanic individuals (P = .04), and those who completed the questionnaire in Spanish (P < .0001) had follow-up delays. BRCA-positive individuals had shorter follow-up times (P = .021). DISCUSSION Follow-up time is affected by cancer risk factors such as BRCA status in addition to race, preferred language, and Hispanic ethnicity.
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Affiliation(s)
- Samantha Platt
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Guy H Montgomery
- Professor, Department of Population Health Science and Policy and Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie H Schnur
- Assistant Professor, Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurie Margolies
- Professor of Diagnostic, Molecular and Interventional Radiology and Professor and Director, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
Hypnosis interventions have too often failed to disseminate, in part because of the relatively few high-quality, randomized clinical trials. The Task Force proposes efficacy guidelines, which are intended to improve the quality of clinical hypnosis research and thereby increase dissemination of beneficial hypnosis interventions. However, the Task Force, in muddying the focus on efficacy with opinions about moderation and mediation, proposes guidelines that are likely to: (1) weaken efficacy findings; (2) increase participant mistrust; (3) make efficacy trials more cumbersome; and, (4) treat hypnosis as though it were something other than a time-honored form of talk therapy. While applauding the Task Force's intentions, the current recommendations could be changed to better accomplish their goal of increasing hypnosis dissemination and implementation.
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Affiliation(s)
- Guy H Montgomery
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, Boston, Massachusetts, USA
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Erblich J, Montgomery GH, Schnur JB. Affective mechanisms of stress-induced cigarette craving: Considerations of gender and race/ethnicity. Addict Behav 2022; 130:107293. [PMID: 35220151 DOI: 10.1016/j.addbeh.2022.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Among the major impediments to successful smoking cessation are strong cravings, especially during times of heightened stress. Affective responses to stress (e.g., acute anxious and depressed mood) may serve as important mediators of cigarette cravings that are amenable to intervention. Experimental models have been developed to reliably induce cravings during stress under laboratory conditions, permitting a closer examination of possible changes in affect that may be driving cigarette cravings. A key limitation of the extant research is its reliance on samples of predominantly White males who smoke. Although several recent studies suggest possible gender- and race/ethnicity-based differences in affective responses to acute stress, no studies have explored how such differences may contribute to cigarette cravings. METHOD To address this gap, we conducted an experimental study in which a diverse sample of healthy volunteer female (n = 163) and male (n = 139) nicotine-dependent individuals who smoked were exposed to a stressor (guided imagery of painful dental work). We assessed negative affect and cigarette craving immediately before and after the imaginal dental stressor. RESULTS Path analyses revealed that the acute stressor induced increases in negative affect, which, in turn, increased cigarette craving (significant direct and indirect effects, p's < 0.05; R2indirect = 0.5). Interestingly, effects were more pronounced in women and in non-White individuals who smoked. CONCLUSIONS Results highlight the important roles of stress and affect in craving, and the need to consider gender and race/ethnicity when developing interventions to manage stress-induced cigarette cravings among individuals attempting to quit.
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Affiliation(s)
- Joel Erblich
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, United States; Hunter College, City University of New York, 695 Park Avenue, HN628, New York, NY 10065, United States.
| | - Guy H Montgomery
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, United States
| | - Julie B Schnur
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, United States
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Aebersold ML, Kraft S, Farris KB, Scherdt M, Olsen M, Polovich M, Shelton BK, Montgomery GH, Friese CR. Evaluation of an Interprofessional Training Program to Improve Cancer Drug Therapy Safety. JCO Oncol Pract 2021; 17:e1551-e1558. [PMID: 33577351 PMCID: PMC9810130 DOI: 10.1200/op.20.00816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Drug therapy for cancer is a high-risk, high-volume clinical intervention that requires interprofessional teams. Given the complexity of anticancer drug therapy and safety concerns, an interdisciplinary team developed a novel training program for oncology registered nurses and pharmacists to improve cancer drug safety. METHODS Participants completed preworkshop learning assessments and received access to web-based modules on six topics: hazardous drug handling, drug extravasation, hypersensitivity reaction management, sepsis recognition, immune checkpoint inhibitor toxicities, and oral oncolytic adherence. In a 7-hour workshop, participants applied module content in interactive exercises and high-fidelity simulations. Preworkshop and postworkshop questionnaires assessed changes in knowledge and confidence in each topic. Program satisfaction and changes to clinical practice or policies were assessed 3 months after the workshop. RESULTS Two hundred ninety-two nurses and 82 pharmacists applied to participate, and 103 (35%) and 44 (54%) have participated, respectively. Long-term follow-up data were available on 133 (90%) participants. Change scores in confidence to meet program objectives increased between pre- and postworkshop (range of increase 0.6-0.8, P < .01). Knowledge scores increased significantly between pre- and postworkshop (average improvement of 3.2 points, P < .01). Overall program satisfaction was high (mean 5.0, standard deviation [0.2] on a five-point scale). Seventy-seven (60%) reported that they had made at least one clinical practice or institutional policy change at 3 months. CONCLUSION An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver cancer drug safety content to practicing oncology clinicians.
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Affiliation(s)
- Michelle L. Aebersold
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI
| | - Shawna Kraft
- University of Michigan College of Pharmacy, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Karen B. Farris
- University of Michigan College of Pharmacy, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Marylee Scherdt
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI
| | - MiKaela Olsen
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - Brenda K. Shelton
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Guy H. Montgomery
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Behavioral Oncology, New York, NY
| | - Christopher R. Friese
- University of Michigan School of Nursing, Center for Improving Patient and Population Health, Ann Arbor, MI,University of Michigan Rogel Cancer Center, Ann Arbor, MI,Christopher R. Friese, PhD, RN, AOCN, 400 North Ingalls Suite 1174, Ann Arbor, MI 48109-5482; twitter: @ChrisFriese_RN; e-mail:
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Soriano AJ, Schnur JB, Harvie HS, Newman DK, Montgomery GH, Arya LA. Pilot randomized controlled trial of a hypnosis intervention for women with bladder pain syndrome. Neurourol Urodyn 2021; 40:1945-1954. [PMID: 34420228 DOI: 10.1002/nau.24771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/06/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the feasibility and acceptability of a randomized controlled trial of a hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in women. METHODS We conducted a parallel arm, non-blinded, pilot randomized controlled trial of standardized hypnosis sessions including a hypnosis web tool versus usual care in adult women with BPS/IC. Pilot study outcomes included feasibility domains: process, resources and management, safety, and acceptability. Clinical outcomes of lower urinary tract symptoms and quality of life were measured using validated questionnaires at baseline and at the end of the 4-week intervention. RESULTS We randomized 29 out of 30 (96.7%) eligible women. In the hypnosis group, 12 of 15 (80.0%) subjects completed the 4-week intervention and follow up, and 13 of 14 (92.9%) in the usual care group. In the hypnosis group, adherence to the standardized sessions was 80% and participants used the web-based tool for an average of 5.6 ± 2.7 times per week. Scores for emotional distress, relaxation, pain severity and expected bladder symptoms significantly improved during the first two of three planned hypnosis sessions (all p < 0.05). Improvement in quality of life scores was greater in the hypnosis group than the usual care group (-2.6 ± 2.3 vs. -0.9 ± 1.1, p = 0.04). There were no significant between-group differences in urinary symptoms or bladder pain. No adverse events were reported. CONCLUSIONS A hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis is feasible, acceptable, safe, and may improve quality of life.
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Affiliation(s)
- Alex J Soriano
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie B Schnur
- Department of Oncological Services, Ichan School of Medicine at Mount Sinai, Mount Sinai, New York, USA
| | - Heidi S Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy H Montgomery
- Department of Oncological Services, Ichan School of Medicine at Mount Sinai, Mount Sinai, New York, USA
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Montgomery GH, Green JP, Erblich J, Force J, Schnur JB. Common paraverbal errors during hypnosis intervention training. Am J Clin Hypn 2021; 63:252-268. [PMID: 33617422 DOI: 10.1080/00029157.2020.1822275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is to identify common paraverbal errors among hypnosis trainees in order to inform future training efforts. In a sample of 196 hypnosis trainees, paraverbal errors (i.e., tone, pacing, and phrasing) were tracked across hypnotic intervention components. Results revealed that trainees had most difficulty with hypnotic tone, particularly during the Induction, Deepening, and Alerting components. Individual trainee characteristics were unrelated to paraverbal errors.
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Affiliation(s)
| | | | - Joel Erblich
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Force
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Erblich J, Montgomery GH, Schnur JB, Ragin C. Abstract C021: Affective mechanisms of stress-induced cigarette craving: Considerations of sex and ethnicity. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Cigarette smoking continues to be the number one modifiable risk factor for the development of cancer. Among the major impediments to successful smoking cessation are strong cravings to smoke, especially during times of heightened stress. Affective responses to stress (e.g., acute anxious and depressed mood) may serve as important mediators of cigarette cravings that are amenable to intervention. Experimental models have been developed to induce cravings reliably during stress under laboratory conditions, permitting a closer examination of possible changes in affect that may be driving cigarette cravings. The possibility that specific types of affect may be responsible for cigarette cravings, however, has not been investigated. Another key limitation of the extant research is its reliance on samples of predominantly male Caucasian smokers. Although several recent studies suggest possible sex- and ethnicity-based differences in affective responses to acute stress, no studies have explored how such differences may contribute to cigarette cravings. To that end, we conducted an experimental study in which an ethnically diverse sample of healthy volunteer female (n=163) and male (n=139) nicotine-dependent smokers were exposed to a mild stressor (guided imagery of painful dental work). We assessed positive affect (happy, relaxed, energized), negative affect (anxious, depressed, emotionally upset), and cigarette craving immediately before and after the imaginal dental stressor. Mean age of the sample was 38.6 (+ 10.2). Participants reported smoking an average of 19.5 (+ 9.8) cigarettes per day for an average of 18.9 (+ 10.0) years. Path analyses revealed that the acute stressor induced significant increases in negative affect and decreases in positive affect (p's < 0.0001). In turn, increases in anxious, but not depressed mood, mediated effects of the stressor on cigarette craving. Bootstrapped confidence intervals indicated that indirect mediated effects were significant at the 0.05 level. Interestingly, effects were particularly pronounced in women (85% of total effect for women vs. 65% of total effect for men). Among Hispanic (n=81) smokers, elevations in depressed mood mediated increases in cigarette craving (p <0.05), unlike among African American (n=138) and Caucasian (n=62) smokers. Results highlight the importance of considering sex and ethnicity when developing interventions to manage stress-induced cigarette cravings among smokers attempting to quit.
Citation Format: Joel Erblich, Guy H. Montgomery, Julie B. Schnur, Camille Ragin. Affective mechanisms of stress-induced cigarette craving: Considerations of sex and ethnicity [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C021.
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Affiliation(s)
- Joel Erblich
- 1Hunter College and Icahn School of Medicine at Mount Sinai, New York, NY,
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Montgomery GH, Force J, Dillon MJ, David D, Schnur JB. The effect of an online lecture on psychosocial cancer care providers' attitudes about hypnosis. Psychol Conscious (Wash D C) 2019; 6:320-328. [PMID: 32984428 PMCID: PMC7517698 DOI: 10.1037/cns0000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hypnosis has been shown to be efficacious in the control of the symptoms and side effects of cancer and its treatment across all stages of the cancer continuum. Yet, hypnosis has generally failed to widely disseminate to clinical cancer settings, potentially due in part to provider attitudes about hypnosis. In a sample of 340 trainees (psychosocial cancer care providers), we tested the effects of a 12-minute online video hypnosis lecture on provider attitudes (using the Attitudes Toward Hypnosis Questionnaire). We hypothesized that viewing the online video would improve attitudes about hypnosis. Using a repeated measures design, total attitudes toward hypnosis improved following the lecture [F(1,339) = 321.97, p < .0001], as did all hypnosis attitude subscales. Older age and ethnicity (Latino/a) were associated with more positive attitudes across assessment points (ps < .05). Those trainees without prior hypnosis experience had the most attitude improvement (p < .05). The results support the use of a brief, online hypnosis lecture to improve cancer care provider attitudes about hypnosis, and suggest a path forward to facilitate more widespread dissemination of hypnosis to cancer care.
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Montgomery GH, Sucala M, Dillon MJ, Schnur JB. Interest and Attitudes about Hypnosis in a Large Community Sample. Psychol Conscious (Wash D C) 2018; 5:212-220. [PMID: 30035144 PMCID: PMC6052866 DOI: 10.1037/cns0000141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the available empirical evidence supporting the efficacy of hypnosis for alleviating symptoms and side effects across a variety of clinical contexts, hypnosis has failed to disseminate widely. One way to try to better understand the lack of hypnosis dissemination is to apply a marketing theory approach, focusing on attitudes and beliefs about a product (hypnosis) held by consumers. Better understanding of such factors can lead to strategies to promote the product among consumers, and in this case, encourage dissemination. The goal of the study was to investigate relationships between interest in hypnosis use and: 1) attitudes about hypnosis; 2) beliefs about the effectiveness of hypnosis (i.e., hypnosis credibility, and hypnosis effectiveness expectancies); 3) past experience with hypnosis; and 4) the perceived hedonic value and utility of hypnosis. The study also explored participants' preferences for hypnosis delivery method (i.e., live or recorded), as well as preferences for hypnosis labeling (i.e., how hypnosis is defined). Participants (N = 509) were recruited through Amazon Mechanical Turk and completed an anonymous online survey. The results revealed that participants' attitudes about hypnosis, their expectancies for the effectiveness of hypnosis, and the perceived hedonic value of hypnosis accounted for unique variance in participants' interest in hypnosis, ps < .05. Together, these variables accounted for 73% of the variance in participants' interest in hypnosis use. Based on these findings, we recommend that these key variables should be considered when planning for greater dissemination and uptake of empirically supported hypnosis interventions.
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Montgomery GH, Sucala M, Dillon MJ, Schnur JB. Cognitive-Behavioral Therapy Plus Hypnosis for Distress During Breast Radiotherapy: A Randomized Trial. Am J Clin Hypn 2017; 60:109-122. [PMID: 28891772 DOI: 10.1080/00029157.2017.1335635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiotherapy is a common and effective treatment for women with breast cancer. However, radiotherapy has also been shown to adversely affect patients' emotional well-being. Currently, few mind-body interventions are designed to improve patients' quality of life during radiotherapy. One intervention which has demonstrated clinical efficacy in the breast cancer radiotherapy setting is Cognitive-Behavioral Therapy plus Hypnosis. The goal of this study was to investigate the impact of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress in women with breast cancer undergoing radiotherapy. One hundred patients were randomly assigned to either the Cognitive-Behavioral Therapy plus Hypnosis (n = 50) or Attention Control (n = 50) group. Results revealed significant benefits of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress at the mid-point (d = 0.54), the conclusion (d = 0.64), and 4 weeks following the conclusion (d = 0.65) of radiotherapy (all ps < 0.05). In summary, results support further study of Cognitive-Behavioral Therapy plus Hypnosis as an evidence-based intervention to reduce emotional distress in women with breast cancer. Cognitive-Behavioral Therapy plus Hypnosis has the benefits of being brief, noninvasive, lacking side-effects, and producing beneficial effects which last beyond the conclusion of radiotherapy. Given these strengths, we propose that Cognitive-Behavioral Therapy plus Hypnosis is a strong candidate for greater dissemination and implementation in cancer populations.
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Abstract
Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep disturbances, pain, appetite loss, and dyspnea. EMBASE, MEDLINE, COCHRANE, PsychINFO, and SCOPUS databases were searched from inception through November 7, 2016. No studies met the inclusion criteria. It appears that hypnosis has never been rigorously tested as a means to ameliorate the most common symptoms in individuals with cancer at the end of their lives. This finding is troubling, as it strongly implies that a population most in need has been largely neglected. However, a clear future research direction is revealed that may have significant clinical impact.
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Affiliation(s)
- Guy H Montgomery
- a Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Madalina Sucala
- a Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Tessa Baum
- a Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Julie B Schnur
- a Icahn School of Medicine at Mount Sinai , New York , New York , USA
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Schnur JB, Chaplin WF, Khurshid K, Mogavero JN, Goldsmith RE, Lee YS, Litman L, Montgomery GH. Development of the Healthcare Triggering Questionnaire in adult sexual abuse survivors. Psychol Trauma 2017; 9:714-722. [PMID: 28447815 DOI: 10.1037/tra0000273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE One in 4 women and 1 in 10 men in the United States are survivors of sexual abuse (SA). For these survivors, healthcare experiences may trigger memories, thoughts, feelings or sensations related to this past abuse. Such triggering can be associated with negative responses to healthcare (e.g., anxiety, avoidance). However, to date, no healthcare triggering assessment tool exists. Therefore, the study goal was to describe the prevalence of healthcare triggering, to develop a brief Healthcare Triggering Questionnaire (HTQ), and to examine its initial validity. METHOD An initial pool of 117 items was developed based on previous research. Two-parameter logistic item response theory models were used to develop the scales. SA survivors [male (n = 233), female (n = 222)] and a comparison group of non-SA individuals [male (n = 114), female (n = 106)] were recruited through Amazon Mechanical Turk and completed the study anonymously online. RESULTS Three 10-item scales were developed: (a) the HTQ-M for males; (b) the HTQ-F for females; and (c) the HTQ-U (unisex) for all respondents. The results supported the utility and initial validity of the gender-specific and unisex scales. CONCLUSIONS The HTQ scales are a psychometrically sound approach to evaluating healthcare triggering experienced by adult sexual abuse survivors. The HTQ may be considered for use by researchers interested in studying healthcare triggering, healthcare retraumatization, and healthcare adherence. The HTQ may also be of use to clinicians interested in identifying trauma survivors who are more likely to experience triggering in healthcare settings. (PsycINFO Database Record
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
| | | | | | | | - Rachel E Goldsmith
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
| | - Young-Sun Lee
- Department of Human Development, Teachers College, Columbia University
| | - Leib Litman
- Department of Psychology, Lander College for Men
| | - Guy H Montgomery
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
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McDonnell GA, Sucala M, Goldsmith RE, Montgomery GH, Schnur JB. Cancer Victim Identity for Individuals with Histories of Cancer and Childhood Sexual Abuse. J Ration Emot Cogn Behav Ther 2017; 35:402-412. [PMID: 29230080 DOI: 10.1007/s10942-017-0268-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Identifying as a 'cancer victim' has been linked to adverse psychosocial sequelae in individuals who have been diagnosed with cancer. Being a childhood sexual abuse (CSA) survivor may predispose individuals towards a "victim" identity in general. The aim of this study was to determine the prevalence of identifying as a 'cancer victim' among CSA survivors who were diagnosed with cancer as adults, and to explore psychological factors associated with identification as a cancer victim. 105 adults reporting both a history of CSA and of having been diagnosed with cancer as an adult were recruited through Amazon Mechanical Turk. Variables assessed included CSA severity, abuse-related powerlessness, general mastery, and cancer victim identity. Fifty-one percent of the sample endorsed a cancer victim identity. Path analysis revealed that abuse-related powerlessness was related to decreased feelings of general mastery, which was in turn associated with cancer victim identification (x2 = .12, DF = 1, p < .73; RMSEA = .00; SRMR = .01: Bentler CFI = 1.0). From a clinical perspective, the results suggest that increasing general mastery in CSA survivors in the cancer setting may be an important mechanism for attenuating the risk for developing a cancer victim identity and, presumably, for downstream adverse psychosocial sequelae.
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Affiliation(s)
- Glynnis A McDonnell
- Department of Psychology, St. John's University, 80-00 Utopia Parkway, Jamaica, NY 11439, USA
| | - Madalina Sucala
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA
| | - Rachel E Goldsmith
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA
| | - Guy H Montgomery
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA
| | - Julie B Schnur
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA
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Lynn SJ, Green JP, Kirsch I, Capafons A, Lilienfeld SO, Laurence JR, Montgomery GH. Grounding Hypnosis in Science: The "New" APA Division 30 Definition of Hypnosis as a Step Backward. Am J Clin Hypn 2015; 57:390-401. [PMID: 25928778 DOI: 10.1080/00029157.2015.1011472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Although therapeutic alliance is a crucial factor in face-to-face therapies, no data exist on clinicians' attitudes towards alliance in E-therapy. The study explored clinicians' perceived importance of alliance in E-therapy, clinicians' confidence in their skills to develop alliance in E-therapy, and whether attitudes towards alliance in E-therapy are associated with intended E-therapy practice. Clinicians (n = 106) responded to an online survey. The majority of clinicians considered alliance to be extremely important in both face-to-face therapy and E-therapy. However, clinicians' ratings of the importance of alliance in face-to-face therapies were significantly higher than their ratings of the importance of alliance in E-therapy. Clinicians reported less confidence in their skills to develop alliance in E-therapy than in face-to-face therapy. Intended E-therapy practice correlated with confidence in one's ability to develop alliance in E-therapy and with previous E-therapy practice.
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Affiliation(s)
- Madalina Sucala
- a Babes-Bolyai University , Icahn School of Medicine at Mount Sinai
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Yeh VM, Schnur JB, Margolies L, Montgomery GH. Dense breast tissue notification: impact on women's perceived risk, anxiety, and intentions for future breast cancer screening. J Am Coll Radiol 2014; 12:261-6. [PMID: 25556313 DOI: 10.1016/j.jacr.2014.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notification, (2) explore individual difference variables (eg, minority status, insurance coverage) that may influence intentions for additional ultrasound screening, and (3) assess whether anxiety mediates the relationship between perceived risk and screening intentions. METHODS A total of 184 women aged >40 years in the United States were recruited from Amazon Mechanical Turk to respond to a dense breast tissue notification as if they had personally received it. RESULTS After reviewing a notification, women reported greater perceived risk (d = 0.67) and intentions to undergo mammography (d = 0.25) than before. Most women intended to undergo additional ultrasound screening, although to a lesser extent when ultrasound was covered by insurance than when it was not (d = 1.03). All screening intentions were lower in women with ambiguity aversion, a tendency to avoid tests without medical consensus, and those who preferred an active decision-making role. Anxiety mediated the relationship between perceived breast cancer risk and all screening intentions. CONCLUSIONS Women who receive dense breast tissue notifications may generally increase their breast cancer screening intentions; however, intention strength varies depending on internal (eg, ambiguity aversion) and external (eg, insurance for ultrasound) factors. Although perceived risk increases after notification, it is anxiety that drives women's intentions for future screening.
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Affiliation(s)
- Vivian M Yeh
- Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Julie B Schnur
- Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurie Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Guy H Montgomery
- Integrative Behavioral Medicine Program, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
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Braschi C, Pelto DJ, Hennelly MO, Lee KK, Shah B, Montgomery GH, Itzkowitz SH, Jandorf L. Patient-, Provider-, and System-Level Factors in Low Adherence to Surveillance Colonoscopy Guidelines: Implications for Future Interventions. J Gastrointest Cancer 2014; 45:500-3. [DOI: 10.1007/s12029-014-9653-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sucala M, Schnur JB, Brackman EH, David D, Montgomery GH. The role of specific and core dysfunctional beliefs in breast cancer radiotherapy patients' fatigue. J Health Psychol 2014; 19:957-65. [PMID: 23632136 PMCID: PMC3835755 DOI: 10.1177/1359105313482166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The goal of the study was to examine the relationships among fatigue catastrophizing, core dysfunctional beliefs, and fatigue in breast cancer radiotherapy patients. Seventy-eight patients participated in the study (mean age = 56.3, standard deviation = 10.5). Patients completed questionnaires on fatigue catastrophizing, core dysfunctional beliefs, and fatigue in their last week of radiotherapy. Using bootstrapping procedures to obtain estimates and confidence intervals for indirect effects, results showed that core beliefs (Need for Comfort and Demandingness for Fairness) had significant indirect effects on fatigue through fatigue catastrophizing, as indicated by the 95 percent confidence interval (.02-.19 for Need for Comfort; .01-.16 for Demandingness for Fairness).
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Affiliation(s)
- Madalina Sucala
- Icahn School of Medicine at Mount Sinai, USA Babes-Bolyai University, Romania
| | | | | | - Daniel David
- Icahn School of Medicine at Mount Sinai, USA Babes-Bolyai University, Romania
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Miller SJ, Sohl SJ, Schnur JB, Margolies L, Bolno J, Szabo J, Hermann G, Montgomery GH. Pre-biopsy psychological factors predict patient biopsy experience. Int J Behav Med 2014; 21:144-8. [PMID: 23065421 DOI: 10.1007/s12529-012-9274-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). PURPOSE The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes. METHODS Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure). RESULTS The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort. CONCLUSIONS Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.
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Fukui JA, Rothwell A, Danesh H, Adelson KB, Morris GJ, Irie H, Port ER, Weltz C, Schmidt H, Montgomery GH, Mandeli JP, Tiersten A. Comparison of weight loss among early-stage breast cancer patients post chemotherapy: Nutrition education in combination with weight loss acupuncture versus nutrition education alone. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Kerin B. Adelson
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | | | - Hanna Irie
- Mount Sinai School of Medicine, New York, NY
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Montgomery GH, David D, Kangas M, Green S, Sucala M, Bovbjerg DH, Hallquist MN, Schnur JB. Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer. J Clin Oncol 2014; 32:557-63. [PMID: 24419112 DOI: 10.1200/jco.2013.49.3437] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group. PATIENTS AND METHODS Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness). RESULTS The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13). CONCLUSION The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.
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Affiliation(s)
- Guy H Montgomery
- Guy H. Montgomery, Daniel David, Sheryl Green, Madalina Sucala, and Julie B. Schnur, Icahn School of Medicine at Mount Sinai, New York, NY; Daniel David and Madalina Sucala, Babeş-Bolyai University, Cluj-Napoca, Romania; Maria Kangas, Macquarie University, Sydney, New South Wales, Australia; Dana H. Bovbjerg, University of Pittsburgh Cancer Institute, University of Pittsburgh; and Michael N. Hallquist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
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Abstract
Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). REACH In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. EFFICACY There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. ADOPTION Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. IMPLEMENTATION Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. MAINTENANCE Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination.
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Affiliation(s)
- Vivian M Yeh
- Integrative Behavioral Medicine Program, Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai
| | - Julie B Schnur
- Integrative Behavioral Medicine Program, Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai
| | - Guy H Montgomery
- Integrative Behavioral Medicine Program, Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai
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Green S, Montgomery GH, Mattson DMK, Hydeman J, Schnur JB. Abstract P6-08-07: Out-of-pocket spending, dermatologic quality of life, and treatment satisfaction in breast cancer radiotherapy patients. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Skin toxicity is one of the most common acute side effects of breast cancer radiotherapy (RT). Past research has largely neglected non-medical out-of-pocket (OOP) spending associated with this side effect. We therefore developed a Skin Toxicity Costs (STC) questionnaire to assess such spending. The primary goal of the present study was to use the STC to estimate non-medical out-of-pocket spending associated with acute skin toxicity in breast cancer RT patients. Secondary goals included exploration of the associations between the STC, dermatologic quality of life, and satisfaction with RT.
Methods: 185 consecutive female breast cancer RT patients (Stage 0-III) participated in the research from 2008 to 2013. All participants received a course of standard fractionated external beam RT. Demographics: mean age = 55.4; 74% White, 10% African American, 16% Other; and 10% Latina. In regard to employment, 46% reported working full-time, 12% part-time, and 42% were not employed. 68% had at least a college degree and 66% reported a household income of ≥ $60,000/year. On their penultimate day of RT, participants completed the STC, the Dermatologic Life Quality Index (DLQI), and a Patient Satisfaction Questionnaire (PSQ). Patients also completed a demographics questionnaire and an Importance of Appearance Scale (IAPP) at the commencement of RT. Note: all patients were provided with skin creams free of charge through the clinic.
Results: Analyses revealed no differences in the STC, DLQI, or PSQ based on recruitment site (all ps > .45). Results revealed that 83% of the sample reported OOP spending associated with skin toxicity. Mean STC spending was $245.11 (95% CI: 135.34 to 354.87; Median = $75.00). Multiple regression of demographic factors (ethnicity, race, marital status, employment, education, income) and IAPP revealed that IAPP and marital status uniquely predicted STC spending (ps < .02; total model R2 = .24), such that increased STC was associated with increased importance of appearance and being unmarried. Controlling for IAPP and marital status, STC was significantly associated with DLQI (p<.001), such that increased STC was associated with decreased dermatologic quality of life. Lastly, we examined whether the STC was associated with treatment satisfaction controlling for IAPP, marital status, and DLQI. Results revealed that only STC was uniquely associated with patient satisfaction (p<.001; total model R2 = .39), such that patients with higher STC scores were less satisfied with their RT.
Discussion: Results are consistent with recent research suggesting that OOP spending can be considered a “financial toxicity” of cancer treatment, and is associated with lower levels of satisfaction with cancer care. However, the present study is the first to examine this issue with a focus on skin toxicity-related spending in breast cancer patients. The results suggest that OOP spending is linked to patient satisfaction with care. OOP may be a marker of skin toxicity. Future research seeking to manage skin toxicity may have the beneficial downstream consequence of reducing OOP spending and improving overall satisfaction with RT.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-07.
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Affiliation(s)
- S Green
- Icahn School of Medicine at Mount Sinai, New York, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - GH Montgomery
- Icahn School of Medicine at Mount Sinai, New York, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - DMK Mattson
- Icahn School of Medicine at Mount Sinai, New York, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - J Hydeman
- Icahn School of Medicine at Mount Sinai, New York, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - JB Schnur
- Icahn School of Medicine at Mount Sinai, New York, NY; Roswell Park Cancer Institute, Buffalo, NY
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Hallquist MN, Jensen MP, Patterson DR, Lynn SJ, Montgomery GH. Clinical hypnosis for acute pain in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd006599.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cristea IA, Montgomery GH, Szamoskozi Ş, David D. Key Constructs in “Classical” and “New Wave” Cognitive Behavioral Psychotherapies: Relationships Among Each Other and With Emotional Distress. J Clin Psychol 2013; 69:584-99. [DOI: 10.1002/jclp.21976] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease); and 3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment. However, a great deal more work needs to be done to explore the use of hypnosis in survivorship, to understand the mediators and moderators of hypnosis interventions, and to develop effective dissemination strategies.
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Affiliation(s)
- Guy H Montgomery
- Integrative Behavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Abstract
This study systematically reviews the hypnosis apps available via iTunes that were compatible with iPhone or iPad. Of 1455 apps identified on iTunes, 407 met inclusion criteria and were further reviewed. Most common hypnosis app targets were weight loss (23%), boosting self-esteem (20%), and relaxation/stress reduction (19%); 83% of apps delivered hypnosis via audio track, and 37% allowed tailoring. Less than 14% of apps reported disclaimers. None of the apps reported having been tested for efficacy, and none reported being evidence based. Although apps have the potential to enhance hypnosis delivery, it seems as though technology has raced ahead of the supporting science. Recommendations from clinical researchers and policy makers are needed to inform responsible hypnosis app development and use.
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Affiliation(s)
- Madalina Sucala
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029-6574, USA.
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Sohl SJ, Danhauer SC, Schnur JB, Daly L, Suslov K, Montgomery GH. Feasibility of a brief yoga intervention during chemotherapy for persistent or recurrent ovarian cancer. Explore (NY) 2012; 8:197-8. [PMID: 22560758 DOI: 10.1016/j.explore.2012.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/17/2022]
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Sucala M, Schnur JB, Constantino MJ, Miller SJ, Brackman EH, Montgomery GH. The therapeutic relationship in e-therapy for mental health: a systematic review. J Med Internet Res 2012; 14:e110. [PMID: 22858538 PMCID: PMC3411180 DOI: 10.2196/jmir.2084] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 05/24/2012] [Indexed: 02/06/2023] Open
Abstract
Background E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.
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Affiliation(s)
- Madalina Sucala
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
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Kangas M, Montgomery GH. The role of cognitive, emotional and personality factors in the experience of fatigue in a university and community sample. Psychol Health 2012; 26 Suppl 1:1-19. [PMID: 20945255 DOI: 10.1080/08870440903521779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to investigate the contribution of cognitive, emotional and personality factors to the experience of fatigue severity in healthy adult individuals. Specifically, the study examined whether fatigue catastrophising and emotional distress mediated the relationships between neuroticism, general irrational and rational thoughts to fatigue severity. One hundred and eighty nine university students and community volunteers completed self-report questionnaires assessing fatigue catastrophising and symptom severity, neuroticism, general rational and irrational thoughts and emotional distress. A series of correlational and path analyses were conducted to test the study hypotheses. Neuroticism and more general negative, irrational cognitions were associated with elevated fatigue catastrophising and fatigue severity, whereas more adaptive, rational cognitions were related to lower fatigue catastrophising and fatigue severity. Both elevated fatigue catastrophising and emotional distress uniquely and simultaneously mediated the relationships between irrational and rational cognitions and neuroticism to fatigue severity. These findings demonstrate that cognitions play a role in fatigue severity. The results have implications in the assessment and treatment of fatigue disturbances in the general community.
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Affiliation(s)
- Maria Kangas
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia.
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Schnur JB, Montgomery GH. E-counseling in psychosocial cancer care: a survey of practice, attitudes, and training among providers. Telemed J E Health 2012; 18:305-8. [PMID: 22424079 DOI: 10.1089/tmj.2011.0142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the cancer setting, e-counseling interventions may be uniquely beneficial as they spare patients the cost and burden of traveling to a hospital or clinic for psychosocial care. However, the prevalence of e-counseling among psychosocial cancer care providers is unknown, as are the training needs with regard to e-counseling among this group of professionals. Thus, our group conducted an online professional training needs assessment with psychosocial cancer care providers. SUBJECTS AND METHODS Participants (n=120) were recruited from the listservs of the Health Psychology Division of the American Psychological Association, the Society of Behavioral Medicine-Cancer Special Interest Group, the American Psychosocial Oncology Society, and the Association of Oncology Social Work. All completed a 14-item online survey. RESULTS Although 84% of participants stated that e-counseling could be important to their clinical work with cancer patients and survivors, 88% reported that they did not have the skills to effectively conduct e-counseling, and 81% reported that there were no adequate e-counseling educational opportunities. When asked about future training opportunities, participants reported a preference for online training versus live training (p<0.001). CONCLUSIONS Overall, the results highlight the need for online training programs in e-counseling for psychosocial cancer care providers. The training of psychosocial cancer care providers in e-counseling is a critical first step towards increasing implementation of e-counseling interventions and using the Internet to deliver effective interventions to cancer patients in need.
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences, Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1130, New York, NY 10029, USA.
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Abstract
INTRODUCTION Cue-induced cigarette cravings have been oft studied as potentially important predictors of smoking cessation outcomes. The literature on the relationship between cue-induced cravings and cessation, however, remains mixed. One possible explanation for the discrepant results in the literature may be the as-yet untested variability in expectancies of craving. Indeed, as with many interoceptive responses, cravings and their downstream consequences may be influenced by expectancies. To date, no study has examined the influence of expected cravings following smoking cue exposures on actual craving experiences and cessation outcomes. The objective of this study, therefore, was to test the possibility that smokers' expected craving levels in response to smoking cues would be related to actual cravings following cue exposure and that expected cravings would be related to cessation outcomes. METHODS Nicotine-dependent adult smokers (n = 153) were exposed to sets of neutral and smoking cues and completed questionnaires assessing (a) prior to the exposures, the cigarette craving levels they expected to experience following the cue exposures and (b) following the exposures, their actual craving levels. Participants also reported the duration of their most recent quit attempt and their perceived future quit difficulty. RESULTS Findings indicated that expected cravings assessed prior to the cue exposures were significantly related to actual cravings following the exposures. In addition, both expected cravings and actual cravings were related to shorter previous quit duration and higher perceived quit difficulty. CONCLUSIONS Study results highlight the importance of considering both expected and actual cravings in cue-induced craving paradigms.
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Affiliation(s)
- Joel Erblich
- Department of Psychology, College of Staten Island, City University of New York, Staten Island, NY 10314, USA.
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Miller SJ, Schnur JB, Montgomery GH, Jandorf L. AFRICAN-AMERICANS' AND LATINOS' PERCEPTIONS OF USING HYPNOSIS TO ALLEVIATE DISTRESS BEFORE A COLONOSCOPY. Contemp Hypn Integr Ther 2011; 28:196-203. [PMID: 26566440 PMCID: PMC4640674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although colorectal cancer (CRC) screenings can effectively detect and prevent cancer, a large portion of African-Americans and Latinos do not undergo regular colonoscopy screening. Research suggests that anticipatory distress can significantly hinder minorities' adherence to colonoscopy recommendations. There is significant promise that hypnosis may effectively reduce such distress. The current study examined African-Americans' and Latinos' (n = 213) perceptions of using hypnosis prior to a colonoscopy. Overall, 69.9% of the sample expressed favourable perceptions of using pre-colonoscopy hypnosis, although there was notable variability. The results from this study can guide clinical decision making and inform future research efforts.
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Affiliation(s)
- Sarah J Miller
- Mount Sinai School of Medicine, Department of Oncological Sciences
| | - Julie B Schnur
- Mount Sinai School of Medicine, Department of Oncological Sciences
| | - Guy H Montgomery
- Mount Sinai School of Medicine, Department of Oncological Sciences
| | - Lina Jandorf
- Mount Sinai School of Medicine, Department of Oncological Sciences
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Mohamed NE, Bovbjerg DH, Montgomery GH, Hall SJ, Diefenbach MA. Pretreatment depressive symptoms and treatment modality predict post-treatment disease-specific quality of life among patients with localized prostate cancer. Urol Oncol 2011; 30:804-12. [PMID: 21795078 DOI: 10.1016/j.urolonc.2011.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 01/26/2011] [Accepted: 02/06/2011] [Indexed: 11/15/2022]
Abstract
PURPOSE This study examines the prevalence of depressive symptoms before prostate cancer treatment and explores associations among pre-treatment depressive symptoms and post-treatment disease-specific QOL, controlling for treatment modality, and demographic and clinical covariates. MATERIALS AND METHODS A case series of patients diagnosed with localized prostate cancer (T1-2N0M0) at a comprehensive cancer center was assessed. Of the 1,370 eligible patients, 869 (63.34%) completed questionnaires at diagnosis (baseline) and 6 months following treatment. Patients were treated with surgery (16.8%), brachytherapy (27.6%), or external beam radiation (EBRT; 55.6%). Depressive symptoms and disease-specific QOL were assessed with established measures (i.e., Center for Epidemiologic Studies Depression Scale (CES-D); sexual adjustment questionnaire (SAQ); and the American Urological Association symptom index). RESULTS A fifth of the sample (19.7%) reported clinically elevated levels of depressive symptoms at baseline. The proportion of clinically elevated levels of baseline depressive symptoms was higher among surgery patients compared with patients treated with brachytherapy or external beam radiation. Depressive symptoms at baseline and treatment modality significantly predicted sexual and urinary dysfunction, related bother, activity limitation due to urinary dysfunction at 6 months, controlling for, age, PSA level, Gleason score, relevant baseline indicators of sexual and urinary dysfunction, related bother, and activity limitation (P < 0.05). CONCLUSIONS Pretreatment depressive symptoms and treatment modality predict QOL after PrCa treatment. Health care providers should be sensitive to the display of depressive symptoms before PrCa treatment and consider preventative interventions, including preparing patients for the changes in disease-specific QOL and related bother following prostate cancer treatment.
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Affiliation(s)
- Nihal E Mohamed
- Department of Urology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Higgins SC, Montgomery GH, Raptis G, Bovbjerg DH. Effect of pretreatment distress on daily fatigue after chemotherapy for breast cancer. J Oncol Pract 2011; 4:59-63. [PMID: 20856780 DOI: 10.1200/jop.0822002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would predict the severity of their postinfusion fatigue. METHODS Sixty stage I (32.6%) and II (67.4%) patients with breast cancer (mean age, 44.5 years) who were receiving standard outpatient chemotherapy participated. The independent variable, emotional distress, was assessed for "last night," "this morning," and "right now" with a visual analog scale (0 to 100). The dependent variable, post-treatment fatigue (PTF), was assessed (0 to 100) over each of the subsequent 6 days using end-of-day diaries, which also included assessments of distress and nausea (0 to 100). For the statistical analyses, post-treatment fatigue was divided into three phases with means calculated for days 1 through 2 (phase 1), 3 to 4 (phase 2), and 5 to 6 (phase 3). RESULTS Consistent with the study hypothesis, patients' pretreatment distress level in the clinic was a significant (P < .001) predictor of PTF. There was also a significant (P < .025) interaction with phase, with distress becoming a predictor of PTF after phase 1. Multivariate analysis indicated that prior levels of distress were not independent predictors of PTF. CONCLUSIONS This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce patient distress immediately before treatment.
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Affiliation(s)
- Sara C Higgins
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences; Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY
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Sohl SJ, Schnur JB, Sucala M, David D, Winkel G, Montgomery GH. Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model. Psychol Health 2011; 27:347-61. [PMID: 21678183 PMCID: PMC3299868 DOI: 10.1080/08870446.2011.569714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N = 106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.
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Affiliation(s)
- Stephanie J Sohl
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Abstract
Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from 10 studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = .24; 95% Confidence Interval = -0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. The authors question the usefulness of assessing hypnotic suggestibility in clinical contexts.
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Affiliation(s)
- Guy H Montgomery
- Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029-6574, USA.
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David D, Montgomery GH. The scientific status of psychotherapies: A new evaluative framework for evidence‐based psychosocial interventions. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1468-2850.2011.01239.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gherman A, Veresiu IA, Sassu RA, Schnur JB, Scheckner BL, Montgomery GH. Psychological insulin resistance: a critical review of the literature. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/pdi.1574] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Schnur JB, Ouellette SC, Dilorenzo TA, Green S, Montgomery GH. A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients. Psychooncology 2011; 20:260-8. [PMID: 20238306 PMCID: PMC3729017 DOI: 10.1002/pon.1734] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES One of the most common acute side effects of breast cancer radiotherapy is treatment-induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on QOL. METHODS Semistructured interviews were conducted with 20 women (Stage 0-III breast cancer), during their last week of external beam radiotherapy. Each interview was transcribed verbatim, and thematic analysis was performed. RESULTS Three themes were identified based on the interview responses: First, skin changes affect multiple dimensions of QOL. They cause physical discomfort, body image disturbance, emotional distress, and impair both day-to-day functioning and satisfaction with radiation treatment. Second, individual differences affect women's experiences. Generally African American women, younger women, women who are not currently in a relationship, women who are being treated during the summer, and women who are more invested in their appearance are more distressed by skin toxicity. Third, women use a variety of symptom management strategies including self-medication, complementary/alternative medicine approaches, and psychological strategies. CONCLUSIONS Implications of results are as follows: (1) skin toxicity affects numerous dimensions of QOL, and assessment approaches and psychosocial interventions should address this; (2) individual differences may affect the experience of skin toxicity and should be considered in treatment and education approaches; and (3) participants' own creativity and problem-solving should be used to improve the treatment experience.
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Affiliation(s)
- Julie B Schnur
- Department of Oncological Sciences and Integrative Behavioral Medicine Program, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Sohl SJ, Schnur JB, Daly L, Suslov K, Montgomery GH. Development of the beliefs about yoga scale. Int J Yoga Therap 2011:85-91. [PMID: 22398348 PMCID: PMC3360551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Beliefs about yoga may influence participation in yoga and outcomes of yoga interventions. There is currently no scale appropriate for assessing these beliefs in the general U.S. population. This study took the first steps in developing and validating a Beliefs About Yoga Scale (BAYS) to assess beliefs about yoga that may influence people's engagement in yoga interventions. Items were generated based on previously published research about perceptions of yoga and reviewed by experts within the psychology and yoga communities. 426 adult participants were recruited from an urban medical center to respond to these items. The mean age was 40.7 (SD=13.5) years. Participants completed the BAYS and seven additional indicators of criterion-related validity. The BAYS demonstrated internal consistency (11 items; α=0.76) and three factors emerged: expected health benefits, expected discomfort, and expected social norms. The factor structure was confirmed: x2 (41, n=213)=72.06, p<.001; RMSEA=06, p=.23. Criterion-related validity was supported by positive associations of the BAYS with past experiences and future intentions related to yoga. This initial analysis of the BAYS demonstrated that it is an adequately reliable and valid measure of beliefs about yoga with a three-factor structure. However, the scale may need to be modified based on the population to which it is applied.
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Affiliation(s)
- Stephanie J Sohl
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Dilorenzo TA, Bovbjerg DH, Montgomery GH, Valdimarsdottir H, Jacobsen PB. The application of a shortened version of the profile of mood states in a sample of breast cancer chemotherapy patients. Br J Health Psychol 2010. [DOI: 10.1348/135910799168669] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Montgomery GH, Bovbjerg DH. Pre-infusion expectations predict post-treatment nausea during repeated adjuvant chemotherapy infusions for breast cancer. Br J Health Psychol 2010. [DOI: 10.1348/135910700168801] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sohl SJ, Stossel L, Schnur JB, Tatrow K, Gherman A, Montgomery GH. Intentions to use hypnosis to control the side effects of cancer and its treatment. Am J Clin Hypn 2010; 53:93-100. [PMID: 21049742 DOI: 10.1080/00029157.2010.10404331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Evidence suggests that hypnosis is an effective intervention for reducing distress, pain and other side effects associated with cancer and its treatment. However, hypnosis has failed to be adopted into standard clinical practice. This study (n = 115) investigated overall intentions to use hypnosis to control side effects of cancer and its treatment, as well as demographic predictors of such intentions among healthy volunteers. Results suggest that the vast majority of participants (89%) would be willing to use hypnosis to control side effects associated with cancer treatment. Mean intention levels did not differ by gender, ethnicity, education or age. These results indicate that in the general public, there is a willingness to consider the use of hypnosis, and that willingness is not determined by demographic factors. This broad acceptance of hypnosis argues for more widespread dissemination.
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Abstract
This study explored the relationship between psychological factors (including intrusive thoughts, anxiety, well-being, depressed mood) and poor sleep the night before surgery. Patients (N = 39) scheduled for breast surgery (mean age = 47 years) wore an actiwatch at home the night before surgery to provide an objective indication of sleep duration and sleep efficiency. Participants also completed 3 measures of their psychological experience during the week prior to surgery. In separate regression analyses, intrusive thoughts, anxiety, and emotional well-being were each related to sleep duration the night before surgery, when controlling for age, body mass index, ethnicity, and marital status. No relationships were found between depressed mood, physical or social well-being, and sleep duration. In a multiple regression model that included all significant variables, intrusive thoughts were most strongly associated with sleep duration. Intrusive thoughts were also significantly related to sleep efficiency. Results suggest that patients' intrusions about impending surgery are associated with lower sleep duration and sleep efficiency the night before surgery. Additional research is warranted to explore the implications of these associations for patients, as well as possible interventions to improve sleep in this clinical setting.
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