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Christopher M, Bowen S, Witkiewitz K, Grupe D, Goerling R, Hunsinger M, Oken B, Korecki T, Rosenbaum N. A multisite feasibility randomized clinical trial of mindfulness-based resilience training for aggression, stress, and health in law enforcement officers. BMC Complement Med Ther 2024; 24:142. [PMID: 38575888 PMCID: PMC10993469 DOI: 10.1186/s12906-024-04452-y] [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: 08/26/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Law enforcement officers (LEOs) are exposed to significant stressors that can impact their mental health, increasing risk of posttraumatic stress disorder, burnout, at-risk alcohol use, depression, and suicidality. Compromised LEO health can subsequently lead to aggression and excessive use of force. Mindfulness training is a promising approach for high-stress populations and has been shown to be effective in increasing resilience and improving mental health issues common among LEOs. METHODS This multi-site, randomized, single-blind clinical feasibility trial was intended to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of mindfulness-based resilience training (MBRT) versus an attention control (stress management education [SME]) and a no-intervention control, on physiological, attentional, and psychological indices of stress and mental health. The current study was designed to enhance efficiency of recruitment, engagement and retention; optimize assessment, intervention training and outcome measures; and ensure fidelity to intervention protocols. Responsiveness to change over time was examined to identify the most responsive potential proximate and longer-term assessments of targeted outcomes. RESULTS We observed high feasibility of recruitment and retention, acceptability of MBRT, fidelity to assessment and intervention protocols, and responsiveness to change for a variety of putative physiological and self-report mechanism and outcome measures. CONCLUSIONS Results of this multi-site feasibility trial set the stage for a full-scale, multi-site trial testing the efficacy of MBRT on increasing LEO health and resilience, and on decreasing more distal outcomes of aggression and excessive use of force that would have significant downstream benefits for communities they serve. TRIAL REGISTRATION ClinicalTrials.gov, NCT03784846 . Registered on December 24th, 2018.
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Affiliation(s)
- Michael Christopher
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA.
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 2001 Redondo S Dr, Albuquerque, NM, 87106, USA
| | - Daniel Grupe
- Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Ave, Madison, WI, 53703, USA
| | - Richard Goerling
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Matthew Hunsinger
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Barry Oken
- Department of Neurology, Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Tyrus Korecki
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Nils Rosenbaum
- Behavioral Sciences Department, Albuquerque Police Department, 400 Rome, NW, Albuquerque, NM, 87102, USA
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Ribeiro L, Colgan DD, Hoke CK, Hunsinger M, Bowen S, Oken BS, Christopher MS. Differential impact of mindfulness practices on aggression among law enforcement officers. Mindfulness (N Y) 2020; 11:734-745. [PMID: 34257735 DOI: 10.1007/s12671-019-01289-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives Home-based mindfulness practice is a common component of formal mindfulness training (MT) protocols. Obtaining objective data from home-based mindfulness practice is challenging. Interpreting associations between home-based mindfulness practice and clinically impactful outcomes is complicated given the variability in recommendations in length, frequency, and type of practice. In this exploratory study, adherence to home-based practices of Mindfulness-Based Resilience Training (MBRT) was studied in order to evaluate associations with clinical outcomes. Methods Home practices from 24 (92% male, non-Hispanic white, aged M = 43.20 years) law enforcement officers (LEOs) from the urban Pacific Northwest enrolled in a feasibility and efficacy trial of MBRT were studied using an objective tracking device and self-report data. Outcomes included adherence to home-based mindfulness practices and self-reported aggression. Results Participants completed 59.12% of the frequency amount of practice assigned in the MBRT curriculum. Frequency of practice was associated with decreased aggression, adjusted R 2 = .41, F(3,23) = 6.14, p = .004. Duration of practice also predicted decreased aggression, adjusted R 2 = .33, F(3,23) = 4.76, p = .011. Conclusions Home-based MBRT practices for LEOs, even at low rates of adherence, may reduce aggression. MTs may show beneficial effects for other populations presented with challenges to engage in regular MT practices.
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Affiliation(s)
- Leticia Ribeiro
- School of Graduate Psychology, Clinical Psychology PhD Program, Pacific University, Hillsboro, USA
| | - Dana D Colgan
- Department of Neurology, Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, Oregon Health and Science University, Portland, OR, USA
| | - Candice K Hoke
- School of Graduate Psychology, Clinical Psychology PhD Program, Pacific University, Hillsboro, USA
| | - Matthew Hunsinger
- School of Graduate Psychology, Clinical Psychology PhD Program, Pacific University, Hillsboro, USA
| | - Sarah Bowen
- School of Graduate Psychology, Clinical Psychology PhD Program, Pacific University, Hillsboro, USA
| | - Barry S Oken
- Department of Neurology, Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, Oregon Health and Science University, Portland, OR, USA
- Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Michael S Christopher
- School of Graduate Psychology, Clinical Psychology PhD Program, Pacific University, Hillsboro, USA
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Bell KP, Hunsinger M, Koslofsky S, Coplen AE, Stein SM. Measuring the Efficacy of a Foundational Interprofessional Education Course Using the Attitudes Towards Health Care Teams Scale. J Allied Health 2020; 49:14-19. [PMID: 32128534] [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] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Interprofessional education (IPE) has been widely embraced over the past several years, in a variety of ways among different institutions. Due to heterogeneity of IPE programming, it has been challenging to determine the efficacy of pre-professional IPE across the field. However, individual institutions need to assess efficacy of their own IPE programming. The purpose of this study was to assess whether the interprofessional competence course (IPC) at Pacific University was effective as determined by changes in pre- to post-course scores on the Attitudes Towards Health Care Teams Scale (ATHCTS). METHODS First-year students in the College of Health Professions completed the ATHCTS on the first and last days of the IPC course. Descriptive and inferential analyses were completed using SPSS. RESULTS Student cohorts from both 2016 (n=423) and 2017 (n=445) demonstrated significant improvements in scores on the ATHCTS (p<0.01). Changes in attitudes differed as a function of gender, with men demonstrating a larger improvement (p=0.013). Changes in attitudes did not differ as a function of professional program. CONCLUSIONS The IPC course demonstrated effective content delivery as measured by changes in the ATHCTS scores.
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Affiliation(s)
- Kathryn P Bell
- Pacific University, 222 SE 8th Ave, Suite 271, Hillsboro, OR 97123, USA. Tel 503-352-7246.
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Abstract
OBJECTIVE The goal of this study was to assess the preliminary efficacy of a Mindfulness-Based Training (Mindfulness-based Resilience Training; MBRT) in improving weapon identification among Law Enforcement Officers (LEOs). METHODS Participants (N = 61) were randomly assigned to either MBRT or a no-intervention control group (NIC). A self-report questionnaire assessing mindfulness and a computerized measure assessing implicit stereotype reliance were administered at baseline, post-training, and three months following intervention completion. We also collected information about meditation practice outside of the training for LEOs in the MBRT group. RESULTS Inferential analyses yielded improvements in mindfulness in the MBRT group compared to NIC. Analyses did not provide evidence for implicit stereotype reliance at baseline and therefore did not yield a significant impact of MBRT versus NIC on implicit stereotype reliance, ps > .05; however, participants across both conditions exerted more control when responding to Black male targets compared to White male targets, F(1,74) = 3.98, p = .05, 95% CI [-.05, -.01], d = .36. CONCLUSIONS Our results do not provide evidence for the impact of MBRT on weapon identification, but do suggest that LEOs exerted more effort when responding to images of Black males compared to White males. We discuss recommendations for future clinical trials assessing implicit stereotype reliance, viz., that researchers utilize measures more sensitive to a wider range of LEO samples and with higher ecological validity, and we discuss potential reasons why our results do not align with past research.
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Affiliation(s)
- Matthew Hunsinger
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Andi M. Schmidt
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
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Christopher MS, Hunsinger M, Goerling LRJ, Bowen S, Rogers BS, Gross CR, Dapolonia E, Pruessner JC. Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial. Psychiatry Res 2018; 264:104-115. [PMID: 29627695 PMCID: PMC6226556 DOI: 10.1016/j.psychres.2018.03.059] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/16/2018] [Accepted: 03/22/2018] [Indexed: 01/13/2023]
Abstract
The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or "booster" sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted.
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Affiliation(s)
| | - Matthew Hunsinger
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Lt Richard J Goerling
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA; Mindful Badge Initiative, Hillsboro, OR, USA
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Brant S Rogers
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA; Stress Reduction Clinic, Hillsboro, OR, USA
| | - Cynthia R Gross
- College of Pharmacy and School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Eli Dapolonia
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Jens C Pruessner
- Departments of Psychology, Psychiatry, Neurology and Neurosurgery, Douglas Institute, McGill University, Montreal, Quebec, Canada
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Abstract
First responders are exposed to critical incidents and chronic stressors that contribute to a higher prevalence of negative health outcomes compared to other occupations. Psychological resilience, a learnable process of positive adaptation to stress, has been identified as a protective factor against the negative impact of burnout. Mindfulness-Based Resilience Training (MBRT) is a preventive intervention tailored for first responders to reduce negative health outcomes, such as burnout. This study is a secondary analysis of law enforcement and firefighters samples to examine the mechanistic role of psychological resilience on burnout. Results indicated that changes in resilience partially mediated the relationship between mindfulness and burnout, and that increased mindfulness was related to increased resilience (b = .41, SE = .11, p < .01), which in turn was related to decreased burnout (b = -.25, SE = .12, p = .03). The bootstrapped confidence interval of the indirect effect did not contain zero [95% CI; -.27, -.01], providing evidence for mediation. Limitations and implications are discussed.
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Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS. A Brief Mindfulness-Based Intervention for Primary Care Physicians: A Pilot Randomized Controlled Trial. Am J Lifestyle Med 2016; 12:83-91. [PMID: 30202383 DOI: 10.1177/1559827616629121] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 10/13/2015] [Revised: 12/17/2015] [Accepted: 01/06/2016] [Indexed: 11/15/2022] Open
Abstract
Primary care physicians experience high rates of burnout, which results in diminished quality of life, poorer quality of care, and workforce attrition. In this randomized controlled trial, our primary aim was to examine the impact of a brief mindfulness-based intervention (MBI) on burnout, stress, mindfulness, compassion, and resilience among physicians. A total of 33 physicians completed the baseline assessment and were randomized to the Mindful Medicine Curriculum (MMC; n = 17) or waitlist control group (n = 16). Participants completed self-report measures at baseline, post-MBI, and 3-month follow-up. We also analyzed satisfaction with doctor communication (DCC) and overall doctor rating (ODR) data from patients of the physicians in our sample. Participants in the MMC group reported significant improvements in stress (P < .001), mindfulness (P = .05), emotional exhaustion (P = .004), and depersonalization (P = .01) whereas in the control group, there were no improvements on these outcomes. Although the MMC had no impact on patient-reported DCC or ODR, among the entire sample at baseline, DCC and ODR were significantly correlated with several physician outcomes, including resilience and personal achievement. Overall, these findings suggest that a brief MBI can have a positive impact on physician well-being and potentially enhance patient care.
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Affiliation(s)
- David A Schroeder
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
| | - Elizabeth Stephens
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
| | - Dharmakaya Colgan
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
| | - Matthew Hunsinger
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
| | - Dan Rubin
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
| | - Michael S Christopher
- Providence Heart Clinic, Portland, OR (DAS)
- Endocrinology-Medical Education, Providence Medical Center, Portland, OR (ES)
- Department of Internal Medicine, Oregon Health and Sciences University, Portland, OR (ES)
- School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC)
- Maitripa College, Portland, OR (DR)
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Singla N, Hunsinger M, Chang PD, McDermott MP, Chowdhry AK, Desjardins PJ, Turk DC, Dworkin RH. Assay sensitivity of pain intensity versus pain relief in acute pain clinical trials: ACTTION systematic review and meta-analysis. J Pain 2015; 16:683-91. [PMID: 25892656 DOI: 10.1016/j.jpain.2015.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/20/2015] [Accepted: 03/31/2015] [Indexed: 01/05/2023]
Abstract
UNLABELLED The magnitude of the effect size of an analgesic intervention can be influenced by several factors, including research design. A key design component is the choice of the primary endpoint. The purpose of this meta-analysis was to compare the assay sensitivity of 2 efficacy paradigms: pain intensity (calculated using summed pain intensity difference [SPID]) and pain relief (calculated using total pain relief [TOTPAR]). A systematic review of the literature was performed to identify acute pain studies that calculated both SPIDs and TOTPARs within the same study. Studies were included in this review if they were randomized, double-blind, placebo-controlled investigations involving medications for postsurgical acute pain and if enough data were provided to calculate TOTPAR and SPID standardized effect sizes. Based on a meta-analysis of 45 studies, the mean standardized effect size for TOTPAR (1.13) was .11 higher than that for SPID (1.02; P = .01). Mixed-effects meta-regression analyses found no significant associations between the TOTPAR - SPID difference in standardized effect size and trial design characteristics. Results from this review suggest that for acute pain studies, utilizing TOTPAR to assess pain relief may be more sensitive to treatment effects than utilizing SPID to assess pain intensity. PERSPECTIVE The results of this meta-analysis suggest that TOTPAR may be more sensitive to treatment effects than SPIDs are in analgesic trials examining acute pain. We found that standardized effect sizes were higher for TOTPAR compared to SPIDs.
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Affiliation(s)
- Neil Singla
- Lotus Clinical Research, Huntington Hospital, Department of Anesthesiology, Pasadena, California.
| | - Matthew Hunsinger
- School of Professional Psychology, Pacific University, Hillsboro, Oregon
| | - Phoebe D Chang
- Lotus Clinical Research, Huntington Hospital, Department of Anesthesiology, Pasadena, California
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Amit K Chowdhry
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester, Rochester, New York
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Smith SM, Hunsinger M, McKeown A, Parkhurst M, Allen R, Kopko S, Lu Y, Wilson HD, Burke LB, Desjardins P, McDermott MP, Rappaport BA, Turk DC, Dworkin RH. Quality of Pain Intensity Assessment Reporting: ACTTION Systematic Review and Recommendations. The Journal of Pain 2015; 16:299-305. [DOI: 10.1016/j.jpain.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/09/2014] [Accepted: 01/03/2015] [Indexed: 11/29/2022]
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Gewandter JS, McKeown A, McDermott MP, Dworkin JD, Smith SM, Gross RA, Hunsinger M, Lin AH, Rappaport BA, Rice ASC, Rowbotham MC, Williams MR, Turk DC, Dworkin RH. Data interpretation in analgesic clinical trials with statistically nonsignificant primary analyses: an ACTTION systematic review. J Pain 2014; 16:3-10. [PMID: 25451621 DOI: 10.1016/j.jpain.2014.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/03/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022]
Abstract
UNLABELLED Peer-reviewed publications of randomized clinical trials (RCTs) are the primary means of disseminating research findings. "Spin" in RCT publications is misrepresentation of statistically nonsignificant research findings to suggest treatment benefit. Spin can influence the way readers interpret clinical trials and use the information to make decisions about treatments and medical policies. The objective of this study was to determine the frequency with which 4 types of spin were used in publications of analgesic RCTs with nonsignificant primary analyses in 6 major pain journals. In the 76 articles included in our sample, 28% of the abstracts and 29% of the main texts emphasized secondary analyses with P values <.05; 22% of abstracts and 29% of texts emphasized treatment benefit based on nonsignificant primary results; 14% of abstracts and 18% of texts emphasized within-group improvements over time, rather than primary between-group comparisons; and 13% of abstracts and 10% of texts interpreted a nonsignificant difference between groups in a superiority study as comparable effectiveness. When considering the article conclusion sections, 21% did not mention the nonsignificant primary result, 22% were presented with no uncertainty or qualification, 30% did not acknowledge that future research was required, and 8% recommended the intervention for clinical use. PERSPECTIVE This article identifies relatively frequent "spin" in analgesic RCTs. These findings highlight a need for authors, reviewers, and editors to be more cognizant of how analgesic RCT results are presented and attempt to minimize spin in future clinical trial publications.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Andrew McKeown
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Shannon M Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Robert A Gross
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Matthew Hunsinger
- School of Professional Psychology, Pacific University, Hillsboro, Oregon
| | - Allison H Lin
- United States Food and Drug Administration, Silver Spring, Maryland
| | - Bob A Rappaport
- United States Food and Drug Administration, Silver Spring, Maryland
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | | | - Mark R Williams
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Gewandter JS, McDermott MP, McKeown A, Smith SM, Williams MR, Hunsinger M, Farrar J, Turk DC, Dworkin RH. Reporting of missing data and methods used to accommodate them in recent analgesic clinical trials: ACTTION systematic review and recommendations. Pain 2014; 155:1871-1877. [PMID: 24993384 DOI: 10.1016/j.pain.2014.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 02/26/2014] [Revised: 06/04/2014] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Abstract
Missing data in clinical trials can bias estimates of treatment effects. Statisticians and government agencies recommend making every effort to minimize missing data. Although statistical methods are available to accommodate missing data, their validity depends on often untestable assumptions about why the data are missing. The objective of this study was to assess the frequency with which randomized clinical trials published in 3 major pain journals (ie, European Journal of Pain, Journal of Pain, and Pain) reported strategies to prevent missing data, the number of participants who completed the study (ie, completers), and statistical methods to accommodate missing data. A total of 161 randomized clinical trials investigating treatments for pain, published between 2006 and 2012, were included. Approximately two-thirds of the trials reported at least 1 method that could potentially minimize missing data, the most common being allowance of concomitant medications. Only 61% of the articles explicitly reported the number of patients who were randomized and completed the trial. Although only 14 articles reported that all randomized participants completed the study, fewer than 50% of the articles reported a statistical method to accommodate missing data. Last observation carried forward imputation was used most commonly (42%). Thirteen articles reported more than 1 method to accommodate missing data; however, the majority of methods, including last observation carried forward, were not methods currently recommended by statisticians. Authors, reviewers, and editors should prioritize proper reporting of missing data and appropriate use of methods to accommodate them so as to improve the deficiencies identified in this systematic review.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Departments of Biostatistics and Computational Biology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA School of Professional Psychology, Pacific University, Hillsboro, OR, USA Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Hunsinger M, Smith SM, McKeown A, Parkhurst M, Gross RA, Lin AH, McDermott MP, Rappaport BA, Turk DC, Dworkin RH. Disclosure of authorship contributions in analgesic clinical trials and related publications: ACTTION systematic review and recommendations. Pain 2013; 155:1059-1063. [PMID: 24334187 DOI: 10.1016/j.pain.2013.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/22/2013] [Accepted: 12/06/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew Hunsinger
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA United States Food and Drug Administration, Silver Spring, MD, USA Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Department of Anesthesiology and Neurology and Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA School of Professional Psychology, Pacific University, Hillsboro, OR, USA
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13
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Gewandter JS, Smith SM, McKeown A, Burke LB, Hertz SH, Hunsinger M, Katz NP, Lin AH, McDermott MP, Rappaport BA, Williams MR, Turk DC, Dworkin RH. Reporting of primary analyses and multiplicity adjustment in recent analgesic clinical trials: ACTTION systematic review and recommendations. Pain 2013; 155:461-466. [PMID: 24275257 DOI: 10.1016/j.pain.2013.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Abstract
Performing multiple analyses in clinical trials can inflate the probability of a type I error, or the chance of falsely concluding a significant effect of the treatment. Strategies to minimize type I error probability include prespecification of primary analyses and statistical adjustment for multiple comparisons, when applicable. The objective of this study was to assess the quality of primary analysis reporting and frequency of multiplicity adjustment in 3 major pain journals (ie, European Journal of Pain, Journal of Pain, and PAIN®). A total of 161 randomized controlled trials investigating noninvasive pharmacological treatments or interventional treatments for pain, published between 2006 and 2012, were included. Only 52% of trials identified a primary analysis, and only 10% of trials reported prespecification of that analysis. Among the 33 articles that identified a primary analysis with multiple testing, 15 (45%) adjusted for multiplicity; of those 15, only 2 (13%) reported prespecification of the adjustment methodology. Trials in clinical pain conditions and industry-sponsored trials identified a primary analysis more often than trials in experimental pain models and non-industry-sponsored trials, respectively. The results of this systematic review demonstrate deficiencies in the reporting and possibly the execution of primary analyses in published analgesic trials. These deficiencies can be rectified by changes in, or better enforcement of, journal policies pertaining to requirements for the reporting of analyses of clinical trial data.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA United States Food and Drug Administration, Silver Spring, MD, USA School of Professional Psychology, Pacific University, Hillsboro, OR, USA Analgesic Solutions, Natick, MA, USA Tufts University, Boston, MA, USA Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Salmoirago-Blotcher E, Hunsinger M, Morgan L, Fischer D, Carmody J. Mindfulness-Based Stress Reduction and Change in Health-Related Behaviors. J Evid Based Complementary Altern Med 2013. [DOI: 10.1177/2156587213488600] [Citation(s) in RCA: 20] [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: 11/17/2022] Open
Abstract
How best to support change in health-related behaviors is an important public health challenge. The role of mindfulness training in this process has received limited attention. We sought to explore whether mindfulness training is associated with changes in health-related behaviors. The Health Behaviors Questionnaire was used to obtain self-reported data on dietary behaviors, drinking, smoking, physical activity, and sleep quality before and after attendance at an 8-week Mindfulness-Based Stress Reduction program. T-tests for paired data and χ2 tests were used to compare pre–post intervention means and proportions of relevant variables with P = .05 as level of significance. Participants (n = 174; mean age 47 years, range 19-68; 61% female) reported significant improvements in dietary behaviors and sleep quality. Partial changes were seen in physical activity but no changes in smoking and drinking habits. In conclusion, mindfulness training promotes favorable changes in selected health-related behaviors deserving further study through randomized controlled trials.
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Affiliation(s)
| | - Matthew Hunsinger
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | - Daniel Fischer
- University of Massachusetts Medical School, Worcester, MA, USA
| | - James Carmody
- University of Massachusetts Medical School, Worcester, MA, USA
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15
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Abstract
OBJECTIVE The purpose of the study was to examine weekly change in self-reported mindfulness and perceived stress in participants who completed an 8-week course in mindfulness-based stress reduction (MBSR). METHOD Participants were 87 adults with problematic levels of stress related to chronic illness, chronic pain, and other life circumstances (mean age = 49 years, 67% female) participating in MBSR in an academic medical center. They completed weekly self-report assessments of mindfulness skills and perceived stress. It was hypothesized that significant improvement in mindfulness skills would precede significant change in stress. RESULTS Mindfulness skills and perceived stress both changed significantly from pretreatment to posttreatment. Significant increases in mindfulness occurred by the second week of the program, whereas significant improvements in perceived stress did not occur until week 4. Extent of change in mindfulness skills during the first three weeks predicted change in perceived stress over the course of the intervention. CONCLUSIONS Evidence that changes in mindfulness precede changes in perceived stress in a standard MBSR course is consistent with previous studies suggesting that improvements in mindfulness skills may mediate the effects of mindfulness training on mental health outcomes.
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Affiliation(s)
- Ruth A Baer
- University of Kentucky, Psychology, 115 Kastle Hall, Lexington, Kentucky 40506-0044, USA.
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16
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Hunsinger M, Isbell LM, Clore GL. Sometimes happy people focus on the trees and sad people focus on the forest: context-dependent effects of mood in impression formation. Pers Soc Psychol Bull 2012; 38:220-32. [PMID: 21957087 PMCID: PMC4116487 DOI: 10.1177/0146167211424166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [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: 11/15/2022]
Abstract
Research indicates that affect influences whether people focus on categorical or behavioral information during impression formation. One explanation is that affect confers its value on whatever cognitive inclinations are most accessible in a given situation. Three studies tested this malleable mood effects hypothesis, predicting that happy moods should maintain and unhappy moods should inhibit situationally dominant thinking styles. Participants completed an impression formation task that included categorical and behavioral information. Consistent with the proposed hypothesis, no fixed relation between mood and processing emerged. Whether happy moods led to judgments reflecting category-level or behavior-level information depended on whether participants were led to focus on the their immediate psychological state (i.e., current affective experience; Studies 1 and 2) or physical environment (i.e., an unexpected odor; Study 3). Consistent with research on socially situated cognition, these results demonstrate that the same affective state can trigger entirely different thinking styles depending on the context.
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17
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Stout JG, Dasgupta N, Hunsinger M, McManus MA. STEMing the tide: Using ingroup experts to inoculate women's self-concept in science, technology, engineering, and mathematics (STEM). J Pers Soc Psychol 2011; 100:255-70. [DOI: 10.1037/a0021385] [Citation(s) in RCA: 544] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dasgupta N, Desteno D, Williams LA, Hunsinger M. Fanning the flames of prejudice: the influence of specific incidental emotions on implicit prejudice. ACTA ACUST UNITED AC 2009; 9:585-91. [PMID: 19653784 DOI: 10.1037/a0015961] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three experiments examined the impact of incidental emotions on implicit intergroup evaluations. Experiment 1 demonstrated that for unknown social groups, two negative emotions that are broadly applicable to intergroup conflict (anger and disgust) both created implicit bias where none had existed before. However, for known groups about which perceivers had prior knowledge, emotions increased implicit prejudice only if the induced emotion was applicable to the outgroup stereotype. Disgust increased bias against disgust-relevant groups (e.g., homosexuals) but anger did not (Experiment 2); anger increased bias against anger-relevant groups (e.g., Arabs) but disgust did not (Experiment 3). Consistent with functional theories of emotion, these findings suggest that negative intergroup emotions signal specific types of threat. If the emotion-specific threat is applicable to prior expectations of a group, the emotion ratchets up implicit prejudice toward that group. However, if the emotion-specific threat is not applicable to the target group, evaluations remain unchanged.
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Affiliation(s)
- Nilanjana Dasgupta
- Department of Psychology, University of Massachusetts, Ambert, MA 01003, USA.
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Dasgupta N, Hunsinger M. The Opposite of a Great Truth Is Also True: When Do Student Samples Help Versus Hurt the Scientific Study of Prejudice? Psychological Inquiry 2008. [DOI: 10.1080/10478400802049860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Jordan JS, Hunsinger M. Learned patterns of action-effect anticipation contribute to the spatial displacement of continuously moving stimuli. ACTA ACUST UNITED AC 2008; 34:113-24. [DOI: 10.1037/0096-1523.34.1.113] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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