1
|
Burns JW, Jensen MP, Thorn BE, Lillis TA, Carmody J, Gerhart J, Keefe F. Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response. J Pain 2024:S1526-5900(24)00011-7. [PMID: 38199593 DOI: 10.1016/j.jpain.2024.01.003] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N = 521) participated in a randomized controlled trial which compared cognitive therapy, mindfulness-based stress reduction, behavior therapy and treatment as usual. Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: 1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; 2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; 3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the treatment as usual condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across cognitive therapy, mindfulness-based stress reduction and behavior therapy, as hypothesized by the Limit, Activate, and Enhance model if these 3 treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the 3 psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (eg, forced-based interventions) non-psychosocial approaches. TRIAL REGISTRATION: The ClinicalTrials.gov Identifier is NCT02133976. PERSPECTIVE: This article examines potential predictors/moderators of response to psychosocial treatments for chronic pain. Results could guide efforts to match people to the most effective treatment type or kind.
Collapse
Affiliation(s)
- John W Burns
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington
| | | | - Teresa A Lillis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center
| | - James Carmody
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School
| | - James Gerhart
- Department of Psychology Central Michigan University
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| |
Collapse
|
2
|
Burns JW, Jensen MP, Gerhart J, Thorn BE, Lillis TA, Carmody J, Keefe F. Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for people with chronic low back pain: A comparative mechanisms study. J Consult Clin Psychol 2023; 91:171-187. [PMID: 36848061 DOI: 10.1037/ccp0000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. Nonetheless, methodological limitations preclude clear understanding of how psychosocial chronic pain treatments work. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatments. METHOD CT, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of "specific" mechanisms (pain catastrophizing, mindfulness, behavior activation) and outcomes. RESULTS CT, MBSR, and BT produced similar pre- to posttreatment effects on all mechanism variables, and all three active treatments produced greater improvements than TAU. Participant ratings of expectations of benefit and working alliance were similar across treatments. Lagged and cross-lagged analyses revealed that prior week changes in both mechanism and outcome factors predicted next week changes in their counterparts. Analyses of variance contributions suggested that changes in pain catastrophizing and pain self-efficacy were consistent unique predictors of subsequent outcome changes. CONCLUSIONS Findings support the operation of shared mechanisms over specific ones. Given significant lagged and cross-lagged effects, unidirectional conceptualizations-mechanism to outcome-need to be expanded to include reciprocal effects. Thus, prior week changes in pain-related cognitions could predict next week changes in pain interference which in turn could predict next week changes in pain-related cognitions, in what may be an upward spiral of improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- John W Burns
- Department of Psychiatry and Behavioral Sciences
| | | | | | | | | | | | | |
Collapse
|
3
|
Lillis TA, Burns J, Aranda F, Burgess HJ, Purim-Shem-Tov YA, Bruehl S, Beckham JC, Pinkerton LM, Hobfoll SE. Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status. J Behav Med 2019; 43:791-806. [PMID: 31832845 DOI: 10.1007/s10865-019-00123-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/21/2018] [Accepted: 12/03/2019] [Indexed: 01/01/2023]
Abstract
Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants' baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women's pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women.
Collapse
Affiliation(s)
- Teresa A Lillis
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA.
| | - John Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA
| | - Frances Aranda
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA.,Center on Mental Health Services Research and Policy, University of Illinois Chicago, 1601 W. Taylor St., MCE 912, Chicago, IL, 60612, USA
| | - Helen J Burgess
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA.,Department of Psychiatry, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Yanina A Purim-Shem-Tov
- Department of Emergency Medicine, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave. South, Nashville, TN, 37212, USA
| | - Jean C Beckham
- Mid-Atlantic MIRECC, VA Medical Center, Durham VA Health Care System, 508 Fulton St., Durham, NC, 27705, USA.,Department of Psychiatry, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Linzy M Pinkerton
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA
| | - Stevan E Hobfoll
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA
| |
Collapse
|
4
|
Stevens NR, Ziadni MS, Lillis TA, Gerhart J, Baker C, Hobfoll SE. Perceived lack of training moderates relationship between healthcare providers' personality and sense of efficacy in trauma-informed care. Anxiety Stress Coping 2019; 32:679-693. [PMID: 31345075 DOI: 10.1080/10615806.2019.1645835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and Objectives: Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers' personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life. Study Design: The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables. Methods: Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life. Results: TIC-efficacy was positively correlated with "intellectence/openness" and inversely correlated with "neuroticism" and perceived lack of training as a barrier. "Intellectence/openness" interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower "intellectence/openness" report greater TIC-efficacy when lack of training is not perceived as a barrier. Conclusions: Provider personality traits and perceived barriers to TIC appear related to providers' TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.
Collapse
Affiliation(s)
- Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center , Chicago , IL , USA
| | - Maisa S Ziadni
- Systems Neuroscience and Pain Lab, Stanford University , Palo Alto , CA , USA
| | - Teresa A Lillis
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center , Chicago , IL , USA
| | - James Gerhart
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center , Chicago , IL , USA
| | - Courtney Baker
- School of Science and Engineering, Tulane University , New Orleans , LA , USA
| | - Stevan E Hobfoll
- STAR Consultants - Stress, Anxiety-Resilience , Chicago , IL , USA
| |
Collapse
|
5
|
Lillis TA, Tirone V, Gandhi N, Weinberg S, Nika A, Sequeira W, Hobfoll SE, Block JA, Jolly M. Sleep Disturbance and Depression Symptoms Mediate Relationship Between Pain and Cognitive Dysfunction in Lupus. Arthritis Care Res (Hoboken) 2019; 71:406-412. [PMID: 29726637 DOI: 10.1002/acr.23593] [Citation(s) in RCA: 9] [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] [Received: 12/10/2017] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). METHODS A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress. RESULTS Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (β = 0.30) and depression symptoms (β = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (β = 0.20) and stress (β = 0.22) remained significantly linked to CD (overall model R2 = 0.53; all P < 0.05). CONCLUSION After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility.
Collapse
Affiliation(s)
| | | | | | | | - Ailda Nika
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
| | | |
Collapse
|
6
|
Gerhart J, Fitchett G, Lillis TA, Kuzel TM, Lo SS, Penedo F, Weldon CB, Diaz A. Brief spiritual well-being screening is nonlinearly related to psychological distress in ambulatory cancer patients. Psychooncology 2018; 27:2873-2876. [DOI: 10.1002/pon.4882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022]
Affiliation(s)
- James Gerhart
- Rush University Cancer Center; Chicago IL USA
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
- Department of Psychology; Central Michigan University; Mount Pleasant MI USA
| | | | - Teresa A. Lillis
- Rush University Cancer Center; Chicago IL USA
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
| | | | - Shelly S. Lo
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
- Stritch School of Medicine; Loyola University Medical Center; Maywood IL USA
| | - Frank Penedo
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
- Northwestern University Medical Center; Chicago IL USA
| | - Christine B. Weldon
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
- Northwestern University Medical Center; Chicago IL USA
- Center for Business Models in Healthcare; Chicago IL USA
| | - Aidnag Diaz
- Rush University Cancer Center; Chicago IL USA
- The Coleman Supportive Oncology Collaborative; Chicago IL USA
| |
Collapse
|
7
|
Lillis TA, Hamilton NA, Pressman SD, Khou CS. The Association of Daytime Maternal Napping and Exercise With Nighttime Sleep in First-Time Mothers Between 3 and 6 Months Postpartum. Behav Sleep Med 2018. [PMID: 28632088 DOI: 10.1080/15402002.2016.1239580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study investigated the relationship of daytime maternal napping, exercise, caffeine, and alcohol intake to objective and subjective sleep indices. PARTICIPANTS Sixty healthy, nondepressed, first-time mothers between 3 and 6 months postpartum. METHODS Seven consecutive days of online behavior diaries, sleep diaries, and wrist actigraphy, collecting Total Sleep Time (TST), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). RESULTS After controlling for infant age, employment status, infant feeding method, and infant sleeping location, mixed linear models showed that longer average exercise durations were associated with longer average TST, and longer average nap durations were associated with longer average WASO durations. Significant within-person differences in TST and SOL were also observed, such that, on days when participants exercised and napped longer than average, their respective TST and SOL durations that night were longer. CONCLUSION Shorter nap durations and longer exercise durations were associated with longer TST, shorter SOL, and reduced WASO. Even small changes in daily exercise and napping behaviors could lead to reliable improvements in postpartum maternal sleep.
Collapse
Affiliation(s)
- Teresa A Lillis
- a Department of Behavioral Sciences, Rush University Medical Center , Chicago , Illinois
| | - Nancy A Hamilton
- b Department of Psychology, University of Kansas , Lawrence , Kansas
| | - Sarah D Pressman
- c Department of Psychology and Social Behavior, University of California,Irvine , Irvine , California
| | - Christina S Khou
- b Department of Psychology, University of Kansas , Lawrence , Kansas
| |
Collapse
|
8
|
Lillis TA, Hamilton NA, Pressman SD, Ziadni MS, Khou CS, Boddy LE, Wagner LM. Sleep quality buffers the effects of negative social interactions on maternal mood in the 3-6 month postpartum period: a daily diary study. J Behav Med 2018; 41:733-746. [PMID: 30191435 PMCID: PMC6404752 DOI: 10.1007/s10865-018-9967-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/25/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
Sleep and social relationships are two key determinants of psychosocial health that undergo considerable change across the transition to motherhood. The current study investigated the bidirectional relationship between daytime Positive and Negative Social Interactions (PSIs & NSIs) and nighttime sleep quality on maternal mood across 1 week in the 3-6 month postpartum period. Sixty healthy, non-depressed first-time mothers completed 7-consecutive days of daily social interaction and sleep diaries. Results indicated that higher than average sleep quality buffered the effect of higher than average NSIs on maternal mood (i.e., buffered mood reactivity) and appeared to promote mood recovery following a particularly "bad day" (i.e., higher than average NSIs). In addition, although PSIs were more common than NSIs overall, the most frequent and positively rated PSIs were with baby as were the most frequent and negatively rated NSIs. To our knowledge, our results are the first to characterize the impact of PSIs on postpartum maternal mood, assess maternal-infant social interactions in daily diary study of postpartum social relationships, and demonstrate the role that maternal sleep quality plays in social discord-related mood reactivity and mood recovery processes in the 3-6 month postpartum period.
Collapse
Affiliation(s)
- Teresa A Lillis
- Department Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA.
| | - Nancy A Hamilton
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Room 426, Lawrence, KS, 6604, USA
| | - Sarah D Pressman
- University of California Irvine, 4201 Social & Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - Maisa S Ziadni
- Systems Neuroscience and Pain Lab, Stanford University, Ste. 200, 1070 Arastradero Road, Palo Alto, CA, 94304, USA
| | - Christina S Khou
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Room 426, Lawrence, KS, 6604, USA
| | - Lauren E Boddy
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Room 426, Lawrence, KS, 6604, USA
| | - Linzy M Wagner
- Department Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Ste. 400, Chicago, IL, 60612, USA
| |
Collapse
|
9
|
Fox RS, Lillis TA, Gerhart J, Hoerger M, Duberstein P. Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample? Psychol Rep 2018; 121:548-565. [PMID: 28836917 PMCID: PMC6053047 DOI: 10.1177/0033294117727747] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 11/16/2022]
Abstract
The DASS-21 is a public domain instrument that is commonly used to evaluate depression and anxiety in psychiatric and community populations; however, the factor structure of the measure has not previously been examined in oncologic settings. Given that the psychometric properties of measures of distress may be compromised in the context of symptoms related to cancer and its treatment, the present study evaluated the psychometric properties of the DASS-21 Depression and Anxiety scales in cancer patients ( n = 376) as compared to noncancer control participants ( n = 207). Cancer patients ranged in age from 21 to 84 years (mean = 58.3, standard deviation = 10.4) and noncancer control participants ranged in age from 18 to 81 years (mean = 45.0, standard deviation = 11.7). Multiple group confirmatory factor analysis supported the structural invariance of the DASS-21 Depression and Anxiety scales across groups; the factor variance/covariance invariance model was the best fit to the data. Cronbach's coefficient alpha values demonstrated acceptable internal consistency reliability across the total sample as well as within subgroups of cancer patients and noncancer control participants. Expected relationships of DASS-21 Depression and Anxiety scale scores to measures of suicidal ideation, quality of life, self-rated health, and depressed mood supported construct validity. These results support the psychometric properties of the DASS-21 Depression and Anxiety scales when measuring psychological distress in cancer patients.
Collapse
Affiliation(s)
- Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Teresa A Lillis
- Department of Behavioral Sciences, 2468 Rush University Medical Center , USA
| | - James Gerhart
- Department of Behavioral Sciences, 2468 Rush University Medical Center , USA
| | - Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, 5783 Tulane University , USA
| | - Paul Duberstein
- Departments of Psychiatry and Family Medicine, University of Rochester, USA
| |
Collapse
|
10
|
Lillis TA, Fischer A, Aranda F, Burgess HJ, Gerhart J, Burns J, Purim-Shem-Tov Y, Hobfoll SE. 0713 Night-to-night Variability In Objective Sleep Differs By Perception Of Unmet Basic Needs Among Inner-city Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T A Lillis
- Rush University Medical Center, Chicago, IL
| | - A Fischer
- Rush University Medical Center, Chicago, IL
| | - F Aranda
- Rush University Medical Center, Chicago, IL
| | | | - J Gerhart
- Rush University Medical Center, Chicago, IL
| | - J Burns
- Rush University Medical Center, Chicago, IL
| | | | | |
Collapse
|
11
|
Fischer A, Aranda F, Lillis TA, Burgess HJ, Burns JW, Purim-Shem-Tov Y, Hobfoll SE. 0709 Racial Differences in Objective and Subjective Sleep Parameters: A Sample of Inner-City Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Fischer
- Rush University Medical Center, Chicago, IL
| | - F Aranda
- Rush University Medical Center, Chicago, IL
| | - T A Lillis
- Rush University Medical Center, Chicago, IL
| | | | - J W Burns
- Rush University Medical Center, Chicago, IL
| | | | | |
Collapse
|
12
|
Gerhart JI, Asvat Y, Lillis TA, Fung H, Grosse J, Hobfoll SE. The impact of posttraumatic stress symptoms on social support and social conflict during hematopoietic stem cell transplant. J Psychosoc Oncol 2018; 36:304-318. [DOI: 10.1080/07347332.2018.1425793] [Citation(s) in RCA: 1] [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: 10/18/2022]
Affiliation(s)
- James I. Gerhart
- Center for Advanced Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Yasmin Asvat
- Center for Advanced Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | - Teresa A. Lillis
- Center for Advanced Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Henry Fung
- Department of Hematology/Oncology, Temple University, United States of America
| | - Johanna Grosse
- Center for Advanced Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Stevan E. Hobfoll
- Center for Advanced Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| |
Collapse
|
13
|
Lillis TA, Gerhart J, Bouchard LC, Cvengros J, O'Mahony S, Kopkash K, Kabaker KB, Burns J. Sleep Disturbance Mediates the Association of Post-Traumatic Stress Disorder Symptoms and Pain in Patients With Cancer. Am J Hosp Palliat Care 2017; 35:788-793. [PMID: 29084448 DOI: 10.1177/1049909117739299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/14/2022] Open
Abstract
BACKGROUND Sleep disturbance is a common complaint of patients with cancer and is well established in both pain conditions and post-traumatic stress disorder (PTSD). An estimated one-third of patients with cancer develop symptoms of PTSD at some point in their treatment. However, few studies have evaluated the contributions of PTSD and sleep disturbance to pain processes in cancer populations. The current study used mediation models to test the hypothesis that sleep disturbance would mediate the relationships between PTSD symptoms and pain intensity and PTSD symptoms and pain interference in a sample of patients with cancer. METHODS A cross-sectional, retrospective chart review was conducted of the electronic medical records of 85 adult patients with cancer (89.4% female; 59% white; 42% metastatic) who sought individual psychosocial support services at our institution. RESULTS Post-traumatic stress disorder symptoms, sleep disturbance, pain intensity, and pain interference were all positively correlated ( P < .01). Clinical levels of PTSD symptoms were reported by 30% to 60% of the sample. Even after controlling for metastatic disease, race, and cancer type, sleep disturbance mediated the relationships between PTSD symptoms and pain intensity ( B = 0.27; 95% CI: 0.10-0.44) and PTSD symptoms and pain-related interference ( B = 0.58; 95% CI: 0.28-0.87). CONCLUSIONS The relationships among PTSD symptoms, pain intensity, and pain interference could be explained by co-occurring sleep disturbance. Given the high frequency of PTSD symptoms among patients with cancer and PTSD's known links to sleep problems and pain, clinicians should be attentive to the role that traumatogenic processes may play in eliciting sleep and pain-related complaints among patients with cancer.
Collapse
Affiliation(s)
- Teresa A Lillis
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Laura C Bouchard
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jamie Cvengros
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- 2 Palliative Medicine Section, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Katherine Kopkash
- 3 Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John Burns
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
14
|
Gerhart J, Vaclavik E, Lillis TA, Miner J, McFadden R, O'Mahony S. A daily diary study of posttraumatic stress, experiential avoidance, and emotional lability among inpatient nurses. Psychooncology 2017; 27:1068-1071. [DOI: 10.1002/pon.4531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- James Gerhart
- Department of Behavioral Sciences; Rush University Medical Center; Chicago IL USA
| | - Elizabeth Vaclavik
- Department of Medical, Oncology and Cardiology Nursing; Rush University Medical Center; Chicago IL USA
| | - Teresa A. Lillis
- Department of Behavioral Sciences; Rush University Medical Center; Chicago IL USA
| | - Jacob Miner
- Department of Psychology; Illinois Institute of Technology; Chicago IL USA
| | - Rory McFadden
- Department of Internal Medicine, Palliative Medicine Section; Rush University Medical Center; Chicago IL USA
| | - Sean O'Mahony
- Department of Internal Medicine, Palliative Medicine Section; Rush University Medical Center; Chicago IL USA
| |
Collapse
|
15
|
Stevens NR, Tirone V, Lillis TA, Holmgreen L, Chen-McCracken A, Hobfoll SE. Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting. J Psychosom Obstet Gynaecol 2017; 38:103-110. [PMID: 27960615 DOI: 10.1080/0167482x.2016.1266480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs. METHODS Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit. RESULTS The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences. DISCUSSION Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.
Collapse
Affiliation(s)
- Natalie R Stevens
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Vanessa Tirone
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Teresa A Lillis
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Lucie Holmgreen
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| | - Allison Chen-McCracken
- b Department of Obstetrics & Gynecology , Rush University Medical Center , Chicago , IL , USA
| | - Stevan E Hobfoll
- a Department of Behavioral Sciences , Rush University Medical Center , Chicago , IL , USA
| |
Collapse
|
16
|
Lillis TA, Aranda F, Burns J, Burgess H, Purim-Shem-Tov Y, Hobfoll SE. 1009 SLEEP QUALITY MEDIATES RACE-RELATED DIFFERENCES IN PAIN INTENSITY AMONG INNER-CITY WOMEN PRESENTING TO THE EMERGENCY DEPARTMENT. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Medina AM, Lederhos CL, Lillis TA. Sleep disruption and decline in marital satisfaction across the transition to parenthood. ACTA ACUST UNITED AC 2009; 27:153-60. [DOI: 10.1037/a0015762] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|