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Rickardsson N, Stopforth DJ, Gillanders D. A systematic review of remotely delivered interventions to support wellbeing amongst caregivers of adults with acquired brain injuries. BRAIN IMPAIR 2024; 25:IB23099. [PMID: 38753958 DOI: 10.1071/ib23099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
Background There is a need for improved access to evidence-based interventions supporting the wellbeing of caregivers of adults with acquired brain injury (ABI). Remotely delivered interventions could address this need. The present systematic review sought to collate studies evaluating remotely delivered interventions designed to improve the wellbeing of caregivers of adults with an ABI, to summarise findings and to comment on the quality of this research. Methods Systematic searches were conducted up until December 2023. Study characteristics, populations, interventions and outcomes were outlined, and papers were appraised on methodological quality. The review was pre-registered (PROSPERO: CRD42020189235). Results Eleven studies meeting inclusion criteria were identified. Methodological quality was generally low to adequate. Most studies evaluated an intervention for caregivers of people with stroke, with a variety of types of interventions trialled. The majority of studies reported non-significant findings on wellbeing outcomes when compared to control conditions. Conclusions There is limited evidence supporting a remotely delivered intervention to improve wellbeing outcomes for ABI caregivers. Specific recommendations are provided, including the development of a core set of outcomes and replication of findings over time, which can improve research into the development and evaluation of remote interventions for this population.
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Affiliation(s)
- Nils Rickardsson
- Department of Psychological Sciences and Health, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK
| | - Daniel Jon Stopforth
- Psychology Services, NHS Ayrshire & Arran, Ayrshire Central Hospital, Kilwinning Road, Irvine, KA12 8SS, UK
| | - David Gillanders
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Willi N, Pancoast A, Drikaki I, Gu X, Gillanders D, Finucane A. Practitioner perspectives on the use of acceptance and commitment therapy for bereavement support: a qualitative study. BMC Palliat Care 2024; 23:59. [PMID: 38418964 PMCID: PMC10900636 DOI: 10.1186/s12904-024-01390-x] [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: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND There is currently a high demand for bereavement support coupled with inconclusive findings as to the efficacy of existing approaches. Acceptance and Commitment Therapy (ACT) aims to improve human functioning and has shown efficacy across a wide range of conditions. ACT may be a promising means of supporting bereaved people, yet evidence on the use of ACT for bereavement support is lacking. The aim of this study is to explore how ACT is currently used for bereavement support and practitioner perspectives of how it helps following bereavement. METHODS Semi-structured interviews were conducted online via MS Teams with practitioners experienced in using ACT for bereavement support. Data were analysed thematically guided by a framework approach. RESULTS Nine participants were recruited. Three themes were identified: (i) creating psychological space around grief; (ii) using psychological space for value-directed action in the midst of grieving, and (iii) adapting ACT for bereavement support. Practitioners indicated that ACT improves clients' relationship with distressing internal experiences. Metaphors and mindfulness techniques were used to encourage acceptance of grief responses, taking perspective on distressing thoughts and images, and contact with the present moment. Better relationships with distressing experiences were regarded as less psychologically taxing, improving coping and well-being, while providing the psychological space to engage in value-directed action. Values exploration, sometimes using metaphors and exercises, was seen as supporting the bereaved person to rediscover a sense of purpose and engage in meaningful activities alongside their grief. Practitioners used ACT flexibly, integrating other interventions, and adapted ACT to the perceived sensitivities of bereaved people, and age-related and developmental factors. CONCLUSION ACT is used to support people who have been bereaved to live effectively with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss.
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Affiliation(s)
- Nikolaus Willi
- Clinical Psychology, University of Edinburgh, Edinburgh, UK.
| | - Anna Pancoast
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Ioanna Drikaki
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Xueying Gu
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | | | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Marie Curie Hospice Edinburgh, Edinburgh, UK
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Chowdhury E, Horrocks T, McAteer G, Gillanders D. Examining the impact of androgen deprivation therapy, masculine self-esteem, and psychological flexibility on distress and quality of life in men with prostate cancer. Psychooncology 2024; 33:e6277. [PMID: 38282234 DOI: 10.1002/pon.6277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Studies suggest that androgen deprivation therapy (ADT) exacerbates psychological and quality of life (QoL) issues associated with prostate cancer (PCa). However, quantitative research examining underlying psychosocial mechanisms for this is limited. We examined the association of PCa symptoms with distress and QoL in ADT-treated and ADT-naïve patients, and the influence of masculine self-esteem and psychological flexibility (PF) on these relationships. METHODS Secondary analysis of a quantitative, cross-sectional survey of 286 PCa patients. Independent samples t-tests, moderation, and conditional process analysis were used to assess relationships between predictor, mediator, moderator, and outcome variables. RESULTS ADT was associated with greater PCa symptomology, lower masculine self-esteem, and lower QoL. Moderation analysis showed that ADT potentiated adverse impacts of PCa symptomology on distress and QoL. High PF attenuated these relationships, though less so for ADT-treated participants. Conditional process analysis showed that masculine self-esteem mediated the predictive effect of symptoms on distress across treatments. However, ADT did not moderate this indirect effect, nor was moderation conditional on PF. CONCLUSION PF appears to: (1) attenuate psychological distress in ADT patients; and (2) improve distress, QoL, and masculine self-esteem in ADT-naïve patients. Interventions targeting PF may thus be a viable adjunct to established approaches. However, their effects may be comparatively limited in ADT patients, who may benefit from more intensive and tailored treatment.
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Affiliation(s)
- Emil Chowdhury
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School, University of Edinburgh, Edinburgh, UK
| | - Thomas Horrocks
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School, University of Edinburgh, Edinburgh, UK
| | - Gareth McAteer
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School, University of Edinburgh, Edinburgh, UK
| | - David Gillanders
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School, University of Edinburgh, Edinburgh, UK
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Sinclair F, Gillanders D, Rooney N, Bonathan C, Hendry K, McLoone P, Hewitt C. Real-world evaluation of an acceptance and commitment therapy-based group programme for breast cancer survivors with fear of cancer recurrence. Support Care Cancer 2023; 31:700. [PMID: 37966674 PMCID: PMC10651702 DOI: 10.1007/s00520-023-08179-3] [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: 03/03/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE To evaluate the effectiveness and acceptability of a 6-week acceptance and commitment therapy (ACT)-based group programme on participants' fear of cancer recurrence (FCR), quality of life (QoL), psychological distress and psychological flexibility at the end of the programme and 12-week follow-up. METHODS A one-group, post-test service evaluation of a real-world psychological programme was carried out to evaluate collected outcome measures and attendance for a total of 21 groups facilitated between 2017 and 2019. Participants were breast cancer survivors who attended a 6-week group programme led by NHS clinicians. Descriptive statistics and repeated measures ANOVA analyses were carried out for each outcome measure. Attendance levels were examined to assess acceptability. RESULTS A total of 97 group participants who had completed curative treatment for breast cancer took part. Of whom, 89% completed at least 4 of the 6 weekly group sessions and 76% attended the 12-week follow-up session. Eighty-four (87%) participants returned outcome measures at all three time points relative to group participation (T1 = pre, T2 = post T3 = 12-week follow-up). Group participants were female, mean age 51.9 years. FCR was highest at T1 (mean 25.2, SD 4.7), reduced T2 (mean 21.2, SD 5.4) and further lowered T3 (mean 19.5, SD 6.2). This difference was statistically significant (p < 0.001). QoL was lowest at T1 (mean 62.4, SD 15.7), increased T2 (mean 71.7, SD 18.1) and further increased at T3 (mean 75.9, SD 17.5). This difference was statistically significant (p < 0.001). Psychological distress measures were shown to reduce, and psychological flexibility increased. CONCLUSIONS This real-world evaluation of an ACT-based group programme led to improvements in FCR, QoL, psychological distress and psychological flexibility in this population. This evaluation provides basis for further investigation to determine if these results can be replicated by controlled research design across diverse populations.
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Affiliation(s)
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, Scotland
| | | | | | - Kirsty Hendry
- School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Philip McLoone
- School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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Gibson Watt T, Gillanders D, Spiller JA, Finucane AM. Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. Palliat Med 2023; 37:1100-1128. [PMID: 37489074 PMCID: PMC10503261 DOI: 10.1177/02692163231183101] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.
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Affiliation(s)
- Tilly Gibson Watt
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - David Gillanders
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Juliet A Spiller
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
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Finucane AM, Hulbert-Williams NJ, Swash B, Spiller JA, Wright B, Milton L, Gillanders D. Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing. Palliat Med 2023; 37:244-256. [PMID: 36576308 DOI: 10.1177/02692163221143817] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy is a form of Cognitive Behavioural Therapy which uses behavioural psychology, values, acceptance and mindfulness techniques to improve mental health and wellbeing. Acceptance and Commitment Therapy is efficacious in treating stress, anxiety and depression in a broad range of settings including occupational contexts where emotional labour is high. This approach could help palliative care staff to manage work-related stress and promote wellbeing. AIM To develop, and feasibility test, an online Acceptance and Commitment Therapy intervention to improve wellbeing of palliative care staff. DESIGN A single-arm feasibility trial of an 8-week Acceptance and Commitment Therapy based intervention for staff, consisting of three online facilitated group workshops and five online individual self-directed learning modules. Data was collected via online questionnaire at four time-points and online focus groups at follow-up. SETTING/PARTICIPANTS Participants were recruited from Marie Curie hospice and nursing services in Scotland. RESULTS Twenty five staff commenced and 23 completed the intervention (93%). Fifteen participated in focus groups. Twelve (48%) completed questionnaires at follow-up. Participants found the intervention enjoyable, informative and beneficial. There was preliminary evidence for improvements in psychological flexibility (Cohen's d = 0.7) and mental wellbeing (Cohen's d = 0.49) between baseline and follow-up, but minimal change in perceived stress, burnout or compassion satisfaction. CONCLUSION Online Acceptance and Commitment Therapy for wellbeing is acceptable to palliative care staff and feasible to implement using Microsoft Teams in a palliative care setting. Incorporating ways to promote long-term maintenance of behaviour changes, and strategies to optimise data collection at follow-up are key considerations for future intervention refinement and evaluation.
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Affiliation(s)
- Anne M Finucane
- Clinical Psychology, University of Edinburgh, UK.,Marie Curie Hospice Edinburgh, Edinburgh, UK
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Carvalho SA, Gillanders D, Forte T, Trindade IA, Pinto-Gouveia J, Lapa T, Valentim A, Santos E, Paciência J, Guiomar R, Castilho P. Self-compassion in Acceptance and Commitment Therapy for chronic pain: a pilot study. Scand J Pain 2022; 22:631-638. [PMID: 34954932 DOI: 10.1515/sjpain-2021-0214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. METHODS The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. RESULTS No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. CONCLUSIONS More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.
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Affiliation(s)
- Sérgio A Carvalho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences, Lusófona University, Lisbon, Portugal
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Teresa Forte
- Department of Social, Political and Territorial Sciences, University of Aveiro, Aveiro, Portugal
| | - Inês A Trindade
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - José Pinto-Gouveia
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Teresa Lapa
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Ana Valentim
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Elsa Santos
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Juliana Paciência
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
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Finucane A, Hulbert-Williams NJ, Swash B, Spiller JA, Lydon B, Gillanders D. Research Evaluating Staff Training Online for Resilience (RESTORE): Protocol for a single-arm feasibility study of an online Acceptance and Commitment Therapy intervention to improve staff wellbeing in palliative care settings. AMRC Open Res 2022; 3:26. [PMID: 38708066 PMCID: PMC11064981 DOI: 10.12688/amrcopenres.13035.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 05/07/2024]
Abstract
Background Palliative care staff commonly experience workplace stress and distress. General stressors include unmanageable workloads and staff shortages. Stressors specific to palliative care include regular exposure to death, loss and grief. The COVID-19 pandemic exacerbated exhaustion and burnout across the healthcare system, including for those providing palliative care. Evidence based psychological support interventions, tailored to the needs and context of palliative care staff, are needed. Acceptance and Commitment Therapy (ACT) is an established form of cognitive behavioural therapy which uses behavioural psychology, values, acceptance, and mindfulness techniques to improve mental health and wellbeing. ACT is effective in improving workplace wellbeing in many occupational settings. Our study examines the acceptability and feasibility of an online ACT-based intervention to improve mental health and wellbeing in staff caring for people with an advanced progressive illness. Methods We plan a single-arm feasibility trial. We will seek to recruit 30 participants to take part in an 8- week online ACT-based intervention, consisting of three synchronous facilitated group sessions and five asynchronous self-directed learning modules. We will use convergent mixed methods to evaluate the feasibility of the intervention. Quantitative feasibility outcomes will include participant recruitment and retention rates, alongside completion rates of measures assessing stress, quality of life, wellbeing, and psychological flexibility. Focus groups and interviews will explore participant perspectives on the intervention. We will run a stakeholder workshop to further refine the intervention and identify outcomes for use in a future evaluation. Results We will describe participant perspectives on intervention acceptability, format, content, and perceived impact, alongside rates of intervention recruitment, retention, and outcome measure completion. Conclusion We will show whether a brief, online ACT intervention is acceptable to, and feasible for palliative care staff. Findings will be used to further refine the intervention and provide essential information on outcome assessment prior to a full-scale evaluation.
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Affiliation(s)
- Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Marie Curie, Edinburgh, UK
| | - Nicholas J Hulbert-Williams
- School of Psychology, University of Chester, Chester, UK
- Department of Psychology, Edge Hill University, Ormskirk, Lancashire, UK
| | - Brooke Swash
- School of Psychology, University of Chester, Chester, UK
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Alonso-Fernández M, Gillanders D, López-López A, Matías B, Losada A, González JL. An Exploration of the Psychometric Properties of the PASS-20 in Older Adults with Chronic Pain: Preliminary Development and Validity. Clin Gerontol 2022; 45:575-590. [PMID: 34047674 DOI: 10.1080/07317115.2021.1929628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Pain Anxiety Symptoms Scale (PASS-20) is well validated in adults and younger populations, but not in older adults. This study aimed to analyze the psychometric properties of the PASS-20 in Spanish older adults who experience chronic pain. METHODS Participants were 111 older adults with chronic pain living in nursing homes (mean age = 83.36; SD = 6.53; 78.6% female). Face-to-face interviews were conducted which included assessment of pain anxiety (PASS-20), chronic pain acceptance (CPAQ), depression symptoms (GDS), catastrophizing beliefs (PCS), pain severity, and sociodemographic information. An Exploratory Structural Equation Modeling (ESEM) approach was used to refine the scale. RESULTS The final scale was composed of seven items, measuring two factors that could be labeled "Internal experiences" and "Escape/Avoidance behaviors". The two factors explained 60.98% of the total variance. PASS-7 version fit properly: χ2/df = 14.57/13, CMIN/df = 1.121, CFI = 0.99, RMSEA = 0.033, TLI = 0.98, GFI = 0.96, AGFI = 0.92. Good validity indices were found and acceptable reliability results in the scale and its subscales (Chronbach´s α; Internal Experiences = 0.70; Escape/Avoidance Behaviors= 0.73; Total Scale = 0.77). CONCLUSIONS The short version of the PASS-7 has good psychometric properties. CLINICAL IMPLICATIONS The brevity of the PASS-7 increases the feasibility of this instrument which could potentially be utilized in a variety of clinical settings and research studies with older people with chronic pain samples, specially institutionalized older adults.
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Affiliation(s)
- Miriam Alonso-Fernández
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Almudena López-López
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Borja Matías
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Andres Losada
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - José Luis González
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Moore R, Gillanders D, Stuart S. The Impact of Group Emotion Regulation Interventions on Emotion Regulation Ability: A Systematic Review. J Clin Med 2022; 11:jcm11092519. [PMID: 35566645 PMCID: PMC9105582 DOI: 10.3390/jcm11092519] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Emotional regulation (ER) as a concept is not clearly defined, and there is a lack of clarity about how individuals can improve their ability to regulate emotions. Nevertheless, there is increasing evidence of the importance of ER as a transdiagnostic treatment target across mental health problems. This review examines the impact of ER group interventions on ER ability compared with no intervention, other comparable group interventions, or control conditions. A systematic review was conducted, in which 15 studies were included. Although types of ER intervention were mixed, the interventions had a considerable overlap in skills taught and how ER was measured. In all but one study, the ER intervention improved ER ability. ER interventions were superior to waitlist or treatment as usual, but there was limited evidence to suggest they were superior to other active treatments. Data from some studies suggest that improved ER was sustained at follow-up. Across the studies, there was generally poor linking of theory to practice, which hampers understanding of how interventions were constructed and why different skills were included. Although the results need to be interpreted with caution due to issues with methodological quality with the included papers, there is promising evidence that ER group interventions significantly improve ER ability.
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Affiliation(s)
- Rebekah Moore
- NHS Greater Glasgow and Clyde, Glasgow Psychological Trauma Service, Festival Business Centre, 150 Brand Street, Glasgow G51 1DH, UK
- Correspondence:
| | - David Gillanders
- School of Health in Social Science, Elsie Inglis Quad, Teviot Place, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Simon Stuart
- NHS Lanarkshire, Hunter Health Centre, Andrew Street, East Kilbride G74 1AD, UK;
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Sathananthan N, Morris EMJ, Gillanders D, Knox L, Dimech-Betancourt B, Wright BJ, das Nair R, Wong D. Does Integrating Cognitive and Psychological Interventions Enhance Wellbeing After Acquired Brain Injury? Study Protocol for a Phase II Randomized Controlled Trial of the VaLiANT (Valued Living After Neurological Trauma) Group Program. Front Rehabilit Sci 2022; 2:815111. [PMID: 36188858 PMCID: PMC9397748 DOI: 10.3389/fresc.2021.815111] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022]
Abstract
Background and Objectives Cognitive and emotional changes affect the majority of individuals with acquired brain injury (ABI) and are associated with poorer outcomes. The evidence for “siloed” rehabilitation approaches targeting cognition and mood separately remains mixed. Valued living (i.e., acting consistently with personal values) is associated with better psychological functioning and participation in work and other productive activities. Rehabilitation interventions that concurrently address cognitive and emotional barriers to valued living may therefore result in improved outcomes. VaLiANT (Valued Living After Neurological Trauma) is an 8-week group intervention developed by our team, which uniquely combines cognitive rehabilitation and psychological therapy to improve wellbeing and meaningful participation (i.e., valued living) following ABI. Method This protocol describes the design and implementation of a Phase II parallel-group randomized controlled trial with blinded outcome assessors, to evaluate the potential efficacy of VaLiANT and the feasibility of a Phase III trial. Participants are adults with a history of ABI at least 3 months prior to study entry, who experience cognitive and/or emotional difficulties and associated reduced participation in valued activities. Random allocation to the treatment condition (8-week VaLiANT group program) or a usual care waitlist control condition occurs at a 2:1 treatment: control ratio. The primary outcome is wellbeing, measured by the Warwick-Edinburgh Mental Wellbeing Scale. Secondary outcomes include measures of valued living, mood, cognitive complaints, quality of life, community participation, post-traumatic growth, and self-efficacy. All measures are collected across three time points by blinded assessors (baseline, 8-week follow-up, 16-week follow-up). Trial feasibility will be evaluated against recruitment rates, drop-out rates, intervention acceptability, and treatment fidelity (manual adherence and therapist competence). Discussion This trial will extend current knowledge on how to improve long-term outcomes following ABI by evaluating an innovative integrated, multi-domain approach to rehabilitation concurrently addressing cognitive and emotional barriers to participation in meaningful life roles.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Eric M. J. Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - Bradley J. Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- *Correspondence: Dana Wong
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Rickardsson N, Scotland J, Poveda B, Gillanders D. Caring for someone with an acquired brain injury: The role of psychological flexibility. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.01.005] [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: 10/19/2022]
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13
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Fisher S, Gillanders D, Ferreira N. The experiences of palliative care professionals and their responses to work-related stress: A qualitative study. Br J Health Psychol 2021; 27:605-622. [PMID: 34676620 DOI: 10.1111/bjhp.12565] [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: 03/02/2021] [Revised: 07/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Previous qualitative research has demonstrated that palliative care professionals (PCPs) deal with a wide array of emotionally challenging issues associated with the care they provide. Although previous research has identified self-care strategies PCPs engage in, there is a lack of focus on what responses are helpful and/or unhelpful. The aim of the current study is to understand and describe the experiences of PCPs and to explore the helpful and unhelpful responses to work-related stress they employ. DESIGN This was a qualitative study of the experiences of working PCPs in a hospice setting. METHODS Nine semi-structured interviews were conducted and subsequently analysed using the framework method. RESULTS The current study revealed five overarching themes: (1) Sources of Meaning and Purpose (making a difference, personal growth), (2) Sources of Stress (emotional challenges, patient family dynamics, work environment factors, public perception, uncontrollability of symptoms), (3) Personal Impact (life engagement, perceptions of death), (4) Unhelpful Responses (self-doubt, emotional suppression, rumination, overidentifying, lack of self-care), and (5) Helpful Responses (acceptance, being present, perspective taking, being able to switch off, social support, active self-care). CONCLUSIONS The experiences of PCPs can be interpreted from or directly mapped onto the psychological (in)flexibility model in Acceptance and Commitment Therapy (ACT). It is suggested that ACT training for professionals may encourage more reliable and explicit helpful responses and reduce the impact of unhelpful responses. Thus, an ACT training intervention may enhance wellbeing and effectiveness in PCPs.
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Affiliation(s)
- Shaun Fisher
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Nuno Ferreira
- School of Humanities and Social Sciences, University of Nicosia, Cyprus
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14
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Sathananthan N, Dimech-Betancourt B, Morris E, Vicendese D, Knox L, Gillanders D, Das Nair R, Wong D. A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma). Neuropsychol Rehabil 2021; 32:2170-2202. [PMID: 34433379 DOI: 10.1080/09602011.2021.1971094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance "valued living" following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5-7 weeks). Eight participants (50% women, aged 26-65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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15
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Sevier-Guy LJ, Ferreira N, Somerville C, Gillanders D. Psychological flexibility and fear of recurrence in prostate cancer. Eur J Cancer Care (Engl) 2021; 30:e13483. [PMID: 34191379 DOI: 10.1111/ecc.13483] [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: 04/14/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Psychological flexibility and fear of cancer recurrence are important variables that influence psychosocial outcomes in individuals diagnosed with a range of different types of cancer. Their role and how they impact on psychological distress and quality of life in men with prostate cancer specifically have not been established. METHODS A cross-sectional sample of 144 men with prostate cancer was recruited. Multiple regression and conditional process analysis were used to assess whether psychological flexibility moderates the relationship between fear of recurrence and distress and quality of life. RESULTS Psychological flexibility significantly predicted psychological distress (β = -0.56, p < 0.0001) and quality of life (β = 0.21, p < 0.0001), appearing a stronger predictor of psychological distress than fear of recurrence (β = 0.25, p < 0.0001). Fear of recurrence was a stronger predictor of quality of life (β = -0.41, p < 0.0001) than psychological flexibility. Psychological flexibility moderated the relationship between fear of recurrence and psychological distress (β = -0.01, p < 0.001). At low and average levels of psychological flexibility, psychological distress mediated the relationship between fear of recurrence and quality of life (β = -0.33 to -0.16, p < 0.05). At high levels of psychological flexibility, distress no longer mediated this relationship (β = 0.01, ns), supporting the role of psychological flexibility as a moderator. CONCLUSIONS These findings suggest that psychological flexibility might be a useful treatment target, through interventions such as Acceptance and Commitment Therapy, to buffer the effects of fear of recurrence and distress and improve psychosocial outcomes in this population.
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Affiliation(s)
- Lindsay-Jo Sevier-Guy
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK.,Psychology Department, NHS Fife, Kirkcaldy, UK.,Psychology Department, NHS Tayside, Dundee, UK
| | - Nuno Ferreira
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK.,School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - David Gillanders
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK
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16
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Hulbert-Williams NJ, Norwood SF, Gillanders D, Finucane AM, Spiller J, Strachan J, Millington S, Kreft J, Swash B. Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliat Care 2021; 20:96. [PMID: 34172029 PMCID: PMC8235846 DOI: 10.1186/s12904-021-00801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting. This study was pre-registered on the Open Science Framework (Ref: 46,033) and retrospectively registered on the ISRCTN registry (Ref: ISRCTN12084782).
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Affiliation(s)
| | - Sabrina F Norwood
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne M Finucane
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Marie Curie Hospice, Edinburgh, UK
| | | | | | | | - Joseph Kreft
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Brooke Swash
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
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17
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Maher-Edwards L, Ng N, Gillanders D. P060 Pilot study showing the efficacy and acceptability of an acceptance and commitment therapy based brief psychological intervention on mood and disability in patients with early inflammatory arthritis. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.057] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence base for psychological intervention is scarce and of poor quality. One trial has found CBT intervention early post-diagnosis of rheumatoid arthritis has small to medium effect sizes for depression and anxiety and no effect on disability. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a good evidence base for a number of long term health conditions. The target process in ACT is psychological flexibility, which relates closely to a number of positive life outcomes including adaptive response to illness and trauma. Psychological inflexibility has been shown to be associated with poorer function and psychological wellbeing in chronic pain populations and more recently juvenile idiopathic arthritis specifically. We aimed to evaluate outcomes for a sample (n = 12) of newly diagnosed (within 3 years of diagnosis) patients with inflammatory arthritis who underwent an individualised ACT intervention using patient satisfaction data, qualitative feedback and measures of mood, quality of life and psychological flexibility.
Methods
Patients received up to 7 sessions of one to one therapy. Outcome measures included PHQ-9, GAD-7, compACT, and Brief Pain Inventory (BPI) and a satisfaction questionnaire with open questions inviting qualitative responses. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. Correlation analysis was conducted using Pearsons correlation coefficients.
Results
Patients who took part in the brief intervention showed significant improvement in depression, anxiety, quality of life and psychological flexibility. Effect sizes were large. Correlation analysis showed strong correlations between PF and both depression and quality of life. Changes in PF from baseline to end of therapy strongly correlated with changes in depression and disability, and moderately correlated with anxiety. Subanalyses will be presented to understand which particular components of PF most closely relate to improvements in outcomes on disability and mood.
Conclusion
A brief one to one ACT-based psychological intervention conferred good benefit for a rheumatology population. Results suggest PF is a key therapeutic target in psychological interventions for people with arthritis and that ACT is a viable, highly acceptable and promising alternative to CBT in this population. More studies are needed to understand whether this effect is generalisable and longer-term outcomes.
Disclosure
L. Maher-Edwards: None. N. Ng: None. D. Gillanders: None.
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Affiliation(s)
| | - Nora Ng
- Guys and St. Thomas NHS, Rheumatology, London, UNITED KINGDOM
| | - David Gillanders
- Clinical Health Psychology, University of Edinburgh, Edinburgh, UNITED KINGDOM
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18
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Boland L, Campbell D, Fazekas M, Kitagawa W, MacIver L, Rzeczkowska K, Gillanders D. An experimental investigation of the effects of perspective-taking on emotional discomfort, cognitive fusion and self-compassion. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Affiliation(s)
- Ken Laidlaw
- Section of Clinical Psychology, University of Edinburgh
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20
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Ferreira NB, Gillanders D, Morris PG, Eugenicos M. Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12123] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Nuno B. Ferreira
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK,
- Department of Gastroenterology, University of Edinburgh, Edinburgh, UK,
| | - David Gillanders
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK,
| | - Paul G. Morris
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK,
| | - Maria Eugenicos
- Department of Gastroenterology, University of Edinburgh, Edinburgh, UK,
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21
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Carvalho SA, Pinto-Gouveia J, Gillanders D, Lapa T, Valentim A, Santos E, Paciência J, Castilho P. Above and beyond emotional suffering: the unique contribution of compassionate and uncompassionate self-responding in chronic pain. Scand J Pain 2020; 20:853-857. [PMID: 32841171 DOI: 10.1515/sjpain-2020-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/30/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022]
Abstract
Objectives Studies have shown that self-compassion plays a protective role against depression in women with chronic pain (CP). However, the majority of studies in CP have used the total score of the self-compassion scale (SCS), which have raised concerns due to potential overlap, not only between the uncompassionate self-responding factors and psychopathology, but also between self-compassion as a whole and other well-known psychological processes (e.g., mindfulness, acceptance, psychological flexibility). This calls for a more nuanced understanding of which components of (un)compassionate self-responding adds to better mental health in CP. Methods This study explores the unique contribution of compassionate and uncompassionate self-responding to depressive symptoms in women with CP undergoing pain consultation (n = 49). Results Correlation analyses suggest that compassionate self-responding only significantly correlates with progress in valued living, while the uncompassionate self-responding significantly correlates with pain fusion, pain avoidance, obstructions to valued living and depression. Multiple regression analysis showed that self-compassion contributes to depressive symptoms (R2 = 8%) above and beyond pain intensity and disability (R2 = 12%) and psychological (in) flexibility processes (R2 = 31%), and uncompassionate (but not compassionate) self-responding uniquely contributes to depressive symptoms (sr 2 = 18%). Conclusions Findings suggest that uncompassionate self-responding is a stronger contributor to depression in CP than compassionate self-responding. Clinical implications are further discussed.
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Affiliation(s)
- Sérgio A Carvalho
- CINEICC, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Teresa Lapa
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Valentim
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Elsa Santos
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Juliana Paciência
- Anaesthesiology Service, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Paula Castilho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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22
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Andrade Carvalho S, Pinto-Gouveia J, Gillanders D, Castilho P. Perceived validation and criticism in pain: Development of a new measure in chronic pain. Eur J Pain 2020; 25:136-148. [PMID: 32865296 DOI: 10.1002/ejp.1655] [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: 04/20/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research suggests that the way others react to a pain flare-up impacts on psychological and pain-related symptoms in chronic pain (CP). Experiencing validation from others is associated with less negative emotions and better functioning. Contrarily, experiencing criticism is linked to greater pain intensity and worse functioning. Nonetheless, studies are limited by an exclusive focus on spouses rather than significant other relationships, the use of proxy constructs (e.g. social support, responsiveness, solicitousness) rather than specific measures of validation and criticism and a focus on significant others' behaviour rather than patients' subjective experience. This study examines the psychometric properties of a new measure - Perceived Validation and Criticism in Pain Questionnaire (PVCPQ), and tests its contribution to functional impairment beyond pain intensity, sociodemographic and medical-related variables, positive and negative affect, safeness and compassion from others. METHODS Women with CP (N = 172), 130 (75.6%) of whom had fibromyalgia, completed an online battery of questionnaires (PVCPQ; numeric pain rating scale; work and social adjustment scale; positive and negative affect schedule; social and pleasure scale; compassionate engagement and action scale). Exploratory factor analysis (EFA), reliability analysis, correlational analysis and hierarchical regression analysis were performed. RESULTS EFA showed a 23-item two-factor solution with good psychometric properties. Criticism in pain (but not validation in pain) contributed to functional impairment above and beyond the variance explained by pain intensity, sociodemographic and medical variables, positive and negative affect, safeness and compassion from others. CONCLUSIONS These findings suggest that the PVCPQ is a psychometrically valid new measure of perceived validation and criticism in pain that contributes to explaining pain-related functional impairment. SIGNIFICANCE The current study provides a new 23-item measure of perceived validation and criticism by others in chronic pain that overcomes the limitations of existing measures. It adds to the literature by suggesting that perceived criticism (but not validation) contributes to functional impairment beyond sociodemographic variables, pain intensity, affect and related constructs such as social safeness and compassion from others. These results suggest that psychosocial interventions that aim to promote functioning in chronic pain should focus on the subjective experience of being criticized and validated by significant others.
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Affiliation(s)
- Sérgio Andrade Carvalho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - José Pinto-Gouveia
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, UK
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
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23
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Bowers H, Gillanders D, Ferreira N. Moderating effect of IBS acceptance on psychosocial mediators of Irritable Bowel Syndrome. Journal of Contextual Behavioral Science 2020. [DOI: 10.1016/j.jcbs.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Maher-Edwards L, Quigley A, Gillanders D, Ng N. P120 Development and analysis of acceptance and commitment therapy (ACT)-informed group and 1-1 psychological interventions for a rheumatology population. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.118] [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: 11/12/2022] Open
Abstract
Abstract
Background
Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence-base for psychological intervention in this population is scarce. Acceptance- and mindfulness-based cognitive therapies are of increasing popularity. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a robust evidence-base for mood disorders and long-term health conditions, in particular in chronic pain populations. ACT aims to help clients to develop skills to identify and let go of unhelpful patterns of symptom control and avoidance so that they can move towards important life areas (values) and goals. Research has consistently shown that higher levels of acceptance (a component of psychological flexibility) in chronic illness is associated with better quality of life and emotional well-being. No studies have looked at the effects of ACT-based interventions in rheumatology. This study aimed to: Develop and pilot I) a 6-week group and II) a brief (up to 6 sessions) one to one intervention based on Acceptance and Commitment Therapy (ACT) in a rheumatology population. Outcomes were evaluated using patient satisfaction data, qualitative feedback and quantitative outcomes using a range of questionnaires measuring mood, quality of life and psychological flexibility.
Methods
Patients attending a rheumatology psychology service received either group OR brief one to one intervention delivered by a qualified psychologist. Group consisted of 6 sessions; each session was 3 hours (18 hours total). The brief one to one intervention consisted of up to 6 one-hour face to face sessions (max 6 hours total). A range of outcome measures were administered pre- and post-treatment. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. For comparison published data in chronic pain populations were used.
Results
Patients responded well to ACT-based interventions: with improvements in mood, psychological flexibility and quality of life. All effect sizes were large and compared favourably to published trials in chronic pain populations. Group participants showed significant improvements in depression and psychological flexibility pre- to post- treatment. On the other hand, participants who received the brief one to one intervention showed significant improvements on all measures. Overall those who had group therapy showed smaller improvements in outcome measures, rated themselves as less improved and were less satisfied with their therapy than those that received up to 6 sessions of individualised therapy.
Conclusion
A brief one to one intervention of up to 6 sessions of ACT-based psychological therapy conferred good benefit for a rheumatology population and outperformed group therapy. More studies are needed to understand whether this effect is generalisable and longer-term outcomes.
Disclosures
L. Maher-Edwards None. A. Quigley None. D. Gillanders None. N. Ng None.
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Affiliation(s)
| | | | - David Gillanders
- Clinical Health Psychology, University of Edinburgh, Edinburgh, UNITED KINGDOM
| | - Nora Ng
- Rheumatology, Guys and St Thomas' NHS, London, UNITED KINGDOM
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25
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Guzmán A, Gillanders D, Stevenson A, Ross K. Psychosocial adjustment to Mild Cognitive Impairment: The role of illness perceptions, cognitive fusion and cognitive impairment. Dementia (London) 2020; 20:464-484. [PMID: 31948271 DOI: 10.1177/1471301219893862] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Receiving a Mild Cognitive Impairment diagnosis and adjusting to this condition is challenging, given the uncertain clinical trajectory surrounding progression to dementia. We aimed to explore the influence of illness perceptions and cognitive fusion on coping and emotional responses in a sample of people diagnosed with Mild Cognitive Impairment.Research design and method: A cross-sectional study of 34 participants with Mild Cognitive Impairment (47% female and 53% male; mean age 76.4 years) evaluated the relationships between cognitive impairment, illness perceptions and cognitive fusion on levels of distress and quality of life. Participants completed standardised measures for cognitive assessment, illness perceptions, cognitive fusion, depression, anxiety and quality of life. Relationships between variables were analysed using correlation, regression and conditional process analyses. RESULTS At the group level, illness perceptions were found to be a stronger predictor of depression and quality of life in the current sample than objective cognitive impairment. Illness perceptions did not directly predict anxiety, rather cognitive fusion significantly mediated this relationship. Cognitive fusion also significantly mediated the relationship between illness perceptions and depression. Illness perceptions had a significant, direct effect on quality of life; however, there was no significant indirect effect via cognitive fusion. Greater fusion with threatening illness perceptions was significantly related to increased anxiety and depression.Discussion and implications: Data suggest multiple potential treatment targets in helping people diagnosed with Mild Cognitive Impairment to successfully adapt and adjust. Targeting appraisals (illness perceptions) using Cognitive Therapy is one potential treatment target. In addition, psychological treatments such as Acceptance and Commitment Therapy, which target cognitive fusion, could also warrant further investigation in this population, due to the significant indirect paths from illness perceptions to distress and quality of life, via cognitive fusion.
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Affiliation(s)
| | - David Gillanders
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Amanda Stevenson
- Psychological Therapies for Older People, NHS Lanarkshire, Scotland, UK
| | - Kerry Ross
- Older People's Psychology Service, NHS Greater Glasgow and Clyde, Belmont Centre, Stobhill Hospital, Scotland, UK
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26
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Hulbert-Williams NJ, Norwood S, Gillanders D, Finucane A, Spiller J, Strachan J, Millington S, Swash B. Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care. Pilot Feasibility Stud 2019; 5:104. [PMID: 31452926 PMCID: PMC6702709 DOI: 10.1186/s40814-019-0488-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components. Discussion This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach. Trial registration Open Science Framework, 46033. Registered 19 April 2018.
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Affiliation(s)
- Nicholas J Hulbert-Williams
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Sabrina Norwood
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - David Gillanders
- 2School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sue Millington
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Brooke Swash
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
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Carvalho SA, Trindade IA, Gillanders D, Pinto-Gouveia J, Castilho P. Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months. Clin Psychol Psychother 2019; 26:616-625. [PMID: 31240784 DOI: 10.1002/cpp.2386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/27/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/08/2022]
Abstract
This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.
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Affiliation(s)
- Sérgio A Carvalho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Inês A Trindade
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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McAteer G, Gillanders D. Investigating the role of psychological flexibility, masculine self‐esteem and stoicism as predictors of psychological distress and quality of life in men living with prostate cancer. Eur J Cancer Care (Engl) 2019; 28:e13097. [DOI: 10.1111/ecc.13097] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Gareth McAteer
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School University of Edinburgh Edinburgh UK
| | - David Gillanders
- Section of Clinical and Health Psychology, School of Health in Social Science, Medical School University of Edinburgh Edinburgh UK
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Carvalho SA, Xavier A, Gillanders D, Pinto-Gouveia J, Castilho P. Rumination and valued living in women with chronic pain: How they relate to the link between mindfulness and depressive symptoms. Curr Psychol 2018. [DOI: 10.1007/s12144-018-0052-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Carvalho SA, Pinto-Gouveia J, Gillanders D, Castilho P. Pain and Depressive Symptoms: Exploring Cognitive Fusion and Self-Compassion in a Moderated Mediation Model. The Journal of Psychology 2018; 153:173-186. [DOI: 10.1080/00223980.2018.1507990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Hulbert-Williams N, Gillanders D, Finucane A, Millington S, Norwood S, Spiller J, Strachan J, Swash B. 18 Brief engagement and acceptance coaching in community and hospice settings (the beaches study): protocol for developing and pilot testing an evidence-based intervention to enhance wellbeing at transition into palliative care. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionThe transition into palliative care can cause uncertainty fear and distress. Quality of life can be detrimentally affected and advance planning for end-of-life is often avoided. Acceptance and Commitment Therapy (ACT) is a promising intervention for supporting palliative patients; the focus on values may be especially relevant to restoring meaningful living. We present a protocol for development and piloting of a brief ACT-based intervention for delivery at the palliative care transition point.Aims and methodsA multiple-baseline single-case non-controlled design is used. This enables exploration of effectiveness and processes causing outcome improvement. Integrated qualitative interviews provide acceptability data. The five-session intervention is delivered by psychologists to 14 participants in two hospices. Participants with an incurable cancer diagnosis but life expectancy of four months or more are eligible. Weekly self-report questionnaires assess study outcomes (quality of life distress) and changes in therapeutic processes. A smartphone app facilitates daily assessment of brief measures to enable sensitive measurement of process change.ResultsQuantitative data will be analysed using visual plots and statistical change indices across study phases: this enables calculation of indicative effect sizes for future trial planning. Recruitment attrition and engagement will be analysed descriptively as feasibility indicators. Framework analysis is used to for qualitative data.ConclusionsSingle-case designs are not commonly used in psychosocial oncology however they offer a scientific data-driven approach to intervention development. By the end of this study we aim to manualise our intervention for non-psychologist delivery to plan a randomised trial with maximised implementation potential.References. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change2011. Guilford Press.. Murray, et al. Patterns of social psychological and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management2007;34(4):393–402.. Ost L. The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy2014;61:105–12.
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Carvalho SA, Gillanders D, Palmeira L, Pinto-Gouveia J, Castilho P. Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance. J Clin Psychol 2018; 74:2094-2106. [PMID: 30101973 DOI: 10.1002/jclp.22689] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/09/2018] [Revised: 07/05/2018] [Accepted: 07/13/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE(S) The aim of this study was to test a theory driven model in which pain acceptance (both pain willingness [PW] and activity engagement [AE]) mediates the relationships of mindfulness and selfcompassion with depressive symptoms, while controlling for pain intensity. METHODS A path analysis was conducted using AMOS software to test a meditational model in a sample of women with chronic musculoskeletal pain (N = 231). RESULTS Participants with higher levels of mindful awareness and selfcompassion presented lower levels of pain intensity and depressive symptoms, and higher levels of AE. PW did not significantly correlate with any variable in study. The mediation analysis showed that AE mediated the relationship between selfcompassion and depressive symptoms, independently from pain intensity. CONCLUSIONS These findings seem to corroborate the hypothesis that selfcompassion is rooted in a motivational system, as it seems to correlate with less depressive symptoms through increasing the engagement with valued actions despite experiencing pain.
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Affiliation(s)
- Sérgio A Carvalho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - David Gillanders
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Lara Palmeira
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Carvalho SA, Palmeira L, Pinto-Gouveia J, Gillanders D, Castilho P. The utility of the Valuing Questionnaire in Chronic Pain. Journal of Contextual Behavioral Science 2018. [DOI: 10.1016/j.jcbs.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rovner GS, Sunnerhagen KS, Björkdahl A, Gerdle B, Börsbo B, Johansson F, Gillanders D. Chronic pain and sex-differences; women accept and move, while men feel blue. PLoS One 2017; 12:e0175737. [PMID: 28441403 PMCID: PMC5404887 DOI: 10.1371/journal.pone.0175737] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. Method 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01. Results Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. Conclusion Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.
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Affiliation(s)
- Graciela S. Rovner
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Katharina S. Sunnerhagen
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- * E-mail:
| | - Ann Björkdahl
- Rehabilitation Medicine, Institute of Neuroscience and Physiology, University of Gothenburg at Sahlgrenska Academy, Gothenburg, Sweden
- Ersta Skondal University College, Campus Bracke, Gothenburg, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linkoping University, Linkoping, SE-581 85 Linköping, Sweden
| | - Björn Börsbo
- Division of Community Medicine, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
- Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jonkoping, Sweden
| | | | - David Gillanders
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
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Gillanders D, Ferreira NB, Angioni E, Carvalho SA, Eugenicos MP. An implementation trial of ACT-based bibliotherapy for irritable bowel syndrome. Journal of Contextual Behavioral Science 2017. [DOI: 10.1016/j.jcbs.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ruiz FJ, Suárez-Falcón JC, Riaño-Hernández D, Gillanders D. Psychometric properties of the Cognitive Fusion Questionnaire in Colombia. Revista Latinoamericana de Psicología 2017. [DOI: 10.1016/j.rlp.2016.09.006] [Citation(s) in RCA: 13] [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: 10/20/2022]
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Dionne F, Gagnon J, Balbinotti M, Peixoto EM, Martel ME, Gillanders D, Monestès JL. "Buying into thoughts”: Validation of a French translation of the Cognitive Fusion Questionnaire. ACTA ACUST UNITED AC 2016. [DOI: 10.1037/cbs0000053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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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Brassington L, Ferreira NB, Yates S, Fearn J, Lanza P, Kemp K, Gillanders D. Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness. Journal of Contextual Behavioral Science 2016. [DOI: 10.1016/j.jcbs.2016.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Graham CD, Gouick J, Krahé C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev 2016; 46:46-58. [DOI: 10.1016/j.cpr.2016.04.009] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/07/2016] [Accepted: 04/07/2016] [Indexed: 12/21/2022]
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Graham CD, Gouick J, Ferreira N, Gillanders D. The influence of psychological flexibility on life satisfaction and mood in muscle disorders. Rehabil Psychol 2016; 61:210-7. [DOI: 10.1037/rep0000092] [Citation(s) in RCA: 22] [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: 11/08/2022]
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Rovner G, Vowles KE, Gerdle B, Gillanders D. Latent Class Analysis of the Short and Long Forms of the Chronic Pain Acceptance Questionnaire: Further Examination of Patient Subgroups. The Journal of Pain 2015; 16:1095-105. [DOI: 10.1016/j.jpain.2015.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
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Wardley MN, Flaxman PE, Willig C, Gillanders D. 'Feel the Feeling': Psychological practitioners' experience of acceptance and commitment therapy well-being training in the workplace. J Health Psychol 2014; 21:1536-47. [PMID: 25476570 DOI: 10.1177/1359105314557977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This empirical study investigates psychological practitioners' experience of worksite training in acceptance and commitment therapy using an interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with eight participants, and three themes emerged from the interpretative phenomenological analysis data analysis: influence of previous experiences, self and others and impact and application The significance of the experiential nature of the acceptance and commitment therapy training is explored as well as the dual aspects of developing participants' self-care while also considering their own clinical practice. Consistencies and inconsistencies across acceptance and commitment therapy processes are considered as well as clinical implications, study limitations and future research suggestions.
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Graham CD, Gillanders D, Stuart S, Gouick J. An Acceptance and Commitment Therapy (ACT)–Based Intervention for an Adult Experiencing Post-Stroke Anxiety and Medically Unexplained Symptoms. Clin Case Stud 2014. [DOI: 10.1177/1534650114539386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
To date, there is little support for the use of any psychotherapy to address post-stroke anxiety. Similarly, there have been no trials of acceptance and commitment therapy (ACT) for post-stroke anxiety, but clinician opinion suggests that an ACT approach may be effective in this context. In this case study, a high-functioning younger man with post-stroke anxiety and associated medically unexplained symptoms (chest pain and dizziness) was assessed and treated using an ACT approach. Mediators of change for both ACT (psychological flexibility) and cognitive therapy (illness perceptions) were recorded as were measures of depression, anxiety, and stress. By the end of treatment, the client was free of chest pain, had successfully returned to work, and had considerable reductions in anxiety, with smaller reductions in depression and stress. As outcomes improved, concomitant changes in psychological flexibility and illness perceptions were observed. The potential benefits offered by an ACT approach to post-stroke anxiety are discussed.
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Affiliation(s)
| | | | - Simon Stuart
- University of Edinburgh, UK
- Royal Edinburgh Hospital, UK
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Sheridan D, Foo I, O'Shea H, Gillanders D, Williams L, Fallon M, Colvin L. Long-term follow-up of pain and emotional characteristics of women after surgery for breast cancer. J Pain Symptom Manage 2012; 44:608-14. [PMID: 22743155 DOI: 10.1016/j.jpainsymman.2011.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/11/2011] [Accepted: 10/19/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Persistent pain after treatment for breast cancer (PPBCT) is a common side effect of breast cancer treatment, with prevalence as high as 50%. It is predominantly a neuropathic condition. OBJECTIVES The aim of this cross-sectional, questionnaire-based study was to examine the emotional characteristics of patients with PPBCT in long-term breast cancer patients. A secondary objective was to characterize the risk factors and severity of that pain. METHODS From March 1, 2010 to April 9, 2010, long-term follow-up patients were invited to complete a questionnaire. This recorded their surgical and demographic data and ascertained whether they had PPBCT. If the patient had pain, she completed a range of validated self-report questionnaires and questions about the nature of the pain, including a visual analogue scale. RESULTS One hundred eleven patients completed the questionnaire; 33 (29.7%) patients reported chronic pain at a median time of 64 months postoperatively (interquartile range 54.25). Patients with persistent pain were not significantly more anxious (t(105)=-0.369, P=0.713) or depressed (t(105)=0.713, P=0.507) than patients without pain. Patients with constant pain compared with intermittent pain were significantly more anxious (t(25)=-3.460, P=0.002). Preoperative pain conferred a fivefold increased risk of PPBCT (odds ratio [OR]=5.17, 95% confidence interval [CI]=1.79-14.97, P=0.002); chemotherapy conferred a threefold increased risk (OR=3.004, 95% CI=1.22-7.40, P=0.017). CONCLUSION We have shown significant numbers of patients suffer from PPBCT. At a median time of 64.5 months, women with pain are not significantly more anxious or depressed than women without pain. Preoperative pain and chemotherapy have been highlighted as risk factors.
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Affiliation(s)
- David Sheridan
- School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, United Kingdom.
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Gillanders D. Paul Flaxman, J. T. Blackledge and Frank W. Bond (2011). Acceptance and Commitment Therapy: Distinctive Features. Hove: Routledge. Clin Psychol Psychother 2012. [DOI: 10.1002/cpp.755] [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: 11/06/2022]
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Affiliation(s)
- Nuno Bravo Ferreira
- Department of Clinical and Health Psychology, and Department of Gastroenterology University of Edinburgh
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Abstract
BACKGROUND Rumination in response to stressful events and depressed mood leads to harmful outcomes. In addition to intra-psychic processes, depression is also associated with daily hassles and major life events. Self-regulatory beliefs such as goal linking could mediate the link between life events, daily hassles, rumination and major depression. METHOD The relationships between depressed mood, rumination, goal linking, life events and daily hassles were investigated in a between-groups design. Standardized questionnaire measures of these constructs were used to compare depressed participants with a group of people experiencing psychological distress, but not major depression, and a never-depressed group. RESULTS Participants with major depression experienced similar numbers of life events as the other groups, though the impact of these was greater for the depressed group than either the psychological distress group or the healthy controls. Depressed participants also experienced greater daily hassles than either of the other two groups. Depressed participants were also higher in goal linking and rumination. Regression analysis demonstrated that neither life events nor goal linking predict rumination or depressed mood. Rumination appears to moderate the relationship between daily hassles and depressed mood. DISCUSSION Theoretical and clinical implications are discussed.
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Affiliation(s)
- Emily McIntosh
- Department of Clinical and Counselling Psychology, Monklands Hospital, NHS Lanarkshire
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Abstract
UNLABELLED The emotional experience of individuals who experience psychosis has historically been neglected, possibly due to the divide between the psychoses and neuroses. This study examined emotional experience and regulation in individuals who had experienced psychosis, individuals experiencing anxiety or mood disorders, and non-patient controls. Participants completed validated measures of emotional experience and emotion regulation. Both clinical groups were found to experience similar levels of emotions, and in comparison to the non-patient controls, they experienced greater levels of negatively valenced emotions and lower levels of happiness. Both clinical groups also used similar emotion regulation strategies, and in comparison to non-patient controls, they used significantly more dysfunctional and less functional strategies, suggesting that the emotional experience and emotion regulation strategies of people who have experienced psychosis are more similar to non-psychotic disorders than have previously been thought to be the case. The theoretical and clinical implications of these findings are discussed. KEY PRACTITIONER MESSAGE *Individuals with psychosis experience similar emotions as individuals with anxiety and mood disorders, namely more unhappiness, fear and less happiness. *People with psychosis attempt to regulate these emotions in similar ways to people with mood and anxiety problems, by using more dysfunctional emotional regulation strategies such as ruminating. *Clinicians may want to pay closer attention to assessing the emotion regulation strategies of those who experience psychosis and consider the implications of these in therapy. *They may also want to consider the role emotional dysregulation may play in the development, maintenance and course of psychosis. *An emotion regulation approach to psychosis may be characterised by focussing on emotional experiences and the individual's response to these, as opposed to psychotic symptoms.
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Affiliation(s)
- Karen Livingstone
- National Health Service Lanarkshire, East Kilbride, South Lanarkshire, Scotland.
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Keith L, Gillanders D, Simpson S. An exploration of the main sources of shame in an eating-disordered population. Clin Psychol Psychother 2009; 16:317-27. [DOI: 10.1002/cpp.629] [Citation(s) in RCA: 40] [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: 11/05/2022]
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Gillanders S, Wild M, Deighan C, Gillanders D. Emotion regulation, affect, psychosocial functioning, and well-being in hemodialysis patients. Am J Kidney Dis 2008; 51:651-62. [PMID: 18371541 DOI: 10.1053/j.ajkd.2007.12.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 12/17/2007] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emotion regulation refers to the psychological strategies people use to cope with such stressors as hemodialysis therapy. These strategies are associated with a range of physical and psychological variation that may be related to kidney disease and its management. This study explores the associations of 2 emotion regulation strategies, reappraisal and suppression, and considers their impact on patient well-being and kidney disease management. STUDY DESIGN Cross-sectional study. SETTING AND PARTICIPANTS 106 hemodialysis patients undergoing renal replacement therapy and 94 friends or relatives. PREDICTORS Reappraisal and suppression, measured by using the Emotion Regulation Questionnaire. OUTCOMES Outcome parameters were measures of affect, psychosocial functioning, and well-being, measured using the Positive and Negative Affect Scale, the Brief COPE questionnaire, the Kidney Disease Quality-of-Life Short Form, and the Brief Symptom Inventory. RESULTS The Emotion Regulation Questionnaire measured reappraisal and suppression. Greater use of reappraisal was associated with lower levels of anxiety (r = -0.22; P = 0.03) and greater acceptance of the disease (r = 0.20; P = 0.04). It was also associated with more experience (r = 0.26; P < 0.01) and expression (r = 0.23; P = 0.02) of positive emotion and less experience (r = -0.35; P < 0.01) and expression (r = -0.29; P < 0.01) of negative emotion. Suppression was associated with less positive emotional expression (r = -0.28; P < 0.01), greater levels of depression (r = 0.22; P = 0.03) and somatization (r = 0.25; P < 0.01), and greater dissatisfaction with the time spent dealing with their kidney disease (r = -0.21; P = 0.04). Suppression also was associated with less emotional coping (r = -0.29; P < 0.01) and greater dissatisfaction with the support received from other people (r = -0.34; P < 0.01). LIMITATIONS The study focuses on emotion regulation strategies and well-being rather than clinical parameters; therefore, extensive medical data were not recorded. CONCLUSION Reappraisal has more positive clinical and psychosocial associations than suppression. The emotion regulation strategy used by hemodialysis patients has important implications for well-being and disease management.
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