ORCID Profile
0000-0002-8790-6272
Current Organisation
University of Sydney
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Psychology | Biological Psychology (Neuropsychology, Psychopharmacology, Physiological Psychology) | Health, Clinical And Counselling Psychology | Health, Clinical and Counselling Psychology | Preventive Medicine | Health psychology | Learning motivation and emotion | Clinical Pharmacology and Therapeutics | Sensory Processes, Perception and Performance | Psychology not elsewhere classified
Health not elsewhere classified | Expanding Knowledge in Psychology and Cognitive Sciences | Skeletal system and disorders (incl. arthritis) | Preventive Medicine | Women’s health |
Publisher: Wiley
Date: 2003
DOI: 10.1002/PON.639
Abstract: There is an increasing number of long-term survivors of cervical and endometrial cancer for whom quality of life is of major importance. We interviewed 20 women (aged 19-64) to explore the dynamics and components of post-treatment sexual adjustment and its impact on quality of life. Stratification by treatment received (surgery alone, surgery plus external-beam radiation, surgery plus brachytherapy, and surgery plus external-beam radiation and brachytherapy) and time since treatment (immediately post treatment, during the next 2 years and thereafter) was undertaken, to ensure representation of all relevant experiences and views, and to allow time for any long-term side effects to appear. The NUD*IST software (Non-numerical Unstructured Data by Indexing, Searching and Theorising) was used to assist with the coding of audio-taped, transcribed interviews and to search for themes and segments. While the data supported findings reported in the literature, important new themes emerged in the course of the qualitative analysis. These included: (a). issues related to being 'feminine', (b). the role of intimacy in post-treatment adjustment and (c). the importance of communication between health professionals, patients and partners. A model is presented that integrates these issues and highlights the need for effective interventions to improve post-treatment outcomes. The provision of information, support and modification of rehabilitation devices is suggested.
Publisher: Wiley
Date: 08-05-2023
DOI: 10.1002/PON.6149
Abstract: Fear of cancer recurrence (FCR) is one of the most common unmet needs for cancer patients and caregivers. Yet little is known about the potentially unique nature of caregiver FCR. Our research aimed to address this gap by qualitatively exploring the features and impact of caregiver FCR. Eighteen semi‐structured telephone interviews with cancer caregivers were conducted to explore the content and impact of caregiver fears and worries about cancer recurrence or progression. Data analysis used a Framework Approach. Qualitative analysis identified three themes (1) fear of the patient suffering, (2) the need to protect the patient from a recurrence and/or cancer‐related distress, and (3) caregiver's sense of unpreparedness and uncertainty. Underpinning these themes was an overarching sense of personal responsibility for the life of the patient. This overarching theme was identified as a key driver of caregivers' personal and patient‐centred fears. Our findings confirm the conceptual differences between patient and caregiver FCR. Future research must therefore acknowledge the unique experiences of caregivers and prioritise the development of empirically driven theoretical models, instruments, and interventions for caregiver FCR.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
DOI: 10.1016/J.PAIN.2011.12.014
Abstract: Potential applications of attention bias modification (ABM) for acute and chronic pain patients are investigated. In study 1, 54 acute back pain patients (46 of whom completed the study) were recruited at their initial physiotherapy session and randomised to receive 1 session of ABM or placebo. Patients were followed up 3 months later. Participants who were randomised to receive ABM reported less average (P=0.001) and current pain (P=0.008) and experienced pain for fewer days (P=0.01) than those who received placebo. In study 2, 34 chronic pain patients were recruited and randomly assigned to receive either 4 sessions of ABM (n=22) or placebo (n=12), followed by 8 sessions of cognitive behavioural treatment (CBT). After ABM, there was a significant group-by-time effect for disability. By 6-month follow-up, differences had emerged between the 2 training groups, such that the ABM group had shown greater reductions in anxiety sensitivity and disability than the placebo group. Although the results of these studies show that there is potential in the application of ABM to pain conditions, the mechanisms of treatment could not be established. Neither group showed an initial bias towards the word stimuli or a training effect, and only in the acute pain group were changes in biases related to outcome. Nonetheless, the fact that 2 independent s les showed a positive effect of ABM on clinical outcomes suggests that ABM is worthy of future study as an intervention for pain patients.
Publisher: Elsevier BV
Date: 12-1993
DOI: 10.1016/0005-7916(93)90062-2
Abstract: The present paper reports a case study documenting the success of a child-appropriate variant of eye movement desensitization (EMD) in the treatment of post-traumatic stress disorder (PTSD). Although there have been numerous case studies and some preliminary controlled trials of this method in adult cases of PTSD, there does not appear to be any information on its use in children. The available literature suggests that it is a more rapid and less traumatic treatment than traditional exposure based therapies. The present paper describes a child-appropriate auditory variant of eye-movement desensitization applied to a case of childhood PTSD.
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.PEC.2007.10.021
Abstract: This randomized controlled trial aimed to evaluate a decision aid for women with multiple sclerosis deciding whether to start or enlarge their families. Decision aid materials were mailed to participants, and their response materials returned by mail. One-hundred and ninety-four women with MS agreed to participate and were randomized to receive the DA or not. Participants completed questionnaires measuring decisional-conflict, self-efficacy, knowledge, depression and anxiety as well as their views regarding having children pre- and post-intervention. Women who received the DA had a significant decrease in decisional-conflict, increase in self-efficacy and knowledge of MS and pregnancy and more certainty in their choice than those in the control group. There were no adverse effects on depression or anxiety and women's decisions were not biased in either direction. The DA is a useful tool that can be used by women with MS contemplating motherhood. This DA is used as a resource by the MS Society illustrating how DAs may help with lifestyle choices complicated by illness. It represents a tool adaptable to suit other illnesses where reproductive decision-making may be compromised and should be of interest to health-care professionals who are consulted by women with family-planning concerns.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.JPAIN.2018.04.010
Abstract: This review investigated whether youth exhibit attention or interpretation biases toward pain-related information and whether such biases are more pronounced in youth with chronic pain. Three databases were searched to identify studies that assessed attention or interpretation biases using an accepted experimental paradigm. Ten studies were identified, 8 examining attentional biases and 2 examining interpretation biases. As in the adult literature, there was no evidence of attentional biases toward pain in youth without chronic pain. Three studies investigating youth without chronic pain found evidence for relationships between catastrophizing or anxiety and indicators of vigilance or avoidance (in 2 cases, for youth with low self-reported attentional control). For attentional biases, 5 studies compared youth with and without chronic pain. Two of these studies measured cortical correlates and found evidence of neurologic activity indicating a bias in orienting to pain-related stimuli. Three studies examined biases toward pain-related words or pictures. Of those, 2 found evidence of biases at subliminal presentation times, indicating vigilance (although 1 only after a stressful task). For supraliminal presentations, 1 study found evidence of avoidance, one of difficulty disengaging, and one of general slowing of responses. Only 1 study compared youth with and without pain for interpretation bias in adolescents, and interpretation biases were greater for youth with chronic pain. As with attention, no evidence for interpretation biases were found in youth without chronic pain. Overall, there is weak evidence to support vigilance in youth with chronic pain compared with those without. However, whether pain affects the subsequent deployment of attention is unclear. There is no evidence for biases toward pain in youth without chronic pain, but evidence suggests that anxiety or catastrophizing and attentional control may moderate pain-related attentional biases. There is also weak evidence of interpretation bias in youth with chronic pain compared with those without. Children without chronic pain do not show interpretation or attention biases toward pain-related stimuli. However, there is weak evidence for the presence of attention biases, characterized by vigilance toward pain-related stimuli and pain-related interpretation bias in children with chronic pain compared with those without.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.HLC.2015.05.003
Abstract: Advances in diagnosis and management of Genetic Aortic (GA) Disorders have improved prognosis for affected in iduals, yet many do not adhere to key management recommendations, and some may experience clinically significant levels of psychological distress. These issues are often not communicated to treating clinicians. Poor adjustment and coping may adversely impact on prognosis, but little is known about the processes contributing to negative outcomes. This study investigated adjustment to GA disorders to determine which processes facilitated or hindered good adherence and psychological outcomes. Semi-structured interviews involving 21 in iduals (12M, 9 F age 19-62 years) with a GA Disorder and psychosocial measures of depression/stress/anxiety (DASS), coping (COPE) and involvement in treatment (CPS) were used. Qualitative data were analysed using grounded theory and a model of adjustment was developed. Although most participants adhered to physician management recommendations and experienced minimal emotional distress, a subset reported poor adherence and/or sub/clinical levels of depression/anxiety/stress (29%). Dysfunctional coping mechanisms were infrequent, however 22% participants reported 'little or no' acceptance and 43% avoided life planning in response to a diagnosis of GA disorder. Interviews revealed an overarching theme: Negotiating perception of self and GA disorder, supported by five sub-themes: Restrictions upon Lifestyle, Destabilisation, Future, Support, and Unmet Needs. Accepting restrictions and having support were conducive to better adherence, whilst destabilisation and loss of control had a negative impact. A model of adjustment is proposed to explain how patients reached one of four outcomes relating to psychological distress and adherence to physician recommendations. The central tenet of the model is founded on how realistically patients appraise their vulnerability to GA threat and whether they are able to integrate their perceptions of illness with their sense of self-identity. This study indicates that in iduals with GA are at risk of experiencing psychosocial distress and coping difficulties, even years after diagnosis. Key factors likely to be associated with impaired coping among GA patients include inability to integrate the illness into one's identity/life, or to follow physician recommendations. Potential unmet needs were identified, including the provision of more relevant information and opportunities for peer support. These findings may also be applicable to other inherited cardiac disorders.
Publisher: Wiley
Date: 04-2015
DOI: 10.1002/PON.3789
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.JBTEP.2013.06.003
Abstract: Although there is some evidence that health anxiety is associated with attentional bias, relatively little research has examined the role of situational threat on bias. This study examined the effect of health threat on attentional bias for negative health words. Participants completed questionnaires and were then randomized to receive either threatening or reassuring health-related feedback. Following randomization, participants completed the emotional Stroop and dot-probe tasks in a counter-balanced order. On the emotional Stroop task, all participants took longer to name the colour of negative words, as compared to positive and neutral words. However on the dot probe task, differences in attentional bias emerged based on feedback condition. Those receiving reassuring feedback displayed a bias away from negative words while those receiving threatening feedback did not display a bias either towards or away from negative words. Following reassuring feedback only, metacognitions were negatively correlated with attention towards positive health-related stimuli, suggesting another avenue for future research. Health threats lead to an increase in the processing of negative information, and the effect of metacognitions on processing appears to be apparent only in the absence of health threat.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.1016/J.PAIN.2011.08.021
Abstract: Despite increasing interest in the attentional biases of pain patients towards pain-related stimuli, there have been no investigations of whether the main caregivers of chronic pain patients also selectively attend to pain-related information. We compared the attentional biases to painful or happy faces of 120 chronic pain patients, 118 caregivers, and 50 controls. Analyses found that both patients and caregivers demonstrated biases towards painful faces that were not observed in control participants or to happy faces. Those patients and caregivers who were high in fear of pain demonstrated greater biases than those low in fear of pain, and the biases of the high-in-fear-of-pain group differed significantly from zero. When sub-groups of caregivers were compared, it was found that biases towards painful faces were not observed for those caregivers who accurately identified the level of pain the patient currently reported. In contrast, those caregivers who overestimated or underestimated the patients' pain demonstrated biases that were significantly greater than zero. These results add to the growing weight of evidence suggesting that biases towards pain-related stimuli are observed in chronic pain patients, but that the nature of the stimuli is important. In addition, the results suggest that caregivers, particularly those who either under- or overestimate the level of pain that the patient reports, also demonstrate similar biases. Future research should investigate the links between caregivers' biases and the way in which caregivers respond to pain.
Publisher: Wiley
Date: 11-2013
DOI: 10.1002/PON.3423
Abstract: Fear of cancer recurrence (FCR) is common amongst cancer survivors and help with this problem is the most frequently reported unmet need in this population. This study investigated how FCR is perceived and managed by clinical health professionals (medical and nursing staff) and psychosocial professionals in oncology settings. Clinical health professionals and psychosocial professionals in oncology settings received emailed invitations from their professional organisation to participate in an online survey. Data from 77 clinical health professionals and 64 psychosocial professionals indicate that FCR is perceived as common and challenging to manage. Thirty-one percent of psychosocial professionals estimated FCR is present in >50% of cancer survivors seen in their practise. Only a minority (21%) of clinical staff reported always referring patients with high levels of FCR to psychosocial support. Strategies for managing FCR differed considerably amongst psychosocial professionals, and most reported that aspects of acceptance and commitment therapy and/or cognitive behaviour therapy were helpful. Greater than 99% of participants were interested in training to help patients manage FCR. Fear of cancer recurrence is commonly identified in oncology settings and a common focus of discussion in follow-up care. However, patients with high levels of FCR are not routinely referred to psychosocial staff, and barriers to referral to psychosocial care should be investigated. The ersity of approaches reported by psychosocial professionals suggests lack of consensus regarding management of FCR, indicating that the development effective, theoretical-based intervention and evidence-based intervention for FCR is a matter of priority.
Publisher: Wiley
Date: 18-03-2019
DOI: 10.1002/PON.5048
Abstract: Fear of cancer recurrence (FCR) is common, debilitating, and costly to the health system. While there has been a rising trajectory in FCR-related research, there remain many unanswered questions. A research agenda is required to clarify priorities and ensure that research dollars and effort are expended wisely. This study aimed to elicit research topics and priorities from clinical and academic experts in FCR. Phase 1 consisted of elicitation by survey of prioritised FCR research topics from 20 members of the Psycho-Oncology Co-operative Research Group (PoCoG) FCR special interest group, followed by a focus group discussion with 28 clinicians, researchers, and cancer survivors, at which survey results were presented and further reflection was encouraged. This resulted in 28 research topics that were then subjected to a Delphi process to establish consensus (phase 2). Thirty-one participants completed round 1 of the Delphi process and 23 round 2, after which satisfactory consensus was reached. Five broad areas of research were identified as priorities. In rank order, they were (1) intervention models (2) definition, predictors, and outcomes of FCR (3) detection and screening (4) training for health professionals and (5) reaching specific populations. It is hoped that the current findings will guide FCR researchers towards clinically relevant, significant research that will move the field forward. Experts nominated intervention research as the top priority, specifically exploring optimal formats of delivery including stepped care and blended models incorporating online or phone elements to increase accessibility.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
DOI: 10.1016/J.PAIN.2008.12.009
Abstract: This study aimed to investigate the efficacy of implicit attention re-training (AR) on pain ratings, threshold and tolerance during the cold-pressor task and to determine whether the effectiveness of AR was affected by threat expectancy. One hundred and four undergraduate psychology students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive an AR that either trained them to implicitly attend to neutral and ignore pain-related stimuli (neutral training) or to attend towards pain-related stimuli (pain training). Hence, the present study had a 2 (threat expectancy: high vs low) x 2 (AR: pain vs neutral) design. Manipulation checks confirmed that the threat manipulation was effective in increasing threat expectancy and the training paradigm shifted attentional biases in predicted directions. Results showed that, relative to neutral re-training, those in the pain re-training group reported higher levels of pain 30s into the cold pressor task and registered pain more quickly. There was no difference in tolerance between the groups, nor pain at tolerance. This was the same pattern of results found for the threat induction. For initial pain ratings, there was an interaction that closely approached significance (p=0.053). These results show that AR affects in idual's perceptions of and their responses to pain during an experimental task in a similar way to increasing the threat expectancy of the task. Future research should trial AR in real-life settings to determine whether these results can be generalized.
Publisher: Springer Science and Business Media LLC
Date: 06-1995
DOI: 10.1007/BF02107116
Publisher: Wiley
Date: 25-11-2019
DOI: 10.1002/PON.5283
Abstract: Without an agreed-upon set of characteristics that differentiate clinical from nonclinical levels of fear of cancer recurrence (FCR), it is difficult to ensure that FCR severity is appropriately measured, and that those in need of intervention are identified. The objective of this study was to establish expert consensus on the defining features of clinical FCR. A three-round Delphi was used to reach consensus on the defining features of clinical FCR. Sixty-five experts in FCR (researchers, psychologists, physicians, nurses, and allied health professionals) were recruited to suggest and rate potential features of clinical FCR. Participants who indicated they could communicate diagnoses within their clinical role were also asked to consider the application of established DSM-5 and proposed ICD-11 diagnostic criteria (Health Anxiety, Illness Anxiety Disorder, Somatic Symptom Disorder) to clinical FCR. Participants' ratings suggested that the following four features are key characteristics of clinical FCR: (a) high levels of preoccupation (b) high levels of worry (c) that are persistent and (d) hypervigilance to bodily symptoms. Of participants whose professional role allowed them to diagnose mental disorders, 84% indicated it would be helpful to diagnose clinical FCR, but the use of established diagnostic criteria related to health anxiety or somatic-related disorders to clinical FCR was not supported. This suggests that participants consider clinical FCR as a presentation that is specific to cancer survivors. Clinical FCR was conceptualized as a multidimensional construct. Further research is needed to empirically validate the proposed defining features.
Publisher: Wiley
Date: 13-08-2014
DOI: 10.1002/J.1532-2149.2013.00383.X
Abstract: Behavioural exposure methods can reduce pain-avoidance behaviours, but outcomes vary. One possible explanation is that patients employ cognitive (experiential) avoidance during behavioural exposure. If so, reducing cognitive avoidance during behavioural exposure should help. One option is interoceptive exposure (IE), which involves sustained exposure (via attention) to pain sensations. In order to test if IE could improve outcomes from behavioural exposure, this study with mixed chronic pain patients compared outcomes from a cognitive behavioural therapy (CBT) pain management programme incorporating either IE or distraction from pain. One hundred forty chronic pain patients were randomly assigned to CBT + IE or CBT + distraction. Outcome measures included pain, disability, depression and medication. Measures reflecting degree of threat of pain were also employed (catastrophizing, fear-avoidance, pain self-efficacy and pain acceptance). An intention-to-treat approach, using mixed-effects model repeated measures, as well as conventional inferential statistical tests, effect sizes and reliable change indices were employed to evaluate the outcomes up to 1-year post-treatment. Significant improvements were achieved by both treatment conditions on all outcome measures and on measures reflecting the threatening nature of pain, with no differences between treatment conditions. The addition of IE to behavioural exposure did not improve outcomes. However, higher adherence to either attentional strategy was associated with larger effect sizes on all measures, suggesting factors shared by the two treatments could have contributed to the outcomes. Taken as a whole, the results suggest that increasing adherence to treatment strategies, possibly by motivational measures, would improve the overall outcomes of these interventions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
Publisher: Wiley
Date: 06-2003
Publisher: Wiley
Date: 03-09-2013
DOI: 10.1111/EPI.12345
Abstract: Cognitive behavioral therapy (CBT) is a recommended treatment for depression in people with epilepsy (PWE) however, a recent Cochrane review found that there was insufficient evidence that any psychological therapy is effective. This conclusion provides little help to clinicians who provide interventions for depressed PWE. The aim of this review was to systematically and qualitatively review the literature on the efficacy of CBT for depression in PWE based on randomized controlled trials (RCTs) and case series. We aim to determine patterns in the literature to inform the type of CBT, if any, that should be offered to PWE who are depressed. Databases MEDLINE, PsycINFO, and the Cochrane EBM Reviews were searched via OVID. Selection criteria included the following: (1) participants with epilepsy (2) use of CBT (3) valid depression outcome measure and (4) published in peer-reviewed journal in English. Inclusions of studies were assessed by two independent researchers. We identified 14 outcome papers for 13 CBT trials including 6 randomized controlled trials (RCTs) and 7 case series. Positive effects of CBT on depression were reported in three of six RCTs. A review of their content revealed that all effective RCTs specifically tailored CBT to improve depression. Conversely, two of three RCTs that failed to find depression-related effects focused on improving seizure-control. This pattern was also observed in the case series. Although limited in number and having methodologic limitations, the treatment studies included in our review suggest that interventions tailored toward improving depression are possibly efficacious, whereas those that focus on improving seizure control do not appear to be. However, this review highlights that there is need for further RCTs in this area in order to confirm the possible efficacy of CBT for depression in PWE.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.SMRV.2017.03.006
Abstract: This systematic review and meta-analysis aimed to determine the size of the placebo effect for insomnia symptoms when comparing placebo treatment with no treatment. PsycINFO, MEDLINE, and CINAHL databases were systematically searched for studies allocating participants with insomnia symptoms (diagnosed or self-reported) to receive a placebo that they were led to believe was an active treatment or to a no treatment control group. Thirteen independent studies (n = 566) met inclusion criteria. Meta-analysis indicated a reliable placebo effect whereby placebo treatment led to improved perceived sleep onset latency (SOL Hedges g = 0.272), total sleep time (TST Hedges g = 0.322), and global sleep quality (GSQ Hedges' g = 0.581), when compared with no treatment. There was no effect on objective assessment of SOL, however only a few studies reported this outcome and there were insufficient s le sizes to meta-analyse other objective outcomes. Moderator analysis indicated that the placebo effect for perceived insomnia symptoms was quite consistent across different variables. The present findings provide strong evidence for placebo effects for perceived insomnia symptoms, but not on the only objective measurement with sufficient s le size to meta-analyse, namely objective SOL. This has important implications for the treatment of insomnia symptoms and the design and interpretation of clinical trials for insomnia symptoms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-01-2022
DOI: 10.1097/J.PAIN.0000000000002593
Abstract: Recent sham-controlled studies suggest placebo effects contribute to acute pain relief after mindfulness interventions. However, the specific effects of mindfulness processes and their interaction with placebo effects remain unclear. This study aimed to characterize the role of mindfulness and placebo processes underlying mindfulness-based pain attenuation. Both treatment (focused attention mindfulness vs sham) and instruction (told mindfulness vs told sham) were manipulated in a balanced placebo design. Changes in acute heat pain were evaluated in 153 healthy adults randomized to receive 6 × 20 minutes of 1 of 4 treatment by instruction interventions or no treatment. Participants receiving any intervention demonstrated improved pain outcomes (unpleasantness, intensity, and tolerance) relative to those receiving no treatment. The instruction manipulation increased expectation for pain relief in those told mindfulness relative to those told sham, but there were no main effects or interactions of treatment or instruction on pain outcomes. However, irrespective of actual intervention received, the belief of receiving mindfulness predicted increased pain threshold and tolerance, with expectancy fully mediating the effect on pain tolerance. These findings suggest a lack of specific effects of mindfulness and instruction on acute pain. Nonetheless, participants' expectancies and beliefs about the treatment they received did predict pain relief. Together with the overall improvement after any intervention, these findings suggest that expectancy and belief may play a stronger role in attenuating acute pain in novices following brief mindfulness interventions than the actual mindfulness-specific processes or instructions delivered.
Publisher: SAGE Publications
Date: 07-03-2017
Abstract: Background. For many women with epilepsy (WWE), decision making about pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs, offspring risk of epilepsy, seizure occurrence during pregnancy, and the challenges of parenting amidst poorly controlled seizures. Objective. This proof-of-concept, randomized controlled trial aimed to evaluate a decision aid (DA) developed to help WWE decide if they should start or enlarge their families. Methods. Seventy-nine WWE of childbearing age were recruited from Epilepsy Action Australia between October and November 2013 and randomized to receive the intervention (the DA) or not, and to complete a set of questionnaires pre- and post- intervention. The DA, delivered as a PDF booklet, provided balanced evidence-based information about options, risks and benefits, including probabilities as well as steps for clarifying values and considering options within one’s personal situation. Results. Compared with the control group, the DA group had statistically significant improvements in knowledge about pregnancy and epilepsy (Cohen’s d = 1.24 95%CI = 0.77 to 1.83) and reduced decisional conflict (Cohen’s d = 0.59 95%CI = 0.21 to 0.99). Changes in decision self-efficacy, certainty of choice, patient-practitioner communication abilities and value congruence with choice were comparable between the DA and control group. Importantly, women’s decisions about motherhood were not biased towards either direction, and there were no adverse effects on depression or anxiety. All women who received the DA indicated they would recommend it to other WWE. Conclusions. The DA has the potential to serve as a useful support tool for WWE who are considering motherhood. Future research is needed to test the DA in clinical settings with guidance from a health professional. The trial was registered with the Australian New Zealand Clinical Trials Registry (ID ACTRN12613001082796).
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.JPSYCHORES.2005.02.017
Abstract: Response shift is a process argued to facilitate adjustment to illness. This study investigated the relationship between response shift and adjustment. Fifty-six patients with metastatic cancer were interviewed using SEIQoL-DW and asked to nominate the five areas of most importance to them. Surviving patients were re-interviewed 3 (n=38) and 6 months (n=28) later. The majority of patients showed evidence of restricted priorities close to the diagnosis of metastatic cancer. Approximately half the s le shifted their priorities from one area to another over time. Response shift was found to be helpful for those who nominated life domains that were poorly rated, but unhelpful, for those who shifted from a highly rated life domain. These results suggest that response shift is common during adjustment to illness. However, response shift can be helpful or unhelpful depending upon the context. The clinical and theoretical implications of these findings are discussed.
Publisher: Wiley
Date: 03-2015
DOI: 10.1002/PON.3775
Publisher: Wiley
Date: 25-08-2015
DOI: 10.1002/PON.3659
Abstract: Fear of cancer recurrence (FCR) is a common and severe problem amongst cancer survivors, but mechanisms to explain its development and maintenance are still lacking. The self-regulatory executive function (S-REF) model suggests that metacognitions and attentional bias to cancer-related words may explain high FCR. Thus, this study aimed to explore relationships between FCR, metacognitions and attentional bias in a mixed group of cancer survivors. Sixty-three early-stage breast or prostate cancer survivors, diagnosed within 6 months to 5 years prior to participation and who had completed all hospital-based treatment with no evidence of cancer recurrence were recruited through two metropolitan oncology clinics. Participants completed a questionnaire battery and the dot-probe task. Survivors with clinical FCR had significantly greater positive beliefs about worry (10.1 vs 7.4, p = 0.002) and beliefs about the uncontrollability and danger of worry (12.0 vs 7.7, p = 0.000) than those with non-clinical FCR, whereas the total metacognition score significantly predicted FCR in multiple regression analysis (β = 0.371, p = 0.001). No significant differences were detected between participants scoring above and below clinical FCR levels in attention bias indices. This study found partial support for the S-REF model of FCR, with metacognitions but not attentional bias found to be related to FCR. Further research is needed to explore attentional biases in more detail.
Publisher: Informa UK Limited
Date: 07-2015
DOI: 10.1111/CP.12066
Publisher: Wiley
Date: 21-06-2018
DOI: 10.1002/PON.4783
Abstract: In 2013, 3 systematic reviews of fear of cancer recurrence (FCR) and its predictors were published. All 3 concurred that FCR is a highly prevalent problem and amongst the largest unmet needs of cancer survivors, even 5 or more years after treatment. However, between them they identified only 1 study that had investigated the relationship between death anxiety and FCR. This is surprising because it is well acknowledged that a diagnosis of cancer, a potentially life-threatening illness, is associated with a number of existential issues that give rise to psychological sequelae such as intrusive thoughts about death and other post-traumatic symptoms. Outside the cancer literature, there has recently been a call to identify death anxiety as a transdiagnostic construct that underlies many anxiety disorders even in healthy people. And yet, the relevance of death anxiety to FCR has not been studied. We explore the barriers to the study of death anxiety and FCR and the reasons that a potential link between the 2 might have important theoretical and clinical implications. We conclude that establishing the relationship between death anxiety, FCR and other existential issues is essential in order to fully understand FCR, particularly in the context of advanced disease. We further conclude that whether death anxiety underlies FCR has important clinical implications which would potentially allow us to optimise currently available evidence-based treatments.
Publisher: American Thoracic Society
Date: 07-2008
Publisher: Wiley
Date: 2007
DOI: 10.1002/ART.22553
Abstract: To examine the relationship between physical appearance concerns and psychological distress in patients with rheumatic diseases. A total of 60 patients with systemic lupus erythematosus (SLE), 44 with chronic rheumatoid arthritis (RA), and 53 with recent-onset RA were evaluated for levels of appearance concern and a range of illness-specific measures to determine how these demographic and clinical variables were related to the dependent variable psychological distress. Using hierarchical multiple regression analyses, we found that both appearance concerns and levels of disability were predictive of depression in patients with RA. In the SLE s le, physical disability was predictive of depression when appearance concerns were not included in the analysis. However, disability did not predict depression when appearance concerns were entered into the analysis. This indicates that appearance concerns mediated the relationship between disability and depression in SLE. There was no association between appearance concerns and anxiety in either s le. The results suggest that appearance concerns are strongly related to depression in patients with rheumatic diseases and should be routinely assessed.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2015
DOI: 10.1007/S00127-014-0921-1
Abstract: Internet treatments have the potential to improve access, especially for cultural groups who face considerable treatment barriers. This study explored the perceived barriers and likelihood of using Internet and face-to-face treatments for depression among Chinese and Caucasian Australian participants. Three-hundred ninety-five (289 Chinese, 106 Caucasian) primary care patients completed a questionnaire about depression history, previous help-seeking, perceived barriers to Internet and face-to-face treatment, and likelihood of using either treatment for depressive symptoms. Internet treatment reduced perceived barriers (including stigma, lack of motivation, concerns of bringing up upsetting feelings, time constraints, transport difficulties, and cost) for both groups to a similar degree, except for time constraints. There were heightened concerns about the helpfulness, suitability, and confidentiality of Internet treatments. Chinese participants and in iduals with a probable depression history reported increased perceived barriers across treatments. Both Chinese and Caucasian groups preferred face-to-face treatment across depression severity. However, when age was controlled, there were no significant concerns about Internet treatment, and face-to-face treatment was only preferred for severe depression. Only 12 % of the entire s le refused to try Internet treatment for depression. Endorsement of perceived Internet treatment barriers (including concerns of bringing up upsetting feelings, that treatment would be unhelpful or unsuitable, lack of motivation, cost, cultural sensitivity, and confidentiality) reduced the likelihood to try Internet treatments. Internet treatment reduced perceived treatment barriers across groups, with encouraging support for Internet treatment as an acceptable form of receiving help. Negative concerns about Internet treatment need to be addressed to encourage use.
Publisher: Informa UK Limited
Date: 12-09-2021
DOI: 10.1080/08039488.2020.1817554
Abstract: A body of research has demonstrated high rates of comorbidity among in iduals with obsessive-compulsive disorder (OCD). Further, recent empirical evidence has demonstrated the relevance of death anxiety in OCD. Given that the trajectory towards OCD remains unclear, the current study aimed to examine which disorders in iduals typically experience prior to the onset of this disorder. Further, the study aimed to explore the role of death anxiety in the developmental pathways to the disorder. The present study involved administering a measure of death anxiety and conducting structured diagnostic interviews among a treatment-seeking s le of 98 in iduals with OCD. First, the findings revealed a number of anxiety-related disorders commonly experienced prior to the development of OCD, the most frequent of which were separation anxiety disorder, specific phobias, and generalised anxiety disorder. Second, consistent with hypotheses, in iduals with higher death anxiety experienced more disorders prior to the onset of OCD. Conversely, those with lower fears of death were significantly more likely to develop OCD as their first disorder. These findings support the argument that death anxiety may influence the trajectory towards OCD, and the comorbidity among anxiety-related disorders. However, further research is needed to clarify whether death anxiety plays a causal role in this trajectory.
Publisher: Oxford University Press (OUP)
Date: 03-2021
DOI: 10.1093/ABM/KAAA115
Abstract: Side effect warnings can contribute directly to their occurrence via the nocebo effect. This creates a challenge for clinicians and researchers, because warnings are necessary for informed consent, but can cause harm. Positive framing has been proposed as a method for reducing nocebo side effects whilst maintaining the principles of informed consent, but the limited available empirical data are mixed. To test whether positive attribute framing reduces nocebo side effects relative to negative framing, general warning, and no warning. Ninety-nine healthy volunteers were recruited under the guise of a study on virtual reality (VR) and spatial awareness. Participants were randomized to receive positively framed (“7 out of 10 people will not experience nausea”), negatively framed (“3 out of 10 people will experience nausea”), general (“a proportion of people will experience nausea”), or no side effect warnings prior to VR exposure. Receiving a side effect warning increased VR cybersickness relative to no warning overall, confirming that warnings can induce nocebo side effects. Importantly, however, positive framing reduced cybersickness relative to both negative framing and the general warning, with no difference between the latter two. Further, there was no difference in side effects between positive framing and no warning. These findings suggest that positive framing not only reduces nocebo side effects relative to negative framing and general warnings, but actually prevents nocebo side effects from occurring at all. As such, positive attribute framing may be a cheap and ethical way to reduce nocebo side effects.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JPAIN.2018.07.005
Abstract: Little is known about the long-term outcomes of emerging Internet-delivered pain management programs. The current study reports the 12- and 24-month follow-up data from a randomized controlled trial (n = 490) of an Internet-delivered pain management program, the Pain Course. The initial results of the trial to the 3-month follow-up have been reported elsewhere. There were significant improvements in disability, depression, anxiety, and pain levels across 3 treatment groups receiving different levels of clinician support compared with a treatment as the usual control. No marked or significant differences were found between the treatment groups either after treatment or at the 3-month follow-up. The current study obtained long-term follow-up data from 78% and 79% of participants (n = 397) at the 12-month and 24-month follow-up marks, respectively. Clinically significant decreases (average percent reduction Cohen's d effect sizes) were maintained at the 12- and 24-month follow-ups for disability (average reduction ≥27% d ≥ .67), depression (average reduction ≥36% d ≥ .80), anxiety (average reduction ≥38% d ≥ .66), and average pain levels (average reduction ≥21% d ≥ .67). No marked or consistent differences were found among the 3 treatment groups. These findings suggest that the outcomes of Internet-delivered programs may be maintained over the long term. PERSPECTIVE: This article presents the long-term outcome data of an established Internet-delivered pain management program for adults with chronic pain. The clinical improvements observed during the program were found to be maintained at the 12- and 24-month follow-up marks. This finding indicates that these programs can have lasting clinical effects.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Wiley
Date: 22-07-2021
DOI: 10.1002/PON.5748
Abstract: Models of fear of cancer recurrence or progression (FCR/P) suggest that the way in which people interpret ambiguous physical symptoms is an important contributor to the development and maintenance of FCR/P, but research has not investigated this claim. The aim of this study is to fill that gap. This was a cross‐sectional study. Sixty‐two women with ovarian cancer reported completed measures of FCR/P, an interpretation bias task and a symptom checklist. The healthy control group ( n = 96) completed the interpretation bias task. Women with ovarian cancer were more likely to interpret ambiguous words as health‐related compared to healthy women ( p 0.001 Cohen's d = 1.28). In women with cancer, FCR/P was associated with overall symptom burden ( r = 0.25 p = 0.04) and interpretation bias score ( r = 0.41 p = 0.001), but interpretation bias and symptom burden were not related ( r = 0.22 p = 0.09). Interpretation bias did not moderate the relationship between symptoms and FCR/P. We found that women with ovarian cancer interpreted ambiguous words as health related more often compared to women without cancer, and this bias was greater for women with higher FCR/P. Symptom burden was also associated with FCR/P. However, interpretation bias did not moderate the relationship between physical symptoms and FCR/P. Hence, the central tenet of the Cancer Threat Interpretation model was not supported in women with ovarian cancer.
Publisher: Informa UK Limited
Date: 02-2018
DOI: 10.1111/AP.12264
Publisher: Wiley
Date: 03-05-2017
DOI: 10.1111/EPI.13769
Abstract: Comorbid anxiety and depressive disorders in people with epilepsy (PWE) are highly prevalent and associated with various adverse outcomes. However, the prevalence of anxiety disorders in PWE across studies is highly variable. Our aim was to estimate the prevalence and moderating factors of anxiety and depressive disorders in PWE. Following prospective registration (PROSPERO CRD42015027101), electronic databases were searched for studies that reported the prevalence of both anxiety and depressive disorders in s les of PWE up until July 2016. Data extracted included the prevalence of anxiety and depressive disorders, and moderators of interest (e.g., method of diagnosis, prevalence of drug-resistant epilepsy). Meta-analysis of the overall pooled prevalence of anxiety and depressive disorders was conducted. The search yielded 8,636 unique articles, with 27 studies meeting final inclusion criteria (3,221 PWE). The pooled prevalence of anxiety and depressive disorders was 20.2% (95% confidence interval [CI] 15.3-26.0%) and 22.9% (95% CI 18.2-28.4%), respectively. Method of diagnosis significantly moderated anxiety disorder prevalence (Q statistic with one degree of freedom [Q Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.
Publisher: Wiley
Date: 18-02-2016
DOI: 10.1002/PON.4099
Abstract: Although cancer care guidelines recommend screening for distress among cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake and adherence to psychological support and to identify predictors of each. Searches were conducted in Embase, Medline, PsychInfo and Scopus to identify studies reporting uptake or adherence rates for in idual psychological interventions targeting distress, anxiety or depression for cancer patients or survivors. Across the 53 included studies reporting uptake and/or adherence rates for 12 323 cancer patients, the uptake and adherence rates were 60.1% and 90.4%, respectively. Patients screened and identified as distressed were less likely to accept intervention than unselected patients (50.3% compared with 66.3%, Q(1) = 4.66, P = 0.031). Uptake of therapy was higher for interventions delivered by telephone rather than face-to-face (71.2% compared with 53.8%, Q(1) = 4.91, P = 0.027) and when therapy was offered prior to medical treatment compared with later (72.9% compared with 56.8%, Q(1) = 5.60, P = 0.018). Patients were more likely to accept intervention from nurses than other allied health professionals (68.3% compared with 50.5%, Q(1) = 5.76, P = 0.016). Patients appeared more receptive to interventions offered near diagnosis, over the telephone and by nurses. Although this suggests higher acceptability of such interventions, evidence of their greater efficacy is lacking, and this merits further investigation. Research is needed to understand barriers to acceptance of psychological support, particularly because uptake rates were lower for distressed patients. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Informa UK Limited
Date: 19-09-2018
DOI: 10.1080/17437199.2018.1521729
Abstract: Studies investigating attentional biases towards pain information vary widely in both design and results. The aim of this meta-analysis was to determine the degree to which attentional biases towards pain occur when measured with the dot-probe task. A total of 2168 references were screened, resulting in a final s le of 4466 participants from 52 articles. Participants were grouped according to pain experience: chronic pain, acute pain, anticipating experimental rocedural pain, social concern for pain, or healthy people. In general, results revealed a significant, but small bias towards pain words (d = 0.136), and pain pictures (d = 0.110) in chronic pain patients, but not in those with acute pain, those anticipating pain, or healthy people. Follow-up analyses revealed an attentional bias towards sensory pain words in the chronic pain group (d = 0.198), and the acute pain group (d = 0.303), but not other groups. In contrast, attentional biases towards affective pain stimuli were not significant for any pain groups. This meta-analysis found support for attentional biases towards sensory pain stimuli in patients with chronic pain in comparison to healthy in iduals across a range of common parameters. Future researchers need to consider task design when seeking to optimally measure pain-relevant attentional biases.
Publisher: Wiley
Date: 23-12-2014
DOI: 10.1111/JPC.12489
Abstract: The purposes of this study are to investigate parents' beliefs about the likelihood of diabetes outcomes for their child, the reasons that they give for these beliefs and the relationship between the beliefs and parental psychopathology. Seventy-one mothers of children with diabetes completed a questionnaire about the likelihood of certain diabetes outcomes and measures of psychopathology. Both qualitative and quantitative data were collected at a single time point. Mothers generally held very optimistic views about their children's future, and this was associated with less maternal depressive symptoms. Mothers typically used their previous experiences and belief that diabetes is controllable to justify optimistic beliefs about short-term consequences. In contrast, formation of mothers' views on long-term consequences generally relied on information from a variety of sources. The results suggest that it is usual and helpful for mothers of children with diabetes to hold overly optimistic views about their children's futures. Medical evidence appears to have little influence on mothers' beliefs about likely outcomes for their children.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.BRAT.2016.11.004
Abstract: Anxiety disorders are highly prevalent in children with asthma yet very little is known about the cognitive and parent factors that may underpin this relationship. The present study investigated interpretation biases in children with asthma and anxiety and their parents, and whether parent-child discussions influenced children's interpretations. Eighty-nine parent-child dyads were included across four groups: children with asthma and anxiety, children with anxiety only, children with asthma only and healthy children (aged between 8 and 13 years old). Interpretation bias was assessed using ambiguous scenarios. Children with anxiety showed an interpretation bias in the general threat scenarios, whereas children with asthma showed an interpretation bias in the asthma threat scenarios. Parental predictions of their child's responses showed similar results. Parent-child discussions increased avoidance for children with anxiety and no asthma across all scenarios, but only for children with asthma and anxiety in the asthma threat scenarios. The results provide partial support for a cognitive theory of asthma and anxiety in children and suggest that parents play a role in influencing children's thinking styles. Treatment programs could thus aim to target and modify interpretation biases in children with anxiety, and include parents as part of treatment.
Publisher: Oxford University Press (OUP)
Date: 26-05-2020
Abstract: Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression. A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress. Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness. Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms. ACTRN12611000859987
Publisher: S. Karger AG
Date: 2003
DOI: 10.1159/000069736
Abstract: i Background: /i In randomised controlled trials, an increasingly used test of the ‘blindness’ of assessors is to have them guess the group to which each participant has been allocated. Because assessors are usually aware of the trial hypotheses, we predicted that trial participants who showed the greatest improvement would be assumed by an assessor to have been in the ‘preferred intervention’ group. i Methods: /i Data were derived from a trial in recent-onset rheumatoid arthritis comparing cognitive behavioural therapy plus routine care with routine care alone. i Results: /i Although in this trial assessor blindness was demonstrated, patients ‘guessed’ by the assessor to be in the cognitive therapy group showed significantly greater improvements than those predicted to have received routine care alone in variables predicted to change in the study protocol. i Conclusions: /i These results indicate that even if an assessor’s guesses about patient group allocations are more accurate than expected by chance, this would not necessarily demonstrate failure of blinding. This casts further doubt on the validity of forced choice paradigms in testing the integrity of blinding in clinical trials.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.CPR.2017.06.003
Abstract: Anxiety is common in the context of cancer, but there are few theoretical models that apply to people with cancer across the trajectory of their illness. The aims of this review are to identify existing theories and to propose an integrated model of cancer-related anxiety. Using a systematic literature search of Medline, Premedline and PsycINFO databases, we identified nine theoretical models of anxiety in the context of cancer. We reviewed these for psychological concepts that fell under five themes: pre-existing schema, the inherent nature of cancer, cognitive factors, coping responses and contextual factors. From these themes, we integrated concepts from different models to develop a theoretical framework to explain the development and maintenance of anxiety in the context of cancer. The resulting model suggests that pre-existing schema, past experiences of cancer, an intolerance of uncertainty and meta-cognitive beliefs about worry interact with the inherent nature of cancer to produce overwhelming distress. The distress activates cognitive processes characterized by vigilance, worry and rumination. Attempts to cope by re-establishing control, and a pattern of vigilance to cancer-related cues and/or avoidance reinforce anxiety, in the context of a range of systemic factors that can either buffer against or worsen the anxiety.
Publisher: Informa UK Limited
Date: 30-08-2017
DOI: 10.1080/07481187.2016.1210696
Abstract: The present study investigated the presence and possible predictors of complicated grief symptoms in perinatally bereaved mothers (N = 121) up to 5 years postbereavement. The presence of complicated grief scores in the clinical range was 12.4%, which is higher than in many other bereaved populations, and the presence of other living children may protect against the development of complicated grief symptoms. The majority of the women were able to negotiate a perinatal loss without developing complicated grief however, there remains an important group of women who up to 5 years later score in the clinical range for complicated grief symptoms.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2001
DOI: 10.1016/S0304-3959(00)00379-1
Abstract: This study examined the efficacy of a cognitive and behavioural intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty-three participants with a diagnosis of classical or definite rheumatoid arthritis, who were seropositive and had less than 2 years of disease history were recruited into the trial. All participants received routine medical management during the study, although half were randomly allocated to receive an adjunctive psychological intervention. All pre- and post-treatment assessments were conducted blind to the allocation. Analyses were conducted of treatment completers and also by intention-to-treat. Significant differences were found between the groups at both post-treatment and 6-month follow-up in depressive symptoms. While the CBT group showed a reduction in depressive symptoms, the same symptoms increased in the Standard group. At outcome but not follow-up, the CBT group also showed reduction in C-reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6-month follow-up compared with the Standard group, indicating physical improvements above those achieved with standard care. These results indicate that cognitive-behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical morbidity
Publisher: Wiley
Date: 22-05-2012
Publisher: Wiley
Date: 05-02-2021
DOI: 10.1002/PON.5617
Abstract: Little is known about the role of attentional processes in the context of cancer. This systematic review aimed to (1) synthesize the literature on attentional biases in cancer survivors and (2) assess if these biases are associated with indicators of psychological distress. Studies were identified through a systematic search in PsycINFO, Medline, Scopus, CINAHL, Web of Science and Embase databases. We included studies that examined attentional biases using an accepted experimental paradigm (Dot‐probe or Stroop) in cancer survivors. Of 4105 papers identified, 18 met inclusion criteria. Cancer survivors had a greater attentional bias towards salient stimuli (cancer/negative stimuli) as compared to controls (Hedge's g = 0.82). Survivors who were more distressed had greater attentional biases (Hedge's g = 0.27). It was unclear whether the nature of stimuli was important in driving these effects (e.g., cancer‐specific vs. negative). These results demonstrate that cancer survivors have an attentional bias towards cancer‐related (typically words) or negative stimuli (typically facial expressions), and that bias is greater for those with higher levels of distress.
Publisher: Wiley
Date: 24-09-2014
DOI: 10.1002/J.1532-2149.2013.00404.X
Abstract: Fear of childbirth is associated with preference for an elective caesarean section (ECS) however, the role of fear of pain and pain catastrophizing (the tendency to predict the worst case scenario) have not been investigated. The aim of current study was to investigate whether fear of pain and catastrophizing were independent predictors of preference for ECS. We hypothesized that pain catastrophizing and negative affectivity would mediate the relationship between fear of pain and preference for ECS. Three hundred pregnant women between 4 and 36 weeks of gestation were asked to indicate whether they would prefer to deliver their baby through an ECS or a vaginal delivery. They were also asked to complete a battery of questionnaires assessing demographic details, mood, fear of childbirth, fear of pain and catastrophizing. Consistent with cultural norms, more than half of the women preferred an ECS (58%). Women who chose ECS were more likely to seek private obstetric care, have had a previous caesarean section and have higher levels of fear of childbirth, fear of pain, more catastrophic cognitions and lower mood. Catastrophizing, but not negative affectivity, mediated the relationship between fear of pain and preference for ECS, as predicted. Fear of both childbirth and pain were both independent predictors of preference for ECS. Catastrophizing mediated the relationship between fear of pain and preference for ECS. Interventions that target these factors may reduce the trend towards increasing numbers of ECS internationally.
Publisher: Center for Open Science
Date: 08-08-2021
Abstract: Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although CBT has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Further, there is a growing need for accessible, scalable, and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based program which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet in idualised online treatment. The present study outlines the development and structure of this program, using responses from two users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical s le.
Publisher: Oxford University Press (OUP)
Date: 11-2012
Publisher: Informa UK Limited
Date: 13-01-2018
DOI: 10.1080/09638237.2016.1276533
Abstract: Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment (2) Influences on decision-making (3) The nature and flow of decision-making (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2015
DOI: 10.1007/S00127-014-0956-3
Abstract: Internet treatments may overcome barriers and improve access to mental health services for people who do not access professional help. It may be particularly beneficial for Chinese Australians, a group that tends to delay and underutilize face-to-face treatments. This study explored the appeal of Internet therapy to Chinese- and English-speaking Australians with depression who accessed Internet-delivered cognitive behavioural therapy (iCBT) programs. Data collected from previous randomised controlled trials of iCBT depression programs were used. Using a matched s les design, 55 Chinese- and 55 English-speaking iCBT participants with depression were matched on age, gender, and depression screener scores. They were compared on their symptom severity, previous help-seeking patterns, and reasons for seeking Internet treatment. The Chinese-speaking participants had significantly milder depressive symptoms and were less likely to have previously sought professional help compared to the English-speaking participants (all ps < 0.05). Both groups endorsed similar number of reasons for seeking iCBT, and the most common reasons related to reduced structural barriers. However, the Chinese-speaking participants were more likely to seek iCBT due to lack of knowledge about face-to-face treatment (p = 0.005), while the English-speaking participants were more likely to report not benefiting from traditional help (p = 0.030). The attraction of iCBT appears to be the reduction of structural barriers to treatment. iCBT may reduce treatment delay and increase access to Chinese Australians who have not sought professional help. English-speaking Australians are seeking iCBT as an additional means of getting help.
Publisher: Elsevier BV
Date: 12-2001
DOI: 10.1016/S0022-3999(01)00266-5
Abstract: This study aimed to investigate the course of depression for patients with recently diagnosed rheumatoid arthritis (RA) and to investigate predictors of depression. Twenty-two patients with a history of recently diagnosed RA of less than 2 years were assessed on a variety of clinical outcome and process measures on six assessment occasions over a 21-month period. These 22 patients constituted the control group of a controlled trial and received standard outpatient clinic treatment during follow-up. Patients became significantly more depressed over time. A set of five factors were found to consistently predict depression at the following assessment. These were initial level of depression, disability, pain, beliefs about the consequences of arthritis and coping strategies. The results confirm the importance of psychological factors in early RA and their relative independence from physical findings. This is the first study to document the importance of illness perceptions in recent onset RA.
Publisher: Wiley
Date: 18-07-2019
DOI: 10.1111/BJC.12229
Abstract: Death anxiety has been implicated theoretically and empirically in mental health and has been proposed to be a transdiagnostic construct. However, it has largely been investigated in relation to specific disorders, such as obsessive-compulsive disorder. Few studies have assessed the relationship between death anxiety and psychopathology using heterogeneous treatment-seeking clinical s les. In the present study, the relationships between death anxiety and broad markers of psychopathology were explored in 200 treatment-seeking participants with various diagnosed mental disorders. Across the s le, death anxiety was a strong predictor of psychopathology, including the number of lifetime diagnoses, medications, hospitalizations, distress/impairment, depression, anxiety, and stress. This relationship was not accounted for by neuroticism. Large to very large correlations were also consistently found between a measure of death anxiety and the symptom severity of 12 disorders. Neither meaning in life nor attachment style moderated the associations between death fears and psychopathology. The findings reveal a strong relationship between death anxiety and psychopathology across numerous disorders, further supporting the transdiagnostic role of fears of death. As such, clinical implications revolve around the potential need for innovative treatments which address death fears directly, in order to produce long-term improvements in mental health. However, experimental research is needed to ascertain causal relationships. Across a large treatment-seeking s le, death anxiety was a significant predictor of broad psychopathology, including distress and number of lifetime diagnoses. Across 12 different disorders, death anxiety significantly predicted symptom severity. Results may suggest the need for novel treatments which specifically target fears of death. Due to the correlational design, future experimental research is needed to establish causal relationships with increased confidence.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-09-2013
Abstract: This study tested the efficacy of an intervention on end-of-life decision making for patients with advanced cancer. One hundred twenty patients with metastatic cancer who were no longer being treated with curative intent (and 87 caregivers) were randomly assigned to the intervention (n = 55) or treatment as usual (n = 65). Primary outcome measures were the proportion of patients with do-not-resuscitate (DNR) orders, timing of DNR orders, and place of death. Secondary outcome measures were completed at study enrollment, 3 weeks later, and 3 months later, including patients' knowledge, mood, and caregiver burden. High, but equivalent, rates of DNR orders were observed in both groups. In per-protocol analyses, DNR orders were placed earlier for patients who received the intervention (median, 27 v 12.5 days 95% CI, 1.1 to 5.9 P = .03) and they were more likely to avoid a hospital death (19% v 50% (95% CI, 11% to 50% P = .004). Differences between the groups over time were evident for estimates of cardiopulmonary rehabilitation (CPR) success rates (P = .01) but not knowledge of CPR (P = .2). There was no evidence that the intervention resulted in more anxious or depressive symptoms. Caregivers experienced less burden in terms of disruption to schedule if the patient received the intervention (P = .05). An intervention, consisting of an informational p hlet and discussion, was associated with earlier placement of DNR orders relative to death and less likelihood of death in hospital. There was no negative impact of the intervention on secondary outcomes, although the s le may have been too small to detect differences.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-09-2023
DOI: 10.1097/J.PAIN.0000000000002784
Abstract: Cognitive bias modification for interpretation (CBM-I) is an effective intervention for anxiety, but there is only a single trial in people with chronic pain. The aim of this randomized controlled trial was to test CBM-I with and without psychoeducation for people with chronic pain. We randomized 288 participants to 4 groups comprising treatment (CBM-I vs placebo) with or without psychoeducation. One hundred and eighty-three participants (64%) completed 4, 15-minute training sessions over 2 weeks. The coprimary outcomes were pain interference and pain intensity. We also measured interpretation bias, fear of movement, catastrophizing, depression, anxiety, and stress. Participants with more psychopathology at baseline were more likely to dropout, as were those allocated to psychoeducation. Intention-to-treat analyses using linear mixed models regression were conducted. Training effects of CBM-I were found on interpretation bias, but not a near-transfer task. Cognitive bias modification of interpretation improved both primary outcomes compared with placebo. For pain interference, there was also a main effect favoring psychoeducation. The CBM-I group improved significantly more than placebo for fear of movement, but not catastrophizing, depression, or anxiety. Cognitive bias modification of interpretation reduced stress but only for those who also received psychoeducation. This trial shows that CBM-I has promise in the management of pain, but there was limited evidence that psychoeducation improved the efficacy of CBM-I. Cognitive bias modification of interpretation was administered entirely remotely and is highly scalable, but future research should focus on paradigms that lead to better engagement of people with chronic pain with CBM-I.
Publisher: Informa UK Limited
Date: 18-03-2014
DOI: 10.1080/16506073.2014.892530
Abstract: This study compared a 9-week in idualised Cognitive Behaviour Therapy (CBT) programme for people with epilepsy (PWE), with a wait-list control. Fifty-nine PWE were randomised and 45 (75%) completed post-treatment outcomes. People with lower quality of life (QoL), particularly for cognitive functioning, were more likely to drop out. Analyses based on treatment completers demonstrated significant improvements on the Neurological Depressive Disorders Inventory for Epilepsy (p = .045) and Hospital Anxiety Depression Scale-Depression subscale (p = .048). Importantly, CBT significantly reduced the likelihood of clinical depressive symptoms (p = .014) and suicidal ideation (p = .005). Improvements were not observed for anxiety, QoL or maintained overtime for depression. Results suggest that CBT was effective, however, and could be improved to increase patient retention and long-term outcomes.
Publisher: Wiley
Date: 18-12-2015
DOI: 10.1002/EJP.648
Abstract: The aim of this study was to compare the effectiveness of training participants' attention towards or away from painful faces versus pain-related words on pain outcomes on an acute experimental pain paradigm. Participants were randomized to receive either training towards or away from painful faces or words. Following training, participants completed the cold pressor task. The results confirm that attention bias modification produced the predicted changes in attentional biases. Clear training effects were observed for words and faces, such that attentional biases changed in the predicted direction on the stimuli presented during the training. However, for those trained on words, training effects also generalized to face stimuli. As predicted, those who received training away from painful stimuli took longer to report pain (higher pain threshold) during the cold pressor task, and this effect was more pronounced for those trained on words. Contrary to expectations, those trained on faces (regardless of training direction) reported less pain than those trained on words. There were no differences between the groups for pain tolerance (length of time participants were able to keep their arms in the cold pressor). These findings confirm that attentional biases are modifiable, and impact (in the expected manner) how quickly participants perceive pain. Further, exposure to painful faces resulted in additional benefits to the level of pain reported. However, we were unable to confirm that change in attentional biases was the mechanism of change.
Publisher: S. Karger AG
Date: 12-12-2004
DOI: 10.1159/000074441
Abstract: i Background: /i The Pictorial Representation of Illness and Self Measure (PRISM) is a recently developed tool purported to assess burden of suffering due to illness. The nature of the PRISM task suggests a conceptual link to the illness self-schema construct hypothesised to be present in some in iduals with chronic illness. This study investigates the relationship between PRISM and schema as measured by cognitive bias. i Methods: /i 43 patients with systemic lupus erythematosus (SLE) completed an information-processing task involving endorsement of positive and negative illness words as descriptors of themselves, followed by free recall of the words. The outcome measures were endorsement and recall bias for negative illness words. Patients also completed the PRISM task and were assessed on other physical and psychological variables. i Results: /i PRISM did not correlate significantly with age, depression, functional impairment or disease activity. In a multiple regression analysis, only recall bias made an independent contribution to PRISM. i Conclusions: /i Illness self-schema appears to play a significant role in determining the way in which SLE patients complete the PRISM task. This is discussed in light of a schema enmeshment model recently proposed in the cognitive bias literature.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
Publisher: Wiley
Date: 18-04-2016
DOI: 10.1002/EJP.887
Abstract: Theoretical accounts of attentional and interpretation biases in pain suggest that these biases are interrelated and are both influenced by perceived threat. A laboratory-based study was conducted to test whether these biases are influenced by threat and their interrelationship and whether attention or interpretation biases predict pain outcomes. Healthy participants (n = 87) received either threatening or reassuring pain information and then completed questionnaires, interpretation and attentional bias tasks (with eye-tracking) and a pain task (the cold pressor). There was an interaction effect for threat group and stimuli type on mean dwell time for face stimuli, such that there was an attentional bias towards happy faces in the low- but not high-threat group. Further, high threat was also associated with shorter pain tolerance, increased pain and distress. In correlational analyses, avoidance of affective pain words was associated with increased pain. However, no relationship was found between attention and interpretation biases, and interpretation biases were not influenced by threat or associated with pain. These findings provide partial support for the threat interpretation model and the importance of threat and affective pain biases, yet no relationship between cognitive processing biases was found, which may only occur in clinical pain s les. WHAT DOES THIS STUDY ADD?: In healthy participants, no relationship between attention and interpretation biases was found. Eye tracking revealed an association between later attentional processes and pain. Threat influenced attentional biases and pain outcomes, partially supporting theoretical accounts.
Publisher: Center for Open Science
Date: 06-04-2023
Abstract: Mindfulness apps are becoming popular treatments for chronic pain and mental health, despite mixed evidence supporting their efficacy. Further, it is unclear whether improvements in pain are due to mindfulness-specific effects or placebo effects because no trials have compared mindfulness against a sham control. The objective of this study was to compare mindfulness against two sham conditions with differing proximity to mindfulness to characterize the relative contributions of mindfulness-specific and non-specific processes on chronic pain. We assessed changes in pain intensity and unpleasantness and mindfulness-specific and non-specific pain-related processes in 169 adults with chronic or recurrent pain randomized to receive a single 20-minute online session of mindfulness, specific sham mindfulness, general sham mindfulness or audiobook control. Mindfulness was not superior to shams for reducing pain intensity or un-pleasantness and no differential engagement of theorized mindfulness-specific processes was observed. However, mindfulness and both shams reduced pain unpleasantness relative to audi-obook control, with expectancy most strongly associated with this effect. Sham specificity had no influence on expectancy or credibility ratings, pain catastrophizing, nor pain effects. These findings suggest that improvements in chronic pain unpleasantness following a single session of online-delivered mindfulness meditation may be driven by placebo effects. Non-specific treat-ment effects including placebo expectancy and pain catastrophizing may drive immediate pain attenuation rather than theorized mindfulness-specific processes themselves. Further research is needed to understand whether mindfulness-specific effects emerge following longer durations of online training.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2009
DOI: 10.1007/S00737-009-0091-4
Abstract: Emerging evidence suggests that many women in the postnatal period experience clinically significant levels of anxiety but do not meet full diagnostic criteria for an existing anxiety disorder. In this study, 167 women with infants aged 2 weeks to 12 months were interviewed for current and lifetime history of depression and anxiety disorders using the SCID-I and completed a range of self-report measures measuring psychological risk factors and current depressive and anxiety symptomatology. Qualitative comments provided by women diagnosed with ADNOS (maternally focused worry) were analyzed and themes identified, and independent t-tests and chi-square tests were conducted to compare differences between these women and women with GAD. Results showed (1) there to be almost as many women who met criteria for ADNOS (maternally focused worry) as met criteria for GAD, and (2) that women with maternally focused worry were indistinguishable from women with GAD in terms of anxiety and depressive symptom severity, functional impairment and a range of risk factors. These results highlight the status of maternally focused worry as an under-recognized phenomenon and one in need of further clinical and research attention.
Publisher: Cambridge University Press (CUP)
Date: 10-1993
DOI: 10.1017/S1352465800011644
Abstract: The present study evaluated the effectiveness of a self-help, cognitive-behavioural programme in the rehabilitation of a s le of chronic pain patients. The results demonstrated significant benefits for subjects who completed the self-help treatment on measures of depression, anxiety, coping strategies, impact on daily living, pain beliefs and self-monitored pain. These benefits were generally maintained at 6 month follow-up and no differences were found in outcome between subjects who completed the self-programme compared to those who completed the same treatment in a traditional clinic-based format. Unfortunately, a very high drop-out rate was found for the self-help condition, indicating the approach to be unsuitable for many clients. Attempts to identify the characteristics of subjects who completed the self-help programme versus those who dropped-out revealed only one predictor, namely pretreatment ratings of the credibility of the programme.
Publisher: Wiley
Date: 02-05-2016
DOI: 10.1002/EJP.890
Abstract: Data have consistently shown that patient coping with chronic pain can be affected by various factors associated with the primary relationship, and hence efforts to include the patient's partner in the treatment process have merit. This study evaluated the benefit of adding an adjunctive, couples-based, cognitive behavioural treatment (CBT) for chronic pain to a standard cognitive behavioural pain management programme. Forty-five couples were randomly assigned to either an adjunctive couples intervention (n = 19) or the pain programme only (n = 26). All patient participants completed a 3-week multi-disciplinary pain management programme, to which their partners were invited to attend one full day. In addition, partners in the adjunctive condition received four, one hour treatment sessions focusing on pain education, patient-partner communication, operant behavioural principles and relapse prevention strategies. Partner sessions for the adjunctive intervention were provided over the telephone. By the completion of the pain programme the adjunctive couples intervention demonstrated significant improvements in marital satisfaction for the spouses over and above attendance at the pain management programme alone (p = 0.003). However, spouse involvement did not facilitate any additional response to treatment for pain patients on marital satisfaction, pain, disability or any indices of distress. All treatment gains were maintained at 1 month follow-up. These data demonstrate that a brief CBT intervention can significantly improve marital satisfaction for spouses of chronic pain patients, but the treatment does not translate to improvements in function on any outcomes, including marital satisfaction, for patients of chronic pain. WHAT DOES THIS STUDY ADD?: A brief, telephone-based intervention for couples living with chronic pain is an acceptable format for intervention. This intervention can significantly improve marital satisfaction for partners of chronic pain patients. Patients who are already participating in a multidisciplinary pain programme will not obtain further benefit.
Publisher: Wiley
Date: 11-06-2023
DOI: 10.1002/PON.6176
Abstract: Fear of cancer recurrence (FCR) is reported by both cancer survivors and caregivers however less is known about caregiver FCR. This study aimed to (a) conduct a meta‐analysis to compare survivor and caregiver FCR levels (b) examine the relationship between caregiver FCR and depression, and anxiety (c) evaluate psychometric properties of caregiver FCR measures. CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research examining caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR and/or measurement, published in English‐language, peer‐review journals between 1997 and November 2022. The COnsensus‐based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy was used to evaluate content and psychometric properties. The review was pre‐registered (PROSPERO ID: CRD42020201906). Of 4297 records screened, 45 met criteria for inclusion. Meta‐analysis revealed that caregivers reported FCR levels as high as FCR amongst survivors, with around 48% of caregivers reporting clinically significant FCR levels. There was a strong correlation between anxiety and depression and medium correlation with survivor FCR. Twelve different instruments were used to measure caregiver FCR. Assessments using the COSMIN taxonomy revealed few instruments had undergone appropriate development and psychometric testing. Only one instrument met 50% or more of the criteria, indicating substantial development or validation components were missing in most. Results suggest FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with more severe depression and anxiety. Caregiver FCR measurement has predominately relied on survivor conceptualisations and unvalidated measures. More caregiver‐specific research is urgently needed.
Publisher: Wiley
Date: 2007
DOI: 10.1002/PON.1045
Abstract: Many women who have had adjuvant chemotherapy for early breast cancer judge small benefits sufficient to make it worthwhile despite significant side effects and inconvenience. The rationality of these preferences has been questioned. We sought to better understand such preferences by assessing associations between preferences and psychosocial factors, and by asking women who judged negligible benefits sufficient to explain why. We recruited 83 consecutive consenting women who had completed adjuvant chemotherapy for early breast cancer 3-34 months earlier. Preferences were elicited during a structured, scripted interview using four sets of validated, hypothetical trade-off scenarios about the possible benefits of adjuvant chemotherapy on survival times (5 and 15 years) and rates (65 and 85% at 5 years). Women completed questionnaires measuring anxiety, depression, optimism, quality and quantity of social support, and illness perceptions. More than half the women judged benefits of 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile. The most important factors in multivariable models were whether the woman had dependants and number of non-specific symptoms attributed to breast cancer and adjuvant chemotherapy since completing treatment. The proportion of variance explained was modest. Preferences were not associated with: scores for anxiety, optimism, and perceived quality and quantity of social support. Explanations for judging negligible benefits sufficient included minimising regret, parenting concerns, doubts about the information provided and feeling that they had no choice. Preferences were highly variable and influenced by women's unique circumstances and attitudes, but not by their anxiety or optimism scores.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Publisher: Wiley
Date: 02-2005
DOI: 10.1016/J.EJPAIN.2004.02.005
Abstract: Evidence of cognitive bias in depression and anxiety has sparked an increasing interest in the potential for pain-related bias in patients suffering from chronic pain and/or illness. Research to date has been somewhat inconsistent, and the vast majority has been conducted on just two patient populations: rheumatoid arthritis (RA) and chronic pain patients. The present study investigates cognitive bias in Systemic Lupus Erythematosus (SLE) patients, particularly in relation to disease activity and depression. Forty-three SLE patients are compared to RA patients and healthy controls on their endorsement and recall of pain/illness words relative to depression and control words. Patients are first ided according to their disease activity, and secondly according to depression. SLE and RA patients self-endorsed more negative illness words and fewer positive illness words than did healthy controls, regardless of disease activity or depression status. Groups did not differ in their recall patterns, although all groups demonstrated a recall bias for positive words and illness words. Post-hoc analyses revealed a significant recall bias for disability-related illness words compared to sensory pain words in ill, depressed patients compared to ill, non-depressed patients and healthy controls. Consistent with the most recent research, it appears to be both the nature of the illness stimuli and the depression status of the patient that determines cognitive bias in chronically ill populations.
Publisher: Wiley
Date: 12-2004
DOI: 10.1016/J.EJPAIN.2004.02.003
Abstract: Research suggests that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. This study examined the degree to which a successful cognitive-behavioural program was able to reduce the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow-up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre- to post-treatment changes in fear of movement (T a Scale for Kinesiophobia) but not other relevant variables, such fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
DOI: 10.1016/S0304-3959(03)00224-0
Abstract: Cognitive-behavioural models of chronic pain contend that appraisals of harm affect the in idual's response to pain. It has been suggested that fear of pain and/or anxiety sensitivity predispose in iduals to chronicity. According to this view, pain is maintained through hypervigilance towards painful sensations and subsequent avoidance. The present study investigates the nature of cognitive biases in chronic pain patients. A s le of 169 consecutive patients referred to a specialist pain management centre participated in the study. Questionnaires measuring different aspects of pain and a computerised version of the Dot-Probe Task were administered. Four types of words related to different dimensions of pain and matched, neutral words were used as stimuli. Reaction times in response to the stimuli were recorded. A factorial design 3 x 4 x 2 x 2 and ANOVAs were employed to analyse the data. Chronic pain patients showed a cognitive bias to sensory pain words relative to affective, disability, and threat-related words. However, contrary to expectations, those high in fear of pain responded more slowly to stimuli than those less fearful of pain. These results suggest that patients with chronic pain problems selectively attend to sensory aspects of pain. However, selective attention appears to depend upon the nature of pain stimuli. For those who are highly fearful of pain they may not only selectively attend to pain-related information but have difficulty disengaging from that stimuli. Theoretical and clinical implications of the data are discussed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
DOI: 10.1016/J.PAIN.2010.05.027
Abstract: This study aimed to investigate the efficacy of an attention training technique (ATT) on pain ratings, threshold and tolerance during the cold pressor task. One hundred and three undergraduate students were randomly assigned to receive either threat-alleviating or threat-inducing information about the task. Participants were then re-randomized to receive either ATT or progressive muscle relaxation (PMR). Hence, the present study had a 2 (threat expectancy: high vs. low)x2 (training: ATT vs. PMR) design. Analyses confirmed that the threat manipulation was effective in increasing the harm associated with the task. ATT resulted in a relative reduction in hypervigilance to sensory pain words compared to PMR. ATT was also associated with a lower degree of focus on internal sensations, but not mindfulness or difficulty disengaging from pain words. Results showed that, relative to relaxation training, those receiving ATT reported pain less quickly than those receiving relaxation, although there were no differences between the training groups for tolerance or pain ratings. These results show that ATT changes the cognitive processes of internal/external focus and hypervigilance towards sensory pain words, but not difficulty disengaging or mindfulness. Although ATT changed threshold, the fact that neither pain ratings nor tolerance was affected suggests that a single, brief session of ATT may not be sufficient to affect broader change. Nonetheless, this study shows that ATT can change cognitive processes thought to be associated with heightened perception of pain and that this changes how quickly pain is registered and is therefore worthy of further investigation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-11-2018
Publisher: Springer Science and Business Media LLC
Date: 19-10-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1016/J.APPET.2012.11.001
Abstract: This study examined the potential role of psychological symptoms in limiting the translation of positive intention into strict gluten free diet (GFD) adherence in coeliac disease (CD) within a theory of planned behaviour (TPB) framework. It was hypothesised that participants with more symptomatic psychological profiles would exhibit poorer adherence, primarily in the context of positive intentions. Coeliac disease participants (N=390) completed online measures of gluten free diet adherence, psychological symptoms, coping behaviour, and TPB items. Intention and behaviour were moderately correlated, confirming the existence of the intention-behaviour gap. Psychological symptoms accounted for additional variance over and above TPB variables in GFD adherence but not intention. Participants who failed to act on their positive intentions displayed more psychological symptoms and greater reliance on maladaptive coping strategies than those with consistent intention-behaviour relationships (p<.01). The heightened incidence of psychological symptoms in CD has a small but significant negative impact on the ability to translate positive intentions into strict adherence. Directions for future research including interventions to improve GFD adherence are discussed.
Publisher: Wiley
Date: 08-08-2022
DOI: 10.1111/BJC.12387
Abstract: Research spanning the fields of clinical, social and health psychology suggests that death anxiety is an important construct. However, no comprehensive, psychometrically adequate measure of the construct exists. The current studies outline the development of a new measure of death anxiety, the Death Anxiety Beliefs and Behaviours Scale (DABBS), which is the first measure to specifically assess unhelpful beliefs and behaviours that may underlie fears of death. In Study 1, items were piloted in a large community s le ( N = 505). In Studies 2A and 2B, exploratory and confirmatory factor analyses were performed using a treatment‐seeking ( N = 200) and non‐treatment‐seeking s le ( N = 200). These analyses resulted in the final 18‐item scale. The DABBS demonstrated good construct validity, criterion validity, internal consistency and test–retest reliability. In Study 3, the DABBS effectively distinguished participants with clinically significant death anxiety and distress from those without, demonstrating excellent discriminant validity. The present data indicate that the DABBS is a valid and reliable measure of affect, beliefs and behaviours relating to death anxiety, in a community s le of adults and among those seeking mental health treatment. Given the increasing recognition of the importance of death anxiety, the DABBS offers a useful research and clinical tool.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JAD.2010.11.014
Abstract: The Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) are commonly used within oncology settings. However there is a paucity of research comparing these measures to gold standard structured clinical interviews assessing for clinical disorders. The aim of this study is to establish the sensitivity, specificity and optimal cut-off scores on these measures when compared to a clinical interview. Ninety-nine patients with colorectal cancer completed the DT and HADS and a psychologist-administered gold standard structured clinical interview (the Composite International Diagnostic Interview-CIDI). Receiver Operator Characteristic analyses (ROC) were conducted to establish the optimal cut-off score on the DT and HADS to identify clinical disorders based on the CIDI. Seventeen patients met criteria for a clinical disorder in the s le. A cut-off score of 4 on the DT indicated acceptable sensitivity (60%) and specificity (67%) to detect a current clinical disorder, while the optimal cut-off for the HADS was 10 (sensitivity=73%, specificity=72%). The area under the ROC values were 0.66 for the DT (95% CI: 0.51, 0.82) and 0.78 for the HADS (95% CI: 0.67, 0.90). The difference in AUC between the two measures was not statistically significant. The limitations to the design and methodology of the study are discussed. The single item DT performed fairly, however not as well as the longer HADS in identifying clinical disorders amongst oncology patients, particularly anxiety disorders.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
DOI: 10.1016/J.PAIN.2013.07.048
Abstract: Despite a high prevalence of pain and ongoing effort to understand and reduce pain, studies show that there remains a considerable unmet need for pain relief and management. In part, this may be due to patient's not adhering to treatment recommendations. Models such the health belief model, self-regulation theory, and the theory of planned behavior suggest two key factors in promoting adherence: (1) good health care provider-patient communication and (2) interventions that are tailored to in iduals' reasons for non-adherence. Hence, communication skills that express a nonjudgmental approach, allow open exploration of patient beliefs and concerns, and use a negotiating approach that fosters shared decision making are crucial. Randomized, controlled trials of brief communication skills training have shown improved outcomes in primary care settings for patients with fibromyalgia and acute pain. Thus, although treatment of chronic pain is challenging, good communication between health providers and patients can promote adherence and improve outcomes.
Publisher: Elsevier BV
Date: 03-2009
DOI: 10.1016/J.JPAIN.2008.10.005
Abstract: There is evidence that pain patients demonstrate attentional biases toward some pain-related stimuli (eg, sensory words) and not others (eg, affective words). However, whether in iduals in chronic pain caused by rheumatoid arthritis (RA) also demonstrate this bias has not been investigated. Further, within the pain literature, whether these biases reflect hypervigilance or difficulty disengaging from stimuli remains contentious. The present study aimed to determine (a) whether RA patients demonstrate an attentional bias to sensory pain words and (b) whether this bias is a result of hypervigilance or failure to disengage from the stimuli. RA patients showed a bias toward sensory words and away from threat-related words. The effect for sensory words resulted from slowed performance on incongruent trials (ie, difficulty disengaging), whereas the bias away from threat words resulted from faster responses on incongruent trials (ie, avoidance of threat). The pattern of attention biases in RA patients is very similar to those found in patients with chronic pain. At least in RA, attentional biases appear to be related to a failure to disengage from pain-related words rather than hypervigilance. There is continued debate about whether these biases are caused by hypervigilance toward pain stimuli or difficulty disengaging from pain stimuli. This study shows that in a group of RA patients, attentional biases toward pain are caused by difficulty disengaging rather than hypervigilance.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.SOCSCIMED.2005.07.010
Abstract: This article examines the literature relating to adjustment to physical illness. Adjustment is invariably defined in the literature as some aspect of psychological function. However, in reality, adjustment is a process that begins at the presentation of symptoms and continues throughout the course of the illness and responds to changes in illness status. Physical illness can be conceptualized as a stressor, the demands of which depend upon the characteristics and severity of the illness. Recent research confirms that many of the factors known to be associated with the development of psychological disorders in the absence of physical illness are also relevant to the development of psychological problems in those with ill health. The prevalence of psychological disorders is also generally found to be considerably higher amongst those with a variety of health problems. Nonetheless, a considerable number of patients who experience even the most devastating of illnesses seem able to adjust to illness without experiencing clinically significant psychological problems. The processes by which these people are able to adjust and, in many cases, find positive meaning in their experiences, are important to understand. While a number of models have been put forward to explain various aspects of adjustment to chronic illness, an integrated approach that describes how the process of adjustment evolves is needed. Such an understanding will allow clinicians to improve interventions that facilitate adjustment and potentially prevent long-term problems. Facilitating a patient's adjustment to illness must be a priority in providing an optimal level of health care.
Publisher: Cold Spring Harbor Laboratory
Date: 03-07-2019
DOI: 10.1101/19000877
Abstract: The sudden cardiac death (SCD) of a young person is a devastating event for any parent. Inherited heart disease is often either identified or assumed to be the cause. Few studies have explored the psychosocial impact to the surviving at-risk family members. We sought to investigate the needs of parents who have experienced the SCD of their child (≤45 years). A quantitative needs analysis questionnaire was developed based on semi-structured interviews, including one focus group, and a review of relevant literature. There were 38 parents who completed a cross-sectional quantitative survey. Parents’ perceived needs for information and support spanned medical, psychosocial, spiritual and financial domains. Medical information and support needs were identified as the most important domains, followed by psychosocial, spiritual and financial information and support needs. Importantly, psychosocial information and support needs were reported as the most unmet need, endorsed by 54% of parents. Medical information and support needs were reported as unmet by almost one third of parents. The two most endorsed needs were “To have the option of whether or not you would pursue genetic testing for yourself or family members” and “To understand what happened”. This work demonstrates for the first time, the multifactorial needs of parents after SCD in the young. With the greatest unmet need reported as psychosocial needs, there is clear necessity to find ways of integrating psychological support in to the care of families after SCD in the young. There is currently very little known about the needs of families following a sudden cardiac death due to inherited heart diseases. We know there is significant risk of poor psychological outcomes including posttraumatic stress and prolonged grief, even years after the death, however this is one of the first studies to formally evaluate the needs of parents during this time. We show that medical information and support needs are ranked very highly, but psychosocial support needs are the most unmet. Our findings provide a platform for developing an approach to delivering psychosocial support interventions in this population. Currently clinical and research efforts in this setting focus on clinical and genetic aspects of care. Here we show the critical need to also focus on the psychological care needs in this population. These data will help to guide services in integrating psychological support in to their multidisciplinary clinic models.
Publisher: Springer Science and Business Media LLC
Date: 06-05-2015
DOI: 10.1007/S12529-014-9416-4
Abstract: Both acceptability and behaviour change data provide important information about the likelihood of success of an intervention when disseminated outside the research context. Despite this, few studies have combined such data for use in ongoing intervention development. To assess the acceptability and feasibility of an online intervention to improve gluten-free diet (GFD) adherence in coeliac disease, and to examine the relationships with participant characteristics, attrition, and effectiveness to inform ongoing intervention developments to ultimately reduce attrition and improve the reach and effectiveness of the programme. All participants completed measures of GFD adherence, theory of planned behaviour variables, psychological symptoms, and demographic and disease characteristics. Acceptability and feasibility ratings were obtained at the conclusion of each of the six intervention modules. Chi-square analyses were used to examine differences between completers and non-completers, and Spearman's correlations were used to determine the relationships between participant characteristics, effectiveness, and acceptability and feasibility. Participants who rated the early modules less favourably were more likely to drop-out of the intervention. Acceptability and feasibility ratings were also associated with the presence of psychological symptoms, use of adaptive coping strategies, GFD duration, and attitude change. The findings suggest that changes to the structure and implementation of the intervention may be useful in minimising attrition and maximising effectiveness for future dissemination in a wider coeliac disease population.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.BRAT.2017.08.010
Abstract: Anxiety disorders are highly prevalent in children with asthma yet very little is known about the parenting factors that may underlie this relationship. The aim of the current study was to examine observed parenting behaviours - involvement and negativity - associated with asthma and anxiety in children using the tangram task and the Five Minute Speech S le (FMSS). Eighty-nine parent-child dyads were included across four groups of children (8-13 years old): asthma and anxiety, anxiety only, asthma only and healthy controls. Overall, results from both tasks showed that parenting behaviours of children with and without asthma did not differ significantly. Results from a subcomponent of the FMSS indicated that parents of children with asthma were more overprotective, or self-sacrificing, or non-objective than parents of children without asthma, and this difference was greater in the non-anxious groups. The results suggest that some parenting strategies developed for parents of children with anxiety may be useful for parents of children with asthma and anxiety (e.g. strategies targeting involvement), however, others may not be necessary (e.g. those targeting negativity).
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.BRAT.2016.06.002
Abstract: There is growing evidence to support attentional bias modification (ABM) techniques such as the modified dot-probe task within the pain literature. Such techniques can help to inform theoretical models of pain by identifying the causal role of attentional bias constructs. The aim of this research was to explore the effects of dot-probe ABM that trains in iduals towards (+) or away from (-) sensory (S) and affective (A) pain words, on attentional biases, interpretation biases, and pain outcomes. Healthy undergraduate students (N = 106) completed questionnaires, an attentional bias dot-probe task, and an interpretation bias task before and after ABM, one of four ABM versions that differed in training direction (S+A+, S-A+, S+A-, S-A-), and pain outcomes using the cold pressor task. Those trained towards affective pain words were found to have a greater pain threshold but also greater distress at tolerance. However, mechanisms of change could not be established, as ABM did not affect attentional or interpretation bias, even though changes in attentional bias were associated with pain outcomes. These findings provide partial support for the threat interpretation model and highlight the utility of affective pain ABM, although further investigation of causal mechanisms is warranted.
Publisher: Informa UK Limited
Date: 09-2010
DOI: 10.1080/16506070903390134
Abstract: The aim of the present study was to test Turk and Okifuji's (2002) model of chronic pain and in particular the moderating role of self-efficacy. We assessed 207 consecutive chronic pain patients (53.1% female) on a range of relevant measures and tested the model using structured equation modelling. The model was supported. These results support Turk and Okifuji's model of chronic pain and suggest that it can account for the relationships between variables in chronic pain patients. In particular, the results support the central role of fear-based avoidance and self-efficacy in chronic pain. Future research should be aimed at testing the alternative contemporary models of chronic pain at different stages of the development and maintenance of chronic pain and over time.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JPSYCHORES.2012.11.001
Abstract: Despite considerable effort to identify correlates of psychopathology in people with epilepsy (PWE), research has yet to identify consistent predictors. We tested the association between factors predicted by a model of adjustment to illness and psychopathology in PWE. In 123 PWE recruited from a tertiary referral centre, we examined the cross-sectional relationship between psychosocial factors (illness representations, coping, self-illness enmeshment and self-efficacy) with depression and suicide risk, while controlling for condition-related and demographic factors. Multivariate analyses confirmed previous findings showing that condition-related and demographic variables did not consistently account for unique variance in depression although employment status was found to be a significant predictor of suicide risk. In multivariate analyses escape-avoidance coping and the illness consequences subscale of the illness representation questionnaire predicted unique variance in both depression and suicide risk. The results provided partial support for a model of adjustment to illness. Specifically, those who believed epilepsy was serious and coped through avoidance were more likely to be depressed and report a current level of suicide risk. These results suggest that interventions that target coping strategies and illness representations may be warranted for PWE with psychopathology.
Publisher: Wiley
Date: 2008
DOI: 10.1002/ART.23312
Abstract: To investigate whether cognitive-behavioral therapy (CBT) administered early in the course of rheumatoid arthritis (RA) has long-term effects on health care use. We reviewed the files of 47 of the original 53 patients with early RA who volunteered for a randomized controlled trial comparing CBT with no psychological intervention. Occasions of service provision associated with RA were documented and health care use was compared between groups. The CBT group used fewer health care resources than the control group in the 5 years following intervention. Significant differences were observed for the number of inpatient nights, physiotherapy referrals, injections, and for total health care use. There was a trend that closely approached significance toward fewer episodes of surgery and orthopedic referrals in the CBT group. These results suggest that CBT administered early in the course of RA can reduce health care use for the first 5 years after treatment. This is a stringent test of the efficacy of a brief psychological intervention, and supports the fact that brief psychological treatments can have long-term effects.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.RESP.2015.05.013
Abstract: There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease (COPD), and increase morbidity. We tested the hypothesis that cognitive behaviour therapy (CBT) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD. From 31 patients with COPD, 18 were randomised to four sessions of specifically targeted CBT and 13 to routine care. Prior to randomisation, participants were tested with an inspiratory external resistive load protocol (loads between 5 and 45cmH2O/L/s). Six months later, we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to randomisation. There was a significant 17% reduction in dyspnoea ratings across the loads for the CBT group, and no reduction for the routine care group. The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.JPAIN.2010.02.017
Abstract: Attentional biases towards pain-related words of chronic and acute low back pain (LBP) patients were compared with healthy pain-free controls. Specifically, the aims were to determine: 1) whether chronic LBP patients demonstrate attentional biases compared to pain-free controls 2) whether observed biases are also present in those with acute LBP and 3) whether observed biases are associated with pain-related fear among the pain groups. Four groups were recruited: 1) acute LBP patients 2) chronic LBP patients from physiotherapy practices 3) chronic LBP patients from a tertiary referral pain-management center and 4) healthy pain-free controls. Participants were assessed on the dot-probe computer task for attentional bias to pain-related words. All 3 pain groups demonstrated biases compared to controls on sensory but not on affective, disability, or threat words. Among the pain groups, those with low and moderate levels of fear of (re)injury demonstrated biases towards sensory pain words that were absent in those with high levels of fear, which is counterintuitive to what the fear of (re)injury model suggests. These results suggest that the experience of pain, rather than duration, is the primary indicator of the presence of pain-related biases. Attentional biases are present in chronic and acute pain. Biases towards sensory-pain stimuli were demonstrated regardless of pain duration however, they were present in those with low and moderate levels of fear of (re)injury only and not those high in fear. These findings are not consistent with the fear of (re)injury model.
Publisher: Emerald
Date: 15-02-2011
DOI: 10.1108/00070701111105321
Abstract: The aim of this paper is to qualitatively examine the ways in which primary school children, aged between 7 and 12, perceive various facets of obesity as defined by the common sense model of illness representation (CCM). The study was qualitative in nature. Semi‐structured interviews were conducted with 33 children on all dimensions of the CSM. Twenty four children were normal weight and nine were overweight. A drawing task formed the methodology for the “identity” section of the interview. Although children identified food intake as a main cause of obesity, almost half did not name sedentary behaviours as a cause of obesity. Duration (timeline) of obesity was regarded by most children as reliant on a person's undertaking of positive health behaviours. Normal weight children were found to list more severe consequences of obesity than the overweight group. It was found that experience contributed to the detailed knowledge of overweight children's perceptions of cures of obesity. Overweight children also spoke of personal incidents of barriers to cures. The findings suggest that the CSMs can be used to classify children's perceptions of obesity. Future childhood obesity interventions can utilise these findings to create c aigns and strategies that are more consistent with children's understandings of this condition. To the authors' knowledge, no previous study has examined children's perceptions of obesity beyond perceived causes.
Publisher: The Journal of Rheumatology
Date: 11-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2017
DOI: 10.1097/J.PAIN.0000000000000916
Abstract: This study compared a remote-delivered pain management program, the Pain Course, when delivered in online and workbook formats. Participants (n = 178) were randomised into 2 groups: (1) an Internet Group (n = 84) who were provided with secure accounts to the program in an online format or (2) a Workbook Group (n = 94) who were mailed workbook versions of the program. The content of both programs was identical and comprised 5 core lessons, which participants were encouraged to work through over an 8-week period, according to a prescribed timetable. All participants were provided with weekly contact with a clinical psychologist through email and telephone throughout the program. The overall findings suggest that the workbook format was no less effective or acceptable than the validated online format. Significant improvements (avg. improvement Internet Group vs Workbook Group) in levels of disability (PDI: 16% vs 24% RMDQ: 12% vs 15%), anxiety (GAD-7: 36% vs 26%), and depression (PHQ-9: 36% vs 36%) were observed in both groups immediately posttreatment. Further improvements were observed in disability levels to 3-month follow-up, and improvements across the other primary outcomes were maintained until 12-month follow-up. High treatment completion rates and levels of satisfaction were reported in both groups, and both groups required a similarly small amount of clinician contact per participant (M = 74.85 minutes SD = 41.03). These results highlight the public health potential of remote-delivered pain management programs, delivered in either workbook or online formats, as methods of increasing access to pain management.
Publisher: Springer Science and Business Media LLC
Date: 23-04-2013
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
DOI: 10.1007/S10802-017-0261-1
Abstract: Children with asthma have a high prevalence of anxiety disorders, however, very little is known about the mechanisms that confer vulnerability for anxiety in this population. This study investigated whether children with asthma and anxiety disorders display attentional biases towards threatening stimuli, similar to what has been seen in children with anxiety disorders more generally. We also examined the relationships between attentional biases and anxiety symptomatology and asthma control for children with asthma. Ninety-three children, aged 8-13, took part in the study and were recruited into one of four conditions (asthma/anxiety, asthma, anxiety, control). Asthma was medically confirmed and anxiety was assessed through clinical interview. We used self- and parent-report questionnaires to measure child asthma (ATAQ) and anxiety (SCAS, CASI) variables. Participants completed a visual dot-probe task designed to measure attentional bias towards two types of stimuli: asthma related words and general threat words, as well as tasks to assess reading ability and attentional control. Results showed that attentional biases did not differ between the groups, although children with anxiety disorders displayed poorer attentional control. A significant correlation was found between poor asthma control and an attentional bias of asthma stimuli. While we found no evidence that anxiety disorders in children with asthma were associated with threat- or asthma-related attentional biases, preliminary evidence suggested that children with poor asthma control displayed biases towards asthma-specific stimuli. Future research is needed to explore whether these attentional biases are adaptive.
Publisher: SAGE Publications
Date: 10-2007
DOI: 10.1080/00048670701579108
Abstract: Objective: Depression and anxiety are known to be common among women presenting to residential mother–infant programmes for unsettled infant behaviour but most studies have used self-report measures of psychological symptomatology rather than diagnostic interviews to determine psychiatric diagnoses. The aim of the present study was to determine rates of depressive and anxiety disorders and rates of comorbidity among clients of the Karitane residential mother–infant programme for unsettled infant behaviour. Method: One hundred and sixty women with infants aged 2 weeks–12 months completed the Edinburgh Postnatal Depression Scale and were interviewed for current and lifetime history of depressive and anxiety disorders using the Structured Clinical Interview for DSM-IV diagnosis (Research version). Results: A total of 25.1% of the s le met criteria for a current diagnosis of major depression, 31.7% had met criteria for major depression since the start of the pregnancy, and 30.5% of clients met criteria for a current anxiety disorder. Of note were the 21.6% who met criteria for generalized anxiety disorder or anxiety disorder not otherwise specified (worry confined to the topics of the baby or being a mother). High levels of comorbidity were confirmed in the finding that 60.8% of those with an anxiety disorder had experienced major or minor depression since the start of their pregnancy and 46.3% of those who had experienced depression since the start of their pregnancy also met criteria for a current anxiety disorder. Conclusions: There are high levels of psychiatric morbidity among clients attending residential mother–infant units for unsettled infant behaviour, highlighting the importance of providing multifaceted interventions in order to address both infant and maternal psychological issues.
Publisher: Springer Science and Business Media LLC
Date: 1993
DOI: 10.1007/BF00797826
Abstract: In the absence of apparent triggers, sudden cardiac death (SCD) during nighttime hours is a perplexing and devastating phenomenon. There are few published reports in the general population, with insufficient numbers to perform sex-specific analyses. Smaller studies of rare nocturnal SCD syndromes suggest a male predominance and implicate sleep-disordered breathing. The purpose of this study was to identify mechanisms of nighttime SCD in the general population. From the population-based Oregon Sudden Unexpected Death Study, we evaluated SCD cases that occurred in the community between 10 PM and 6 AM (nighttime) and compared them with daytime cases. Univariate comparisons were evaluated using Pearson χ A total of 4126 SCD cases (66.2% male, 33.8% female) met criteria for analysis and 22.3% (n = 918) occurred during nighttime hours. Women were more likely to present with nighttime SCD than men (25.4% vs 20.6% P < .001). In a multivariate regression model, female sex (odds ratio [OR] 1.3 [confidence interval (CI) 1.1-1.5] P = .001), medications associated with somnolence/respiratory depression (OR 1.2 [CI 1.1-1.4] P = .008) and chronic obstructive pulmonary disease/asthma (OR 1.4 [CI 1.1-1.6] P < .001) were independently associated with nighttime SCD. Women were taking more central nervous system-affecting medications than men (1.9 ± 1.7 vs 1.4 ± 1.4 P = .001). In the general population, women were more likely than men to suffer SCD during nighttime hours and female sex was an independent predictor of nighttime events. Respiratory suppression is a concern, and caution is advisable when prescribing central nervous system-affecting medications to patients at an increased risk of SCD, especially women.
Publisher: Oxford University Press (OUP)
Date: 28-02-2003
DOI: 10.1093/RHEUMATOLOGY/KEG144
Abstract: This study examined the long-term efficacy of a cognitive behavioural intervention for patients with recent-onset, seropositive rheumatoid arthritis (RA). Fifty-three consecutive patients with less than a 2-yr history of classic or definite RA were recruited into the trial. All participants received routine medical management during the study, and half were randomly allocated to receive an 8-week adjunctive psychological intervention. All assessments were conducted blind to the allocation. This paper reports intention-to-treat analyses of the 18-month follow-up. Consistent with short-term results, significant differences were found between the groups in depressive symptoms. The intervention group maintained improvements in joint function, although those in routine care made similar improvements over the ensuing 18 months. At follow-up, group differences emerged for disability and anxiety. These results indicate that cognitive behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing improvements in both psychological and physical indices. Furthermore, improvements appear to increase 18 months after a brief, time-limited psychological treatment.
Publisher: JMIR Publications Inc.
Date: 02-03-2021
DOI: 10.2196/19309
Abstract: Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems however, it is highly intensive and time-consuming, which is a barrier for service provision. This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subs le of the initial group of end users (n=11), and the program was reviewed by experts (n=8). We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2001
DOI: 10.1097/00002508-200106000-00004
Abstract: The study examined symptom-specific muscle hyperreactivity in patients with chronic pain with upper limb cumulative trauma disorder (CTD). Four tasks were presented in counterbalanced order and included neutral, general stressor, personal stressor, and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations in inducing stress experiences for all subject groups. The study was conducted in a university research center. Thirty patients with CTD were matched as closely as possible for age and gender to control groups of chronic low back pain, arthritis, and pain-free subjects. Surface electromyograph recordings were taken from the frontalis, forearm flexors, trapezius, and lower back during baseline and tasks. The study found no evidence of greater muscle tension increases or extended duration of return to baseline for the CTD or low back pain patients at any of the muscle sites for any of the tasks in comparison to control groups. The results indicate that symptom-specific psychophysiological responses may be limited to certain subgroups rather than being characteristic of chronic musculoskeletal pain patients in general.
Publisher: Wiley
Date: 18-12-2014
DOI: 10.1002/EJP.637
Abstract: The aim of this study was to investigate the impact of chronic pain on interpretation bias for ambiguous faces, using a recently developed paradigm with ecologically valid stimuli. Fifty patients with chronic pain and 25 healthy controls were trained to respond to probes following the presentation of happy or painful faces, using an incidental learning task. During a test phase, ambiguous faces were presented. The degree to which participants were faster to respond to probes presented where painful (rather than happy) faces had previously been presented was taken as an indication of the interpretation bias towards painful faces. All participants had learnt the originally presented contingency. As predicted, chronic pain patients showed a greater bias towards interpreting ambiguous faces as painful than control participants. Further, there were correlations between fear of pain and catastrophizing and interpretation bias, indicating that participants with higher fear of pain and higher scores on a measure of catastrophizing were more likely to interpret ambiguous faces as painful. Severity of pain was inversely associated with increased interpretation bias for pain. These results show clear evidence that chronic pain patients do demonstrate an interpretation bias towards painful faces and that this bias is greater for those who catastrophize more and have higher levels of fear of pain, but experienced less pain in the preceding week. Given the recent potential shown for interventions that modify cognitive biases, this paradigm would seem to be well suited to future efforts to modify interpretation biases in pain.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.JAD.2009.04.011
Abstract: It has been suggested that there may be two groups of women with postnatal depression (PND) - one who have a history of depression and whose depression is etiologically similar to depression experienced at other times of life, and another who develop depression de novo in the postnatal period and whose depression is uniquely 'postnatal'. The primary aim of this study was to clarify the role of negative attitudes (general and maternal-specific) for these proposed subtypes, whilst also considering the role of a range of other potentially relevant etiological factors. 157 postnatal women were classified into four groups: (i) 'recurrent depression', (ii) 'de novo PND', (iii) 'prior (but not current) depression', (iv) 'healthy control'. Groups were compared on known vulnerability and situational risk factors for depression including negative attitudes (general and maternal-specific), personality style vulnerability, relationship insecurity, low social support, stressful life events and difficult infant behaviour. Hierarchical regressions were conducted to examine the role of general and maternal-specific negative attitudes in mediating the relationship between previous depression and PND. Women with recurrent depression had more personality vulnerability and maternal-specific negative attitudes than women with de novo PND, but there were no differences in general negative attitudes or relationship insecurity. Non-depressed women with a history of prior depression were characterized by elevated general depression vulnerability but lower maternal-specific negative attitudes. General negative attitudes mediated the relationship between previous depression and PND. All participants had unsettled infants and the generalizability of results to general postpartum s les is not known. Although these results do not provide support for the proposed subtypes of PND, they highlight encouraging new avenues for cognitively based preventative interventions.
Publisher: Wiley
Date: 21-11-2013
DOI: 10.1002/J.1532-2149.2012.00241.X
Abstract: This study aimed to investigate the efficacy of mindfulness training in comparison with relaxation training on pain, threshold and tolerance during the cold pressor task. Undergraduate psychology students (n = 140) were randomly assigned to receive reassuring or threatening information about the cold pressor. Participants were then re-randomized to receive mindfulness or a control intervention: relaxation training. Analyses confirmed that the threat manipulation was effective in increasing worry, fear of harm and expectations of pain, and reducing coping efficacy. Interaction effects revealed that mindfulness was effective in increasing curiosity and reducing decentring under conditions of high threat but not low threat. Other interactions on cognitive variables (attentional bias to pain and self-focus) confirmed that mindfulness and relaxation appeared to exert influences under different conditions (i.e. mindfulness: high threat and relaxation: low threat). Despite these cognitive effects being discerned under different conditions, there were no differences between mindfulness and relaxation on pain, tolerance or threshold in either threat group. These results show that a single, brief session of mindfulness based on body scanning is not sufficient to change the way in which in iduals approach an experimental pain task in comparison with relaxation, which has previously been shown to be ineffective.
Publisher: SAGE Publications
Date: 06-2004
DOI: 10.1191/0961203303LU1037OA
Abstract: The Disease Repercussion Profile (DRP) was developed for use with patients with rheumatoid arthritis (RA) and has been shown to be a valid and clinically useful assessment of patient-perceived handicap. This study aimed to determine whether the Disease Repercussion Profile was also suitable for use with patients with systemic lupus erythematosus (SLE). Sixty patients with a definite diagnosis of SLE from a consultant rheumatologist were recruited into the study. They completed a series of questionnaires that assessed quality of life, depression, anxiety, attitudes towards the illness and the DRP. Results showed that patients with SLE endorsed each of the six spheres of the DRP as being frequently affected by their illness. Activity was most often endorsed. Both relationships and social activity were equally frequently adversely affected, and more often affected than the remaining spheres of finance, emotions and appearance. However, as in RA, when any area of function was affected, it was rated as very important to the in idual. Indicators of quality of life were reliably related to all areas of function, as was depression and attitudes towards illness. The present study indicates that the DRP does have relevance for patients with SLE. Strong correlations between quality of life indicators, depression, attitudes towards illness and DRP subscales and total score indicate that this measure is a valid tool to assess the effect of illness on in iduals with SLE.
Publisher: S. Karger AG
Date: 2018
DOI: 10.1159/000486806
Abstract: b i Background: /i /b Psychosocial interventions are often used as an adjunct to the medical management of multiple sclerosis (MS). However, the efficacy of such approaches for a range of psychosocial indications remains unclear. b i Objective: /i /b To determine the efficacy of psychosocial therapies for people with MS (PwMS). b i Methods: /i /b We searched 6 electronic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, and Clinicaltrials.gov) until April 21, 2016, for randomized controlled trials reporting the effect of psychological interventions for depressive symptoms, anxiety, pain, fatigue, or health-related quality of life (HRQoL) in PwMS. b i Results: /i /b The search yielded 356 articles with 13 included studies ( i n /i = 1,617). Benefits of psychological interventions were found for depressive symptoms (Cohen’s i d /i = 0.281), anxiety ( i d /i = 0.285), fatigue ( i d /i = 0.228), and mental ( i d /i = 0.398) and total HRQoL ( i d /i = 0.444), but not physical HRQoL. There were insufficient studies to meta-analyze posttreatment outcomes for pain. Interventions were more effective for HRQoL for patients with relapsing-remitting MS and when treatment doses were larger. Cognitive behavioral therapy (CBT) was not efficacious for PwMS when considered alone. b i Conclusion: /i /b Psychosocial interventions have a significant, positive impact across a range of outcomes for PwMS with small, yet consistent, effect sizes. There was some indication that CBT was less efficacious than other interventions. However, this may be due to smaller treatment doses in CBT studies.
Publisher: Springer Science and Business Media LLC
Date: 12-2005
DOI: 10.1007/S10899-005-5560-8
Abstract: This study aimed to evaluate the effectiveness of three proposed modifications to the structural characteristics of electronic gaming machines as harm minimisation strategies for non-problem and probable problem gamblers. Structural changes included reducing the maximum bet size, reducing reel spin and removing large note acceptors. Behavioural patterns of play were observed in 779 participants attending clubs and hotels. Observations were conducted in the gaming venue during regular gaming sessions. Eight experimental machines were designed to represent every combination of the modifications. 210 participants played at least one modified and one unmodified machine. Following play, the South Oaks Gambling Screen (SOGS) was administered. More problem than non-problem gamblers used high denomination bill acceptors and bet over one-dollar per wager. Machines modified to accept the one-dollar maximum bet were played for less time and were associated with smaller losses, fewer in idual wagers and lower levels of alcohol consumption and smoking. It was concluded that the reduction of maximum bet levels was the only modification likely to be effective as a harm minimization strategy for problem gamblers.
Publisher: Wiley
Date: 03-10-2011
DOI: 10.1002/PON.2066
Abstract: The primary aim of this study was to investigate objective and subjective aspects of sexual adjustment for women with early stage cervical and endometrial cancer during the first 6 months post-treatment, compared to women with benign and pre-invasive gynaecological conditions. 'Objective' aspects of sexual function were operationalised as the frequency of sexual activity and 'subjective' aspects as the perceived quality of sexual interactions. This multi-centre controlled study compared sexual outcomes of women treated for early stage cervical and endometrial cancer (n = 53) with (i) benign gynaecological patients (n = 60), as a comparison group for the physical effects of major pelvic surgery, and (ii) pre-invasive cancer patients (n = 52), as a comparison group for the emotional effect of the perceived threat of cancer. All patients were assessed at baseline and at 6 months follow-up using standardised measures of objective and subjective aspects of sexual function, overall satisfaction with sexual life, relationship satisfaction and psychological distress. Despite experiencing treatment-related physical changes, women with early stage cervical and endometrial cancer did not report more severe or longer-lasting sexual sequelae than the benign or pre-invasive groups. There were no significant differences between the three groups or changes over time for the objective, subjective or overall measures of sexual function, controlling for age, psychological distress and relationship satisfaction. The current findings suggest that early stage cervical and endometrial cancer patients fare as well as benign and pre-invasive cancer groups in terms of sexual adjustment over the 6 months post-treatment.
Publisher: Springer Science and Business Media LLC
Date: 25-07-2019
DOI: 10.1007/S11764-019-00788-4
Abstract: ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation. One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months' follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up. Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR. These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear. ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2017
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.SMRV.2015.08.002
Abstract: Sleep complaints are common amongst mothers of infants and insufficient, inefficient or fragmented sleep is associated with postnatal depression. The aim of this review is to determine whether psychosocial sleep-focused interventions offered in the perinatal period improve infant sleep or maternal mood. We searched PubMed, PsycInfo, EMBASE and CINAHL with no date restriction. We reviewed 1097 articles, resulting in nine papers (n = 1,656) that fit the eligibility criteria for inclusion in the analyses. The primary outcome was infant sleep, defined as maternal reports of infant nocturnal total sleep time and number of night-time wakes. The secondary outcome was maternal mood. The meta-analysis indicated improvements in reported infant nocturnal total sleep time (Hedge's g = 0.204, p < 0.01). However, there was no evidence for reducing infant night wakes (Hedge's g = 0.103, p = 0.134). There was evidence of maternal mood improvements (Hedge's g = 0.152, p = 0.014), however, this could have been influenced by publication bias. Psychosocial sleep interventions appear to impact the amount of sleep that a mother reports her baby to have, although the infants continue to wake as frequently. More research is needed to confirm whether sleep-related improvements can translate into improvements in maternal mood.
Publisher: Wiley
Date: 24-05-2014
DOI: 10.1111/DME.12474
Abstract: Research has suggested that the additional impact of a diabetes-related utation is associated with poorer physical functioning, poorer psychosocial outcome and greater body image disturbance. However, no study to date has compared patients with diabetes with and without utation and adequately controlled for additional medical morbidity often found among in iduals with an utation. The aim of this study was to statistically control for any group differences on medical and demographic variables to examine the isolated psychosocial impact of diabetes-related utation. In iduals with diabetes with an utation (n = 50) were compared to a control s le (in iduals with diabetes without an utation n = 240). All participants completed a demographic and medical questionnaire, as well as measures of psychological distress, quality of life and body image. The results indicated that, in univariate analyses, depression, physical quality of life and body image disturbance were all poorer in the utee group. These differences remained for body image disturbance (P = 0.005), but were no longer significant for depression or physical quality of life in multivariate analyses controlling for important demographic and medical variables. The present study found that the impact of diabetes-related utation was significant for body image disturbance. However, it appears that other psychosocial outcomes are better accounted for by medical co-morbidities common in this group rather than the utation itself. This research certainly highlights that clinicians must assess for and address all potential medical contributors to psychosocial outcomes, rather than assuming that people will experience poorer outcomes following utation.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.JAD.2011.11.039
Abstract: People with epilepsy (PWE) have a high chance of experiencing depression and anxiety disorders over their lifetime. However, those most at risk are unknown. Psychosocial variables have been suggested as potentially important risk factors. A systematic review was conducted in order to critically assess available evidence regarding the psychosocial predictors of depression and anxiety in adults with epilepsy. Electronic databases searched were MEDLINE, PsycINFO and Web of Science. Studies were included if they assessed depressive or anxiety symptoms using a validated questionnaire, and controlled for the role of potentially important epilepsy factors. Eleven studies were identified and assessed for research standards using the Quality Index Scale (QIS). Ten of the eleven studies found at least one significant predictor of depression and all six studies that assessed anxiety found one or more significant predictors. Overall QIS score was only 7.5 out of 15, indicating significant design limitations of many included studies. There was also large variability between studies in measures used to assess psychosocial variables. Studies did not support the importance of attributional theory and stigma in the development of depression in epilepsy. There was inconsistent support for the role of illness representations but likely support for the role of stress and self-efficacy. Consistent support was found for the role of coping strategies and perceived social support. Given that psychosocial factors are potentially modifiable, a better understanding of their role in the development of depression in people with epilepsy is urgently needed to guide effective treatments.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JPAIN.2018.10.005
Abstract: Persistent pain in young people in the community is common, but in iduals vary in how much pain impacts daily life. Information-processing accounts of chronic pain partly attribute the fear and avoidance of pain, as well as associated interference, to a set of involuntary biases, including the preferential allocation of attention resources toward potential threats. Far less research has focused on the role of voluntary goal-directed attention control processes, the ability to flexibly direct attention toward and away from threats, in explaining pain-associated interference. Using a visual search task, we explored a poor attention control account of pain interference in young people with persistent pain from the community. One hundred and forty five young people aged 16 to 19 years were categorized into three groups: non-chronic pain (n = 68), low-interfering persistent pain (n = 40), and moderate- to high-interfering persistent pain (n = 22). We found that only adolescents with moderate-to high-interfering persistent pain but not the other two groups of adolescents were affected by a search task preceded by a pain face (compared to a neutral face), but this within-group difference emerged only under low perceptual load conditions. Because low perceptual load conditions are thought to require more strategic attention resources to suppress the interfering effects of pain face primes, our findings are consistent with a poor attention control account of pain interference in young people. Analyses further showed that these differences in task performance were not explained by confounding effects of anxiety. If replicated, these findings may have implications for understanding and managing the pain-associated disability in adolescents with chronic pain. PERSPECTIVE: Young people with moderately and highly interfering pain responded slower on an easy search task after seeing a pain face than after seeing a neutral face. If replicated, these findings could mean that boosting the ability to control attention toward and away from threatening cues is an effective strategy for managing interference from pain.
Publisher: Wiley
Date: 28-05-2018
DOI: 10.1002/EJP.1239
Abstract: The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. A large s le (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.PEC.2008.02.021
Abstract: Preferences of women who had completed adjuvant chemotherapy for early breast cancer were compared with those of their partners by determining the smallest benefits they judged sufficient to make adjuvant chemotherapy worthwhile. Forty-six women and their partners were interviewed separately, 3-34 months after completing adjuvant chemotherapy. Preferences were elicited using four sets of validated, hypothetical trade-off scenarios about the possible benefits of adjuvant chemotherapy on survival times (5 and 15 years) and survival rates (65% and 85% at 5 years). Agreement within couples was assessed with the intraclass correlation coefficient (ICC). Associations between baseline characteristics, preferences, and agreement within couples were assessed with linear regression after normal score transformation. The mean age of the women was 57 years and of their partners' was 60. Most couples were married (91%). Benefits of an extra 1 day or 0.1% were judged sufficient to make adjuvant chemotherapy worthwhile by 59-72% of women and 54-59% of partners. Agreement was exact in 35-41% of couples and approximate in 59-83%. Agreement was better for scenarios with a worse prognosis (ICC 0.67 and 0.35) than for scenarios with a better prognosis (ICC 0.13 and 0.05). Having dependent children was associated with partners requiring larger benefits but patients requiring smaller benefits to make adjuvant chemotherapy worthwhile (interaction P=0.001). Patients' and partners' preferences for adjuvant chemotherapy differed and were influenced by considerations other than length and quality of life. Clinicians who are aware of these differences can tailor discussions to ensure that all interested parties understand and agree on the goals and benefits of treatment.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2016
DOI: 10.1007/S11764-015-0512-5
Abstract: Fear of cancer recurrence (FCR) is prevalent among survivors. However, a comprehensive and universally accepted theoretical framework of FCR to guide intervention is lacking. This paper reviews theoretical frameworks previously used to explain FCR and describes the formulation of a novel theoretical framework for FCR. A systematic review of the literature was undertaken to identify conceptual frameworks or theories applied to FCR. MEDLINE, PubMED, CINAHL, AMED, PsycINFO and Web of Science were searched. Identified conceptual frameworks were reviewed for strength of evidence supporting their validity. Of 558 papers initially identified, 16 made reference to six different conceptual frameworks relating to FCR. The most comprehensive and evidence-based theoretical approach is the Common Sense Model (CSM). Other approaches have limited evidence supporting their application to FCR. Two theoretical approaches developed in the context of emotional disorders that appear to be highly relevant to FCR: the Self-Regulatory Executive Function (S-REF) model and Relational Frame Theory were combined with the CSM to produce a novel cognitive processing account of FCR. Few conceptual frameworks have been used consistently to guide FCR research, and not all frameworks are empirically well supported, suggesting that further discussion regarding the conceptualisation of FCR is needed. The novel theoretical framework for FCR presented highlights the multidimensional nature of FCR and the importance of cognitive processing and metacognitions in the development and maintenance of FCR. The novel theoretical formulation of FCR outlined here provides a much-needed comprehensive framework to further investigate and address FCR in cancer survivors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-08-2023
DOI: 10.1097/J.PAIN.0000000000002997
Abstract: Mindfulness interventions have become popular in recent decades, with many trials, systematic reviews, and meta-analyses of the impact of mindfulness-based interventions (MBIs) on pain. Although many meta-analyses provide support for MBIs, the results are more mixed than they at first appear. The aim of this umbrella review was to determine the strength of evidence for MBIs by synthesizing available meta-analyses in pain. We conducted a systematic search in 5 databases and extracted data from published meta-analyses as the unit of analysis. For each outcome, we reported the range of effect sizes observed across studies and identified the largest meta-analysis as the “representative” study. We separately analysed effect sizes for different pain conditions, different types of MBIs, different control groups, and different outcomes. We identified 21 meta-analyses that included 127 unique studies. According to Assessment of Multiple Systematic Review ratings, the meta-analyses ranged from very strong to weak. Overall, there was an impact of MBIs on pain severity, anxiety, and depression but not pain interference or disability. When conditions were considered in isolation, only fibromyalgia and headache benefited significantly from MBIs. Mindfulness-based interventions were more efficacious for pain severity than passive control conditions but not active control conditions. Only pain severity and anxiety were affected by MBIs at follow-up. Overall, our results suggest that in idual meta-analyses of MBIs may have overestimated the efficacy of MBIs in a range of conditions. Mindfulness-based interventions likely have a role in pain management but should not be considered a panacea.
Publisher: Informa UK Limited
Date: 06-05-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
Publisher: Informa UK Limited
Date: 21-06-2014
DOI: 10.1080/13548506.2013.808750
Abstract: Young people with chronic illnesses including type 1 diabetes mellitus (T1DM) are at increased risk of developing psychological problems during adolescence. The aim of the present study was to explore whether a relationship exists between developmental challenges of adolescence (eating attitudes, family support and fear of negative evaluation) and psychopathology in adolescents with T1DM, and the nature of such a relationship. Sixty-one adolescents with T1DM completed a series of questionnaires assessing illness beliefs, eating attitudes, family support, Fear of Negative Evaluation (FNE) and psychopathology. The study was of a correlational design, and also included a seven-day diabetes management diary in order to collect blood glucose levels over this time. Results demonstrated the relevance of all three developmental challenges. In multiple regression analyses, FNE and eating attitudes independently predicted current levels of depressive symptomatology. Current levels of anxiety were predicted by FNE and family support, but not eating attitudes. The results support the relevance of all three developmental challenges of adolescence to psychopathology in young people with diabetes. These results suggest that in working with adolescents who are having difficulty coping with diabetes it may be beneficial to focus on the developmental issues that commonly face adolescents.
Publisher: Frontiers Media SA
Date: 23-05-2018
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JAD.2017.06.009
Abstract: Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression. A systematic literature search was conducted using the databases PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity. Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62-2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06-4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28-1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18-0.33) p <0.001]. Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures. Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.
Publisher: Informa UK Limited
Date: 18-03-2015
DOI: 10.1080/08870446.2015.1022548
Abstract: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease. Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74 three-month: n = 68 six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence). Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention by the six-month follow-up change in perceived behavioural control was the stronger predictor. Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control.
Publisher: S. Karger AG
Date: 2012
DOI: 10.1159/000332334
Abstract: i Background: /i Despite evidence that cognitive-behavioral therapy (CBT) is effective for rheumatoid arthritis (RA), little is known about which components of therapy are most efficacious. The present study compared the efficacy of CBT with cognitive therapy (CT) and behavioral therapy (BT) for patients with RA. We hypothesized that CBT would be more efficacious on a broader range of outcomes. i Methods: /i Participants (n = 104) with classic or definite RA were randomized to receive one of three active treatments (CBT, CT or BT) or a wait-list control (WLC). Participants were assessed at baseline, post-treatment and 6 months on a range of outcomes. Measures of disease activity, joint function, disability and psychological functioning were included. i Results: /i The results showed that participants who received cognitive components had greater improvements in tender joint counts and C-reactive protein at post-treatment. Those receiving either BT or CT alone improved more on anxiety than CBT or WLC. At 6 months, the three active treatment groups could only be distinguished on tender joints, which favored CT and CBT. i Conclusions: /i CBT did not demonstrate the broader benefits to patients that we expected, nor was there evidence that BT produced effects that were superior to CT alone. CT was superior to at least one of the other two active treatment components on 3 of the 7 outcome measures at post-treatment. Effect sizes for the interventions that included cognitive components were similar to those reported in the literature. These results suggest that CT is an effective treatment for RA and need not necessarily include behavioral strategies.
Publisher: Springer Science and Business Media LLC
Date: 2004
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JPAIN.2018.09.002
Abstract: Patient blinding is a critical feature of double-blind placebo-controlled randomized controlled trials (RCTs). Yet, very little is known about practices for assessing and reporting blinding in chronic pain trials. We examined the rates and predictors of assessing blinding and its success in pharmacological RCTs for chronic pain. Four-hundred eight trials (n = 103,983 participant) were identified via a systematic search between 2006 and 2016. Only 23 RCTs (5.6%) reported assessing patient blinding. Larger s le size, reference to a CONSORT statement, and pharmaceutical sponsorship were associated with lower rates of assessing blinding. A meta-analysis of the available data using Bang's Blinding Index indicated that blinding was not successful when combined across studies (g = 1.12, 95% confidence interval .92-2.01). Moderator analysis revealed that higher rates of adverse events and larger treatment effect sizes were associated with worse blinding outcomes, whereas including "don't know" responses seemed to improve blinding. Overall then, blinding is rarely reported and often fails in RCTs of pharmacological interventions for chronic pain. To address this finding, we recommend that all researchers conducting RCTs for chronic pain assess and report on the status of patient blinding when reporting the trial outcome. PERSPECTIVE: This meta-analysis examined patient blinding in pharmacological RCTs of chronic pain. The results indicated that blinding is rarely assessed and often fails. Some study characteristics were associated with lower rates of assessing blinding and its success, for ex le, pharmaceutical sponsorship and side effects. Implications and recommendations for chronic pain RCTs are discussed.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.YEBEH.2013.09.044
Abstract: For women with epilepsy (WWE), pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs (AEDs) versus the risks of having seizures during pregnancy. However, qualitative research suggests that many WWE remain uninformed about the risks associated with epilepsy and pregnancy and may, therefore, be making uninformed decisions about their families. The objectives of this review were to determine the level of patient knowledge, their informational needs, and whether these needs concerning pregnancy and childbirth issues are met among WWE. Electronic databases searched were PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science. Studies were included if they used quantitative methods to survey WWE aged 16years or older about their knowledge, access to information, or informational needs specifically regarding epilepsy and pregnancy. Twelve studies were identified and assessed for research standards using the Quality Index. Overall Quality Index score was only 7.1 out of 14, indicating significant design limitations of many included studies, including highly selective s ling methods and the use of unvalidated outcome measures. There was a paucity of studies investigating specific areas of women's knowledge and information needs. Overall, WWE reported adequate awareness, but limited knowledge, of key issues regarding pregnancy and childbirth. Across studies, many women reported not receiving information about these issues. Evidence suggested that many WWE wanted to receive more information - particularly about the risks of AEDs for their offspring - well in advance of choosing an AED or planning pregnancy. Women aged under 35years wanted the most information. Preconception counseling received by many WWE appears insufficient, risking uninformed decision-making about pregnancy. Further research is needed to investigate the barriers that WWE face in accessing, receiving, and retaining appropriate information.
Publisher: Informa UK Limited
Date: 24-04-2016
DOI: 10.1080/17437199.2016.1168268
Abstract: The current aim was to examine the effectiveness of behaviour change techniques (BCTs), theory and other characteristics in increasing the effectiveness of computer-delivered interventions (CDIs) to reduce alcohol consumption. Included were randomised studies with a primary aim of reducing alcohol consumption, which compared self-directed CDIs to assessment-only control groups. CDIs were coded for the use of 42 BCTs from an alcohol-specific taxonomy, the use of theory according to a theory coding scheme and general characteristics such as length of the CDI. Effectiveness of CDIs was assessed using random-effects meta-analysis and the association between the moderators and effect size was assessed using univariate and multivariate meta-regression. Ninety-three CDIs were included in at least one analysis and produced small, significant effects on five outcomes (d+ = 0.07-0.15). Larger effects occurred with some personal contact, provision of normative information or feedback on performance, prompting commitment or goal review, the social norms approach and in s les with more women. Smaller effects occurred when information on the consequences of alcohol consumption was provided. These findings can be used to inform both intervention- and theory-development. Intervention developers should focus on, including specific, effective techniques, rather than many techniques or more-elaborate approaches.
Publisher: Emerald
Date: 25-05-2010
DOI: 10.1108/00346651011043989
Abstract: The purpose of this paper is to investigate children's understandings of the intent and importance of current media initiatives designed to target childhood obesity. Semi‐structured interviews were analysed using qualitative content analysis, for the responses of overweight and normal weight children. In total, 33 children were interviewed, 24 of normal weight and nine overweight. They were shown two print and four television advertisements from the New South Wales Health Department web site that were popularly broadcast between 2003 and 2007. Children were then asked if they had seen the advertisement prior to the interview, and their understanding of the intent and importance of the advertisements. Most children in both weight groups recalled seeing five out of the six presented advertisements prior to interview. The main themes identified were “Health Maintenance” and “Illness Prevention” for five of the six advertisements. Overweight children were more numerous in their detection of a health message as opposed to normal weight children, who mostly commented on the safety aspect of advertisement six. Future evaluations of mediated health c aigns should go beyond recording simple recall of c aign material and investigate instead the understandings of target groups. Mediated health c aigns should also specify messages to particular target groups, as they appear to be most likely to facilitate behaviour change. Mediated health c aigns are mostly evaluated quantitatively rather than by qualitative means. In addition, no study has evaluated the views of overweight and normal weight children with regards to these health c aigns.
Publisher: Oxford University Press (OUP)
Date: 30-03-2015
Abstract: To provide a review of the literature comparing anxious and depressive symptoms in caregivers of children with asthma with caregivers of healthy children. A systematic search identified 25 studies from 17 articles, reporting outcomes on 4,300 caregivers of children with asthma and 25,064 caregivers of healthy children. Overall, anxious (d = 0.50) and depressive symptoms (d = 0.44) were higher in caregivers of children with asthma compared with caregivers of healthy children. Age, site of recruitment, and whether the asthma diagnosis was medically confirmed were included as potential moderators. The relationship between parental psychopathology and asthma was stronger in those with medically confirmed asthma and participants recruited from clinical settings. Other moderators were not significant. Caregivers of children with asthma appear to have greater anxious and depressive symptoms than caregivers of healthy children, but the reasons are unclear. More research that investigates modifiable factors that may moderate this association is urgently needed.
Publisher: American Psychological Association (APA)
Date: 11-2022
DOI: 10.1037/HEA0001217
Abstract: The Cancer Threat Interpretation model proposes that clinically significant fear of cancer recurrence rogression (FCR/P) can occur when people misinterpret ambiguous physical symptoms as a sign of recurrence. The aim of this research is to test whether interpretation biases moderate the relationship between pain and FCR/P in women with breast cancer, as predicted. One hundred forty-seven women with breast cancer completed questionnaire measures of demographic and medical information, FCR/P, interpretation bias, and symptom burden, as well as other known predictors of FCR/P. Women with clinically significant levels of FCR/P were more likely to interpret ambiguous words as health-related and experienced more pain than women with levels of FCR/P in the nonclinical range. FCR was associated with both pain ( We found that women with breast cancer with clinically significant FCR/P interpreted ambiguous words as health-related more often and experienced more pain than those with nonclinical FCR/P. Moreover, we found that among those with higher levels of pain, FCR was also higher only among those with higher levels of interpretation bias, as the threat interpretation model predicts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.JPAIN.2018.09.006
Abstract: Despite widespread use as a chronic pain management strategy, pacing has been linked with higher levels of pain and disability. A recent meta-analysis found a positive correlation between existing measures of pacing and avoidance, which may partially account for these poorer outcomes. A measure was developed to differentiate pacing from avoidance by emphasizing non-pain-contingent pacing behaviors and nonavoidance of pain. A s le of 283 adults with chronic pain completed the Non-Avoidant Pacing Scale (NAPS) and existing measures of pacing, avoidance, pain, and physical and psychological functioning. Exploratory factor analysis of 10 items (subs le 1, n = 141) suggested two 4-item factors: planned pacing behaviors and pacing through flare ups. Confirmatory factor analysis of 8 items (subs le 2, n = 142) revealed satisfactory fit (goodness-of-fit index .947, comparative fit index .964). The pattern of correlations between each factor and avoidance and key outcomes suggests that the NAPS total scale (ɑ = .819) captures key pacing behaviors and differentiates pacing from avoidance. Unlike existing measures, the NAPS was not positively correlated with avoidance and was associated with better psychological functioning across affective and cognitive domains. The NAPS allows researchers and clinicians to assess the role of pacing in chronic pain management without artefactual overlap with avoidance. PERSPECTIVE: The NAPS assesses activity pacing in chronic pain without artefactual overlap with avoidance. Associations were found between more frequent pacing, as measured by the NAPS, and better psychological functioning. Clearly differentiating pacing from avoidance allows for accurate assessment of the role of pacing in chronic pain management.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JPAIN.2017.04.008
Abstract: Activity pacing is ubiquitous in chronic pain management and aims to reduce pain-contingent avoidance of activity to improve functioning. A meta-analysis, however, has linked pacing with higher levels of pain and disability. One potential explanation is an overlap between existing measures of pacing and avoidance, leading to links with poorer outcomes that are typically associated with avoidance. This study systematically reviews the evidence regarding the relationship between measures of pacing and avoidance. A search was conducted for studies measuring both constructs in adults with chronic pain. A meta-analysis of correlations between pacing and avoidance was conducted 16 studies were included and a small positive correlation was found (r = .290, P < .001) overall. Single-item and multiple-item measures were also compared a moderate positive correlation was found for multiple-item measures (r = .410, P < .001), which differed significantly from a small positive correlation found for single-item measures (r = .105, P < .001). Due to limited studies, independent analyses of in idual subscales were not possible. Existing measures of pacing-particularly multiple-item measures-may partially confound pacing with avoidance. Further research is required to ensure that a reliable measure of pacing that distinguishes this construct from avoidance is available to adequately evaluate pacing instruction and the effect of pacing on key outcomes in chronic pain. This meta-analysis examines the correlation between pacing and avoidance in adults with chronic pain. Results indicate that existing measures may partially confound pacing with avoidance. Directions for future research are proposed to ensure that an adequate measure of pacing exists to evaluate its effect on key outcomes in chronic pain.
Publisher: Cambridge University Press (CUP)
Date: 12-2017
DOI: 10.1017/BEC.2018.1
Abstract: The experience of paediatric asthma is associated with increased stress and emotional difficulties for both the child and family. The current study aimed to qualitatively explore parents’ views of their child's asthma experience, from initial diagnosis onwards, to enhance our understanding of how families emotionally adjust and adapt to the diagnosis and management of asthma. Semi-structured interviews were conducted with 17 parents of children ( years) with physician-diagnosed asthma. Questionnaires were used to capture demographic information and anxiety symptom status of parents (State Trait Anxiety Inventory — Form Y [STAI-Y1/Y2]) and children (Spence Children's Anxiety Scale — Parent reported [SCAS-P]). Grounded theory was used to analyse the results. Analysis saw three themes emerge as important in understanding the impact of asthma on the family: (1) the experience of obtaining an asthma diagnosis, (2) parents’ belief in their competence to manage asthma, and (3) parents’ behaviour in response to the asthma. A model was developed that posits adaptive parental adjustment to asthma is determined in part by the circumstances around the time of diagnosis, the level of knowledge and skills, and the controllability of the asthma. This model can guide medical and allied health professionals to specific areas where intervention may reduce stress and emotional difficulties associated with asthma and its management for affected families.
Publisher: Informa UK Limited
Date: 03-2016
DOI: 10.2147/JPR.S83653
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-1995
DOI: 10.1016/0304-3959(95)00047-V
Abstract: Generally, vaccination uptake in Japan lags behind World Health Organization targets. This study aimed to understand how risk information and advice affect intention to receive vaccinations. This study had a within-subjects design. An online survey based on the Health Belief Model was sent to 2501 Japanese in iduals (≧20 years) to assess the intention to be vaccinated for influenza and rubella after receiving minor and severe risk information and hypothetical advice about each vaccine. Regression analysis was used to measure changes in intentions to receive each vaccination after being provided with (1) risk information about each vaccine and (2) hypothetical encouragement and discouragement to be vaccinated. The main outcomes included changes in vaccination intentions from baseline. Forty-one percent (N = 1030) of those sent the survey completed it. At baseline, 43% and 65% of the respondents intended to have influenza and rubella vaccinations, respectively. Being provided with information about severe risks and susceptibility increased the intention to have the influenza vaccination among females in their 40s. Receiving inaccurate and discouraging information from one's mother significantly decreased the intention to have the rubella vaccination. Women 50 and older were more likely to intend not to have vaccination for rubella. Severe risk information decreased rubella vaccination intention in all age groups, except women in their 30s and 40s (p < .05). For both vaccinations, older in iduals demonstrated vaccine hesitancy. This group requires tailored messaging to help them understand their vulnerability (to influenza) and their role in transmission (for rubella) to encourage uptake of essential vaccinations. Members of the Japanese public responded to our online questionnaire on vaccination risk.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Center for Open Science
Date: 13-02-2023
Abstract: Several authors have claimed that death anxiety may be a transdiagnostic construct, underlying a range of psychological disorders. One category of disorders that may be influenced by death anxiety is eating disorders (EDs). Terror Management Theory (TMT) argues that pursuing the ‘thin ideal’ may be one way that women can defend against fears of death. The present study used the mortality salience (MS) paradigm to examine whether priming death would increase disordered eating behaviours and attitudes. We recruited two s les of 128 women from analogue (Study 1), and clinically relevant (Study 2) populations. Participants were randomised to either a MS or control condition. Following priming, participants completed a portion size estimation task, two measures of body dissatisfaction, and an intention to eat item. The results from Study 1 were inconsistent with the claimed role of death anxiety in disordered eating. However, in Study 2, MS priming led to increased dissatisfaction with current thinness and smaller portion sizes for high-fat food compared to low-fat food, but not other outcomes. Overall, the results suggest that death anxiety may exacerbate disordered eating in women for whom these behaviours are part of an existing maladaptive coping strategy.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.JPSYCHORES.2010.11.003
Abstract: This study aimed to investigate the effect of having a stoma on body image in patients with colorectal cancer and to determine whether disturbances in body image predicted distress. A prospective analysis of 79 colorectal cancer patients. Patients were assessed within 9 weeks of surgery and followed up at the end of adjuvant treatment. Body image disturbance, depressive symptoms, anxiety, and general distress were measured at baseline and follow-up. Patients who received stomas had poorer body image, which worsened over time. Although there were no differences between stoma groups on anxiety or depressive symptoms, those with a late stoma were most depressed. Body image was a strong predictor of initial levels of anxiety, depression, and distress and subsequent anxiety and distress. These results confirm that stomas negatively impact on the body image of patients with colorectal cancer. Importantly, those whose body image is most disturbed are at risk for experiencing more anxiety and depression. These results underscore the importance of assessing and treating body image disturbance in colorectal patients who receive a stoma.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.JPSYCHORES.2013.05.011
Abstract: Despite evidence indicating a heightened incidence of psychological symptoms in coeliac disease (CD), the direct link between psychological factors and quality of life (QOL) has received little attention. The purpose of this paper was to compare the relative impacts of psychological symptoms and coping to the known negative impacts of gastrointestinal symptoms and adherence to the gluten free diet (GFD) on QOL. In study 1 (N=390), participants completed measures of QOL, psychological symptoms, coping, several indices of symptom severity, and adherence. Correlations and regression analyses were used to determine the relationships between QOL and the measured variables. Study 2 (N=189) replicated the findings using a validated measure of current gastrointestinal symptom severity and a more comprehensive measure of coping. Across both studies, poorer QOL was correlated with a higher incidence of psychological and gastrointestinal symptoms, greater reliance on maladaptive coping strategies, and poorer GFD adherence. The relationship between psychological symptoms (particularly depression) and QOL persisted when controlling for past (study 1) and current (study 2) gastrointestinal symptom severity. Psychological symptoms and GFD adherence were more strongly related to reduced QOL than gastrointestinal symptoms. The negative impact of psychological symptoms on QOL and adherence suggests that management in CD should include the provision of psychological coping skills, as well as purely dietetic-based strategies to minimise gastrointestinal symptoms.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.JPAIN.2011.07.003
Abstract: In recent years, there has been increasing acknowledgment of the need for psychometric data regarding the dot-probe paradigm. The aim of the present study was to provide some data on the psychometric properties of the dot-probe paradigm in the context of pain-related research. Using the data of a large pain-free s le and a large chronic pain s le, the present study examined the psychometric properties of a picture- and word-based dot-probe task. It also examined the data of idiosyncratically selected stimuli designed to be relevant to each participant and compared this with the data of neutral stimuli and nonsalient pain-related stimuli. Poor levels of internal consistency (α range: -.44 to .28 split-half r range: -.35 to .11) and test-retest reliability (r range: -.14 to .13) were found among the pain-free s le, irrespective of the task used or the stimuli used. There was limited evidence of comparability between the 2 tasks among the chronic pain s le (r range: -.08 to .26) and similarly poor levels of internal-consistency (α range: -.56 to .17 split-half r range: -.20 to .25). The findings of the present study therefore suggest that psychometric issues may be important to pain-related attentional bias research. More research is, however, undoubtedly needed. The aim of the present study was to provide data regarding the psychometric properties of the dot-probe paradigm within the specific context of pain-related attentional bias research. The findings of this study suggest that psychometric issues may be an important consideration in pain-related attentional biases research.
Publisher: Springer Science and Business Media LLC
Date: 27-12-2019
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.APPET.2014.08.037
Abstract: The primary aim of this study was to extend previous research on food-related attentional biases by examining biases towards pictorial versus word stimuli, and foods of high versus low calorific value. It was expected that participants would demonstrate greater biases to pictures over words, and to high-calorie over low-calorie foods. A secondary aim was to examine associations between BMI, dietary restraint, external eating and attentional biases. It was expected that high scores on these in idual difference variables would be associated with a bias towards high-calorie stimuli. Undergraduates (N = 99) completed a dot probe task including matched word and pictorial food stimuli in a controlled setting. Questionnaires assessing eating behaviour were administered, and height and weight were measured. Contrary to predictions, there were no main effects for stimuli type (pictures vs words) or calorific value (high vs low). There was, however, a significant interaction effect suggesting a bias towards high-calorie pictures, but away from high-calorie words and a bias towards low-calorie words, but away from low-calorie pictures. No associations between attentional bias and any of the in idual difference variables were found. The presence of a stimulus type by calorific value interaction demonstrates the importance of stimuli type in the dot probe task, and may help to explain inconsistencies in prior research. Further research is needed to clarify associations between attentional bias and BMI, restraint, and external eating.
Publisher: American Psychological Association (APA)
Date: 02-2021
DOI: 10.1037/ABN0000577
Publisher: Wiley
Date: 2005
DOI: 10.1002/PON.825
Abstract: Caregiver burden is an increasing problem with patients surviving longer and more care tasks falling to informal caregivers. While research has identified patient and caregiver variables associated with caregiver burden, less research has focused on aspects of the care environment. The present study investigated the available support and unmet needs of 57 patients with advanced cancer, 45 of their carers and 40 of their health professionals. Carers and patients consistently identified higher levels of available support for the patient than health care professionals, with carers identifying higher levels of support than patients. Carers also identified more patient unmet needs than health care professionals, who in turn identified more than patients. Surprisingly, available support did not increase over 6 months and there was a tendency for unmet needs to decrease over time. Low available support, high unmet needs and a larger discrepancy between carer and patients' reports of patients' unmet need predicted negative aspects of caregiver burden. These results suggest that health care professionals underestimate available support to patients and both patients and health care professionals underestimate patients' unmet needs in comparison to carers. Carers' reports of patients' unmet needs are important to consider as they were associated with high levels of caregiver burden, including poorer caregiver health. Health care professionals should encourage opportunities for carers to discuss their views of the ongoing needs of patients with advanced cancer.
Publisher: Springer Science and Business Media LLC
Date: 11-2023
DOI: 10.1007/S12529-022-10137-Y
Abstract: Using fear to increase the uptake of preventative health behaviours is a longstanding practice, which could be useful in mitigating the spread of COVID-19. However, the impact of fear c aigns beyond behavioural outcomes has rarely been considered. It is possible that these threatening health messages could heighten health-related anxiety by inducing a tendency to interpret ambiguous stimuli in a threatening manner. This research aimed to evaluate the effects of fear-based articles about COVID-19, on intentions to adhere to mitigation measures and interpretation bias—a core maintenance factor in health anxiety. Two pilot studies were conducted with the aim of validating our novel COVID-related measures and assessing engagement with the threat manipulation. Following this, 375 community members were recruited through social media for the main study. Participants were then randomly allocated to read an article about COVID which was manipulated on both threat and efficacy. After reading the article, participants then completed measures of interpretation bias and intentions to engage in COVID-19 mitigation measures. Although the threatening articles consistently produced greater COVID-related threat, they only generated a stronger interpretation bias in the first pilot study. Importantly, threat-based communications failed to enhance intentions to perform mitigation measures in any of the studies. Likewise, reading an article which bolstered self-efficacy did not increase intentions, compared to reading a low efficacy article. This research suggests that fear appeals are unlikely to increase intentions to perform COVID-related mitigation measures.
Publisher: JMIR Publications Inc.
Date: 17-04-2020
Abstract: indfulness-based stress reduction is an efficacious treatment for people with chronic health problems however, it is highly intensive and time-consuming, which is a barrier for service provision. his study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. e co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subs le of the initial group of end users (n=11), and the program was reviewed by experts (n=8). e identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. he web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program.
Publisher: Wiley
Date: 23-07-2013
DOI: 10.1002/MSC.1031
Abstract: Planning a family is a complex decision. For women with chronic conditions such as rheumatoid arthritis (RA), there are additional concerns about their own and their baby's health. This qualitative study examined women's experiences of negotiating their family decisions in the context of RA. A qualitative study was conducted in 14 women who provided a written account of their motherhood decisions and experiences. Those 'stories' were then thematically analysed. RA was found to affect women's motherhood decisions and experiences. Three key themes were identified for both the process of decision making and the experience of that decision: capacity, uncertainty and acceptance. Only two of the women decided not to have children, while for others the decision centred on changing expectations from the number of children they planned to have, to parenting within the restrictions of their physical abilities. While many women struggled through the negotiations of their motherhood choices, those who chose to have children reported great joy in that experience. The challenges faced by women with RA contemplating motherhood, however, highlight the need for understanding and support from health professionals and the provision of resources so that women can make informed choices.
Publisher: Wiley
Date: 16-08-2016
Publisher: Springer Science and Business Media LLC
Date: 12-06-2023
DOI: 10.1007/S10865-023-00422-W
Abstract: Death anxiety is understudied in people with cancer, especially in relation to fear of cancer recurrence (FCR) and fear of progression (FOP). The present study aimed to identify if death anxiety can predict FCR and FOP over and above other known theoretical predictors. One hundred and seventy-six participants with ovarian cancer were recruited for an online survey. We included theoretical variables, such as metacognitions, intrusive thoughts about cancer, perceived risk of recurrence or progression, and threat appraisal, in regression analyses to predict FCR or FOP. We investigated whether death anxiety added to the variance over and above these variables. Correlational analyses demonstrated that death anxiety is more strongly associated with FOP than FCR. The hierarchical regression including the theoretical variables described above predicted 62–66% of variance in FCR and FOP. In both models, death anxiety predicted a small but statistically significant unique variance in FCR and FOP. These findings draw attention to the importance of death anxiety in understanding FCR and FOP in people with a diagnosis of ovarian cancer. They also suggest that elements of exposure and existentialist therapies may be relevant in treating FCR and FOP.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
DOI: 10.1016/J.PAIN.2013.09.004
Abstract: This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought.
Publisher: SAGE Publications
Date: 03-2010
DOI: 10.3109/00048670903487225
Abstract: Objective: Residential mother-infant intervention programmes for unsettled infant behaviour have been shown to be associated with positive child and maternal outcomes. Despite evidence of elevated rates of maternal psychopathology among residential unit populations, little is known about whether psychological disorders interfere with the effectiveness of such interventions. Method: Two cohorts (n = 104 and 147, respectively) were recruited from a residential mother-infant intervention programme for unsettled infant behaviour. In study 1, mothers completed self-report questionnaires measuring depression, anxiety and parenting stress at three time points (admission, 1 month after discharge and 3 months after discharge). In study 2, mothers were interviewed using a structured clinical interview for depressive and anxiety disorders. In both studies, nurses recorded infant behaviours over the duration of the 5 day admission using 24 h behaviour charts. Results: Study 1 showed the intervention to be associated with significant improvements in child behaviours and in levels of maternal depression, anxiety and parenting stress. These improvements were evident for women who scored above the Edinburgh Postnatal Depression Scale threshold for major depression during the admission, as well as for women in the normal range. Study 2 confirmed that the intervention was associated with significant improvements in infant behaviours. Infants of mothers with a depressive or anxiety disorder were less unsettled on admission, but improvements over the course of the admission were comparable for infants of women who had, or had not, experienced an anxiety or depressive disorder during the admission. Conclusions: These results show positive infant and maternal outcomes associated with a residential mother-infant intervention for unsettled infant behaviour, regardless of the women's psychiatric status on admission. This suggests that women with depression or anxiety disorders who also report unsettled infant behaviour, will benefit from referral to residential programmes.
Publisher: Wiley
Date: 30-04-2020
DOI: 10.1002/EJP.1561
Publisher: Cambridge University Press (CUP)
Date: 16-03-2017
DOI: 10.1017/BEC.2017.3
Abstract: Anxiety disorders occur at an increased rate in children with asthma however, there is only a small evidence base to support specific psychological treatments for these children. The current study evaluated the efficacy of a pilot cognitive behavioural treatment (CBT) group intervention for children with asthma and a comorbid anxiety disorder in a case series design. Five children (aged 8–11 years old) with asthma and a comorbid anxiety disorder and their mothers took part in eight 1-hour group treatment sessions. Primary outcomes measures were anxiety diagnosis and asthma-related quality of life. Secondary outcome measures were asthma symptom control and parent quality of life associated with caring for a child with asthma. Three of the participants no longer met diagnostic criteria for an anxiety disorder following treatment and three different participants reported a reliable improvement in asthma-related quality of life. Two participants reported a reliable improvement in asthma symptom control. Three mothers reported an improvement in caregiver quality of life. The findings provide preliminary proof of concept evidence for the efficacy of a CBT intervention for children with asthma and clinical anxiety.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.CPR.2015.05.007
Abstract: Although it is well known that anxious adults show selective attention to threatening stimuli, research investigating attentional bias in children with anxiety has produced mixed results. The purpose of this paper is to provide a comprehensive analysis of studies investigating attentional bias in children with anxiety. Using a systematic search for articles which included both children with anxiety and reported data suitable for a meta-analysis, 38 articles were identified involving 4221 subjects (anxiety n=2222). We used a random effects meta-analysis with standardized mean difference as our primary outcome to estimate between- and within-group effects of attentional bias towards threat-related information in children with anxiety. Overall, children with anxiety showed a significantly greater bias to threat-related stimuli, compared to controls (d=0.21). Children with anxiety also showed a significant bias to threat-related stimuli, over neutral stimuli (d=0.54), which was greater than the bias shown by control children (d=0.15). Specific variables in attentional bias were also explored, with varying results. The review concluded that anxious children do show a similar bias towards threatening stimuli as has been documented in adults, albeit to a lesser degree and this bias is moderated by age, such that the difference between anxious and control children increases with age. Given the small number of studies in some areas, future research is needed to understand the precise conditions under which anxious children exhibit selective attentional biases to threat-related stimuli.
Publisher: Wiley
Date: 10-09-2019
DOI: 10.1002/PON.5218
Abstract: To develop and evaluate the usability of iConquerFear, an online self-management adaptation of an efficacious face-to-face therapist-delivered treatment for fear of cancer recurrence (FCR). iConquerFear development was theory based and person based. Development was guided by Ritterband et al's behaviour change model for internet interventions. iConquerFear end users (cancer survivors) provided iterative feedback in accordance with Yardley et al's person-based approach to maximise engagement and usability. Online focus groups and cognitive interviews were conducted to evaluate the usability of iConquerFear. Discussions were recorded, transcribed verbatim, and thematically analysed. Five online FCR modules were developed. Twenty-three cancer survivors (47% of those eligible) participated 11/23 (58%) were breast cancer survivors, and average age was 53 years (SD = 10.8). Thematic saturation was reached after six focus groups (n = 16) and seven in idual think-aloud interviews. Thematic analysis produced five overarching themes: easy navigation essential satisfaction and engagement with content flexible access is key normalising and empowering and a useful first step. Online self-management interventions like iConquerFear have the potential to address the unmet supportive care needs reported by burgeoning numbers of cancer survivors. However, that potential may not be realised unless interventions are rigorously developed and user tested, as benefits are constrained by limited engagement. Themes from the usability testing of iConquerFear highlight the importance of developing flexible, tailored, interactive, and contextual online self-management interventions for people with cancer.
Publisher: Cambridge University Press (CUP)
Date: 07-2001
DOI: 10.1017/S1352465801003046
Abstract: A considerable literature has developed over the past two decades that has investigated the utility of cognitive behavioural treatments for a variety of medical disorders, including rheumatoid arthritis. Research has consistently found that psychological variables affect the course of the illness and that cognitive behavioural approaches can improve psychological and physical function. However, the literature has focused almost exclusively on chronic illness. There is little literature that has investigated the role of cognitive behavioural therapy in facilitating the adjustment early in the disease course to diagnosis and subsequent illness. The diagnosis of any potentially chronic illness has enormous ramifications for a person's life and it is well documented that many people become depressed even early in the disease course. Theoretical accounts have been put forward that allow a model for understanding the process of adaptation and offer a foundation for the use of cognitive and behavioural strategies with a recently diagnosed group of patients. The present paper reports the use of a cognitive and behavioural intervention to facilitate coping and adjustment to illness.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.CPR.2019.101754
Abstract: Attentional Control Theory (ACT) (Eysenck & Derakshan, 2011) proposes that attention control (AC) deficits are central to the development of anxiety. This meta-analysis investigated the size and nature of AC deficits in anxious compared to non-anxious participants. We made the following hypotheses based on ACT: i) anxiety-related AC deficits occur in the AC components of inhibition and switching, but not updating ii) deficits will be more pronounced for AC efficiency (reaction times) than effectiveness (accuracy) iii) studies with high cognitive load conditions will observe greater deficits than studies with normal cognitive load iv) age and anxiety level will moderate the effect of anxiety on AC. Fifty-eight studies (N = 8292) met inclusion criteria. The meta-analysis revealed a significant AC deficit for high compared to low anxiety participants (Hedges' g = -0.58). Overall, results supported assumptions of ACT: anxiety produced significant deficits in AC efficiency but not effectiveness these deficits occurred in inhibition and switching but not updating and studies with high cognitive load conditions found larger anxiety related AC deficits. Age moderated the relationship between anxiety and AC in behavioural studies and anxiety severity moderated this relationship in self-report studies. Theoretical implications of the results are discussed, and future directions for research are proposed. This meta-analysis has been registered with PROSPERO in 2016, Registration number: CRD42016036927.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JPSYCHORES.2012.08.010
Abstract: This study aimed to test the relevance of a cognitive behavioural model of body image in a prospective study of colorectal surgery patients and to determine if pre-existing body image disturbance influenced psychological adjustment following surgery. Sixty-seven adult consecutive colorectal surgery patients completed measures assessing psychopathology, body image related beliefs and health related quality of life during pre-admission for surgery using a questionnaire battery. Each participant was followed up three months after surgery. Depression and anxiety were positively correlated with body image disturbance and self evaluation at baseline. Those patients who went on to receive stomas experienced a significant deterioration in their body image that was not observed in those whose surgery did not result in the formation of a stoma. In the regression analysis, body image disturbance was a significant predictor of baseline levels of depression and emotional quality of life. Initial levels of body image disturbance remained a significant predictor of depression and anxiety at follow up assessment after medical variables and baseline levels of depression and anxiety, respectively, had been controlled for. Our findings support the hypothesis that pre-existing vulnerabilities in body image influence emotional adjustment during the recovery phase following surgery. Further research on screening for body image disturbance in surgical patients in order to promote adjustment is warranted.
Publisher: Elsevier BV
Date: 02-2002
DOI: 10.1016/S0272-7358(00)00087-8
Abstract: With most Western countries expanding the availability of gambling facilities in recent decades, considerable research interest has developed in those people who develop problematic levels of gambling. In the recent decade, a large body of research has been conducted into the determinants of gambling behavior in an attempt to understand this complex social and psychological problem. Research has varied in its nature from investigating underlying biological, psychological, or social factors that are hypothesized to contribute to gambling behavior. Evidence now exists that biological, psychological, and social factors are all relevant to the development of problematic levels of gambling. However, the theoretical explanation for gambling has lagged behind the advances in empirical work in recent years. The purpose of the current paper is to provide a review of the major research findings in the area of gambling and propose a biopsychosocial model that integrates erse areas of research. The model described is empirically derived, and it is hoped it will stimulate future research work that investigates not only in idual factors and their relationship to gambling, but also the interactions between different variables.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.JBTEP.2014.07.006
Abstract: In forensic settings, in iduals who experience a traumatic event are often encouraged to recall it soon afterwards to preserve their memory for it. Some theories of the development of post-traumatic stress disorder (PTSD) suggest that this may increase psychopathology. The primary aim of the study was to examine the effect of immediate recall of a trauma analogue video on psychopathology. Eighty-five undergraduate students were randomised to view a video of a car accident, described as either a real event (high stress) or training event (low stress). They then completed either the Self-Administered Interview (SAI©, Gabbert, Hope, & Fisher, 2009) or a filler task. All participants returned one week later to provide an account of the event. As predicted, participants in the SAI early recall task condition remembered the video content better one week after seeing the video, shown both by their greater recall of correct details and greater rejection of misinformation. However, completing the SAI resulted in higher anxiety immediately afterwards, and more severe PTSD-like symptoms one week later, compared to control condition. PTSD intrusion-like symptoms also predicted more accurate recall, while avoidance predicted poorer memory. While the trauma analogue video used in this study has been previously used, and did effectively trigger post-traumatic-like symptoms, it is unclear how well these results generalise to actual trauma situations. These results suggest the relationship between PTSD symptoms and memory might be more complex than previously recognised, with intrusive phenomena possibly promoting memory and avoidance symptoms compromising memory.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-06-2023
Publisher: Springer Science and Business Media LLC
Date: 22-09-2015
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.RMED.2010.04.011
Abstract: The prevalence of panic disorder in patients with chronic obstructive pulmonary disease (COPD) is up to 10 times greater than the overall population prevalence of 1.5-3.5%, and panic attacks are commonly experienced. When present, clinically significant anxiety decreases quality of life for COPD patients, and also increases health care costs. Therefore, understanding why COPD patients have such high rates of panic attacks and panic disorder is important for optimal management of COPD. The cognitive model of panic anxiety is the most widely accepted theory of panic attacks and panic disorder in physically healthy adults. According to this model, panic attacks occur when catastrophic misinterpretations of ambiguous physical sensations (such as shortness of breath or increased heart rate) increase arousal, creating a positive feedback loop that results in panic. As the major symptom of a terminal illness that threatens our most basic physical requirement, dyspnea in COPD is open to catastrophic misinterpretation. There is some experimental and clinical evidence for the applicability of the cognitive model of panic anxiety in COPD, and of the utility of cognitive behavior therapy (CBT), based on this model, for treating anxiety symptoms and panic attacks in COPD patients. However, there is much need for further studies. Evidence is increasing that mental health professionals, in collaboration with multi-disciplinary pulmonary teams, potentially have key roles to play in preventing and treating panic attacks and panic disorder in COPD patients. This review addresses diagnosis, epidemiology, theoretical conceptualizations, treatment, and recommendations for future research.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-12-2017
Abstract: Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
DOI: 10.1038/AJG.2013.47
Abstract: To test the effectiveness of an interactive online intervention to improve gluten free diet adherence in adults with celiac disease. A Randomized controlled trial was conducted. A total of 189 adults with biopsy-confirmed celiac disease were recruited and randomized to receive the intervention (n=101) or to a waitlist control condition (n=88). Post-intervention data was available for 70 intervention and 64 waitlist participants. Three month follow-up data was obtained for 46/50 completers from the intervention group. The primary outcome measure was gluten-free diet adherence. Secondary outcomes were gluten-free diet knowledge, quality of life and psychological symptoms. Results were based on intention-to-treat analyses. The intervention group evidenced significantly improved gluten-free diet adherence, and gluten-free diet knowledge following the treatment period relative to the waitlist control group. The change in knowledge did not contribute to the change in adherence. These improvements were maintained at 3-month' follow-up. The online program was effective in improving adherence and represents a promising resource for in iduals with celiac disease who are struggling to achieve or maintain adequate gluten free diet adherence.
Publisher: Informa UK Limited
Date: 10-2014
DOI: 10.2147/DMSO.S68428
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JPAIN.2010.11.010
Abstract: The literature regarding pain-related attentional biases is currently marked by considerable inconsistency. The primary aim of the present study was to examine whether 2 stimulus-related factors may be important to the detection of pain-related attentional biases: 1) the personal relevance of stimuli and 2) their ecological validity. To do this, the present research compared the ability of a word-based dot-probe task (ie, lower ecological validity) and picture-based dot-probe task (ie, higher ecological validity) to detect attentional biases using generally selected (ie, lower personal relevance) and idiosyncratically selected stimuli (ie, higher personal relevance). To do this, the present study used a large s le of chronic pain patients and matched pain-free in iduals. Attentional biases were found among both chronic pain patients and pain-free in iduals for idiosyncratically selected pictorial stimuli (ie, highest ecological validity and personal relevance) but not for generally selected pictorial stimuli or for pain-related word stimuli, irrespective of whether they were idiosyncratically or generally selected. These biases were found to stem from vigilance for pain-related stimuli. Overall, the findings of the present study suggest that similar pain-related attentional biases can be found among both pain-free in iduals and chronic pain patients and that stimulus-related factors may be important to the detection of those biases. To date, research examining pain-related attentional biases has yielded inconsistent results. The present study sought to examine 2 stimulus-related factors often identified for their potential to influence the consistency of findings. The findings of this study highlight the importance of considering stimulus-related factors when designing and interpreting pain-related dot-probe research.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 24-10-2017
DOI: 10.1002/EJP.936
Abstract: This study aimed to investigate the effects of fear of pain (FOP) and threat on attentional biases, using eye-tracking methods. One hundred and seven undergraduate students were randomized to receive threatening or reassuring information about the cold pressor task and ided into high and low FOP groups. Participants completed the dot-probe task, while their eye movements were tracked. Results showed that those who received threatening information were less likely to have their first fixation on pain words, particularly affective pain words. Furthermore, under conditions of high threat, the high FOP group who did fixate on affective pain words, fixated more quickly than for sensory pain words, whereas the opposite was the case under low threat. In regression analyses, initial vigilance towards affective pain words was a significant predictor of reporting pain more quickly on the cold pressor. Taken together, these results suggest that initial vigilance of affective pain stimuli predicts actual hypervigilance to an acute experimental pain task. However, under conditions of high threat, participants show evidence of avoidance of affective pain words, even though when they do fixate on these stimuli, the high FOP group does so more quickly. These results confirm that attentional processes, characterized by vigilance avoidance, appear important. Interventions that change attention towards pain to reduce vigilance and subsequent avoidance may be indicated to improve pain outcomes.
Publisher: European Respiratory Society (ERS)
Date: 09-09-2010
DOI: 10.1183/09031936.00060309
Abstract: This study examined whether cognitive behavioural therapy (CBT) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease (COPD). 41 patients with COPD, who had undergone pulmonary rehabilitation, were randomised to either a four-session CBT intervention condition (n = 21) or a routine care condition (n = 20). Assessments were at baseline, post-intervention, and at 6-, 12- and 18-month follow-ups. Primary outcomes were the rates of panic attacks, panic disorder and anxiety symptoms. Secondary outcomes were depressive symptoms, catastrophic cognitions about breathing difficulties, disease-specific quality of life and hospital admission rates. There were no significant differences between the groups on outcome measures at baseline. By the 18-month follow-up assessment, 12 (60%) routine care group participants had experienced at least one panic attack in the previous 6 months, with two (17%) of these being diagnosed with panic disorder, while no CBT group participants experienced any panic attacks during the follow-up phase. There were also significant reductions in anxiety symptoms and catastrophic cognitions in the CBT group at all three follow-ups and a lower number of hospital admissions between the 6- and 12-month follow-ups. The study provides evidence that a brief, specifically targeted CBT intervention can treat panic attacks in COPD patients and prevent the development and worsening of panic-spectrum psychopathology and anxiety symptoms.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.JAD.2009.02.004
Abstract: The Edinburgh Postnatal Depression Scale (EPDS) was developed as a uni-dimensional measure of depression, however there is evidence that it also measures anxiety. This study examined the factor structure of the EPDS and validity of the identified subscales. 309 women with infants aged up to 12 months completed the EPDS, BDI-II, BAI and the SCID-I. Exploratory factor analysis revealed distinct anxiety and depression factors. Confirmatory factor analyses showed the identified two-factor model to be an adequate fit to the data and superior to a uni-dimensional model. An anxiety subscale score of 4 or more detected the presence of an anxiety disorder with sensitivity of 63%, specificity 70%, positive predictive value of 45% and negative predictive value of 81%. All participants were mothers with unsettled infants, a group that is known to have higher than average rates of depression and anxiety. The factor structure of the EPDS may have unique features in this group and so these results may not be generalizable to general postnatal s les. Also, participants in this study ranged from 1 week to 12 months postpartum and there may be variations in the factor structure of the EPDS over this time. The 7-item depression subscale could be used in place of the total scale to identify women with major depression and the 3-item anxiety subscale could be used to identify women with anxiety disorders (occurring co-morbidly with depression or occurring alone). Future research should seek to replicate these findings in a general postnatal s le and to develop anxiety-specific screening tools for use in the postnatal period.
Publisher: Wiley
Date: 27-07-2017
DOI: 10.1002/PPUL.23689
Abstract: Anxiety often presents comorbidly with asthma in youth under 18 however, prevalence rates are unclear. The aim of this review was to provide an up-to-date analysis of the literature investigating the prevalence of anxiety disorders, and comparisons of anxiety disorders and symptomatology in youth with asthma, compared to those without. A systematic search was conducted using the databases PsycINFO, MEDLINE, EMBASE, and CINAHL. The search process produced 15 studies (n = 7443) reporting data on youth with asthma and anxiety disorders, 11 studies (n = 10 332) reporting data on youth with and without asthma and anxiety disorders, and 28 studies (n = 5848) reporting data on youth with and without asthma and anxiety symptomatology. Youth with asthma had an anxiety disorder prevalence rate of 22.7%. Youth with asthma also had a greater number of anxiety disorders, compared to those without asthma (d = 0.37, 95%CI: 0.24-0.50, P < 0.001), and higher levels of anxiety symptomatology than youth without asthma (d = 0.29, 95%CI: 0.19-0.39, P < 0.001). Youth with asthma display a prevalence rate for anxiety disorders that is more than three times higher than the prevalence in healthy youth. For the specific anxiety disorders investigated, elevated prevalence rates for youth with asthma were also found. Future research needs to focus on the factors that mediate or predict the development and maintenance of anxiety in youth with asthma and the development of clinically efficacious treatments.
Publisher: Wiley
Date: 08-03-2017
DOI: 10.1002/EJP.1020
Abstract: This study examined the effects of rumination on attentional processes in relation to an acute experimental pain task. In keeping with recent theory and research, it was hypothesized that we would identify a pattern of attentional bias characterized by enhanced initial vigilance followed by avoidance of pain-related stimuli. Undergraduate students were randomized to a rumination condition, which received threat-inducing information about the cold pressor task, or a distraction condition. Using the dot probe task, attentional biases to sensory and affective pain words were assessed at two presentation intervals (500 and 1250 ms). Those in the rumination condition did not show differences in attentional biases compared to the control group, however, they did respond more quickly to pain congruent trials compared to neutral/neutral trials when affective pain words were presented for 500 ms. In addition, those in the rumination group responded more slowly in congruent trials to neutral/neutral trials than affective/neutral trials indicating avoidance at 1250 ms. Although those in the rumination condition exhibited higher levels of distress and reported higher levels of pain when they withdrew their hands from the cold pressor task, the congruency biases did not predict these results. These results suggest that experimentally manipulating rumination changes attentional processes consistent with the vigilance-avoidance hypothesis. The rumination manipulation led to increased worry about pain and induced to an attentional pattern of vigilance-avoidance for affective pain words. The induction also led to more distress and pain. Rumination and worry appear to increase unhelpful patterns of attention and could be an appropriate focus of intervention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-06-2023
Publisher: Elsevier BV
Date: 10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
DOI: 10.1016/J.PAIN.2014.05.003
Abstract: Research confirms that patients with chronic pain show a tendency to interpret ambiguous stimuli as pain related. However, whether modifying these interpretive pain biases impacts pain outcomes is unknown. This study aimed to demonstrate that interpretation biases towards pain can be modified, and that changing these biases influences pain outcomes in the cold pressor task. One hundred and six undergraduate students were randomly allocated to receive either threatening or reassuring information regarding the cold pressor. They also were randomly allocated to 1 of 2 conditions in the Ambiguous Scenarios Task, in which they were trained to have either a threatening interpretation of pain (pain bias condition) or a nonthreatening interpretation of pain (no pain bias condition). Therefore, the study had a 2 (threat/reassuring)×2 (pain bias/no pain bias) design. Analyses showed that a bias was induced contingent on condition, and that the threat manipulation was effective. Participants in the pain bias condition hesitated more before doing the cold pressor task than those in the no pain bias condition, as did those in the threat compared with the reassurance condition. The major finding was that interpretive bias mediated the relationship between bias condition and hesitance time, supporting the causal role of interpretive biases for avoidance behaviors in current chronic pain models. No differences were found on other pain outcomes regarding bias or threat, and the efficacy of the bias modification was not impacted by different levels of threat. These results suggest that cognitive bias modification should be further explored as a potential intervention in pain.
Publisher: Cambridge University Press (CUP)
Date: 23-09-2008
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000522530
Abstract: b i Introduction: /i /b Psychological adjustment to chronic health conditions is important, as poor adjustment predicts a range of adverse medical and psychosocial outcomes. Psychological treatments demonstrate efficacy for people with chronic health conditions, but existing research takes a disorder-specific approach and they are predominately delivered in face-to-face contexts. The internet and remotely delivered treatments have the potential to overcome barriers to accessing traditional face-to-face treatment. b i Objective: /i /b The current study examined the efficacy and acceptability of an internet-delivered transdiagnostic psychological intervention to promote adjustment to illness, based on cognitive behaviour therapy principles. b i Methods: /i /b In a two-arm randomised controlled trial, participants ( i n /i = 676) were randomly allocated to the 8-week intervention or a waitlist control. Treatment included five core lessons, homework tasks, additional resources, and weekly contact with a psychologist. Primary outcomes included depression, anxiety, and disability, assessed at pre-treatment, post-treatment, 3-month follow-up, and 12-month follow-up. b i Results: /i /b The treatment group reported significantly greater improvements in depression (between-groups i d = /i 0.47), anxiety ( i d /i = 0.32), and disability ( i d /i = 0.17) at post-treatment (all i s /i & #x3c .001). Improvements were sustained over the 3-month and 12-month follow-ups. High treatment completion rates (69%) and levels of satisfaction (86%) were reported by participants in treatment. The intervention required a mean clinician time of 56.70 min per participant. b i Conclusions: /i /b The findings provide preliminary and tentative support for the potential of internet-delivered transdiagnostic interventions to promote adjustment to chronic health conditions. Further research using robust control groups, and exploring the generalisability of findings, is needed before firm conclusions can be drawn.
Publisher: European Respiratory Society (ERS)
Date: 31-07-2010
Publisher: Wiley
Date: 2007
DOI: 10.1002/PON.1104
Abstract: The early detection of pre-cancerous cervical conditions has risen dramatically, prompting more in-depth investigations regarding psychological implications inherent within the diagnosis and treatment of this condition. This study aimed to identify factors that influence women's experience of diagnosis and treatment of cervical abnormalities and factors that facilitate positive adjustment. Using a semi-structured telephone interview, we interviewed 21 women (age 24-54) treated at a colposcopy clinic. Systematic recruitment of women with varying degrees of cervical abnormality (CIN 1-3) and time since treatment was undertaken to ensure representation of all relevant experiences and allow the identification of long-term factors. Coding of audio-taped, transcribed interviews and searching for themes was achieved by using NUD*IST software. The results identified uncertainty, trust and communication as the key factors for women following diagnosis and treatment. The primary concern following diagnosis was related to cancer but changed to a more prominent concern with future reproductive issues in the post-treatment period. The majority of women acknowledged the importance of the doctor's empathic communication style. These findings have important implications for future studies and clinical practice.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.JPSYCHORES.2012.02.001
Abstract: Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled. Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second. Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled. The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions.
Publisher: Wiley
Date: 05-2022
DOI: 10.1002/PON.5944
Abstract: The predominant definition of fear of cancer recurrence (FCR) conflates FCR with fear of progression (FOP). However, this assumption has never been tested. Importantly, if FCR and FOP are distinct and have different predictors, existing interventions for FCR may not be equally effective for survivors who fear progression rather than recurrence of their disease. The present study aimed to determine whether FCR and FOP are empirically equivalent and whether they are predicted by the same theoretically derived variables. Three hundred and eleven adults with a history of breast or ovarian cancer were analysed ( n = 209, 67% in remission). Exploratory factor analysis was conducted on the items of the FCR Inventory severity subscale and short‐form FOP Questionnaire together. Structural equation modelling was conducted to predict FCR and FOP and determine whether theoretical models accounted equally well for both constructs, and whether models were equally relevant to those with and without current disease. The factor analysis demonstrated that the FCR Inventory severity subscale and the short‐form FOP Questionnaire loaded onto distinct, but related, factors which represented FCR and FOP. Structural modelling indicated that risk perception and bodily threat monitoring were more strongly associated with FCR than FOP. However, both FCR and FOP were associated with metacognitions and intrusions. These findings suggest that whilst FCR and FOP are related with some overlapping predictors, they are not the same construct. Hence, it is necessary to ensure that in clinical practice and research these constructs are considered separately.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
DOI: 10.1016/J.PAIN.2008.11.020
Abstract: Evidence that patients with chronic pain selectively attend to pain-related stimuli presented in modified Stroop and dot-probe paradigms is mixed. The pain-related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronic pain, relative to healthy controls, show selective attention for pictures depicting painful faces. To do so, 170 patients with chronic pain and 40 age- and education-matched healthy control participants were tested using a dot-probe task in which painful, happy, and neutral facial expressions were presented. Selective attention was denoted using the mean reaction time and the bias index. Results indicated that, while both groups shifted attention away from happy faces (and towards neutral faces), only the control group shifted attention away from painful faces. Additional analyses were conducted on chronic pain participants after iding them into groups on the basis of fear of pain/(re)injury. The results of these analyses revealed that while chronic pain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronic pain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2019
Publisher: Wiley
Date: 15-01-2019
DOI: 10.1002/PON.4971
Abstract: ConquerFear is a metacognitive intervention for fear of cancer recurrence (FCR) with proven efficacy immmediately and 6 months post-treatment. This qualitative study documented barriers and facilitators to the sustainability of ConquerFear from the perspective of study therapists. Fourteen therapists who had delivered ConquerFear in a randomised controlled trial completed a semi-structured phone interview, reaching theoretical saturation. Themes from thematic analysis were mapped to the Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework. Participants were 13 males and one female with, on average, 14 years psycho-oncology experience. Nine over-arching themes were identified, falling into three domains, which when present, were facilitators, and if absent, were barriers: evidence (intervention credibility, experienced efficacy, perceived need for intervention) context (positive attitude to and capacity for survivorship/FCR care, favourable therapist orientation and flexibility, strong referral pathways) and facilitation of implementation (intervention/service fit, intervention atient fit, and training, support, and provided resources). ConquerFear is a sustainable intervention in routine clinical practise. Facilitators included a sound evidence base a receptive context good fit between the intervention, therapist orientation, and patient need and flexibility of delivery. Where absent, these factors served as barriers. These results have implications for enhancing uptake of psycho-oncology interventions in routine care.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.ADDBEH.2017.04.017
Abstract: Alcohol consumption contributes significantly to the global burden from disease and injury, and specific patterns of heavy episodic drinking contribute uniquely to this burden. Temporal self-regulation theory and the dual-process model describe similar theoretical constructs that might predict heavy episodic drinking. The aims of this study were to test the utility of temporal self-regulation theory in predicting heavy episodic drinking, and examine whether the theoretical relationships suggested by the dual-process model significantly extend temporal self-regulation theory. This was a predictive study with 149 Australian adults. Measures were questionnaires (self-report habit index, cues to action scale, purpose-made intention questionnaire, timeline follow-back questionnaire) and executive function tasks (Stroop, Tower of London, operation span). Participants completed measures of theoretical constructs at baseline and reported their alcohol consumption two weeks later. Data were analysed using hierarchical multiple linear regression. Temporal self-regulation theory significantly predicted heavy episodic drinking (R Both temporal self-regulation theory and the extended temporal self-regulation theory provide good prediction of heavy episodic drinking. Intention, behavioural prepotency, planning ability and inhibitory control may be good targets for interventions designed to decrease heavy episodic drinking.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JPSYCHORES.2014.12.002
Abstract: Anxiety disorders and symptoms are highly prevalent and problematic comorbidities in people with epilepsy (PWE), yet they remain poorly understood and often go undetected. This research aimed to further our understanding about anxiety in PWE. Study 1 assessed the effectiveness of the commonly utilised yet unvalidated measure (Hospital Anxiety Depression Scale-Anxiety subscale HADS-A) to identify DSM-IV anxiety disorders in 147 adult epilepsy outpatients. This study found that although the HADS-A had reasonable specificity (75%), its poor sensitivity (61%) and inadequate area under the curve (.68) deemed it unreliable as a screener for anxiety disorders in this population. Study 2 aimed to further our understanding of the relationship between anxiety disorders, as defined by clinical interview, and psychosocial correlates in PWE. One hundred and twenty-two participants from Study 1 completed a battery of psychosocial measures. Multivariate analysis revealed that the presence of an anxiety disorder was associated with unemployment, which was found to be the only independent predictor. That is, despite the fact that psychosocial factors together contributed to the variance in anxiety disorders none were revealed to be significant independent predictors. These findings add to the literature indicating that the HADS may indicate distress, but does not adequately identify people with anxiety disorders and highlights the urgent need for the development of a reliable anxiety screening measure for PWE. Further, the results suggest that anxiety disorders in PWE are likely to be multiply determined with respect to psychosocial factors and require further investigation.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JANXDIS.2018.09.004
Abstract: Death anxiety has been proposed as a transdiagnostic construct, underlying numerous mental disorders. Although it has been argued that treatments, which reduce death anxiety, are needed, research investigating the impact of interventions on death fears has produced mixed results. As such, the current meta-analysis aimed to examine the effect of psychosocial interventions on death anxiety. Overall, results from 15 randomised controlled trials suggested that psychosocial treatments produced significant reductions in death anxiety, with a small to medium effect size (g = .45). Intervention type (death education vs. therapy) did not significantly moderate the effect of intervention on death anxiety (g = -.47). However, therapy type was a significant moderator of treatment efficacy (g = -1.39). Cognitive Behaviour Therapy was found to be particularly efficacious, producing significant reductions in death anxiety relative to control (g = 1.7), whereas other therapies did not (g = .20). The number of treatment sessions and baseline death anxiety significantly moderated intervention efficacy, whereas the duration of the intervention, training of the interventionist, and clinical nature of the s le did not. Given the small number and generally low quality of the included studies, future research using more rigorous methodology, as well as clinical s les, is needed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-05-2016
DOI: 10.1097/J.PAIN.0000000000000639
Abstract: There is significant interest in the potential of Internet-delivered pain management programs for adults with chronic pain. Understanding the characteristics of people who do and do not benefit from Internet-delivered programs will help to guide their safe and effective use. Using a large s le from a previous randomised controlled trial of an established Internet-delivered pain management program, the Pain Course, this study (n = 463) examined whether several demographic, clinical, psychological, and treatment-related variables could be used to predict clinical response in levels of disability, depression, anxiety, or average pain. Multiple univariate and multivariate stepwise logistic regressions were used to identify unique predictors of clinical improvement, which, consistent with recommendations, was defined as a ≥30% reduction in symptoms or difficulties from baseline. Several unique predictors of clinical improvement were found. However, no particularly decisive or dominant predictors emerged that were common across time points or across the outcome domains. Reflecting this, the identified predictors explained only 18.1%, 13.7%, 7.6%, and 9.5% of the variance in the likelihood of making a clinical improvement in disability, depression, anxiety, and average pain levels, respectively. The current findings suggest that a broad range of patients may benefit from emerging Internet-delivered pain management programs and that it may not be possible to predict who will or will not benefit on the basis of patients' demographic, clinical, and psychological characteristics.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.YEBEH.2012.10.023
Abstract: Despite recent research into the impact of seizure control on mood disorders in epilepsy, it is often assumed that rates of psychiatric disorders are higher in people with refractory rather than well-controlled epilepsy. We assessed the point prevalence of mood and anxiety disorders and suicide risk using the Mini International Neuropsychiatric Interview (MINI) in a consecutive s le of epilepsy outpatients from a tertiary referral center. One hundred and thirty patients, whose epilepsy was categorized as well-controlled versus drug-treatment-refractory epilepsy (69 53% well-controlled epilepsy) were recruited. High rates of mood disorders (n = 34 26%), anxiety disorders (n = 37 29%) and suicide risk (n = 43 33%) were found. However, there was no difference in rates of disorders or suicide risk for those with refractory versus well-controlled epilepsy. These results underscore the importance of assessment and management of psychopathology in all people with epilepsy, regardless of their seizure control.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-07-2012
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.SOCSCIMED.2005.05.007
Abstract: Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the s le 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative s les, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each in idual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the s le. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire s le. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the s le (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses and (3) crime did not precede homelessness for all but one youth however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service development are discussed.
Publisher: SAGE Publications
Date: 06-2008
Abstract: Objective This study aimed to determine the main themes and concerns for women with Multiple Sclerosis when considering motherhood. Method Twenty women with multiple sclerosis from various stages in the decision-making process participated in focus-groups where information was gathered regarding their experiences of making this decision. Results The themes emerging most frequently during the decision-making process were: a) concerns about the mother's own health and well-being b) well-being of the child c) coping with parenting d) societal attitudes e) experiencing parenting and f) timing and pressure of the decision. Conclusion The results indicate that information regarding the effect of MS on pregnancy and child-rearing and the effect of pregnancy on MS and its progression need to be made more accessible to women. Information would be a valuable resource for women going through this decision-making process.
Publisher: Cambridge University Press (CUP)
Date: 07-1994
DOI: 10.1017/S1352465800013096
Abstract: Recent advances have been made in the treatment of post-traumatic stress disorder (PTSD). Cognitive behavioural techniques have been reported in controlled trials to be very effective in reducing arousal symptoms associated with post-traumatic stress disorder, such as sleep disturbance, hypervigilance, intrusive thoughts and flashbacks. It remains unclear from the literature, however, how well these treatment modalities can alleviate post-traumatic stress disorder where the predominant clinical features are associated with depersonalization and dissociative states. Depersonalization is evident in a significant proportion of in iduals presenting with PTSD and yet does not appear to be amenable to exposure based therapies. A case study presented suggests methods through which depersonalization may be addressed within the therapeutic context.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.JPAIN.2015.10.021
Abstract: Motivational interviewing (MI) has become a popular approach for increasing adherence. In this study we investigated whether MI is effective in improving adherence, and pain and physical function for patients with chronic pain. A literature search of randomized controlled trials identified 7 eligible studies with 962 participants with chronic pain. There was a small to moderate overall effect of MI on increased adherence to treatment from baseline to after intervention, but not from baseline to follow-up. Although significant short-term effects of MI were also observed for pain intensity, analyses revealed that this finding might be due to publication bias. There were insufficient studies to examine physical functioning meta-analytically, however, none of the 3 available studies showed that MI resulted in gains in physical function compared with the control group. These results indicate that MI can probably increase short-term adherence to chronic pain treatments, although publication bias cannot be ruled out. Further, it is as yet unclear whether these effects result in improvements in patient function. Although the studies were methodologically strong, they investigated MI in relation to a number of treatments for chronic pain. Future research on the efficacy of MI on adherence to evidence-based self-management interventions for chronic pain is needed. MI significantly increased adherence to prescribed chronic pain treatments in the short term, however, effect sizes were small to moderate and publication bias was likely. MI showed some promise in promotion of adherence to pain treatments, but more research is required to confirm its efficacy.
Publisher: Springer Science and Business Media LLC
Date: 05-11-2014
DOI: 10.1007/S12529-013-9360-8
Abstract: Regular blood glucose monitoring is important for children with type-1 diabetes however, the relationship between maternal fear of hypoglycaemia and glycaemic control is not well understood. The relationship between maternal beliefs about diabetes, concerns about glycaemic control and adherence to recommended blood glucose levels in young children with type-1 diabetes were examined in this study. Seventy-one mothers with children under 13 were recruited, and a prospective design was used. Demographics, maternal self-reported hypoglycaemic fear and illness perceptions were measured at baseline. Self-report daily blood sugar levels were recorded over 1 week, and glycosylated haemoglobin (HbA1c) blood glucose levels were collected at baseline and 3 months later. High maternal fears of hypoglycaemia were predictive of suboptimal daily glycaemic control (elevated blood glucose levels), irrespective of illness duration or age at diagnosis. The results suggest that mothers who worry most about hypoglycaemia compensate by maintaining their child's blood glucose levels above recommended levels. Elevated blood glucose levels have important consequences for long-term health, and further research could explore ways to target maternal fear of hypoglycaemia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2005
DOI: 10.1016/J.PAIN.2005.09.032
Abstract: The aims of this study were threefold. Firstly, to investigate the effect of increasing threat-expectancy on attentional biases towards pain-related words. Secondly, to determine the interaction between threat-expectancy and the effectiveness of two coping strategies on pain threshold and tolerance. Thirdly, to investigate the relationship between fear of pain and the experimental manipulations. One hundred undergraduate psychology students were randomly assigned to receive either threat-increasing or reassuring information about the cold pressor task. After reading the information, all participants completed the dot-probe task for four categories of pain-related words. Following the dot-probe task, participants were randomly allocated to one of two coping strategy conditions (focusing on affective vs sensory aspects of pain). Participants then completed the cold pressor task while engaging in the relevant coping strategy. There was a significant effect of threat on bias towards affective vs sensory pain words. Participants in the threat condition showed a stronger bias towards affective pain words. In contrast, the no-threat condition displayed a stronger bias towards sensory pain words. Significant interaction effects were observed between threat and coping strategy for threshold and tolerance. These results indicated that focusing on sensory pain sensations was helpful in the absence of threat, however, in the presence of threat was relatively unhelpful in comparison to focusing on the affective components of pain. The present results provide support for the fear-avoidance model of pain [Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000 :317-332] and confirm the importance of threat-expectancy in hypervigilance towards pain and fear avoidance.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.YEBEH.2018.05.023
Abstract: There is an elevated prevalence of anxiety disorders among people with epilepsy, and the comorbidity of anxiety in epilepsy is associated with adverse medical and psychosocial outcomes. Despite its importance, little is known about what psychosocial or epilepsy factors may be associated with the development of anxiety. The aim of this qualitative study was to determine what factors may explain why some people with epilepsy develop anxiety disorders and others do not. Adults with epilepsy were recruited from an outpatient epilepsy service. Semistructured interviews were conducted with 26 participants, 15 of whom reported clinically significant levels of anxiety. Grounded theory analysis was used to develop a theoretical model of anxiety development in the context of epilepsy. Qualitative analyses revealed a number of processes that appeared to account for the development of anxiety in the context of epilepsy. These included inflated estimates regarding epilepsy-specific risks and excessive attempts to avoid these risks. Such excessive avoidance often resulted in greater interference with participants' role functioning, thus risking ongoing quality of life. A number of premorbid and contextual factors also appear to be implicated in the development of anxiety. This investigation provides a comprehensive account for the development of anxiety in epilepsy, which is consistent with existing theories of anxiety development and maintenance. Importantly, this model provides a foundation for future research and appropriate treatment strategies to address anxiety in people with epilepsy.
Publisher: S. Karger AG
Date: 1998
DOI: 10.1159/000012284
Abstract: b Background: /b Health outcome is multi-faceted, and for both research and clinical practice, greater knowledge of its facets is required. The Pictorial Representation of Illness and Self Measure (PRISM) was developed as a simple, rapid measure of the current impact of illness and symptoms on the in idual. b Methods: /b The PRISM task was completed by 26 outpatients with rheumatoid arthritis participating in a larger study of psychosocial correlates of arthritis, which included assessment of disease variables, functional impairment, pain, depression and patients’ appraisals of their illness. In the PRISM task, the patient was asked to imagine that a small board represents his/her life and a fixed disk on the board represents his/her ‘self’. The task was to place another (Illness) disk on the board to represent the current importance of illness in the patients’ life. The main outcome measure was the distance between the Self and Illness disks. b Findings: /b Only 2 patients had difficulty understanding the task. PRISM distance did not correlate with any disease variables. It correlated inversely with pain, functional impairment and depression, and positively with coping resources. PRISM distance correlated with perceived control over illness and negatively with awareness of illness. b Interpretation: /b PRISM is an innovative measure, simple and well accepted by patients. It appears to measure what in German is termed i leidensdruck /i , the burden of suffering due to illness. It offers a promising measure of an intangible but important health outcome, hitherto neglected, applicable to research interventions and clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2017
DOI: 10.1007/S10597-016-0077-4
Abstract: This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment (2) types of decisions (3) treatment uncertainty and balancing act and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.
Publisher: Wiley
Date: 23-07-2013
DOI: 10.1002/EAT.22041
Abstract: The aim of this study was to conduct a preliminary evaluation of Children's Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues. Overweight children (ages 6-12 years old) were randomized to either the CAAT treatment group (N = 23), to receive 1-h treatment sessions over 6 weeks, or a wait-list group (N = 24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a 6-month follow-up for those in the CAAT group. The intervention had a significant, short-term effect on the BMI of children who participated. Although at 6-month follow-up, children's BMI has not increased significantly, the difference between pretreatment and follow-up BMI was no longer significant. These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 10-2023
End Date: 09-2026
Amount: $510,087.00
Funder: Australian Research Council
View Funded ActivityStart Date: 05-2021
End Date: 05-2024
Amount: $506,237.00
Funder: Australian Research Council
View Funded ActivityStart Date: 2018
End Date: 12-2020
Amount: $339,018.00
Funder: Australian Research Council
View Funded ActivityStart Date: 03-2009
End Date: 06-2011
Amount: $75,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 04-2012
End Date: 12-2014
Amount: $185,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 03-2015
End Date: 12-2017
Amount: $294,900.00
Funder: Australian Research Council
View Funded ActivityStart Date: 01-2007
End Date: 06-2010
Amount: $212,000.00
Funder: Australian Research Council
View Funded Activity