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Necaise A, Amon MJ. Peer Support for Chronic Pain in Online Health Communities: Quantitative Study on the Dynamics of Social Interactions in a Chronic Pain Forum. J Med Internet Res 2024; 26:e45858. [PMID: 39235845 DOI: 10.2196/45858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/20/2024] [Accepted: 06/24/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Peer support for chronic pain is increasingly taking place on social media via social networking communities. Several theories on the development and maintenance of chronic pain highlight how rumination, catastrophizing, and negative social interactions can contribute to poor health outcomes. However, little is known regarding the role web-based health discussions play in the development of negative versus positive health attitudes relevant to chronic pain. OBJECTIVE This study aims to investigate how participation in online peer-to-peer support communities influenced pain expressions by examining how the sentiment of user language evolved in response to peer interactions. METHODS We collected the comment histories of 199 randomly sampled Reddit (Reddit, Inc) users who were active in a popular peer-to-peer chronic pain support community over 10 years. A total of 2 separate natural language processing methods were compared to calculate the sentiment of user comments on the forum (N=73,876). We then modeled the trajectories of users' language sentiment using mixed-effects growth curve modeling and measured the degree to which users affectively synchronized with their peers using bivariate wavelet analysis. RESULTS In comparison to a shuffled baseline, we found evidence that users entrained their language sentiment to match the language of community members they interacted with (t198=4.02; P<.001; Cohen d=0.40). This synchrony was most apparent in low-frequency sentiment changes unfolding over hundreds of interactions as opposed to reactionary changes occurring from comment to comment (F2,198=17.70; P<.001). We also observed a significant trend in sentiment across all users (β=-.02; P=.003), with users increasingly using more negative language as they continued to interact with the community. Notably, there was a significant interaction between affective synchrony and community tenure (β=.02; P=.02), such that greater affective synchrony was associated with negative sentiment trajectories among short-term users and positive sentiment trajectories among long-term users. CONCLUSIONS Our results are consistent with the social communication model of pain, which describes how social interactions can influence the expression of pain symptoms. The difference in long-term versus short-term affective synchrony observed between community members suggests a process of emotional coregulation and social learning. Participating in health discussions on Reddit appears to be associated with both negative and positive changes in sentiment depending on how individual users interacted with their peers. Thus, in addition to characterizing the sentiment dynamics existing within online chronic pain communities, our work provides insight into the potential benefits and drawbacks of relying on support communities organized on social media platforms.
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Affiliation(s)
- Aaron Necaise
- School of Modeling, Simulation, and Training, University of Central Florida, Orlando, FL, United States
| | - Mary Jean Amon
- Department of Informatics, Luddy School of Informatics, Computing, and Engineering, Indiana University Bloomington, Bloomington, IN, United States
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Yang Y, Mischkowski D. Integrating intra- and interpersonal perspectives on chronic low back pain: the role of emotion regulation and attachment insecurity. Front Psychol 2024; 15:1331227. [PMID: 38680279 PMCID: PMC11050035 DOI: 10.3389/fpsyg.2024.1331227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Chronic low back pain (CLBP) is burdensome and interferes with psychological and physical functioning of those affected. Past research has examined interpersonal (e.g., attachment insecurity) or intrapersonal factors (e.g., emotion regulation [ER]) involved in chronic pain. However, to enhance our understanding of CLBP's biopsychosocial underpinnings, more empirical integration of both intra- and interpersonal factors involved in CLBP is needed. Thus, our study examined the independent and joint associations of insecure attachment dimensions and ER strategies with CLBP severity and interference. Methods We recruited 242 US adults with CLBP through Prolific Academic, an online participant pool. Participants from Prolific Academic were eligible for the study if they were at least 18 years of age, resided in the US, reported CLBP at least half the days over the past 6 months (>3 months), and used prescribed pain medication for their CLBP. Data collection was between November 2021 and February 2022. Eligible participants filled out a Qualtrics survey which consisted of measures assessing insecure attachment dimensions, ER strategies, as well as demographical information. Outcome variables in the present study were CLBP severity and interference. We ran multiple linear regression models to examine the associations between ER strategies and insecure attachment dimensions as predictors, and CLBP severity or interference as predicted variables, after controlling for sex as a covariate; we also conducted moderation analyses to investigate the interactions between ER strategies and insecure attachment dimensions when testing associations with CLBP severity or interference. Results Our results indicated that, after controlling for ER strategies, anxious attachment was positively associated with CLBP interference but not pain severity (CI: 0.101 to 0.569; CI: -0.149 to 0.186); avoidant attachment was not associated with CLBP interference or severity (CI: -0.047 to 0.511; CI: -0.143 to 0.256). After adjusting for anxious and avoidant attachment, emotional expression and expressive suppression were positively associated with CLBP severity (CI: 0.037 to 0.328; CI: 0.028 to 0.421) but not interference (CI: -0.003 to 0.403; CI: -0.406 to 0.143). Furthermore, emotional expression was associated with CLBP severity and interference at low and medium levels of avoidant attachment (CI: 0.165 to 0.682; CI: 0.098 to 0.455); expressive suppression and cognitive reappraisal did not interact with attachment dimensions when examining CLBP severity or interference (CIs: LLs ≤ -0.291 to ULs ≥ 0.030). Conclusion Our study shows that anxious attachment may be an interpersonal risk factor related to CLBP, above and beyond intrapersonal ERs, as anxious attachment was associated with higher levels of pain interference. Furthermore, emotional expression was associated with increased CLBP severity and interference, particularly among individuals at low and medium levels of avoidant attachment. Existing studies on chronic pain have mostly focused on examining intrapersonal or interpersonal correlates in isolation. The present study extends our understanding of CLBP by considering the role of interpersonal factors (i.e., insecure attachment dimensions), in combination with intrapersonal ER strategies. Given the correlational nature of the present study, longitudinal studies are needed to establish causality between psychosocial correlates and CLBP symptoms. Ultimately, we hope our integrated approach will facilitate the development of treatments and interventions tailored to address patients' attachment-related needs, enhancing the management and maintenance of CLBP among patients.
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Affiliation(s)
- Yixin Yang
- Department of Psychology, Ohio University, Athens, OH, United States
| | - Dominik Mischkowski
- Department of Psychology, University of Illinois at Urbana- Champaign, Champaign, IL, United States
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Kow S, Rieger B, Morse K, Keens T, Wu S. The positive impact of journaling on adolescents with cystic fibrosis. Pediatr Pulmonol 2024; 59:63-71. [PMID: 37772647 DOI: 10.1002/ppul.26708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) often have psychological difficulties on top of their medically complex care, such as anxiety, depression, and medical mistrust. These have been shown to be associated with worse adherence, pulmonary function test results, and other health outcomes. In this pilot trial, we implemented a journaling program based on narrative therapy methodology to improve mental and physical health outcomes for individuals with CF. METHODS Eight adolescents aged 12-17 with a confirmed diagnosis of CF followed in a single center CF clinic were emailed weekly journaling prompts that explored topics like treatment adherence, feeling different with CF, anxiety, depression, and interpersonal relationships. Subjects completed surveys about their experience with the writing assignment and measures of wellness including the Pediatric Symptom Checklist (PSC-17) and baseline health data was collected from the electronic medical records. RESULTS The average score for the PSC-17 decreased by 5.5 points, and fell to less than 28 (mean 23.5, SD 12.2), which is the cutoff for screening positive for behavioral or emotional problems. Participants reported the study was enjoyable and had improvement in feelings of anxiety/depression. 100% of participants responded "Strongly Agree" to the statement "I recommend other people with CF to write about the topics from this study." CONCLUSIONS The journaling intervention for individuals with CF was feasible and well received. Initial results show improvement in PSC-17 and other well-being measures. Further studies are needed to evaluate the impact of journaling on mental health and disease outcomes.
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Affiliation(s)
- Sean Kow
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Brenda Rieger
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kimberly Morse
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas Keens
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Susan Wu
- Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
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Raudenská J, Šteinerová V, Vodičková Š, Raudenský M, Fulková M, Urits I, Viswanath O, Varrassi G, Javůrková A. Arts Therapy and Its Implications in Chronic Pain Management: A Narrative Review. Pain Ther 2023; 12:1309-1337. [PMID: 37733173 PMCID: PMC10616022 DOI: 10.1007/s40122-023-00542-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
Chronic nonmalignant pain is recognized as a complex, dynamic, phenomenological interplay between biological, psychological, and social factors that are individual to the person suffering from it. Therefore, its management and treatment ought to entail the individual's biopsychosocial aspects that are often addressed by collaborative, inter/multidisciplinary multimodal care, as there is no biologic treatment. In an effort to enhance inter/multidisciplinary multimodal care, a narrative review of arts therapy as a mind-body intervention and its efficacy in chronic pain populations has been conducted. Changes in emotional and physical symptoms, especially pain intensity, during arts therapy sessions have also been discussed in in the context of attention distraction strategy. Arts therapy (visual art, music, dance/movement therapy, etc.) have been investigated to summarize relevant findings and to highlight further potential benefits, limitations, and future directions in this area. We reviewed 16 studies of different design, and the majority reported beneficial effects of art therapy in patients' management of chronic pain and improvement in pain, mood, stress, and quality of life. However, the results are inconsistent and unclear. It was discovered that there is a limited amount of high-quality research available on the implications of arts therapy in chronic nonmalignant pain management. Due to the reported limitations, low effectiveness, and inconclusive findings of arts therapy in the studies conducted so far, further research with improved methodological standards is required.
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Affiliation(s)
- Jaroslava Raudenská
- Department of Nursing, 2nd Medical School and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Veronika Šteinerová
- Amsterdam Emotional Memory Lab, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Martin Raudenský
- Department of Art Education, Faculty of Education, Charles University, Prague, Czech Republic
| | - Marie Fulková
- Department of Art Education, Faculty of Education, Charles University, Prague, Czech Republic
| | - Ivan Urits
- Southcoast Physicians Group Pain Medicine, Southcoast Health, Wareham, MA, USA
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | | | - Alena Javůrková
- Department of Nursing, 2nd Medical School and University Hospital Motol, Charles University, Prague, Czech Republic
- Department of Clinical Psychology, 3rd Medical Faculty, University Hospital KV, Prague, Czech Republic
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Junghaenel DU, Schneider S, Lucas G, Boberg J, Weinstein FM, Richeimer SH, Stone AA, Lumley MA. Virtual Human-Delivered Interviews for Patients With Chronic Pain: Feasibility, Acceptability, and a Pilot Randomized Trial of Standard Medical, Psychosocial, and Educational Interviews. Psychosom Med 2023; 85:627-638. [PMID: 37363989 PMCID: PMC10527278 DOI: 10.1097/psy.0000000000001228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Seminal advances in virtual human (VH) technology have introduced highly interactive, computer-animated VH interviewers. Their utility for aiding in chronic pain care is unknown. We developed three interactive telehealth VH interviews-a standard pain-focused, a psychosocial risk factor, and a pain psychology and neuroscience educational interview. We then conducted a preliminary investigation of their feasibility, acceptability, and efficacy. We also experimentally compared a human and a computer-generated VH voice. METHODS Patients ( N = 94, age = 22-78 years) with chronic musculoskeletal pain were randomly assigned to the standard ( n = 31), psychosocial ( n = 34), or educational ( n = 29) VH interview and one of the two VH voices. Acceptability ratings included patient satisfaction and expectations/evaluations of the VH interview. Outcomes assessed at baseline and about 1-month postinterview were pain intensity, interference, emotional distress, pain catastrophizing, and readiness for pain self-management. Linear mixed-effects models were used to test between- and within-condition effects. RESULTS Acceptability ratings showed that satisfaction with the VH and telehealth format was generally high, with no condition differences. Study attrition was low ( n = 5). Intent-to-treat-analyses showed that, compared with the standard interview, the psychosocial interview yielded a significantly greater reduction in pain interference ( p = .049, d = 0.43) and a marginally greater reduction in pain intensity ( p = .054, d = 0.36), whereas the educational interview led to a marginally greater yet nonsignificant increase in readiness for change ( p = .095, d = 0.24), as well as several significant improvements within-condition. Results did not differ by VH voice. CONCLUSIONS Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education.
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Affiliation(s)
- Doerte U. Junghaenel
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, CA, USA
| | - Stefan Schneider
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
- Leonard Davis School of Gerontology, University of Southern California, CA, USA
| | - Gale Lucas
- Institute for Creative Technologies, University of Southern California, CA, USA
- Viterbi School of Engineering, University of Southern California, CA, USA
| | - Jill Boberg
- Institute for Creative Technologies, University of Southern California, CA, USA
| | - Faye M. Weinstein
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, CA, USA
| | - Steven H. Richeimer
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, CA, USA
| | - Arthur A. Stone
- Dornsife Center for Self-Report Science and Center for Economic & Social Research, University of Southern California, CA, USA
- Department of Psychology, University of Southern California, CA, USA
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, MI, USA
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Yildirim M, Akbal S, Turkoglu M. The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial. Appl Nurs Res 2023; 72:151687. [PMID: 37423676 DOI: 10.1016/j.apnr.2023.151687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/15/2023] [Accepted: 05/06/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery. AIM To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. METHODS This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS). RESULTS The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group. CONCLUSIONS Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery. CLINICALTRIALS gov Identifier: NCT05487430.
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Affiliation(s)
- Meltem Yildirim
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M(3)O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain.
| | - Sevim Akbal
- Trakya University, Kesan Hakki Yoruk School of Health, Department of Nursing, Hersekzade Yerleskesi Yeni Mah., Yusuf Capraz Cad., No:13, 22880 Izzetiye Koyu/Kesan/Edirne, Turkey.
| | - Meryem Turkoglu
- Istanbul Mehmet Akif Ersoy, Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi, Istasyon, Turgut Ozal Bulvari No:11, 34303 Kucukcekmece/Istanbul, Turkey
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Storytelling of Young Adults with Chronic Rheumatologic Illnesses: A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10101979. [PMID: 36292429 PMCID: PMC9601485 DOI: 10.3390/healthcare10101979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Narrative medicine allows patients to reconstruct medical experiences through written portrayals of perspectives, building a mutual depiction of illness while creating a sense of belonging. This modality has not been previously studied in youth with rheumatologic illnesses, a population with high mental health burden and worse health-related quality of life. We aimed to assess the feasibility of a storytelling intervention in this patient population. Methods: This is a mixed-methods study of 14−21-year-olds with rheumatologic diseases followed in the Bronx, NY. Participants completed an hour-long creative writing session focused on patient experience with chronic disease. Pre- and post-questionnaires assessed patient-reported outcomes, and post-participation video interviews assessed personal experiences through the storytelling session. Results: Thirteen female patients were divided amongst four creative writing sessions. Twelve patients completed pre-study questionnaires and 10 completed post-study questionnaires, with 100% completion of the post-participation interviews. PedsQL surveys showed statistically significant improvement in physical health (p < 0.02), and there was no significant difference between pre- and post-scores for any other questionnaires. Interview thematic domains included writing motivation, prior writing experience, illness experience, relating to others, relationship with providers, and support. Conclusion: Creative writing is a feasible and acceptable intervention for youth with rheumatologic illnesses.
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Brownlow BN. How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 18:576-596. [PMID: 36179058 DOI: 10.1177/17456916221113762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically and contemporarily, Black Americans have been compelled to use effortful coping styles characterized by high behavioral and emotional restraint in the face of systematic racism. Lynch and colleagues have previously conceptualized a class of regulatory strategies-overcontrolled coping-characterized by emotional suppression, hypervigilance for threat, and high distress tolerance, which bear close analogy to coping styles frequently used among individuals facing chronic racial stress. However, given the inherent culture of racism in the United States, engaging in highly controlled coping strategies is often necessitated and adaptive, at least in the short term. Thus, for Black Americans this class of coping strategies is conceptualized as culturally compelled coping rather than overcontrolled coping. In the current article, I offer a critical examination of the literature and introduce a novel theoretical model-culturally compelled coping-that culturally translates selected components of Lynch's model. Cultural translation refers to considering how the meaning, function, and consequences of using overcontrolled coping strategies changes when considering how Black Americans exist and cope within a culture of systematic racism. Importantly, this model may offer broad implications for future research and treatment by contextualizing emotion regulation as a central mechanism, partially answering how racism "gets under the skin" and affects the health of Black Americans.
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Kundakci B, Kaur J, Goh SL, Hall M, Doherty M, Zhang W, Abhishek A. Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:1432-1445. [PMID: 34813518 DOI: 10.1097/j.pain.0000000000002500] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
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Affiliation(s)
- Burak Kundakci
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- cCentre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jaspreet Kaur
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Siew Li Goh
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Michelle Hall
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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Valtonen J. The Health Benefits of Autobiographical Writing: An Interdisciplinary Perspective. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:1-19. [PMID: 32440974 PMCID: PMC8664792 DOI: 10.1007/s10912-020-09631-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A large body of experimental evidence in the empirical sciences shows that writing about life experiences can be beneficial for mental and physical health. While empirical data regarding the health benefits of writing interventions have been collected in numerous studies in psychology and biomedicine, this literature has remained almost entirely disconnected from scholarship in the humanities and cognitive neuropsychology. In this paper, I review the literature from psychological and biomedical writing interventions, connect these findings to views from philosophy, cognitive neuropsychology and narratology and argue that examining established regularities in how narratives are structured can shed further light on the psychological processes engaged during writing interventions. In particular, I argue that the narratological concept of conflict can be applied to resolve patterns of seemingly conflicting empirical findings in psychological studies. More generally, I propose that an interdisciplinary perspective can provide a broader theoretical basis for understanding the psychological processes underlying the health benefits of autobiographical writing and provide directions for future research in psychology and biomedicine.
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Affiliation(s)
- Jussi Valtonen
- Department of Psychology, New York University, 6 Washington Place, New York, NY, 10003, USA.
- Theatre Academy, University of the Arts Helsinki, P.O. Box 20, FI-00097, Helsinki, Finland.
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland.
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Levis M, Levis A. Contrasting narratives: a randomised control study comparing Conflict Analysis and narrative disclosure. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2021. [DOI: 10.1080/03069885.2021.1970111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, Hartford, VT, USA
- Psychiatry Department, Dartmouth College, Hanover, NH, USA
- Museum of the Creative Process, Manchester, VT, USA
| | - Albert Levis
- Museum of the Creative Process, Manchester, VT, USA
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Samami E, Shahhosseini Z, Elyasi F. The Effect of Psychological Interventions on the Quality of Life in Women with Fibromyalgia: A Systematic Review. J Clin Psychol Med Settings 2021; 28:503-517. [PMID: 34216335 DOI: 10.1007/s10880-021-09794-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
Fibromyalgia refers to a painful type of rheumatological clinical syndrome, and its prevalence varies from 0.7% to 6.6%. This syndrome is associated with different physical and psychological symptoms, which ultimately leads to a decline in women's quality of life. A wide range of pharmacological and non-pharmacological interventions are conducted to mitigate these symptoms and improve the quality of life. Therefore, the present study aims to investigate the effect of psychological interventions on the quality of life in women with fibromyalgia. This systematic review with comprehensive search was carried out on Google Scholar, Scopus, PubMed, Web of Science, Science Direct, Cochrane Library, PsycINFO, and Scientific Information Database (SID), databases using the suitable keywords, and a total of 3125 articles from 2000 to 2019 were retrieved. Finally, the quality of 16 experimental and semi-experimental clinical trials was evaluated using the Jadad scale. The psychological interventions affecting the quality of life in women with fibromialgia included cognitive-behavioral therapy and behavioral therapy, coping strategies training, mindfulness, acceptance and commitment treatment, hypnosis, meditation, music therapy, short-term psychodynamic psychotherapy and writing emotions. The results of the study showed that except four studies, the studies generally improved the quality of life and reduced the symptoms in women with fibromyalgia. The results of the study suggest that most psychological interventions affect the quality of life in women with fibromyalgia. Therefore, besides pharmacological therapy, psychological interventions can be used by health-care providers to reduce the symptoms of fibromyalgia and improve the quality of their life.
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Affiliation(s)
- Elahe Samami
- Department of Reproductive Health and Midwifery, Student of Midwifery Counseling, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Shahhosseini
- Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. .,Department of Psychiatry, School Of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. .,Consultation-Liaison Psychiatry Ward, Imam Khomeini General Hospital, Razi Ave., Sari, 48157-33971, Iran.
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McInnerney D, Kupeli N, Stone P, Anantapong K, Chan J, Flemming K, Troop N, Candy B. Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors. Palliat Med 2021; 35:1323-1343. [PMID: 34053341 PMCID: PMC8267079 DOI: 10.1177/02692163211013248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emotional disclosure is the therapeutic expression of emotion. It holds potential as a means of providing psychological support. However, evidence of its efficacy in palliative settings is mixed. This may be due to variation in intervention characteristics. AIM To derive a greater understanding of the characteristics of potentially effective emotional disclosure-based interventions in palliative care by:(1) Developing a taxonomy of emotional disclosure-based interventions tested in people with advanced disease and(2) Mapping and linking objectives, outcomes, underlying mechanisms, and implementation factors. DESIGN A scoping review drawing on Intervention Component Analysis to combine evidence from studies' methods, results, and discussion sections. DATA SOURCES Six databases were searched to May 2020 including CINAHL, PsycINFO, and MEDLINE. Studies of emotional disclosure in adults with advanced disease were included. Study quality was appraised using an established tool. RESULTS Seven thousand seven hundred ninety-two unique records were screened, of which 25 primary studies were included. Intervention characteristics were grouped into classes within three domains: topic of disclosure, format, and dose. Evidence was not available to determine which, if any, of the characteristics is most effective. Thematic synthesis of evidence from methods and discussion sections identified factors to consider in tailoring an emotional disclosure-based intervention to this setting, including: population characteristics (e.g. time since diagnosis), providing a safe environment, and flexibility in format. CONCLUSIONS This review approach facilitated a clearer understanding of factors that may be key in developing emotional disclosure-based interventions for palliative populations. Intervention Component Analysis has potential for application elsewhere to help develop evidence-based interventions.
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Affiliation(s)
- Daisy McInnerney
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Nuriye Kupeli
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Paddy Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Kanthee Anantapong
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Justin Chan
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Nicholas Troop
- Department of Psychology, Sports and Geography, University of Hertfordshire, Hertfordshire, UK
| | - Bridget Candy
- Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK
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Positive and negative emotional expression measured from a single written essay about trauma predicts survival 17 years later in people living with HIV. J Psychosom Res 2020; 136:110166. [PMID: 32559504 DOI: 10.1016/j.jpsychores.2020.110166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether expression of positive and negative emotions measured within a single written trauma essay predicts survival over 17 years in people living with HIV. METHODS This is a longitudinal, observational study of a volunteer sample of HIV-seropositive individuals at the mid-range of disease (150-500 CD4-cells/mm3 with no prior AIDS-defining symptoms). Exclusion criteria included substance dependence, dementia, and/or psychosis. Baseline assessments occurred between 1997 and 1999 and survival data was collected in 2014 (17 year follow up). At baseline, participants wrote an essay about the most traumatic event in their life. Emotional expression was measured by the number of positive and negative emotional words in the essay. The primary study outcome measure was survival from baseline. Biomedical covariates included CD4 count, viral load, age, and antiretroviral medications. Sociodemographic covariates included gender, race, and education. RESULTS The sample was diverse in terms of age (M [SD] 37.60 [9.07]), sex (70.7% male), sexual orientation (55.5% gay or bisexual), and race/ethnicity (37.2% African American, 30.5% white, 28.0% Hispanic, and 4.3% other). Positive, negative, and total emotional expression predicted greater survival (ps < 0.015). Those in the top third of total emotional expression had 3.83 times the survival rate (95% CI: 1.62, 9.02) of those in the bottom third. Odds ratios were 1.85 for positive emotion expression and 2.18 for negative emotion expression. CONCLUSIONS Both positive and negative emotions expressed in a written trauma essay predict survival over 17 years in people living with HIV. Expressing emotions may have benefits for health.
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Abstract
OBJECTIVE Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. METHODS We briefly review the leading evidence-based psychological therapies for chronic pain-cognitive-behavioral and acceptance/mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. RESULTS Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. CONCLUSIONS This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.
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Affiliation(s)
- Mark A Lumley
- From the Department of Psychology (Lumley), Wayne State University, Detroit, Michigan; and Department of Internal Medicine (Schubiner), Providence-Providence Park Hospital, Ascension Health, and Michigan State University College of Human Medicine, Southfield, Michigan
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De Almeida‐Marques FX, Sánchez‐Blanco J, Sanduvete‐Chaves S, Cano‐García FJ. Causal attributions of potentially traumatic life events in fibromyalgia patients. Int J Rheum Dis 2019; 22:2170-2177. [DOI: 10.1111/1756-185x.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Francisco X. De Almeida‐Marques
- Department of Personality, Psychological Assessment and Treatment Faculty of Psychology Universidad de Sevilla Seville Spain
| | | | - Susana Sanduvete‐Chaves
- Department of Experimental Psychology Faculty of Psychology Universidad de Sevilla Seville Spain
| | - Francisco J. Cano‐García
- Department of Personality, Psychological Assessment and Treatment Faculty of Psychology Universidad de Sevilla Seville Spain
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17
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Renzi A, Solano L, Di Trani M, Ginobbi F, Minutolo E, Tambelli R. The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment. Psychol Health 2019; 35:718-733. [PMID: 31549861 DOI: 10.1080/08870446.2019.1667500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: World Health Organization reported that in developed countries one in four couples experience infertility with serious implications for the psychophysical well-being. Aim of this study was to evaluate the effects of Pennebaker's writing technique on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment (ART).Method: 91 women admitted for an ART were randomly divided into two groups: an experimental one (n = 46), where women wrote about their thoughts and emotions concerning the infertility experience, and a control group (n = 45) where women did not write. All subjects completed a socio-demographic questionnaire, the 20-item Toronto Alexithymia Scale and the Symptoms Checklist-90-R before and after the writing sessions.Results: A significant difference in pregnancy rates between the experimental group (n = 13) and the control group (n = 5) was found (χ2 = 4.216; p < .04). A significant difference was also found between women who participated in the study (experimental + control= 91) and women who declined to participate, in the direction of more ART successes (n = 18 vs. n = 0) in the group of women who participated (χ2 = 10.17; p < .01).Conclusions: The findings support the usefulness of the writing technique during ART in promoting treatment success.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi Solano
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Elisa Minutolo
- Department of Reproductive Medicine, Altamedica-Artemisia SpA, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Abstract
OBJECTIVE This study investigated whether childhood adversity would be associated with hypersensitivity on two measures of central pain facilitation: area of secondary allodynia and temporal summation of second pain (TSSP), and whether pain facilitation would be explained by adult posttraumatic stress disorder (PTSD) symptoms. METHOD Participants endorsing high (n = 31) and low (n = 31) childhood adversity underwent capsaicin-induced secondary allodynia and TSSP testing. The tests were conducted a week apart with test order counterbalanced. RESULTS Larger areas of secondary allodynia were observed in the high adversity group compared with the low adversity group (F(1,60) = 4.81, p = .032). This group difference was largely (62%) explained by greater PTSD symptoms in the high adversity group. Although no overall difference was found in TSSP slopes (p = .886), this was attributed to an order by group interaction (F(1,58) = 5.07, p = .028) and low power. Subsequent analyses revealed positive TSSP slopes in the high adversity group when TSSP testing was performed first, and this order effect was associated with blunted sympathetic responses to TSSP on the first visit. The two facilitation measures were unrelated (p = .631). CONCLUSIONS Larger areas of secondary allodynia were observed in the high adversity group, which was explained largely by PTSD symptoms. This suggests that adversity-related changes in pain facilitation may underlie the association between childhood adversity and generalized widespread pain. Although TSSP was affected by previous testing, adversity-related pain facilitation was observed when TSSP testing occurred first. Finally, adversity was not associated with a consistent pattern of hypersensitivity across the two measures of central pain facilitation.
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Fibromyalgia and rheumatoid arthritis: Personality and psychopathology differences from the Minnesota Multiphasic Personality Inventory-2. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pavlacic JM, Buchanan EM, Maxwell NP, Hopke TG, Schulenberg SE. A Meta-Analysis of Expressive Writing on Posttraumatic Stress, Posttraumatic Growth, and Quality of Life. REVIEW OF GENERAL PSYCHOLOGY 2019. [DOI: 10.1177/1089268019831645] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Expressive writing is beneficial for promoting both positive psychological and physical health outcomes. Unfortunately, inhibiting emotions is related to impairments in psychological and physical health. James Pennebaker and others have used expressive writing as an experimental manipulation to gauge its efficacy in treating a wide variety of physical and psychological outcomes. While many studies have been conducted that examine the efficacy of expressive writing across such outcomes, a considerable amount of these studies tend to neglect necessary considerations, such as different levels of symptomatology, power, and meaningfulness of respective effect sizes. Six previous meta-analyses have been conducted that examine expressive writing’s effect on psychological outcomes. However, these studies focus on the experimental versus control group effect size. Thus, our meta-analysis sought to examine the efficacy of an expressive writing task on only the experimental conditions in studies measuring posttraumatic stress, posttraumatic growth, and quality of life using random effects models. Results indicated a small overall effect size for posttraumatic stress and negligible to small effect sizes for posttraumatic growth and quality of life. However, those studies requiring a diagnosis of posttraumatic stress disorder (PTSD) exhibited a medium to large effect size. Implications for future research design and interpretation of published research are discussed.
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21
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Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR Ment Health 2018; 5:e11290. [PMID: 30530460 PMCID: PMC6305886 DOI: 10.2196/11290] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Positive affect journaling (PAJ), an emotion-focused self-regulation intervention, has been associated with positive outcomes among medical populations. It may be adapted for Web-based dissemination to address a need for scalable, evidence-based psychosocial interventions among distressed patients with medical conditions. OBJECTIVE This study aimed to examine the impact of a 12-week Web-based PAJ intervention on psychological distress and quality of life in general medical patients. METHODS A total of 70 adults with various medical conditions and elevated anxiety symptoms were recruited from local clinics and randomly assigned to a Web-based PAJ intervention (n=35) or usual care (n=35). The intervention group completed 15-min Web-based PAJ sessions on 3 days each week for 12 weeks. At baseline and the end of months 1 through 3, surveys of psychological, interpersonal, and physical well-being were completed. RESULTS Patients evidenced moderate sustained adherence to Web-based intervention. PAJ was associated with decreased mental distress and increased well-being relative to baseline. PAJ was also associated with less depressive symptoms and anxiety after 1 month and greater resilience after the first and second month, relative to usual care. CONCLUSIONS Web-based PAJ may serve as an effective intervention for mitigating mental distress, increasing well-being, and enhancing physical functioning among medical populations. PAJ may be integrated into routine medical care to improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT01873599; https://clinicaltrials.gov/ct2/show/NCT01873599 (Archived by WebCite at http://www.webcitation.org/73ZGFzD2Z).
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Affiliation(s)
- Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States.,Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Jillian A Johnson
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Brandon J Auer
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Giampaolo Talamo
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christopher N Sciamanna
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
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Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain 2018; 158:2354-2363. [PMID: 28796118 DOI: 10.1097/j.pain.0000000000001036] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with fibromyalgia (FM) experience increased lifetime levels of psychosocial adversity, trauma, and emotional conflict. To address these risk factors, we developed emotion awareness and expression therapy (EAET) and tested its benefits against an active control condition, FM education, and the field's gold standard intervention for FM, cognitive behavioral therapy (CBT) for symptom management. Adults with FM (N = 230) formed 40 treatment groups, which were randomized to EAET, CBT, or education and given 8, 90-minute sessions. Patient-reported outcomes were assessed at baseline, posttreatment, and 6-month follow-up (primary end point). Retention of patients to follow-up was excellent (90.4%). Intent-to-treat analyses indicated that although EAET did not differ from FM education on pain severity (primary outcome), EAET had significantly better outcomes than FM education on overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect, and life satisfaction (between-condition d's ranging from 0.29-0.45 SD) and the percentage of patients reporting being "very much/much" improved (34.8% vs 15.4%). Emotional awareness and expression therapy did not differ from CBT on the primary or most secondary outcomes, but compared to CBT, EAET led to significantly lower FM symptoms (d = 0.35) and widespread pain (d = 0.37) and a higher percentage of patients achieving 50% pain reduction (22.5% vs 8.3%). In summary, an intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was well received, more effective than a basic educational intervention, and had some advantages over CBT on pain. We conclude that EAET should be considered as an additional treatment option for FM.
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Memarian N, Torre JB, Haltom KE, Stanton AL, Lieberman MD. Neural activity during affect labeling predicts expressive writing effects on well-being: GLM and SVM approaches. Soc Cogn Affect Neurosci 2018; 12:1437-1447. [PMID: 28992270 PMCID: PMC5629828 DOI: 10.1093/scan/nsx084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/19/2017] [Indexed: 01/07/2023] Open
Abstract
Affect labeling (putting feelings into words) is a form of incidental emotion regulation that could underpin some benefits of expressive writing (i.e. writing about negative experiences). Here, we show that neural responses during affect labeling predicted changes in psychological and physical well-being outcome measures 3 months later. Furthermore, neural activity of specific frontal regions and amygdala predicted those outcomes as a function of expressive writing. Using supervised learning (support vector machines regression), improvements in four measures of psychological and physical health (physical symptoms, depression, anxiety and life satisfaction) after an expressive writing intervention were predicted with an average of 0.85% prediction error [root mean square error (RMSE) %]. The predictions were significantly more accurate with machine learning than with the conventional generalized linear model method (average RMSE: 1.3%). Consistent with affect labeling research, right ventrolateral prefrontal cortex (RVLPFC) and amygdalae were top predictors of improvement in the four outcomes. Moreover, RVLPFC and left amygdala predicted benefits due to expressive writing in satisfaction with life and depression outcome measures, respectively. This study demonstrates the substantial merit of supervised machine learning for real-world outcome prediction in social and affective neuroscience.
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Affiliation(s)
| | | | | | - Annette L Stanton
- Department of Psychology.,Department of Psychiatry/Biobehavioral Sciences, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Matthew D Lieberman
- Department of Psychology.,Department of Psychiatry/Biobehavioral Sciences, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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El bèze Rimasson D, Bouvet C, Hamdi H. La gestion des émotions et ses déficits, chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping. PSYCHOLOGIE FRANCAISE 2018. [DOI: 10.1016/j.psfr.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Jensen-Johansen MB, O’Toole MS, Christensen S, Valdimarsdottir H, Zakowski S, Bovbjerg DH, Jensen AB, Zachariae R. Expressive writing intervention and self-reported physical health out-comes - Results from a nationwide randomized controlled trial with breast cancer patients. PLoS One 2018; 13:e0192729. [PMID: 29474441 PMCID: PMC5825018 DOI: 10.1371/journal.pone.0192729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/24/2018] [Indexed: 11/18/2022] Open
Abstract
The objective was to examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect. Women who had recently completed treatment for primary breast cancer (n = 507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic. Results revealed no group by time interaction effects for any outcomes. Moderation analyses showed that 1) low alexithymic women in the EWI group showed larger decreases in GP telephone calls over time than both high alexithymic women and controls and 2) women in the EWI group writing about their own cancer, but not women writing about other topics, showed a larger decrease than controls. The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure might have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.
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Affiliation(s)
| | - Mia S. O’Toole
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, University of Aarhus, Aarhus, Denmark
- * E-mail:
| | - Søren Christensen
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, University of Aarhus, Aarhus, Denmark
| | - Heiddis Valdimarsdottir
- Reykjavik University, Reykjavik, Iceland
- Mount Sinai School of Medicine, New York, United States of America
| | - Sandra Zakowski
- Illinois School of Professional Psychology, Argosy University, Chicago, United States of America
| | - Dana H. Bovbjerg
- Biobehavioral Oncology Program, UPMC Hillman Cancer Center, Pittsburgh, PA, United States of America
- Departments of: Psychiatry, Psychology, Behavioral Community Health Sciences and Health & Community Systems, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Anders B. Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, University of Aarhus, Aarhus, Denmark
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Almeida-Marques FXD, Sánchez-Blanco J, Cano-García FJ. Hypnosis is More Effective than Clinical Interviews. Int J Clin Exp Hypn 2018; 66:3-18. [PMID: 29319461 DOI: 10.1080/00207144.2018.1396104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To determine whether hypnosis is more effective than conventional interviewing to find traumatic life events in patients with fibromyalgia, we carried out a within-subject experimental design with complete intragroup counterbalancing. Thirty-two women under care in a public primary care center gave 2 identical interviews, with an interval of 3 months, in which the occurrence of traumatic life events was explored, once in a state of wakefulness and once in a state of hypnosis. The state of consciousness was evaluated using 3 measures: bispectral index, skin conductance level, and pain intensity. In the hypnotic state, the patients expressed 9.8 times more traumatic life events than in the waking state, a statistically significant difference with a large effect size.
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Affiliation(s)
| | - José Sánchez-Blanco
- b South Seville Area Health Authority , Andalusian Health Service , Seville , Spain
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Wardecker BM, Edelstein RS, Quas JA, Cordon IM, Goodman GS. Emotion Language in Trauma Narratives is Associated with Better Psychological Adjustment among Survivors of Childhood Sexual Abuse. JOURNAL OF LANGUAGE AND SOCIAL PSYCHOLOGY 2017; 36:628-653. [PMID: 29180832 PMCID: PMC5701514 DOI: 10.1177/0261927x17706940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Traumatized individuals are often encouraged to confront their experiences by talking or writing about them. However, survivors of childhood sexual abuse (CSA) might find it especially difficult to process abuse experiences, particularly when the abuse is more severe, which could put them at greater risk for mental health problems. The current study examined whether CSA survivors who use emotion language when describing their abuse experiences exhibit better mental health. We analyzed the trauma narratives of 55 adults who, as children, were part of a larger study of the long-term emotional effects of criminal prosecutions on CSA survivors. Abuse narratives were analyzed using the Linguistic Inquiry and Word Count (LIWC) program. We examined whether positive and negative emotion language in participants' abuse narratives were associated with self- and caregiver-reported mental health symptoms and whether these associations differed according to the severity of the abuse. As hypothesized, participants who used more positive and negative emotion language had better psychological outcomes, especially when the abuse was severe. Our findings suggest that survivors of more severe abuse might benefit from including emotion language, whether positive or negative in valence, when describing the abuse.
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Affiliation(s)
- Britney M Wardecker
- Department of Psychology, University of Michigan, Ann Arbor, 530 Church Street, Ann Arbor, MI 48109 USA
| | - Robin S Edelstein
- Department of Psychology, University of Michigan, Ann Arbor, 530 Church Street, Ann Arbor, MI 48109 USA
| | - Jodi A Quas
- Department of Psychology and Social Behavior, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697 USA
| | - Ingrid M Cordon
- Department of Psychology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
| | - Gail S Goodman
- Department of Psychology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616 USA
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Tonarelli A, Cosentino C, Artioli D, Borciani S, Camurri E, Colombo B, D'Errico A, Lelli L, Lodini L, Artioli G. Expressive writing. A tool to help health workers. Research project on the benefits of expressive writing. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:13-21. [PMID: 29189701 PMCID: PMC6357577 DOI: 10.23750/abm.v88i5-s.6877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/23/2022]
Abstract
Background and Aims: Numerous studies in the international literature hold that expressive writing is a useful tool to take care of the person as a whole. It gives voice to emotions, moods and intimate thoughts of patients, as well as caregivers and family members. The reference model is based on Pennebaker’s theory (2004), which posits that expressing our deeper thoughts and feelings can result in significant health benefits in the short and long term. Studies over the past 25 years have shown that expressive writing, that is, simple writing on deeper thoughts and emotional sensations, is a useful tool to alleviate both physical and psychological symptoms. This research seeks to ascertain whether and how expressive writing has an impact on work satisfaction, coping strategies, and relational communication satisfaction of health practitioners. Methods: a comparison was made between the expressive writing and neutral writing of two randomized groups of health care professionals. A group of 66 healthcare professionals participated in this study. They were evaluated pre- and post-intervention using several scales and an ad hoc questionnaire, with one-month follow-up. Results: After analyzing the texts, as in Pennebaker’s studies, there was a reduction of words with negative emotion in the course of writing sessions. Discussion: Expressive writing has a positive impact on adaptive coping strategies and work relational communication satisfaction. It also can facilitate the clarification and solution of various problems, increase cognitive abilities, and promote social interactions.
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Ziadni MS, Carty JN, Doherty HK, Porcerelli JH, Rapport LJ, Schubiner H, Lumley MA. A life-stress, emotional awareness, and expression interview for primary care patients with medically unexplained symptoms: A randomized controlled trial. Health Psychol 2017; 37:282-290. [PMID: 29154608 DOI: 10.1037/hea0000566] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lifetime trauma, relationship adversities, and emotional conflicts are elevated in primary care patients with medically unexplained symptoms (MUS), and these risk factors likely trigger or exacerbate symptoms. Helping patients disclose stressors, increase awareness and expression of inhibited emotions, and link emotions to physical symptoms may improve health. We developed an emotional awareness and expression interview that targets stressful life experiences and conflicts and then tested its effects on primary care patients with MUS. METHOD Patients (N = 75) with MUS were recruited at a family medicine clinic and randomized to an interview condition or treatment-as-usual (TAU) control condition. In a single 90-min interview in the clinic, the interviewer elicited disclosure of the patient's stressors, linked them to the patient's symptom history, and encouraged emotional awareness and expression about unresolved relationship trauma or conflict. At baseline and 6-week follow-up, patients completed self-report measures of their physical and psychological health. RESULTS Analyses of covariance, controlling for baseline symptoms, compared patients in the interview condition with TAU at 6-week follow-up. Compared with TAU, the interview led to significantly lower pain severity, pain interference, sleep problems, and global psychological symptoms. CONCLUSIONS This study provides preliminary evidence for the value of integrating a disclosure and emotional awareness and expression interview into the primary care setting for patients with MUS. (PsycINFO Database Record
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Poole JL, Siegel P. Effectiveness of Occupational Therapy Interventions for Adults With Fibromyalgia: A Systematic Review. Am J Occup Ther 2017; 71:7101180040p1-7101180040p10. [PMID: 28027041 DOI: 10.5014/ajot.2017.023192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review addresses the effectiveness of occupational therapy-related interventions for adults with fibromyalgia. METHOD We examined the literature published between January 2000 and June 2014. A total of 322 abstracts from five databases were reviewed. Forty-two Level I studies met the inclusion criteria. Studies were evaluated primarily with regard to the following outcomes: daily activities, pain, depressive symptoms, fatigue, and sleep. RESULTS Strong evidence was found for interventions categorized for this review as cognitive-behavioral interventions; relaxation and stress management; emotional disclosure; physical activity; and multidisciplinary interventions for improving daily living, pain, depressive symptoms, and fatigue. There was limited to no evidence for self-management, and few interventions resulted in better sleep. CONCLUSION Although the evidence supports interventions within the scope of occupational therapy practice for people with fibromyalgia, few interventions were occupation based.
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Affiliation(s)
- Janet L Poole
- Janet L. Poole, PhD, OTR/L, FAOTA, is Professor and Program Director, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque;
| | - Patricia Siegel
- Patricia Siegel, OTD, OTR/L, CHT, is Lecturer II, Occupational Therapy Graduate Program, University of New Mexico, Albuquerque
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Bowers H, Wroe AL, Pincus T. 'Isn't it ironic?' Beliefs about the unacceptability of emotions and emotional suppression relate to worse outcomes in fibromyalgia. Clin Rheumatol 2017; 36:1121-1128. [PMID: 28255740 PMCID: PMC5400783 DOI: 10.1007/s10067-017-3590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 01/24/2023]
Abstract
Beliefs about the unacceptability of experiencing and expressing emotions have been found to be related to worse outcomes in people with persistent physical symptoms. The current study tested mediation models regarding emotional suppression, beliefs about emotions, support-seeking and global impact in fibromyalgia. One hundred eighty-two participants took part in an online questionnaire testing potential mechanisms of this relationship using mediation analysis. The model tested emotional suppression and affective distress as serial mediators of the relationship between beliefs about emotions and global impact. In parallel paths, two forms of support-seeking were tested (personal/emotional and symptom-related support-seeking) as mediators. Emotional suppression and affective distress significantly serially mediated the relationship between beliefs about emotions and global impact. Neither support-seeking variable significantly mediated this relationship. Results indicate a potential mechanism through which beliefs about emotions and global impact might relate which might provide a theoretical basis for future research on treatments for fibromyalgia.
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Affiliation(s)
- Hannah Bowers
- Psychology Department, Royal Holloway University of London, Egham, TW10 0EX, UK.
| | - Abigail L Wroe
- Department of Clinical Psychology, Royal Holloway University of London, Egham, UK
| | - Tamar Pincus
- Psychology Department, Royal Holloway University of London, Egham, TW10 0EX, UK
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Ziemer KS, Fuhrmann A, Hoffman MA. Effectiveness of a Positive Writing Intervention for Chronic Pain: A Randomized Trial. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/24708593.2017.1307893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kathryn Schaefer Ziemer
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
| | - Amy Fuhrmann
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
| | - Mary Ann Hoffman
- The Department of Counseling, Special Education and Higher Education, University of Maryland, College Park, MD, USA
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Perrot S, Launay A, Desjeux D, Cedraschi C. Pain patients' letters: The visit before the visit - A qualitative analysis of letters from patients referred to a tertiary pain center. Eur J Pain 2017; 21:1020-1030. [PMID: 28169480 DOI: 10.1002/ejp.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pain centers manage only selected patients, and have long waiting lists. Some patients spontaneously send letters, before the visit, and these letters represent the first contact between the patients and the pain centers. We report a study of the content and format of these letters, for a patient perspective analysis. METHODS During a 3 month-period, all newly referred patients to a tertiary pain center were considered. If a patient letter was provided, it was collected for analysis. Qualitative analyses including semantic and content analyses were performed to identify themes and categories. RESULTS Among 138 newly referred patients, 44 had sent a letter before consultation. Content analysis of 42 letters disclosed four themes: I) pain experience; II) impact of the pain problem; III) patient history; and IV) expectations. These themes could be distributed along four pain dimensions: (1) physical; (2) psycho-affective; (3) social; and (4) temporal. This first study on patient letters reveals that a bio-psychosocial model. Patients contribute actively to their trajectory, not only as healthcare seekers but also by constructing their narrative identity. CONCLUSIONS Patient letters constitute narrative material to be integrated into clinical analysis, alongside patient interviews, especially in pain management. Pain specialists should take account of this narrative approach to better understand the unvoiced and sometimes silent experience of pain. This may increase quality of medical care by including patient-centered data in an original method. Further studies may be valuable to analyze the possible contributions of such letters to patient management. SIGNIFICANCE Patients' letters constitute original narrative material to be integrated into clinical analysis, especially for pain management. Patients' letters analyses may improve the patient physician relationship, by understanding patient's perspectives, beliefs and expectations.
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Affiliation(s)
- S Perrot
- Pain Center, Cochin Hotel-Dieu Hospital, INSERM U 987, Paris Descartes University, Paris, France
| | - A Launay
- Pain Center, Cochin Hotel-Dieu Hospital, INSERM U 987, Paris Descartes University, Paris, France
| | - D Desjeux
- Department of Anthropology and Education, Paris Descartes University, Paris, France
| | - C Cedraschi
- Pain Center, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.,Division of General Medical Rehabilitation, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Nyssen OP, Taylor SJC, Wong G, Steed E, Bourke L, Lord J, Ross CA, Hayman S, Field V, Higgins A, Greenhalgh T, Meads C. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Health Technol Assess 2017; 20:vii-xxxvii, 1-367. [PMID: 27071807 DOI: 10.3310/hta20270] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched. DATA SOURCES Databases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015). REVIEW METHODS Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately under International Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. OBJECTIVES To review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom. RESULTS From 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) -0.61, 95% confidence interval (CI) -0.96 to -0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted across all of the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD -0.04 95% CI -0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW. LIMITATION Difficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure. CONCLUSIONS Overall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003343. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de la Princesa, Instituto de Investigación, Sanitaria Princesa (IP), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Steed
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liam Bourke
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Joanne Lord
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Carol A Ross
- Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Sheila Hayman
- Medical Foundation for the Care of Victims of Torture, London, UK
| | - Victoria Field
- Freelance experienced therapeutic writing practitioner, International Federation for Biblio/Poetry Therapy, Steamboat Springs, CO, USA
| | - Ailish Higgins
- Health Economics Research Group, Brunel University, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Travagin G, Margola D, Dennis JL, Revenson TA. Letting Oneself Go Isn't Enough: Cognitively Oriented Expressive Writing Reduces Preadolescent Peer Problems. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2016; 26:1048-1060. [PMID: 28453210 DOI: 10.1111/jora.12279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Peer problems are a stressor for many early adolescents, and simple cost-effective tools for managing peer stress are needed. Expressive writing (EW) may be one such tool. With a sample of middle school children aged 12-14 years (n = 119; 53% males), this research evaluates whether cognitively oriented expressive writing (CEW), which focuses more on psychological self-distancing, improves personal well-being better than traditional EW, which focuses more on emotional disclosure. CEW-compared with EW-slightly enhanced long-term social adjustment for the entire sample, and increased positive affect for those early adolescents that reported more peer problems at baseline. These findings suggest that structured writing instructions with early adolescents may be key to improvements.
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Butcher HK, Gordon JK, Ko JW, Perkhounkova Y, Cho JY, Rinner A, Lutgendorf S. Finding Meaning in Written Emotional Expression by Family Caregivers of Persons With Dementia. Am J Alzheimers Dis Other Demen 2016; 31:631-642. [PMID: 27574336 PMCID: PMC7241250 DOI: 10.1177/1533317516660611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study tested the effect of written emotional expression on the ability to find meaning in caregiving and the effects of finding meaning on emotional state and psychological burden in 91 dementia family caregivers. In a pretest-posttest design, participants were randomly assigned to either an experimental or a comparison group. Experimental caregivers (n = 57) wrote about their deepest thoughts and feelings about caring for a family member with dementia, whereas those in the comparison group (n = 34) wrote about nonemotional topics. Results showed enhanced meaning-making abilities in experimental participants relative to comparison participants, particularly for those who used more positive emotion words. Improved meaning-making ability was in turn associated with psychological benefits at posttest, but experimental participants did not show significantly more benefit than comparison participants. We explore the mediating roles of the meaning-making process as well as some of the background characteristics of the individual caregivers and their caregiving environments.
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Affiliation(s)
| | - Jean K Gordon
- Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
| | - Ji Woon Ko
- Department of Nursing Science, Sun Moon University, Asan, Chungcheongnam-do, South Korea
| | - Yelena Perkhounkova
- Office for Nursing Research and Scholarship, The University of Iowa College of Nursing, Iowa City, IA, USA
| | - Jun Young Cho
- Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
| | - Andrew Rinner
- Information Technology Services, University of Iowa, Iowa City, IA, USA
| | - Susan Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, IA, USA
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Creswell JD, Lam S, Stanton AL, Taylor SE, Bower JE, Sherman DK. Does Self-Affirmation, Cognitive Processing, or Discovery of Meaning Explain Cancer-Related Health Benefits of Expressive Writing? PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016; 33:238-50. [PMID: 17259584 DOI: 10.1177/0146167206294412] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although expressive writing has positive effects on health, little is known about the underlying psychological mechanisms for these effects. The present study assessed self-affirmation, cognitive processing, and discovery of meaning as potential mediators of the effects of expressive writing on physical health in early-stage breast cancer survivors. A content analysis of the essays showed that self-affirmation writing was associated with fewer physical symptoms at a 3-month follow-up assessment, with self-affirmation writing fully mediating the effects of the emotional expression and benefit-finding writing conditions on reduced physical symptoms. Cognitive processing and discovery of meaning writing were not associated with any physical health outcomes. Consistent with evidence showing that self-affirmation plays an important role in buffering stress, the present study provides the first evidence for self-affirmation as a viable mechanism underlying the health benefits of expressive writing.
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Affiliation(s)
- J David Creswell
- University of California, Department of Psychology, Los Angeles, CA 90095-1563, USA.
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Cash TV, Lageman SK. Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers. BMC Psychol 2015; 3:44. [PMID: 26621025 PMCID: PMC4666161 DOI: 10.1186/s40359-015-0101-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Parkinson’s disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers. Methods Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention. Results Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions. Conclusions Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population. Trial registration ClinicalTrials.gov, NCT02217735, Study Start Date: August 30, 2011. Electronic supplementary material The online version of this article (doi:10.1186/s40359-015-0101-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Therese Verkerke Cash
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Psychology, Virginia Commonwealth University, Richmond, USA.
| | - Sarah K Lageman
- Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. .,Department of Neurology, Virginia Commonwealth University, Richmond, USA.
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Zhou C, Wu Y, An S, Li X. Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0131802. [PMID: 26151818 PMCID: PMC4494859 DOI: 10.1371/journal.pone.0131802] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 06/05/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Numerous randomized controlled trials (RCTs) have arrived at conflicting conclusions on expressive writing (EW) as an intervention for breast cancer (BC) patients, but there has been no meta-analysis of these studies to assess the effectiveness of EW in BC population. METHODS PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL and the www.clinicaltrial.gov database on ongoing clinical trials were searched to identify all the RCTs investigating efficacy of EW on the physical and psychological health in BC patients. The risk of bias of the original studies was assessed using the Cochrane Collaboration's tool. Our primary outcomes for physical and psychological health were respectively negative somatic symptoms and negative mood which were stratified by emotional, benefit-finding and multiple prompts in sub-group analyses. The data were analyzed using Review Manager 5.2 and Stata version 12.0 statistical software. RESULTS Of the 5,232 titles screened, we identified 11 RCTs with a total of 1,178 participants. The pooled results showed a significant effect of EW using either an emotional prompt or a benefit-finding prompt on reducing negative somatic symptoms in BC patients in the ≤3-month follow-up group [Mean Difference (MD), -13.03, 95% CI, -19.23 to -6.83, P<0.0001; MD, -9.18, 95% CI, -15.57 to -2.79, P = 0.005]. There was no significant effect of EW on physical health in the >3-month follow-up group. There were no significant differences regarding psychological health indexes between EW intervention and control groups at any of the follow-up time-points (P>0.05). CONCLUSION This systematic review and meta-analysis reveals that EW intervention may have a significantly positive impact on the physical health but not the psychological health in BC patients, but this benefit may not last long. However, further high-quality studies with more homogeneity are needed to confirm the current findings.
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Affiliation(s)
- Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shengli An
- Department of Bio-Statistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaojin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Rodham K, Gavin J, Coulson N, Watts L. Co-creation of information leaflets to meet the support needs of people living with complex regional pain syndrome (CRPS) through innovative use of wiki technology. Inform Health Soc Care 2015; 41:325-39. [PMID: 25710714 DOI: 10.3109/17538157.2015.1008491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE People living with complex regional pain syndrome (CRPS) experience frustration with the lack of knowledge and understanding of CRPS as a pain condition. We report on our attempt to address this issue. METHODS People living with CRPS taking part in a larger study were invited to co-construct a CRPS wiki page that addressed the areas in which they had experienced the most difficulty. A blank wiki page was set up for participants to populate with issues they felt needed to be raised and addressed. RESULTS Participants failed to engage with the wiki technology. We modified our procedure and completed an inductive analysis of a sister-forum which participants were using as part of the larger study. Six issues of importance were identified. We used the discussion forum threads to populate the themes. Due to a continued lack of engagement with the wiki technology, the team decided to create a suite of leaflets which were piloted with delegates at a CRPS patient conference. CONCLUSIONS Future work should be mindful of the extent to which patients are able and willing to share their experiences through such technology. Striking the balance between patient-endorsed and researcher-driven co-creation of such material is imperative.
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Affiliation(s)
- Karen Rodham
- a School of Psychology, Sport and Exercise, Staffordshire University , Stoke-on-Trent , UK
| | - Jeff Gavin
- b Department of Psychology , University of Bath , Bath , UK
| | - Neil Coulson
- c Division of Rehabilitation and Ageing , University of Nottingham , Nottingham , UK
| | - Leon Watts
- d Department of Computer Science , University of Bath , Bath , UK
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A pilot study on the effects and feasibility of compassion-focused expressive writing in Day Hospice patients. Palliat Support Care 2014; 10:115-22. [PMID: 24650433 DOI: 10.1017/s1478951512000181] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Research has found that writing about stress can confer physical and psychological health benefits on participants and that adopting a self-compassionate stance may have additional benefits. This pilot study evaluated a self-compassionate expressive writing intervention in a Day Hospice setting. METHOD Thirteen patients with life-limiting illnesses wrote on two occasions about recent stressful experiences. Half also received a self-compassion instruction for their writing. Outcome measures were taken at baseline and one week after the second writing session, and text analysis was used to identify changes in the types of words used, reflecting changes in psychological processes. RESULTS Patients given the self-compassion instruction increased in their self-soothing and self-esteem in contrast to patients in the stress-only condition. Happiness broadly increased in both groups although reported levels of stress generally increased in patients given the self-compassion instruction but decreased in patients in the stress-only condition. Those given the self-compassion instruction also increased in their use of causal reasoning words across the two writing sessions compared with those in the stress-only condition. SIGNIFICANCE OF RESULTS Expressive writing appears to be beneficial in patients at a hospice and was viewed as valuable by participants. The inclusion of a self-compassion instruction may have additional benefits and a discussion of the feasibility of implementing expressive writing sessions in a Day Hospice is offered.
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Vincent A, Benzo RP, Whipple MO, McAllister SJ, Erwin PJ, Saligan LN. Beyond pain in fibromyalgia: insights into the symptom of fatigue. Arthritis Res Ther 2014; 15:221. [PMID: 24289848 PMCID: PMC3978642 DOI: 10.1186/ar4395] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.
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Hevey D, Wilczkiewicz E. Changes in language use mediate expressive writing's benefits on health-related quality of life following myocardial infarction. Health Psychol Behav Med 2014; 2:1053-1066. [PMID: 25750834 PMCID: PMC4345899 DOI: 10.1080/21642850.2014.971801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 09/29/2014] [Indexed: 11/14/2022] Open
Abstract
The present study assessed linguistic mediators on the effects of expressive writing on health-related quality of life (HRQOL), depression and anxiety following myocardial infarction (MI). One hundred and twenty-one cardiac patients were randomised (expressive writing = 61; control = 60), 98 (expressive writing = 47; control = 51) provided pre- and post-data, with 89 (expressive writing = 43; control = 46) completing the three-month follow-up. The expressive writing group wrote (20 mins/day for three consecutive days) about their thoughts and feelings regarding their MI, and the control group wrote (20 mins/day for three consecutive days) about daily events that occurred during the year prior to the MI. The outcome measures of depression, anxiety and HRQOL were completed pre-randomisation, post-intervention and three months post-intervention; the mediating variables assessed were changes in (a) positive emotion words, (b) negative emotion words and (c) cognitive-processing words. Three months post-intervention, the expressive writing group had significantly higher HRQOL. The positive effects of expressive writing were significantly associated with increases in both positive emotion words and cognitive-processing words across the three days of expressive writing. Expressive writing is a beneficial intervention that may enhance HRQOL among cardiac patients.
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Affiliation(s)
- David Hevey
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin , Dublin , Ireland ; Department of Cardiology, Beaumont Hospital , Dublin , Ireland
| | - Eva Wilczkiewicz
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin , Dublin , Ireland
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Constantinou E, Van Den Houte M, Bogaerts K, Van Diest I, Van den Bergh O. Can words heal? Using affect labeling to reduce the effects of unpleasant cues on symptom reporting. Front Psychol 2014; 5:807. [PMID: 25101048 PMCID: PMC4106456 DOI: 10.3389/fpsyg.2014.00807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/07/2014] [Indexed: 12/29/2022] Open
Abstract
Processing unpleasant affective cues induces elevated momentary symptom reports, especially in persons with high levels of symptom reporting in daily life. The present study aimed to examine whether applying an emotion regulation strategy, i.e. affect labeling, can inhibit these emotion influences on symptom reporting. Student participants (N = 61) with varying levels of habitual symptom reporting completed six picture viewing trials of homogeneous valence (three pleasant, three unpleasant) under three conditions: merely viewing, emotional labeling, or content (non-emotional) labeling. Affect ratings and symptom reports were collected after each trial. Participants completed a motor inhibition task and self-control questionnaires as indices of their inhibitory capacities. Heart rate variability was also measured. Labeling, either emotional or non-emotional, significantly reduced experienced affect, as well as the elevated symptoms reports observed after unpleasant picture viewing. These labeling effects became more pronounced with increasing levels of habitual symptom reporting, suggesting a moderating role of the latter variable, but did not correlate with any index of general inhibitory capacity. Our findings suggest that using an emotion regulation strategy, such as labeling emotional stimuli, can reverse the effects of unpleasant stimuli on symptom reporting and that such strategies can be especially beneficial for individuals suffering from medically unexplained physical symptoms.
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Affiliation(s)
- Elena Constantinou
- Health Psychology Group, Department of Psychology, University of Leuven Leuven, Belgium
| | - Maaike Van Den Houte
- Health Psychology Group, Department of Psychology, University of Leuven Leuven, Belgium
| | - Katleen Bogaerts
- Health Psychology Group, Department of Psychology, University of Leuven Leuven, Belgium
| | - Ilse Van Diest
- Health Psychology Group, Department of Psychology, University of Leuven Leuven, Belgium
| | - Omer Van den Bergh
- Health Psychology Group, Department of Psychology, University of Leuven Leuven, Belgium
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Bryan JL, Lu Q. Vision for improvement: Expressive writing as an intervention for people with Stargardt's disease, a rare eye disease. J Health Psychol 2014; 21:709-19. [PMID: 24934432 DOI: 10.1177/1359105314536453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study implemented and evaluated the effectiveness of an expressive writing intervention among patients with Stargardt's disease, a rare disease due to macular degeneration. Participants were randomly assigned to either an expressive writing intervention or a neutral writing condition. Participants completed measures at three time points: baseline, 3 weeks, and 6 weeks post-intervention. Psychological health outcomes improved at the 3-week follow-up for the intervention condition compared to control. Self-reported physical health improved at the 6-week follow-up in the intervention condition compared to control. These results suggest that expressive writing may be an effective, practical, and low-cost intervention for those with Stargardt's disease.
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Abstract
OBJECTIVE This study investigated the effects of written emotional disclosure on a model of chronic pain in healthy women with and without trauma history. METHOD Participants were prescreened for their trauma history (N = 78) and randomized to a disclosure or a control writing condition. Pain testing occurred either 1 day or 1 month after disclosure. Capsaicin was applied to the forearm to evoke spontaneous burning pain at the application site and mechanical secondary hyperalgesia in the surrounding untreated skin. RESULTS As hypothesized, the effect of disclosure on the area and intensity of secondary hyperalgesia depended on trauma history and time of testing (F(1,69) ≥ 7.37, p = .008). Disclosure increased secondary hyperalgesia in participants with trauma history compared with those without trauma when testing occurred 1 day after writing (F(1,69) ≥ 5.27, p ≤ .025), whereas the opposite pattern was observed 1 month later (F(1,69) ≥ 4.88, p ≤ .031). Of the participants with trauma history in the disclosure condition, secondary hyperalgesia was reduced at 1 month compared with 1 day after writing (p = .001). Moreover, greater use of positive emotional words predicted reduced secondary hyperalgesia at 1 month (β = -0.71, p = .022). In contrast, disclosure had no effect on spontaneous pain. CONCLUSIONS Disclosure modulates secondary hyperalgesia observed in women with trauma history, producing a short-term enhancement and a long-term reduction. This suggests that disclosure has a long-term protective effect that reduces sensitization of pain, which may explain the therapeutic effects of disclosure in patients with chronic pain.
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Lumley MA, Keefe FJ, Mosley-Williams A, Rice JR, McKee D, Waters SJ, Partridge RT, Carty JN, Coltri AM, Kalaj A, Cohen JL, Neely LC, Pahssen JK, Connelly MA, Bouaziz YB, Riordan PA. The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. J Consult Clin Psychol 2014; 82:644-58. [PMID: 24865870 DOI: 10.1037/a0036958] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. METHOD We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. RESULTS Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. CONCLUSIONS The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.
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Affiliation(s)
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - John R Rice
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Daphne McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Sandra J Waters
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | | | | | | | | | | | | | - Mark A Connelly
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Yelena B Bouaziz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Paul A Riordan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Martínez MP, Sánchez AI, Miró E, Lami MJ, Prados G, Morales A. Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia. THE JOURNAL OF PSYCHOLOGY 2014; 149:115-40. [PMID: 25511201 DOI: 10.1080/00223980.2013.844673] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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PeñAcoba Puente C, Velasco Furlong L, Écija Gallardo C, Cigarán Méndez M, McKenney K. Anxiety, Depression and Alexithymia in Fibromyalgia: Are There Any Differences According to Age? J Women Aging 2013; 25:305-20. [DOI: 10.1080/08952841.2013.816221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lumley MA, Sklar ER, Carty JN. Emotional disclosure interventions for chronic pain: from the laboratory to the clinic. Transl Behav Med 2013; 2:73-81. [PMID: 22905067 DOI: 10.1007/s13142-011-0085-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Life stress and the avoidance of negative emotions may contribute to chronic pain. The technique of written or spoken emotional disclosure can reverse emotional avoidance and improve health, and 18 randomized studies have tested it among people with chronic pain. We review these studies to provide guidance for the clinical use of this technique. The benefits of emotional disclosure for chronic pain are quite modest overall. Studies in rheumatoid arthritis show very limited effects, but two studies in fibromyalgia suggest that disclosure may be beneficial. Effects in other populations (headaches, cancer pain, pelvic pain, abdominal pain) are mixed. Moderator findings suggest that some patients are more likely to benefit than others. Emotional disclosure has been tested in well-controlled efficacy trials, leaving many unanswered questions related to translating this technique to practice. Issues needing further study include determining disclosure's effects outside of randomized controlled trials, identifying the optimal pain populations and specific individuals to target for disclosure, presenting a valid rationale for disclosure, selecting the location and method of disclosure, and choosing between cognitive-behavioral or emotional disclosure techniques.
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Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., 7th Floor, Detroit, MI 48202 USA
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