Effects of Cognitive-Behavioral Therapy on Empathy in Patients with Chronic Pain

Empathic Skills Training As a Means of Reducing Cyberbullying among Adolescents: An Empirical Evaluation

Cyberbullying is a form of aggression in which electronic communication such as e-mails, mobile phone calls, text messages, instant messenger contacts, photos, social networking sites and personal webpages are used to threaten or intimidate individuals. Cognitive-behavioral therapy (CBT) counselling based on empathic training may reduce cyberbullying among adolescents. The present study investigated the impact of developing empathy skills in reducing cyberbullying among a sample of adolescents using two groups (i.e., an experimental group and control group). The experimental group received counselling intervention based on CBT with special focus on improving empathy whereas the control group received CBT general counselling. The participants comprised 217 adolescents (experimental group = 98 adolescents, control group = 119 adolescents) with a mean age of 15.1 years (SD ± 1.5). The measures included the Toronto Empathy Questionnaire (TEQ) and the Bullying, Cyberbullying Scale for Adolescents (BCS-A). Results showed that there were statistically significant differences on TEQ scores and BCS-A scores in the experimental and control groups after the intervention but more so in favor of the experimental group in terms of reduced levels of cyberbullying (both victimization and perpetration). Positive gains among the experimental group in both empathy and reduced cyberbullying remained at two-month follow-up. It is recommended that teachers and school counselors tackling cyberbullying should use empathy training as part of their cyberbullying prevention programs.

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

Background

In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored.

Objective

To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain.

Methods

Patients with chronic MSK pain (n = 22) and healthy controls (n = 26) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)).

Results

The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student's t = −2.119, P = 0.040, and longer task completion time: Student's t = 3.382, P = 0.002) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity (r = −0.614, P = 0.002). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions.

Conclusion

These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.

Impaired pain empathic abilities among patients with functional dyspepsia

INTRODUCTION

Brain structure or functioning abnormality in regions such as insula and anterior cingulate cortex (ACC) is associated with functional dyspepsia (FD) and pain empathy, but the relationship between FD and pain empathy remains unclear. The aim of this study was to compare the pain empathic abilities of FD patients and healthy controls (HCs) and investigate the association of pain empathy with clinical characteristics and quality of life of FD patients.

METHODS

Pain empathic abilities was measured in 30 FD patients and 30 HCs using a validated pain empathy paradigm. Demographic characteristics, Helicobacter pylori status, duration, dyspeptic symptom score and Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients.

RESULTS

FD patients scored higher than HCs when rating painful pictures, but the accuracy for painful pictures was significantly lower than HCs. Pearson correlation analysis showed significant negative correlation between NDLQI and pain rating scores for painful pictures. When sex, age, educational level, the number of complaints, duration, H. pylori infection and NDLQI were included in multiple linear regression analysis, NDLQI was independently associated with pain ratings.

CONCLUSIONS

FD patients showed abnormally enhanced pain empathic abilities, which may be associated with the severity of symptoms and quality of life.

The physician as a success determining factor in CT-guided pain therapy

BACKGROUND

Back pain is a common problem and a burden for the patient. MR-morphologically proven pain-causing changes of the spine is often successfully treated utilizing CT-guided pain therapy. The CT-guided execution enables a controlled and reproducible therapy. Nevertheless, treatment results can differ even with the same patient; the physician is a possible influencing factor of the outcome. Accordingly, the present study analyzes the different behaviors and forms of communication of the treating physicians during the course of the intervention as factors influencing the outcome of treatment.

METHODS

67 patients suffering from specific back pain were included in this study. 5 treating physicians (2 female, 3 male) of different age (29-63 years), and experience and a total of 244 CT-guided treatments were included in this study. In every case a psychologist observed the treatment based on a standardized observation protocol. Observed were both the verbal and non-verbal interactions as well as the reaction of patient and physician. The success of the therapy was measured in the course of the treatment using the visual analogue pain scale. The technical comparability of the performed CT-guided periradicular therapy was ensured by the distribution of the drug mixture.

RESULTS

The outcome is significantly better if the patient considers the treating physician to be competent (correlation coefficient: 0.24, p < 0.006) and feels understood (correlation coefficient: 0.29, p < 0.001). In addition, the outcome is better when the physician believes that the treatment brings a positive reduction of pain, underlining his belief with positive statements of affirmation before the intervention thus creating a positive atmosphere [correlation coefficient: 0.24 (p < 0.009)]. In contrast, the outcome is worse if the patient complains about pain during the intervention [average pain reduction M = 0.9 (pain group) vs. M = 2.0 (no-pain group)].

CONCLUSION

Our study shows that with comparable implementation of CT-guided periradicular therapy, the outcome of the patient with specific back pain can be significantly improved by certain behavioral patterns of the performing physician and this without side effects and without significant additional time expenditure. Our findings indicate that there is a non-negligible psychological factor linking confidence in therapy to actual therapy success.

TRIAL REGISTRATION

The study was designed as an observational study, therefore a trial registration was not necessary.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial

Background

Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses.

Methods

A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393).

Results

Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group.

Conclusions

CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Electronic supplementary material

The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.

Assessment of quality of life in individuals with chronic headache. Psychometric properties of the WHOQOL-BREF

BACKGROUND

The WHOQOL-BREF is a frequently used instrument for the assessment of health-related quality of life. Unlike other generic instruments used for the assessment of this construct, little is known about its properties in individuals with headache disorders. The present study examines the reliability and factorial validity of the WHOQOL-BREF in individuals with chronic headache residing in Austria.

METHODS

Data from a representative population-based survey on 963 individuals with chronic headache surveyed between 2013 and 2015 was used. The factorial validity was examined by means of confirmatory factor analysis. Differential item functioning related to sex was analyzed using multiple indicators multiple causes models.

RESULTS

Information on 239 men and 724 women with chronic headache was available. The four-factor, 24-item baseline model showed a moderate fit (RMSEA = 0.066; CFI = 0.868; TLI = 0.852; SRMR = 0.053), which improved significantly after the addition of six error covariances (RMSEA = 0.052; CFI = 0.920; TLI = 0.908; SRMR = 0.046). Sex-related differential item functioning was observed in two items of the environment factor, two items of the psychological health factor and two items of the physical health factor.

CONCLUSIONS

After some modifications to the measurement model, the WHOQOL-BREF shows a satisfactory fit among individuals with chronic headache in Austria. Because of these modifications and the questionnaire's susceptibility for differential item functioning, a latent variable framework should be employed for the analysis. Future studies need to confirm these results for other language regions and should also examine different subtypes of headache.

The Complex Interplay Between Weight, Chronic Pain, and Mood: How Team-Based Care and Personalized Approaches Can Improve Function and Quality of Life

Patients presenting with a desire to lose weight often have underlying factors that complicate recommendations regarding diet and exercise. In this woman's story, a significant physical injury resulted in chronic pain and a loss in her ability to participate in activities she had previously enjoyed and which played a role in her self-identity. While her previous history of a mood disorder may have increased her risk of developing chronic pain, the impact her injury had on her sense of self was also a likely factor. A multidisciplinary approach that addressed her sense of loss; incorporated innovative adaptations that enabled her to exercise outdoors and led to a renewed sense of hope; helped her find creative outlets and increase her sense of self efficacy; and improve the quality of sleep was instrumental in supporting her ability to incorporate dietary change, lose weight, and improve her mood and well-being. The biopsychosocial model of pain provides a framework of understanding for the complex interplay between mood, pain, and social support, which in turn can impact weight and ability to incorporate lifestyle change. Addressing these underlying factors is a critical part of whole person health.

Greater empathy in MDMA users

BACKGROUND

3,4-Methylenedioxymethamphetamine (MDMA) is widely known for its positive acute effects on social behaviour, such as increasing empathy, whilst also attenuating the negative impact of social exclusion. However there is a scarcity of research that investigates the long-term impact of recreational MDMA use on these fundamental social processes.

METHOD

Sixty-seven individuals were split into three groups based on their drug-use history: poly-drug MDMA users ( n = 25), poly-drug users who do not use MDMA ( n = 19), alcohol-only users ( n = 23), and were tested in an independent groups design. Participants completed both a self-report measure of emotional and cognitive empathy, along with the Multifaceted Empathy Task - a computerised assessment of empathy - and the Cyberball Game - a social exclusion paradigm.

RESULTS

MDMA users had significantly greater subjective emotional empathy, and greater cognitive empathy on the computer task compared with the poly-drug users who do not use MDMA. There were no significant differences in subjective responses to social exclusion between the groups. Indices of MDMA use did not correlate with empathy.

CONCLUSIONS

Long-term MDMA users in this sample exhibited normal psychosocial functioning in regard to empathy and social pain and had higher subjective emotional empathy. This conflicts with previous suggestions that moderate, long-term MDMA use may cause heightened social distress, and is further evidence of the safety of the drug, which is relevant to considerations of its therapeutic use.