1
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Moorehead NR, Goodie JL, Krantz DS. Prospective bidirectional relations between depression and metabolic health: 30-year follow-up from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study. Health Psychol 2024; 43:259-268. [PMID: 38095973 PMCID: PMC10939906 DOI: 10.1037/hea0001339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
OBJECTIVE This study investigated prospective bidirectional relationships between depressive symptoms and metabolic syndrome (MetS) and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years. METHOD Data were analyzed from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study, a 30-year prospective study of young adults (N = 5,113; Mage = 24.76 [SD = 3.63] at baseline; 45% male) who were tested every 5 years between 1985 and 2015. Measures included biological assessments of MetS components and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bidirectional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS. RESULTS There was a consistent, bidirectional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms, Wald χ²(1) = 7.09, p < .008, and MetS was similarly predictive of CESD. MetS more consistently predicted CESD scores at each 5-year exam than CESD predicted MetS. Race and sex moderated these relationships, with White females, White individuals overall, and females overall demonstrating significant relationships between CESD depressive symptoms and MetS. Health behaviors were not related to associations between CESD and MetS. CONCLUSION In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depressive symptoms over time than depressive symptoms predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Nicholas R. Moorehead
- 354 Operational Medical Readiness Group, Eielson Air Force Base, Alaska, U.S. Air Force
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Jeffrey L. Goodie
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Family Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - David S. Krantz
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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2
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Goodie JL, Hunter CL, Dobmeyer AC. Optimising and personalising behavioural healthcare in the US Department of Defense through Primary Care Behavioral Health. BMJ Mil Health 2023:military-2022-002312. [PMID: 37045539 DOI: 10.1136/military-2022-002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
Over the past 25 years, one way the US Department of Defense (DoD) has worked to optimise and personalise the delivery of behavioural healthcare is by integrating behavioural health providers into primary care settings. Using the Primary Care Behavioral Health (PCBH) model for integration allows behavioural health providers to see service members and their families for brief and targeted appointments. These appointments are focused on ensuring that the patient receives the care that is needed, while reducing the barriers (eg, delays in receiving care, negative stigma, isolated from other medical care) that are often associated with seeking behavioural healthcare. We review the primary components of the PCBH model, detail the history of how the DoD implemented the PCBH model, review the training methods used by the DoD and briefly describe some of the research that has been conducted by the DoD evaluating the PCBH model.
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Affiliation(s)
- Jeffrey L Goodie
- Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - C L Hunter
- Medical Affairs, Defense Health Agency, Arlington, Virginia, USA
| | - A C Dobmeyer
- Medical Affairs, Defense Health Agency, Arlington, Virginia, USA
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3
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Moorehead NR, Goodie JL, Krantz DS. Prospective Bidirectional Relations Between Depression and Metabolic Health: 30 Year Follow-up from the NHLBI CARDIA Study. medRxiv 2023:2023.03.08.23286983. [PMID: 36945452 PMCID: PMC10029061 DOI: 10.1101/2023.03.08.23286983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Objective This study investigated prospective bidirectional relationships between depression and metabolic syndrome (MetS), and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years. Methods Data were analyzed from the NHLBI CARDIA study, a 30 year-prospective study of young adults (N = 5113; M age = 24.76 (SD = 3.63) at baseline; 45% male) who were tested every 5 years between 1985-2015. Measures included biological assessments of MetS components, and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bi-directional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS. Results There was a consistent, bi-directional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms (Wald Chi-Square = 7.09 (1), p < 0.008), and MetS was similarly predictive of CESD. MetS more consistently predicted depressive symptoms at each 5-year exam than depressive symptoms predicted MetS. Race and sex moderated relationships between depression and MetS, with White females, White individuals overall, and females overall demonstrating significant relationships. Health behaviors were not related to depression-MetS associations. Conclusion In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depression over time than depression predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors.
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Affiliation(s)
- Nicholas R. Moorehead
- 59 Medical Operations Group, Wilford Hall Ambulatory Surgical Center, U.S. Air Force, Joint Base San Antonio – Lackland, TX 78236
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Jeffrey L. Goodie
- Department of Family Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Medical and Clinical Psychology, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - David S. Krantz
- Department of Family Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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Novak LA, LaCroix JM, Perera KU, Stivers M, Schvey NA, Goodie JL, Olsen C, Sbrocco T, Goldston DB, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Help-seeking among psychiatrically hospitalized military personnel at risk for suicide. Suicide Life Threat Behav 2023; 53:75-88. [PMID: 36369831 DOI: 10.1111/sltb.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care. METHODS Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support. RESULTS Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help. CONCLUSION Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.
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Affiliation(s)
- Laura A Novak
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Max Stivers
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Natasha A Schvey
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jeffrey L Goodie
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa Soumoff
- Directorate for Behavioral Health, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer Weaver
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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5
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Wang JH, Denic-Roberts H, Goodie JL, Thomas DL, Engel LS, Rusiecki JA. Risk factors for acute mental health symptoms and tobacco initiation in Coast Guard Responders to the Deepwater Horizon oil spill. J Trauma Stress 2022; 35:1099-1114. [PMID: 35290683 PMCID: PMC9355914 DOI: 10.1002/jts.22817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Acute mental health symptoms experienced during oil spill response work are understudied, especially among nonlocal responders. We assessed potential risk factors for acute mental health symptoms and tobacco initiation among U.S. Coast Guard responders to the 2010 Deepwater Horizon (DWH) oil spill who completed a deployment exit survey. Cross-sectional associations among responder characteristics, deployment-related stressors (deployment duration, timing, crude oil exposure, physical symptoms, injuries), and professional help-seeking for stressors experienced with concurrent depression/anxiety and tobacco initiation were examined. Log-binomial regression was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals. Sensitivity analyses excluded responders with a history of mental health conditions using health encounter data from the Military Health System Data Repository. Of the 4,855 responders, 75.5% were deployed from nonlocal/non-Gulf home stations, 5.8% reported concurrent depression and anxiety, and 2.8% reported the initiation of any tobacco product during oil spill response. Self-report of concurrent depression and anxiety was more prevalent among female responders and positively associated with longer deployments, crude oil exposure via inhalation, physical symptoms and injuries, and professional help-seeking during deployment, aPRs = 1.54-6.55. Tobacco initiation was inversely associated with older age and officer rank and positively associated with deployment-related stressors and depression/anxiety during deployment, aPRs = 1.58-4.44. Associations remained robust after excluding responders with a history of mental health- and tobacco-related health encounters up to 3 years before deployment. Depression, anxiety, and tobacco initiation were cross-sectionally associated with oil spill response work experiences among DWH responders, who largely originated outside of the affected community.
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Affiliation(s)
- Jeanny H. Wang
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
- Oak Ridge Institute for Science and Education, Maryland, USA
| | - Jeffrey L. Goodie
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
| | - Dana L. Thomas
- United States Coast Guard Headquarters, Directorate of Health, Safety, and Work Life, Washington, D.C., USA
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer A. Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
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6
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Goodie JL, Bennion LD, Schvey NA, Riggs DS, Montgomery M, Dorsey RM. Development and implementation of an objective structured clinical examination for evaluating clinical psychology graduate students. Training and Education in Professional Psychology 2022. [DOI: 10.1037/tep0000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Magaletta PR, Glynn SM, Goodie JL. Responding to individuals and communities after disasters and other traumatic events: An introduction. Psychol Serv 2022. [DOI: 10.1037/ser0000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Krantz DS, Shank LM, Goodie JL. Post-traumatic stress disorder (PTSD) as a systemic disorder: Pathways to cardiovascular disease. Health Psychol 2021; 41:651-662. [PMID: 34807673 DOI: 10.1037/hea0001127] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evidence indicates that post-traumatic stress disorder (PTSD) is a significant risk factor for the development and progression of cardiovascular disease (CVD). Most explanations for PTSD-CVD associations conceptualize PTSD as a stress-related mental health disorder that elicits physiological, behavioral, and psychological responses that are causal factors in the development of cardiovascular disorders. This article reviews evidence for the broader physical health consequences of PTSD, and presents a conceptual model based on research suggesting that PTSD is a systemic disorder. Specifically, research findings indicate that diagnostic criteria are just the "tip of the iceberg" of a broader systemic disorder with elements that are cardiovascular risk factors. These systemic physiological and behavioral elements therefore should not be regarded as accompanying but unrelated diseases or comorbidities, but as inherent components of PTSD that directly impact the development of CVD. The systemic disorder approach has implications for the conceptualization of PTSD as a cardiovascular risk factor, for needed research on PTSD and CVD, and for clinical efforts to reduce PTSD-associated cardiovascular risk. It is suggested that treatments that aim to reduce cardiovascular disease risk need to address both the PTSD diagnostic components and its associated cardiovascular risk factors. Further research is needed to test the applicability and implications of the systemic disorder perspective. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Science
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Science
| | - Jeffrey L Goodie
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Science
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9
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Wilfong KM, Goodie JL, Curry JC, Hunter CL, Kroke PC. The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety, Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 2021; 29:318-331. [PMID: 34626278 DOI: 10.1007/s10880-021-09826-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Limited scalability combined with limited opportunities for patients to receive evidence-based interventions in traditional behavioral health treatment models for anxiety and depression creates a gap in access to adequate care. Primary Care Behavioral Health (PCBH) is one model of treatment in which behavioral health consultants (BHC) work directly within primary care settings, but there is limited evidence regarding the effectiveness of this model of care. The functional outcomes and appointment characteristics of Beneficiaries (N = 5402) within the military healthcare system were assessed. The study sample was predominately Caucasian, female, military dependents seen for 2 to 4 appointments. A reliable change index revealed that 17.2% showed reliable improvement and 2.4% showed reliable deterioration (p < .05). Of individuals with a severe Behavioral Health Measure-20 score at baseline, 81.5% showed some improvement at their final appointment, with 33% demonstrating reliable improvement. A mixed model analysis was used to determine the predictive value of appointment characteristics. All relations were significant (p < .001), except the between-subjects effect of appointment duration. Appointment duration revealed individuals reported worse functioning at the start of atypically long appointments. Individuals with generally longer intervals between appointments reported worse functioning, but an atypically long interval predicted better functioning at the following appointment. As it relates to number of appointments, individuals with more total appointments reported worse functioning outcomes, with generally better functioning across appointments. Overall, these data support the effectiveness of time-limited care provided through the PCBH model.
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Affiliation(s)
- Kevin M Wilfong
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| | - Jeffrey L Goodie
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Justin C Curry
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Christopher L Hunter
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Phillip C Kroke
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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10
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Peterson AL, Young-McCaughan S, Roache JD, Mintz J, Litz BT, Williamson DE, Resick PA, Foa EB, McGeary DD, Dondanville KA, Taylor DJ, Wachen JS, Fox PT, Bryan CJ, McLean CP, Pruiksma KE, Yarvis JS, Niles BL, Abdallah CG, Averill LA, Back SE, Baker MT, Blount TH, Borah AM, Borah EV, Brock MS, Brown LA, Burg MM, Cigrang JA, DeBeer BB, DeVoe ER, Fina BA, Flanagan JC, Fredman SJ, Gardner CL, Gatchel RR, Goodie JL, Gueorguieva R, Higgs JB, Jacoby VM, Kelly KM, Krystal JH, Lapiz-Bluhm MD, López-Roca AL, Marx BP, Maurer DM, McDevitt-Murphy ME, McGeary CA, Meyer EC, Miles SR, Monson CM, Morilak DA, Moring JC, Mysliwiec V, Nicholson KL, Rauch SAM, Riggs DS, Rosen CS, Rudd MD, Schobitz RP, Schrader CC, Shinn AM, Shiroma PR, Sloan DM, Stern SL, Strong R, Vannoy SD, Young KA, Keane TM. STRONG STAR and the Consortium to Alleviate PTSD: Shaping the future of combat PTSD and related conditions in military and veteran populations. Contemp Clin Trials 2021; 110:106583. [PMID: 34600107 DOI: 10.1016/j.cct.2021.106583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
The STRONG STAR Consortium (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) and the Consortium to Alleviate PTSD are interdisciplinary and multi-institutional research consortia focused on the detection, diagnosis, prevention, and treatment of combat-related posttraumatic stress disorder (PTSD) and comorbid conditions in military personnel and veterans. This manuscript outlines the consortia's state-of-the-science collaborative research model and how this can be used as a roadmap for future trauma-related research. STRONG STAR was initially funded for 5 years in 2008 by the U.S. Department of Defense's (DoD) Psychological Health and Traumatic Brain Injury Research Program. Since the initial funding of STRONG STAR, almost 50 additional peer-reviewed STRONG STAR-affiliated projects have been funded through the DoD, the U.S. Department of Veterans Affairs (VA), the National Institutes of Health, and private organizations. In 2013, STRONG STAR investigators partnered with the VA's National Center for PTSD and were selected for joint DoD/VA funding to establish the Consortium to Alleviate PTSD. STRONG STAR and the Consortium to Alleviate PTSD have assembled a critical mass of investigators and institutions with the synergy required to make major scientific and public health advances in the prevention and treatment of combat PTSD and related conditions. This manuscript provides an overview of the establishment of these two research consortia, including their history, vision, mission, goals, and accomplishments. Comprehensive tables provide descriptions of over 70 projects supported by the consortia. Examples are provided of collaborations among over 50 worldwide academic research institutions and over 150 investigators.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - John D Roache
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Brett T Litz
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; Boston University, Boston, MA, USA.
| | - Douglas E Williamson
- Duke University, Durham, NC, USA; Durham VA Health Care System, Durham, NC, USA.
| | | | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA.
| | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA; University of Texas at San Antonio, San Antonio, TX, USA.
| | | | | | - Jennifer Schuster Wachen
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Women's Health Sciences Division, Boston, MA, USA.
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Craig J Bryan
- Ohio State University College of Medicine, Columbus, OH, USA.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University, Stanford, CA, USA.
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Barbara L Niles
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | - Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - Sudie E Back
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | - Monty T Baker
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Tabatha H Blount
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Adam M Borah
- Carl R Darnall Army Medical Center, Fort Hood, TX, USA.
| | - Elisa V Borah
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Matthew S Brock
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | - Lily A Brown
- University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | - Bryann B DeBeer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA.
| | | | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | | | - Cubby L Gardner
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | | | - Jeffrey L Goodie
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - Jay B Higgs
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA
| | - Vanessa M Jacoby
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Kevin M Kelly
- Carl R Darnall Army Medical Center, Fort Hood, TX, USA.
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
| | - M Danet Lapiz-Bluhm
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Brian P Marx
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | | | | | - Cindy A McGeary
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Eric C Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA.
| | - Shannon R Miles
- James A. Haley Veterans' Affairs Hospital, Tampa, FL, USA; University of South Florida, Tampa, FL, USA.
| | | | - David A Morilak
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - John C Moring
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | | | - Sheila A M Rauch
- Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Healthcare System, Atlanta, GA, USA.
| | - David S Riggs
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Craig S Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA; Stanford University, Stanford, CA, USA.
| | | | - Richard P Schobitz
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX, USA.
| | | | - Antoinette M Shinn
- 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX, USA.
| | - Paulo R Shiroma
- Minneapolis VA Health Care System, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA.
| | - Denise M Sloan
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
| | - Stephen L Stern
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Randy Strong
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
| | | | - Keith A Young
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M University College of Medicine, Bryan, TX, USA.
| | - Terence M Keane
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division, Boston, MA, USA.
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Kanzler KE, McGeary DD, McGeary C, Blankenship AE, Young-McCaughan S, Peterson AL, Buhrer JC, Cobos BA, Dobmeyer AC, Hunter CL, Bhagwat A, Star JAB, Goodie JL. Conducting a Pragmatic Trial in Integrated Primary Care: Key Decision Points and Considerations. J Clin Psychol Med Settings 2021; 29:185-194. [PMID: 34100153 PMCID: PMC8184053 DOI: 10.1007/s10880-021-09790-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Pragmatic trials testing the effectiveness of interventions under “real world” conditions help bridge the research-to-practice gap. Such trial designs are optimal for studying the impact of implementation efforts, such as the effectiveness of integrated behavioral health clinicians in primary care settings. Formal pragmatic trials conducted in integrated primary care settings are uncommon, making it difficult for researchers to anticipate the potential pitfalls associated with balancing scientific rigor with the demands of routine clinical practice. This paper is based on our experience conducting the first phase of a large, multisite, pragmatic clinical trial evaluating the implementation and effectiveness of behavioral health consultants treating patients with chronic pain using a manualized intervention, brief cognitive behavioral therapy for chronic pain (BCBT-CP). The paper highlights key choice points using the PRagmatic-Explanatory Continuum Indicator Summary (PRECIS-2) tool. We discuss the dilemmas of pragmatic research that we faced and offer recommendations for aspiring integrated primary care pragmatic trialists.
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Affiliation(s)
- Kathryn E Kanzler
- Research to Advance Community Health (ReACH) Center, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7768, San Antonio, TX, 78229, USA. .,Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. .,Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Donald D McGeary
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Cindy McGeary
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abby E Blankenship
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Briana A Cobos
- Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anne C Dobmeyer
- Psychological Health Center of Excellence J-9/Defense Health Agency, Falls Church, VA, USA
| | - Christopher L Hunter
- J3 Medical Affairs-Clinical Support Division/Defense Health Agency, Falls Church, VA, USA
| | - Aditya Bhagwat
- J3 Medical Affairs-Clinical Support Division/Defense Health Agency, Falls Church, VA, USA
| | - John A Blue Star
- 59 Medical Operations Squadron, Wilford Hall Ambulatory Medical Center, JBSA-Lackland, San Antonio, TX, USA
| | - Jeffrey L Goodie
- Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD, USA
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Goodie JL, Kanzler KE, McGeary CA, Blankenship AE, Young-McCaughan S, Peterson AL, Cobos BA, Dobmeyer AC, Hunter CL, Blue Star J, Bhagwat A, McGeary DD. Targeting Chronic Pain in Primary Care Settings by Using Behavioral Health Consultants: Methods of a Randomized Pragmatic Trial. Pain Med 2020; 21:S83-S90. [PMID: 33313725 PMCID: PMC7825087 DOI: 10.1093/pm/pnaa346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care-based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. DESIGN A randomized pragmatic clinical trial will be used to examine whether telehealth booster contacts improve outcomes associated with BCBT-CP treatments. Monthly booster contacts will reinforce BCBT-CP concepts and the home practice plan. Outcomes will be assessed 3, 6, 12, and 18 months after the first appointment for BCBT-CP. Focus groups will be conducted to assess the usability, perceived effectiveness, and helpfulness of the booster contacts. SUMMARY Most individuals with chronic pain are managed in primary care, but few are offered biopsychosocial approaches to care. This pragmatic brief trial will test whether a pragmatic enhancement to routine clinical care, monthly booster contacts, results in sustained functional changes among patients with chronic pain receiving BCBT-CP in primary care.
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Affiliation(s)
- Jeffrey L Goodie
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kathryn E Kanzler
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
| | - Abby E Blankenship
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Briana A Cobos
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Anne C Dobmeyer
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, Virginia
| | - Christopher L Hunter
- Patient Centered Medical Home Branch, Defense Health Agency, Falls Church, Virginia
| | - John Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Aditya Bhagwat
- Patient Centered Medical Home Branch, Defense Health Agency, Falls Church, Virginia
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Rozensky RH, Grus CL, Goodie JL, Bonin L, Carpenter BD, Miller BF, Ross KM, Rybarczyk BD, Stewart A, McDaniel SH. A Curriculum for an Interprofessional Seminar on Integrated Primary Care: Developing Competencies for Interprofessional Collaborative Practice. J Allied Health 2018; 47:e61-e66. [PMID: 30194832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
Health care is increasingly delivered through team-based, collaborative strategies with interprofessional education as an important mechanism for building interprofessional practice competencies. This paper describes an Interprofessional Seminar on Integrated Primary Care (IS-IPC) designed to meet this educational need with interprofessional team-based learning as the foundation of an iterative process such that education and practice inform one another. The IS-IPC can be used to educate an interprofessional group of learners about key topics relevant to working together in integrated primary care. The IS-IPC describes steps in developing an interprofessional seminar, common challenges, and their solutions in creating interprofessional learning experiences, and eight foundational content modules containing an outline and curricular resources. The IS-IPC facilitates interprofessional educator partnerships at the local level and can be customized to fit the local environment, pedagogical philosophy, and learning objectives.
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Affiliation(s)
- Ronald H Rozensky
- Dep. of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 16225 SW State Road 45, Archer, FL 32618, USA. Tel 352-256-7800.
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Sobell MB, Peterson AL, Sobell LC, Brundige A, Hunter CM, Hunter CM, Goodie JL, Agrawal S, Hrysko-Mullen AS, Isler WC. Reducing alcohol consumption to minimize weight gain and facilitate smoking cessation among military beneficiaries. Addict Behav 2017; 75:145-151. [PMID: 28734154 DOI: 10.1016/j.addbeh.2017.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/20/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Smoking cessation-related weight gain can have significant negative health and career consequences for military personnel. Alcohol reduction combined with smoking cessation may decrease weight gain and relapse. METHOD A randomized clinical trial of military beneficiaries compared a standard smoking cessation (i.e., brief informational) intervention (N=159), with a brief motivational smoking cessation intervention that emphasized reduced drinking to lessen caloric intake and minimize weight gain (N=158). RESULTS Participants who received the motivational intervention were significantly more likely to quit smoking at the 3-month follow-up (p=0.02), but the differences were not maintained at 6 (p=0.18) or 12months (p=0.16). Neither weight change nor alcohol reduction distinguished the 2 groups. Smoking cessation rates at 12months (motivational group=32.91%, informational group=25.79%) were comparable to previous studies, but successful cessation was not mediated by reduced drinking. CONCLUSIONS Alcohol reduction combined with smoking cessation did not result in decreased weight gain or improved outcomes.
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Cigrang JA, Rauch SA, Mintz J, Brundige AR, Mitchell JA, Najera E, Litz BT, Young-McCaughan S, Roache JD, Hembree EA, Goodie JL, Sonnek SM, Peterson AL. Moving effective treatment for posttraumatic stress disorder to primary care: A randomized controlled trial with active duty military. ACTA ACUST UNITED AC 2017; 35:450-462. [DOI: 10.1037/fsh0000315] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vogel ME, Kanzler KE, Aikens JE, Goodie JL. Integration of behavioral health and primary care: current knowledge and future directions. J Behav Med 2016; 40:69-84. [DOI: 10.1007/s10865-016-9798-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/22/2016] [Indexed: 01/17/2023]
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Cigrang JA, Rauch SAM, Mintz J, Brundige A, Avila LL, Bryan CJ, Goodie JL, Peterson AL. Treatment of active duty military with PTSD in primary care: A follow-up report. J Anxiety Disord 2015; 36:110-4. [PMID: 26519833 DOI: 10.1016/j.janxdis.2015.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/25/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
First-line trauma-focused therapies offered in specialty mental health clinics do not reach many veterans and active duty service members with posttraumatic stress disorder (PTSD). Primary care is an ideal environment to expand access to mental health care. Several promising clinical case series reports of brief PTSD therapies adapted for primary care have shown positive results, but the long-term effectiveness with military members is unknown. The purpose of this study was to determine the long-term outcome of an open trial of a brief cognitive-behavioral primary care-delivered protocol developed specifically for deployment-related PTSD in a sample of 24 active duty military (15 men, 9 women). Measures of PTSD symptom severity showed statistically and clinically significant reductions from baseline to posttreatment that were maintained at the 6-month and 1-year follow-up assessments. Similar reductions were maintained in depressive symptoms and ratings of global mental health functioning.
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Affiliation(s)
| | - Sheila A M Rauch
- Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia, USA.
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
| | - Antoinette Brundige
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
| | - Laura L Avila
- San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.
| | - Craig J Bryan
- National Center for Veterans Studies and University of Utah, Salt Lake City, Utah, USA.
| | - Jeffrey L Goodie
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; South Texas Veterans Health Care System, San Antonio, Texas, USA; University of Texas at San Antonio, San Antonio, Texas, USA.
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Bynum WE, Goodie JL. Shame, guilt, and the medical learner: ignored connections and why we should care. Med Educ 2014; 48:1045-54. [PMID: 25307632 DOI: 10.1111/medu.12521] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/24/2014] [Accepted: 05/07/2014] [Indexed: 05/27/2023]
Abstract
CONTEXT Shame and guilt are subjective emotional responses that occur in response to negative events such as the making of mistakes or an experience of mistreatment, and have been studied extensively in the field of psychology. Despite their potentially damaging effects and ubiquitous presence in everyday life, very little has been written about the impact of shame and guilt in medical education. METHODS The authors reference the psychology literature to define shame and guilt and then focus on one area in medical education in which they manifest: the response of the learner and teacher to medical errors. Evidence is provided from the psychology literature to show associations between shame and negative coping mechanisms, decreased empathy and impaired self-forgiveness following a transgression. The authors link this evidence to existing findings in the medical literature that may be related to unrecognised shame and guilt, and propose novel ways of thinking about a learner's ability to cope, remain empathetic and forgive him or herself following an error. RESULTS The authors combine the discussion of shame, guilt and learner error with findings from the medical education literature and outline three specific ways in which teachers might lead learners to a shame-free response to errors: by acknowledging the presence of shame and guilt in the learner; by avoiding humiliation, and by leveraging effective feedback. CONCLUSIONS The authors conclude with recommendations for research on shame and guilt and their influence on the experience of the medical learner. This critical research plus enhanced recognition of shame and guilt will allow teachers and institutions to further cultivate the engaged, empathetic and shame-resilient learners they strive to create.
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Affiliation(s)
- William E Bynum
- National Capital Consortium Family Medicine Residency Programme, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
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Tien KJ, Goodie JL, Duncan CL, Szabo MM, Larson NA. Is it asthma or a panic attack? A case study of asthma and anxiety in an adolescent male. Clinical Practice in Pediatric Psychology 2014. [DOI: 10.1037/cpp0000057] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goodie JL, Kanzler KE, Hunter CL, Glotfelter MA, Bodart JJ. Ethical and effectiveness considerations with primary care behavioral health research in the medical home. ACTA ACUST UNITED AC 2013; 31:86-95. [DOI: 10.1037/a0031852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kanzler KE, Goodie JL, Hunter CL, Glotfelter MA, Bodart JJ. From colleague to patient: Ethical challenges in integrated primary care. ACTA ACUST UNITED AC 2013; 31:41-8. [DOI: 10.1037/a0031853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goodie JL, Williams PM, Kurzweil D, Marcellas KB. Can blended classroom and distributed learning approaches be used to teach medical students how to initiate behavior change counseling during a clinical clerkship? J Clin Psychol Med Settings 2012; 18:353-60. [PMID: 21948183 DOI: 10.1007/s10880-011-9261-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical school curricula often provide insufficient time and instruction for health behavior change counseling. We examined the feasibility of blending classroom and distributed learning experiences to teach medical students how to initiate health behavior change counseling and analyzed the impact of this approach on their attitudes, knowledge, and skills. Usage patterns and pre- to post-class attitude and knowledge changes were assessed with self-report questions among 153 third year family medicine clerkship students. Most students viewed at least 90% of the online written content and took an average of 41 min (SD = 24 min 35 s) to view all of the content. Students' confidence in their ability to help patients change unhealthy behaviors significantly improved (p < .01). The blended learning curriculum facilitated learning of behavior change skills, encouraged interaction with course materials, and improved medical students' self confidence for using health behavior change skills.
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Affiliation(s)
- Jeffrey L Goodie
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Reamy BV, Williams PM, Wilson C, Goodie JL, Stephens MB. Who will be the faculty of the future? Results of a 5-year study growing educators using an immersive third postgraduate year (PGY-3) faculty development mini-fellowship. Med Teach 2012; 34:e459-63. [PMID: 22435917 DOI: 10.3109/0142159x.2012.668631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Residency education requires large numbers of skilled teaching faculty. Potential faculty can often be identified during residency training. AIMS Employ a 4-week immersive faculty development mini-fellowship to enhance the teaching skills of selected PGY-3 residents and study outcomes over 5 years. METHODS PGY-3 residents were competitively selected and completed the 4-week curriculum to increase skills in precepting, small group teaching, large group teaching, learner feedback/assessment, academic career development, and research. RESULTS Fifteen residents completed the mini-fellowship over the 5-year study period. The curriculum was rated highly by the residents with mean ratings of curriculum components ranging from 4.5 to 4.9 on a 5-point scale. Eight residents (53%) were selected for faculty positions compared to a usual selection rate of 11%. Compared to new faculty without mini-fellowship completion, program directors rated the residents completing the mini-fellowship as better prepared to perform learner feedback (4.1 vs. 3.0, p ≤ 0.01) and to understand the conduct of research (3.6 vs. 2.5 p ≤ 0.01). CONCLUSIONS This study demonstrates short-term success at growing faculty with enhanced teaching skills during residency. While long-term retention in academic medicine cannot be predicted, this program represents one method to mitigate shortages of qualified junior residency faculty.
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Affiliation(s)
- Brian V Reamy
- Faculty of Family Medicine, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
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Hunter CL, Goodie JL. Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home. Fam Syst Health 2010; 28:308-321. [PMID: 21299278 DOI: 10.1037/a0021761] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Behavioral healthcare will be an essential piece of meeting the patient-centered medical home (PCMH) principles of easy access and whole person, coordinated, and integrated care as primary care clinics transform themselves into PCMHs. As this transformation occurs, PCMH clinic staff and behavioral health providers must carefully consider how to adapt their operations to include the provision of integrated-collaborative behavioral health services within the PCMH. Without this careful consideration, integrated-collaborative behavioral healthcare will likely fail to reach its full potential. We discuss the operational and clinical components that appear to be important for success when integrating behavioral healthcare into the PCMH.
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Affiliation(s)
- Christopher L Hunter
- TRICARE Management Activity, Office of the Chief Medical Officer, Behavior Medicine Division, Falls Church, VA, USA.
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Goodie JL, Isler WC, Hunter C, Peterson AL. Using behavioral health consultants to treat insomnia in primary care: a clinical case series. J Clin Psychol 2009; 65:294-304. [DOI: 10.1002/jclp.20548] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Larkin KT, Schauss SL, Elnicki DM, Goodie JL. Detecting white coat and reverse white coat effects in clinic settings using measures of blood pressure habituation in the clinic and patient self-monitoring of blood pressure. J Hum Hypertens 2007; 21:516-24. [PMID: 17361194 DOI: 10.1038/sj.jhh.1002180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To examine the utility of blood pressure (BP) habituation within and across multiple clinic visits and patient-determined home BP monitoring for detecting white coat (WCE) and reverse white coat effects (RWCE) commonly observed in medical settings, 54 patients undergoing evaluation for hypertension in an internal medicine group practice were categorized according to the magnitude of differences between systolic BP (SBP) and diastolic BP (DBP) obtained in the clinic and through ambulatory BP monitoring. BPs were measured four times during three separate clinic visits, during a 1-week home BP monitoring period, and during a single 24-h ambulatory monitoring period. Patients whose mean clinic and average daytime BPs were within +/-5 mm Hg were categorized as having stable BP; patients whose clinic BPs were >5 mm Hg of their daytime BPs were categorized as showing a WCE and patients whose average daytime BPs were >5 mm Hg of their clinic BPs were categorized as showing a RWCE. Results revealed that degree of habituation occurring between the first and third clinic visits significantly predicted magnitude of both the WCE and RWCE for SBP, with greater habituation being associated with the WCE and lesser habituation associated with the RWCE. Greater SBP habituation within clinic visits was associated with the WCE for SBP and greater DBP habituation within clinic visits was associated with the WCE for DBP. Lesser DBP habituation within clinic visits was associated with the RWCE for both SBP and DBP. Home BP monitoring did not contribute to predicting either WCE or RWCE.
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Affiliation(s)
- K T Larkin
- Department of Psychology and Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA.
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Abstract
To examine whether transfer of heart rate (HR) feedback training to tasks not used during training could be improved by using multiple tasks during training, a modified multiple baseline across tasks, single subject design study was conducted using six high HR-reactive young adults. Participants received HR feedback training during the presentation of a videogame, and transfer of training was assessed to a mental arithmetic challenge and handgrip task. Transfer of training was next assessed following training with the mental arithmetic challenge and handgrip task. HR responses to each training task with no HR feedback were assessed during a pre-treatment session, an immediate post-training period following training on each task, a short delay (1-2 days) post-training session, and a long delay (1-2 weeks) post-training session. HR response to a novel speech task was assessed at pre-treatment and during short delay and long delay post-training sessions. Results revealed that participants reduced HR during training and generally maintained this reduction in HR during the immediate post-training assessment when HR feedback was not present. Participants were not able to reduce HR responses to tasks during short delay and long delay post-training sessions, and they were unable to transfer HR reduction skills to the speech task. Transfer of HR feedback training to new tasks was limited in nature and efforts to train across multiple stressors did not appear to improve transfer of training.
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Frazer NL, Larkin KT, Goodie JL. Do behavioral responses mediate or moderate the relation between cardiovascular reactivity to stress and parental history of hypertension? Health Psychol 2002; 21:244-53. [PMID: 12027030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
To examine whether differences in behavioral responses to stress mediated or moderated the relation between cardiovascular response to stress and parental history of hypertension, 64 healthy undergraduates-16 men with hypertensive parents (PH+), 16 men without hypertensive parents (PH-), 16 PH+ women, and 16 PH- women-participated in a mental arithmetic task, mirror tracing task, and 2 interpersonal role plays. PH+ participants exhibited higher resting heart rates than PH- participants and higher resting systolic blood pressures (SBPs) than PH- women. PH+ participants exhibited greater SBP responses to tasks and engaged in more negative verbal and nonverbal behavior across tasks than PH- counterparts. Differences in behavioral responding neither mediated nor moderated the observed relation between parental history status and SBP response to stress.
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Affiliation(s)
- Nicole L Frazer
- Department of Psychology, West Virginia University, Morgantown 26506-6040, USA
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Zvolensky MJ, Goodie JL, Ruggiero KJ, Black AL, Larkin KT, Taylor BK. Perceived Stress and Anxiety Sensitivity in the Prediction of Anxiety-Related Responding: A Multichallenge Evaluation. Anxiety, Stress & Coping 2002. [DOI: 10.1080/1061580021000020699] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Frazer NL, Larkin KT, Goodie JL. Do behavioral responses mediate or moderate the relation between cardiovascular reactivity to stress and parental history of hypertension? Health Psychol 2002. [DOI: 10.1037/0278-6133.21.3.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
This study was designed to examine underlying hemodynamic changes that accompany observed reductions in heart rate (HR) response to mental stress following HR feedback training. Twenty-five college males, assigned to either a HR feedback training group (FB+) or a control group (FB-), were presented with a videogame and mental arithmetic challenge, as HR, blood pressure, and impedance cardiography-derived measures of hemodynamic functioning were recorded. During training, the FB+ group received HR feedback and the FB- group was not provided with HR feedback while playing a videogame. At posttraining, results revealed that the FB+ group exhibited significantly lower HR, systolic blood pressure, stroke volume, and total peripheral resistance responses to the videogame compared to that at pretraining. There was no evidence that the acquired skills generalized to a mental arithmetic task. These results suggest that HR feedback training is an effective method for reducing cardiovascular and hemodynamic responses to a mental stressor; however, the generalizability of this effect remains questionable.
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Affiliation(s)
- J L Goodie
- P.O. Box 6040, West Virginia University, Morgantown, West Virginia 26506-6040, USA
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Zvolensky MJ, Goodie JL, McNeil DW, Sperry JA, Sorrell JT. Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population. Behav Res Ther 2001; 39:683-96. [PMID: 11400712 DOI: 10.1016/s0005-7967(00)00049-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67-73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.
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Affiliation(s)
- M J Zvolensky
- West Virginia University, Department of Psychology, Morgantown 26506-6040, USA.
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Davig JP, Larkin KT, Goodie JL. Does cardiovascular reactivity to stress measured in the laboratory generalize to thesis and dissertation meetings among doctoral students? Int J Behav Med 2000. [DOI: 10.1207/s15327558ijbm0703_03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Abstract The Polar Vantage XL heart rate monitor provides an ambulatory, inexpensive method of continuously measuring heart rate. To examine the validity of the Polar monitor for measuring heart rate during resting periods and while engaging in two stressful tasks, 30 students participated in a 1-hour laboratory session. Heart rates were measured simultaneously using the Polar monitor and electrocardiography (ECG) during a hand grip exercise and a mental arithmetic task, each preceded by a 4-min resting period. Within-subject correlations between the two devices were significant (mean r = 0.98, P < .001). All correlations, except for three participants, exceeded r = 0.90. Between-task correlation analyses revealed high correlations (i. e., rs ≥ 0.98) between the Polar monitor and ECG. The Polar monitor obtained readings that were slightly, though significantly higher than readings obtained using ECG. The correspondence between observed mean heart rates from the Polar monitor and ECG suggest that the Polar monitor provides a valid measure of heart rate during stationary laboratory tasks.
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Abstract
Researchers often present and interpret empirical findings with reference to hypothetical constructs and diagnostic labels. Such interpretations commonly are based upon "summary" scores obtained through interview, self-report, or rating-scale assessment instruments. Although there are advantages associated with communicating empirical findings through analysis with summary scores, there also are weaknesses that may limit the interpretability of empirical findings and impede theory development. We discuss the importance of item analysis as a tool that may guide presentation of empirical findings, and we describe how it may be used to minimize these limitations of assessment, facilitate data interpretation, and increase the opportunity for theoretical advances.
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Affiliation(s)
- K J Ruggiero
- Department of Psychology, West Virginia University, Morgantown 26506-6040, USA.
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Kamarck TW, Shiffman SM, Smithline L, Goodie JL, Paty JA, Gnys M, Jong JY. Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: daily life consequences of recurring stress in a multiethnic adult sample. Health Psychol 1998. [PMID: 9459066 DOI: 10.1037//0278-6133.17.1.17] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ambulatory blood pressure (ABP) may be an independent predictor of cardiovascular endpoints, but little is known about its psychosocial determinants. The acute effects of psychosocial processes on cardiovascular activity during daily life were examined by random-effects regression. Healthy adults (N = 120) were monitored over a 6-day period with ABP monitors and computer-assisted self-report assessments. Task strain, social conflict, and emotional activation were rated following each ABP measurement, as were activity, posture, and other covariates. Results show that blood pressure (BP) and heart rate (HR) were elevated during periods of emotional activation (high negative affect or high arousal). Diastolic BP was lower during periods involving high decisional control, and HR was lower during high-control, low-demand activities. There were substantial individual differences in the effects of psychosocial influences on ambulatory cardiovascular activity. Psychological factors are reliable determinants of ABP, which may account in part for the unique predictive value of ABP.
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Affiliation(s)
- T W Kamarck
- Department of Psychology, University of Pittsburgh, Pennsylvania 15260, USA. tkam+@pitt.edu
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39
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Kamarck TW, Shiffman SM, Smithline L, Goodie JL, Paty JA, Gnys M, Jong JY. Effects of task strain, social conflict, and emotional activation on ambulatory cardiovascular activity: daily life consequences of recurring stress in a multiethnic adult sample. Health Psychol 1998; 17:17-29. [PMID: 9459066 DOI: 10.1037/0278-6133.17.1.17] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ambulatory blood pressure (ABP) may be an independent predictor of cardiovascular endpoints, but little is known about its psychosocial determinants. The acute effects of psychosocial processes on cardiovascular activity during daily life were examined by random-effects regression. Healthy adults (N = 120) were monitored over a 6-day period with ABP monitors and computer-assisted self-report assessments. Task strain, social conflict, and emotional activation were rated following each ABP measurement, as were activity, posture, and other covariates. Results show that blood pressure (BP) and heart rate (HR) were elevated during periods of emotional activation (high negative affect or high arousal). Diastolic BP was lower during periods involving high decisional control, and HR was lower during high-control, low-demand activities. There were substantial individual differences in the effects of psychosocial influences on ambulatory cardiovascular activity. Psychological factors are reliable determinants of ABP, which may account in part for the unique predictive value of ABP.
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Affiliation(s)
- T W Kamarck
- Department of Psychology, University of Pittsburgh, Pennsylvania 15260, USA. tkam+@pitt.edu
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