Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients (aged 21–64 yrs) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 mo after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal changes in behavioral problems in old age: a study in an adult day care population

BACKGROUND: Four types of agitation have been identified: physically aggressive behaviors, physically nonaggressive behaviors, verbally aggressive behaviors, and verbally nonaggressive behaviors. These pose a major challenge to caregivers and are sometimes indicators of the emotional state of the older person. Longitudinal changes in these four subtypes of agitated behaviors were examined. METHODS: One hundred and four community-dwelling participants of five senior day care centers (mean age = 79) were followed up for 2 years. Their agitation was assessed, as was their cognitive functioning, affect, and medical functioning. RESULTS: Although physically nonaggressive, physically aggressive, and verbally aggressive behaviors increased significantly over 2 years, verbally nonaggressive behaviors did not show significant changes over time. These patterns can be partially explained by the relationship between the different types of agitation and cognitive functioning. Increases in physically nonaggressive behaviors from start to end of the 2 years were predicted by greater cognitive impairment at baseline and by receiving a smaller number of medications at baseline. Increases in verbally aggressive behaviors and in physically aggressive behaviors during the study period correlated significantly with a greater decline in cognitive functioning and increased depression at baseline. In addition, increases in physical aggression were correlated with greater cognitive impairment at baseline. CONCLUSIONS: The course of change for each type of agitation was unique. The relationships between inappropriate behaviors, cognitive functioning, physical health, and depression over time are complex and vary by type of agitation.     

The effect of homework compliance on treatment outcomes for participants with myalgic encephalomyelitis/chronic fatigue syndrome.

Purpose: This study examined the relationship between level of treatment engagement through completion of homework on treatment outcomes within nonpharmacological interventions for participants with ME/CFS. Method: A sample of 82 participants with ME/CFS was randomly assigned to one of four nonpharmacological interventions. Each intervention involved 13 sessions over the course of 6 months. Change scores were computed for self-report measures taken at baseline and 12-month follow-up. Homework compliance was calculated as the percentage of completed assignments across the total number of sessions and grouped into three categories: minimum (0–25%), moderate (25.1–75%), or maximum (75.1–100%). Results: Findings revealed that after controlling for treatment condition, those who completed a maximum amount of homework had greater improvement on a number of self-report outcome measures involving role, social, and mental health functioning. There were no differential improvements in physical and fatigue functioning based on level of homework compliance. Implications: Findings from this study suggest homework compliance can have a positive influence on some aspects of physical, social, and mental health functioning in participants with ME/CFS. It should be emphasized that these interventions do not cure this illness. The lack of significant changes in physical functioning and fatigue levels suggests a need for more multidisciplinary treatment approaches that can elicit improvement in these areas. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Maintaining perceptions of control: Finding perceived control in low-control circumstances.

Three questions about the role of perceived control in coping with a major life stressor were addressed in a sample of 71 cancer patients. As expected, those with greater perceptions of control were less depressed, even when physical functioning, marital satisfaction, and negative affectivity were controlled for. Consistent with a compensatory model of control, it was more important for patients to believe that they could control daily emotional reactions and physical symptoms than the course of the disease. Patients who endorsed irrational beliefs had lower overall perceptions of control. The results indicated that even patients who were physically or psychosocially worse off were better adjusted if they had higher perceptions of control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral self-regulation in adolescents with Type I diabetes: Negative affectivity and blood glucose symptom perception.

The hypothesis that negative affectivity (NA) is associated with accuracy of blood glucose (BG) symptom perceptions and diabetes control was assessed. After completing measures of BG symptom beliefs and NA-related constructs (i.e., attentional focus and trait anxiety), 35 adolescents with insulin-dependent diabetes monitored their physical symptoms and their actual BG levels 3 times daily for 2 weeks. Each subject's actual BG symptoms were determined by correlating symptom ratings with BG levels and were then compared with symptom beliefs. Those who were more internally focused were more able to discern which symptoms actually covaried with BG fluctuations; those with higher trait anxiety tended to misattribute non-diabetes-related symptoms to BG levels. Finally, interactions suggested that those who both attend to internal physical sensations and experience-heightened anxiety display poorer metabolic control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain injury: Psychological and medical factors related to rehabilitation outcome.

Examined the relationship of medical and psychological factors of adaptive physical functioning (APF) at discharge and length of rehabilitation stay following traumatic brain injury. 32 Ss (aged 16–55 yrs) with severe traumatic brain injury underwent interdisciplinary rehabilitation evaluations, including the MMPI, WAIS, and the Wechsler Memory Scale, at admission to and discharge from an inpatient rehabilitation program. Results suggest that the actual status of APF at discharge was related to initial assessments of medical, not psychological, factors. However, psychological factors were related to relative improvement in APF when change occurred. Even Ss who were minimally aware of their physical abilities and limitations at admission improved in their APF during treatment. Length of rehabilitation stay was determined by both physical and psychological functioning. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpreting correlations between children's perceived control and cognitive performance: Control, agency, or means€nds beliefs?

The types of beliefs responsible for correlations between children's perceived control and cognitive performance were investigated in 180 2nd, 4th, and 6th graders. Children were interviewed for control beliefs regarding the attainment of desired goals, for agency beliefs regarding the accessibility of different types of means to the self, and for means–ends beliefs regarding the efficacy of different types of means. Cognitive performance variables included fluid and crystallized intelligence as well as short-term and recognition memory. Of the three types of beliefs, only agency beliefs were strongly and consistently related to cognitive performance. Correlations were greater than zero beginning in 4th grade, increased monotonically from 2nd to 6th grade, and occurred for all cognitive performance measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttreatment functioning of alcoholic patients: Its relation to program participation.

Assessed the posttreatment functioning of 429 alcoholic patients selected from 5 different types of residential treatment facilities. Substantial improvement in 3 areas of functioning (drinking, occupational, and psychological) occurred among patients in each of the programs, although there were significant differences among the programs in the level of functioning at intake and at follow-up. The extent to which posttreatment adjustment could be predicted from patients' sociodemographic and drinking characteristics at intake was estimated from multiple regression analyses: 15 to 33% of the variance of several posthospital performance criteria was explained. Measures of relative improvement (differences between actual and predicted posttreatment functioning) were obtained and showed some variation among the programs. Analyses relating relative improvement to the treatment experiences of the patients in each program demonstrated that (a) patients who participated more actively tended to have better than expected outcomes, (b) patients given more medications tended to function relatively more poorly at follow-up, and (c) patients given Antabuse had better than expected outcomes. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome of multimodal day treatment for children with severe behavior problems: a five-year follow-up

OBJECTIVE: To evaluate the long-term outcome of a multimodal day treatment program for children with severe behavior problems and to identify factors that may predict a positive outcome. METHOD: Thirty-three children who completed a day treatment program were assessed using a prospective, single-cohort design tested at intake, discharge, and 5-year follow-up. The child's functioning was assessed using the Revised Child Behavior Profile (RCBP), Hare Self-Esteem Scale, Depression Self-Rating Scale, Hopelessness Scale for Children, Index of Peer Relations, and a 5-point ordinal scale for scholastic reintegration. RESULTS: Repeated-measures analyses of variance showed that improvement was maintained on all measures between intake and 5-year follow-up. A stepwise multiple regression showed that 92% of the adjusted variance in the behavioral functioning of the children at 5-year follow-up, as assessed by the RCBP, was explained by parental cooperation, initial RCBP total and externalizing scores, and history of problem pregnancy. CONCLUSIONS: Children who were admitted to a day treatment setting appear to function well globally, even 5 years after discharge. Parental cooperation was the most important variable in predicting positive outcome.     

Adverse perinatal outcomes in young adolescents

BACKGROUND: Identification of psychiatric patients with severe and persisting impairments can facilitate treatment, aid in program planning, and provide data for cost-of-care projections. METHODS: In this prospective study of patient outcomes, 1,679 inpatients were classified on admission using a functional status measure developed by the authors. Consenting subjects were reassessed at discharge and at 3, 6, and 12 months postdischarge to determine what proportion of patients classified as low functioning on admission remained so at follow-up. RESULTS: Patients classified as low functioning on admission represented 23.4% of the sample; the proportion that remained low functioning at the follow-ups ranged from 56.1% to 65.2%. Compared to the high functioning group, three times more low functioning patients were rehospitalized within 12 months of discharge (9.4% vs 32%). CONCLUSIONS: Patients with increased risk of persisting disability can be identified on admission using commonly available clinical measures. Of patients with low functioning on admission, more than half will have long-term impairment.     

Pain, depression, and physical functioning following burn injury.

Objective: Little is known about how pain and depression after burn injury may influence long-term outcomes such as physical functioning. This prospective study examined associations between pain, depression, and physical functioning in a sample of burn injury survivors. Design and Participants: Questionnaires assessing pain, depression, and physical functioning were completed by 64 (52% of original sample) adult burn survivors shortly after discharge from burn care and at 1- and 2-year follow-ups. Results: Pain and physical functioning improved over the 2 years of the study, whereas depression levels were stable. Pain and depression were associated with poorer physical functioning over time, but associations varied according to the time span under consideration. Also, the association between pain and physical functioning was strongest among persons with higher depression scores. Conclusions: Pain and depression may contribute independently to compromises in physical functioning. The co-occurrence of pain and depression represents even greater risk for reduced physical functioning over time among burn survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.

Examined the role of self-efficacy beliefs in the rehabilitation of 45 low back pain patients participating in a 3-wk rehabilitation program. Increments in self-efficacy beliefs during the rehabilitation program were not associated with improved patient functioning at discharge from the program. However, in support of the theorized role of self-efficacy in behavior change, these increments in self-efficacy significantly predicted better patient functioning and less reported pain at the 6-mo follow-up assessment. Implications of these findings for the rehabilitation of low back pain patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders

Changes in calorie intake and weight gain were evaluated in five children with cystic fibrosis (CF) who received behavioral intervention and four children with CF who served as wait list controls. The behavioral intervention was a 6-week group treatment that provided nutritional education plus management strategies aimed at mealtime behaviors that parents find most problematic. The control group was identified prospectively and was evaluated on all dependent measures at the same points in time pre- and posttreatment as the intervention group. Difference scores on calorie intake and weight gain from pre- to posttreatment were compared between groups using t tests for independent samples. The behavioral intervention group increased their calorie intake by 1,032 calories per day, while the control group's intake increased only 244 calories per day from pre- to posttreatment [t(6) = 2.826, p = 0.03]. The intervention group also gained significantly more weight (1.7 kg) than the control group (0 kg) over the 6 weeks of treatment [t(7) = 2.588, p = 0.03] and demonstrated catchup growth for weight, as indicated by improved weight Z scores (-1.18 to -0.738). The control group showed a decline in weight Z scores over this same time period (-1.715 to -1.76). One month posttreatment, the intervention was replicated with two of the four children from the control group. Improved calorie intake and weight gain pre- to posttreatment were again found in these children. At 3- and 6-month follow-up study of children receiving intervention, maintenance of calorie intake and weight gain was confirmed. No changes were found on pulmonary functioning, resting energy expenditure, or activity level pre- to posttreatment. This form of early intervention appears to be promising in improving nutritional status and needs to be investigated over a longer period of time to evaluate the effects of treatment gains on the disease process.     

Beliefs about control over gambling among young people, and their relation to problem gambling.

The aim of this study was to assess the association between beliefs about 2 types of control—(a) illusion of control and (b) internal locus of control—and gambling frequency–problem gambling among young people age 14 to 25 years (435 males, 577 females, and 5 unreported gender). A revised version of the South Oaks Gambling Screen and measures of gambling frequency and gambling beliefs were administered. Results indicated that irrational control beliefs were strongly associated with problem gambling. Young problem gamblers were more likely to believe that they needed money and that gambling would provide it. In addition, young problem gamblers had more faith in their ability to manipulate chance and "beat the system." Regression models with illusion of control and internal control over gambling significantly predicted gambling frequency and problem gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religious coping and health status in medically ill hospitalized older adults

Associations between specific religious coping (RC) behaviors and health status in medically ill hospitalized older patients were examined and compared with associations between nonreligious coping (NRC) behaviors and health status. The sample consisted of 577 patients age 55 or over consecutively admitted to the general medical inpatient services of Duke University Medical Center (78%) or the Durham VA Medical Center (22%). Information was gathered on 21 types of RC, 11 types of NRC, and 3 global indicators of religious activity (GIRA). Health measures included multiple domains of physical health, depressive symptoms, quality of life, stress-related growth, cooperativeness, and spiritual growth. Demographic factors, education, and admitting hospital were control variables. "Negative" and "positive" types of religious coping were identified. Negative RC behaviors related to poorer physical health, worse quality of life, and greater depression were reappraisals of God as punishing, reappraisals involving demonic forces, pleading for direct intercession, and expression of spiritual discontent. Coping that was self-directed (excluding God's help) or involved expressions reflecting negative attitudes toward God, clergy, or church members were also related to greater depression and poorer quality of life. Positive RC behaviors related to better mental health were reappraisal of God as benevolent, collaboration with God, seeking a connection with God, seeking support from clergy/church members, and giving religious help to others. Of 21 RC behaviors, 16 were positively related to stress-related growth, 15 were related to greater cooperativeness, and 16 were related to greater spiritual growth. These relationships were both more frequent and stronger than those found for NRC behaviors. Certain types of RC are more strongly related to better health status than other RC types. Associations between RC behaviors and mental health status are at least as strong, if not stronger, than those observed with NRC behaviors.     

Long-term comparison of brief versus unlimited psychodynamic treatments with children and their parents.

30 children and their parents were assigned randomly to either time-unlimited or time-limited (12 sessions) psychodynamically oriented treatments or to a minimal-contact control group. All groups showed significant improvements from pretest to posttest. Comparisons between groups at posttest on parental measures of family functioning showed that changes reported by the minimal contact control group were significantly greater than those of the time-unlimited group. When assessments from pretest to 4-yr follow-up were compared, all groups improved significantly on therapist measures of goal attainment, but only the minimal-contact control group reported significant improvements on severity of target problems and measures of family functioning. The results of this study suggest that long-term therapy does not necessarily provide more effective therapy. These findings have important implications for clinical practice, service delivery, and research, particularly in the present climate of financial restraint in health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and Physical Adjustment to Breast Cancer Over 4 Years: Identifying Distinct Trajectories of Change.

The goal of this study was to identify distinct trajectories of adjustment to breast cancer over 4 years as well as to distinguish among the different trajectories. The mental and physical functioning of 287 women with breast cancer who remained alive and disease free through 4 years of follow-up were examined. The majority of women showed slight and steady improvement in functioning with time, but subgroups of women were identified who showed marked improvement and marked deteriorations over time. Age successfully distinguished different trajectories of physical functioning. Indices of personal resources (i.e., self-image, optimism, perceived control) and social resources (i.e., social support) successfully distinguished different courses of mental and physical functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Locus of control and patient role adjustment of the elderly in acute-care hospitals.

Felton and Kahana's (1974) conclusion that patients with external locus of control beliefs were better adjusted in institutions was reexamined in a high-constraint acute-care hospital. Subjects were 105 patients aged 60–93. The Multidimensional Health Locus of Control (MHLC) scales were used to measure locus of control, and eight staff-rating items measured hospital adjustment. Also, the Loss of Independence subscale of the Hospital Stress Rating Scale was used to indicate perceived institutional constraint. The three MHLC scales correlated weakly with adjustment, and each contributed significantly in multiple regression. Those patients who perceived greater constraint were more poorly adjusted. Those with stronger beliefs that powerful others control health outcomes perceived less constraint in the hospital situation, whereas those with stronger internal control beliefs perceived greater constraint. Beliefs in chance were unrelated. Findings are related to concepts of primary and secondary control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)