Review of Cognitive-behavioral treatment of irritable bowel syndrome: The brain-gut connection.

Reviews the book, Cognitive-behavioral treatment of irritable bowel syndrome: The brain-gut connection by Brenda B. Toner, Zindel V. Segal, Shelagh D. Emmott, and David Myran (see record 1999-04420-000). This treatment manual represents a significant step forward in improving the biopsychosocial understanding and level of care available to patients with irritable bowel syndrome (IBS). Couched in cognitive-behavioural terms, the book identifies the pathogenic schema or "toxic" thoughts that characterize individuals prone to IBS symptoms. The goal of treatment is to shift the patient from a medical view that the IBS condition is largely outside the person's control to a view that the symptoms are under significant patient control. The book, part of the publisher's series of treatment manuals for practitioners, follows an accepted format with respect to cognitive techniques and interventions (collaborative empiricism, use of questions, present focus, self-help assignments, automatic thoughts). Practitioners who are not familiar with the rationale and techniques of cognitive behaviour therapy will appreciate the detail, which is provided for implementing their program. The book would have been strengthened by a discussion of medication, especially analgesic and bowel medications that might be having positive and negative effects on the IBS condition. By remaining loyal to the cognitive behavioural framework, the authors may have missed an important dimension of biopsychosocial patient care. Also, more attention to the sensory aspects of IBS symptoms (e.g., uncontrollable urges) would have strengthened the intervention. Still, this remains an excellent book and is highly recommended to all health professionals who work with patients with gastrointestinal symptoms and chronic illness conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial factors in peptic ulcer and inflammatory bowel disease.

Over the past decade, while gastroenterologists' interest in mind-body interactions in organic disorders dwindled, stronger evidence has linked psychosocial factors with the incidence and recurrence of peptic ulcer and with the course of inflammatory bowel disease. Psychological-behavioral approaches to treatment continue to be disappointing. Psychosocial factors may affect ulcer by increasing duodenal acid load, altering local circulation or motility, intensifying Helicobacter pylori infection, stimulating corticosteroid secretion, and affecting health risk behaviors; possible mechanisms for inflammatory bowel disease include immune deregulation, gut permeability changes, and poor medication adherence. Both belong to the growing category of diseases thought to have an infectious component: for peptic ulcer the bacterium Helicobacter pylori, for inflammatory bowel disease an exaggerated immune response to gut bacteria. Peptic ulcer and inflammatory bowel disease, which present unique interactions among psychological, immunologic, endocrine, infectious, and behavioral factors, are splendid paradigms of the biopsychosocial model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain assessment and management in older adults: Conceptual issues and clinical challenges.

This article reviews clinical pain assessment and psychological pain management in older persons through the lens of a Communications Model of Pain (Craig, in press; Hadjistavropoulos & Craig, 2002; Hadjistavropoulos, Craig, & Fuchs-Lacelle, 2004; Prkachin & Craig, 1995). The Communications Model of Pain has the advantage of drawing attention to a variety of important factors that come into play when selecting assessment instruments and when making decisions concerning intervention. The authors examine a variety of assessment methodologies (including both self-report and observational approaches) that are suitable for older persons with and without dementia. The authors also review psychosocial pain management methods (e.g., cognitive behavior therapy and applications of behavioral approaches within long-term care facilities) that have potential applications with older persons. The role of psychological service providers is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An emotional exposure-based treatment of traumatic stress for people with chronic pain: Preliminary results for fibromyalgia syndrome.

Emotional trauma occurs in many patients with chronic pain, particularly fibromyalgia syndrome (FMS). Current cognitive-behavioral treatments for chronic pain have limited effects, perhaps because the trauma is not addressed, whereas emotional exposure-based treatments improve post-traumatic stress, but have not been tested on chronic pain. The authors present a novel, brief treatment protocol for people with chronic pain and unresolved trauma (Multi- Stimulus, Multi-Technique Emotional Exposure Therapy), which involves detecting avoidance of a range of emotion-related stimuli, implementing exposure techniques tailored to the patient's avoidances, and negotiating the process and therapeutic alliance. This treatment was pilot tested on 10 women with intractable FMS and trauma histories. Three months post-treatment, the sample showed moderate to large effects on stress symptoms, FMS impact, and emotional distress; and small-to-moderate improvements on pain and disability. Two patients showed substantial improvement, four made moderate gains, two showed modest improvement, and two did not benefit. This pilot study suggests that emotional exposure treatment for unresolved trauma may benefit some patients with FMS. Controlled testing of the treatment for FMS and other chronic pain populations is indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial functioning in the context of diagnosis: Assessment and theoretical issues.

Psychosocial functioning is an important focus of attention in the revision of the Diagnostic and Statistical Manual of Mental Disorders. Researchers and clinicians are converging upon the opinion that psychometrically strong, comprehensive assessment of individuals’ functioning is needed to characterize disorder fully. Also shared is the realization that existing theory and research in this domain have critical shortcomings. The authors urge that the field reexamine the empirical evidence and address theoretical issues to guide future development of the construct and its measurement. The authors first discuss several theoretical issues relevant to the conceptualization and assessment of functioning: (a) definitions of functioning, (b) the role of functioning in defining disorder, and (c) understanding functioning within environmental contexts. The authors then present data regarding empirical domains of psychosocial functioning and their interrelations. Self-reported data on multiple domains of psychosocial functioning were collected from 429 participants. Factor-analytic results (promax rotation) suggest a 4-factor structure of psychosocial functioning: Well-Being, Basic Functioning, Self-Mastery, and Interpersonal and Social Relationships. Finally, the authors propose an integration of theory and empirical findings, which they believe will better incorporate psychosocial functioning into future diagnostic systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and management of pain in the older adult.

Objective: To discuss the unique issues related to pain in older adults and to outline methods for assessment and treatment of geriatric pain. Synthesis: A model for pain assessment and treatment in the older adult is presented. Existing data indicate that cognitive-behavioral treatments are effective for pain management in older adults, although modification in treatment procedures may be needed to optimize treatment outcome. Conclusion: Geriatric pain is an understudied and undertreated problem. Multidisciplinary assessment and treatment should focus on pain reduction, relieving emotional distress, and improving function, with the ultimate goal of reducing disability and improving quality of life. Severe, disabling pain is not part of normal aging and should be assessed and treated. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care.

This study describes the results of a controlled clinical trial involving 44 7–14 yr old children with recurrent abdominal pain who were randomly allocated to either cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatment conditions resulted in significant improvements on measures of pain intensity and pain behavior. However, the children receiving CBFI had a higher rate of complete elimination of pain, lower levels of relapse at 6- and 12-mo follow-up, and lower levels of interference with their activities as a result of pain. Parents reported a higher level of satisfaction with the treatment than children receiving SPC. After controlling for pretreatment levels of pain, children's active self-coping and mothers' caregiving strategies were significant independent predictors of pain behavior at posttreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: An analysis of generalization, maintenance, and side effects.

From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3-month follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults

OBJECTIVE: Our purpose was to evaluate the impact of sonographic data on clinical physicians' diagnostic confidence and their treatment of children and young adults with acute lower abdominal pain. SUBJECTS AND METHODS: Senior surgical and emergency department staff completed questionnaires before and after abdominal sonography was performed on 94 of 101 consecutive children and young adults with acute lower abdominal pain, pelvic pain, or both. Physicians who were unaware of sonographic data stated the most likely diagnosis and their level of confidence in their diagnosis and then formulated clinical plans. After they were given sonographic data, physicians again stated the most likely diagnosis, estimated their level of confidence, and formulated revised treatment plans. RESULTS: Sonographic data resulted in revised clinical diagnoses in 52% of the patients. Overall, the gain in diagnostic confidence for the entire study population was 33% (95% confidence interval [CI], 27-38%; p < .0001). The impact on the physicians' confidence was greater in those children and young adults whose diagnoses changed after sonography (mean increase in physicians' confidence, 48.3%; 95% CI, 47-75%). In patients whose diagnoses were not changed after sonography, the mean increase in physicians' confidence was 17.6% (95% CI, 11-24%; p < .0001 [analysis of variance]). Physicians used sonographic data to change initial treatment plans in 43 patients (46%). Of these 43 patients, a lower intensity of care was given to 30 patients (70%) and a higher intensity to 13 patients (30%). CONCLUSION: Sonographic data frequently changed initial clinical diagnoses, thus increasing diagnostic confidence and changing clinical treatment decisions in the setting of acute lower abdominal pain in children and young adults.     

Psychosocial treatment of the addictions: Problems in specific populations.

Psychosocial treatment programs have made recent advances in understanding and intervening with the problems of addiction. This article reviews the contributions included in this special series, which encompasses several specific issues facing psychologists who conduct treatment, research, and teaching in the field of addictive behaviors. These topics include a mood management intervention for Spanish-speaking substance abusers, factors influencing crack cocaine use by African-American teens, development of culturally sensitive treatment models, patients with the dual diagnoses of mental illness and substance abuse, and recent developments regarding substance abusers and human immunodeficiency virus and acquired immunodeficiency syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome.

Thirty-four patients with irritable bowel syndrome were randomly assigned to 1 of 3 treatment conditions: individualized cognitive treatment (CT), self-help support group (SG), or symptom monitoring waiting-list control (WL). Each of the 3 conditions lasted approximately 8 weeks. Pre- to posttreatment analyses revealed significantly greater reductions in both individual gastrointestinal (GI) symptoms and in a composite index for GI symptom change for the CT condition than for the SG or WL conditions. When compared with the SG and WL conditions, the CT condition also showed significant improvement on psychological measures of depression and anxiety. At 3-month follow-up, the results for the CT condition were maintained and revealed further numerical improvements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial aspects of selected issues in women's reproductive health: Current status and future directions.

Emphasizing research published in the past decade, this article presents a summary and evaluation of psychosocial investigations of women's reproductive health, with a focus on selected aspects of menstruation, pregnancy and birth, infertility, and menopause. In some areas, studies have focused on negative physical and psychological concomitants of these health issues. However, research reveals substantial individual variability, with most women adapting well to reproductive health changes. Although methodological and conceptual shortcomings have limited firm conclusions, research has advanced our understanding of the multivariate biological, psychological, and social influences on women's reproductive health and associated outcomes. Understanding and promoting women's reproductive health across the lifespan requires biopsychosocial approaches to research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of daily stressors to somatic and emotional symptoms in children with and without recurrent abdominal pain.

Prior investigations of the relation between stressors and symptoms in children with recurrent abdominal pain (RAP) have focused on major negative life events. This study used consecutive daily telephone interviews to assess daily stressors and symptoms in 154 pediatric patients with RAP and 109 well children. Results showed that patients with RAP reported more frequent daily stressors than well children reported both at home and at school. Idiographic (within-subject) analyses indicated that the association between daily stressors and somatic symptoms was significantly stronger for patients with RAP than for well children. In contrast, the relation between daily stressors and negative affect did not differ between the groups. The relation between daily stressors and somatic symptoms was stronger for patients with RAP who had higher levels of trait negative affectivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and treatment of sleep disorders in older adults: A review for rehabilitation psychologists.

Recent research has led to significant progress in the assessment and treatment of sleep disturbance in older adults. Similar advances have been made with sleep disorders secondary to age-related chronic illness. The assessment and treatment of sleep disorders encompasses numerous behavioral aspects. Thus, rehabilitation psychologists are ideally positioned to help apply these new advances to the growing number of older adult patients in the rehabilitation setting. The authors provide an overview of age and disease-related sleep disorders. They provide details for implementation of behavioral treatments for geriatric insomnia that is comorbid with chronic illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Phantom limb pain and pain interference in adults with lower extremity amputation: The moderating effects of age.

Purpose/Objective: To determine whether the relationship between phantom limb pain severity and pain-related interference was moderated by age and to compare 2 theoretical perspectives used in the literature to account for age-related differences in the experience of chronic pain. Research Method/Design: Analysis of survey data provided by 375 adults with lower extremity amputations who reported phantom limb pain. Results: The relationship between phantom limb pain severity and pain-related interference was shown to be moderated by age (β = -.10, p     

Review of Pain in children and adolescents.

Reviews the book, Pain in children and adolescents by P. J. McGrath and A. M. Unruh (1987). This book is an extremely comprehensive work, dealing not only with specific clinical problems but also with such broader and complex issues as ethics and service delivery in pediatric pain. McGrath and Unruh go a long way to unravel the 'mystery' of pain in children by discussing clearly and concisely the literature on the assessment and measurement of pain in children. Clinical problems such as post-operative pain, abdominal pain, headache, muskuloskeletal pain, colic, injuries, psychogenic pain, and chronic intractable pain are all dealt with in individual chapters divided into clearly labelled sections, making it very easy for busy clinicians to locate their particular area of interest. One of the strengths of this book is the methodological expertise of the authors, which is evident in their evaluations of the research cited in the text. Novice researchers reading this book will be reminded of the many pitfalls to be avoided in research design, and postgraduate students seeking topics for research will find numerous suggestions in the 'future directions' sections of the book. The publishers are to be congratulated on their attractive presentation of the book. The type is large and very easy to read, the text is well spaced, and considering the amount of material in the book, it is remarkably compact in size and very reasonably priced. Providing as it does a comprehensive summary and analysis of the literature to date on pain in children, it is essential reading for all clinicians, paramedics, and researchers concerned with this important and long neglected area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting treatment outcome by combining different assessment tools: Toward an integrative model of decision support in psychotherapy.

Different types of evidences must be integrated to derive predictions about the possible outcome of psychotherapeutic interventions. We use the Minnesota Multiphasic Personality Inventory–2 (MMPI–2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) as a tool for gathering assessment data and propose a new method of statistical prediction to apply to psychotherapy. We apply artificial neural network (ANN) technology to a pool of clinical data gathered from the MMPI–2 profiles of 150 patients to derive indications about the outcomes of the interventions. ANNs are nonlinear computational devices, directly inspired by the principles of biological neural computation, that process information to learn patterns as a result of exposure to a set of representative “training cases.” The performance of the paper's ANN in forecasting successful and unsuccessful treatment cases shows a mean rate of correct classification of 81%. This suggests that ANNs may be considered a potentially useful tool for supporting clinical practice and for deriving prognostic indicators for psychotherapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children with down syndrome: Implications for assessment and intervention in the school.

Down syndrome is the most common genetic cause of mental retardation and one of the most frequently occurring neurodevelopmental genetic disorders in children. Children with Down syndrome typically experience a constellation of symptomology that includes developmental motor and language delay, specific deficits in verbal memory, and broad cognitive deficits. Children with Down syndrome are also at increased risk of medical problems, which can exacerbate their cognitive deficits. Although the diagnosis of Down syndrome is facilitated by cytogenetic testing and the unique physical phenotype, the development of proper interventions for this group of children is less obvious. Despite their functional deficits, children with Down syndrome possess relative strengths, which can be the focus of interventions. This article reviews the etiology and developmental course of Down syndrome, appraises examples of empirically validated interventions, and discusses neurocognitive processing issues that should be considered during a psychoeducational evaluation for intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developments in the self-report assessment of personality and psychopathology in adults.

This article reports on current developments associated with the self-report assessment of personality and psychopathology in adults. Formats for assessment are reviewed, novel approaches to the collection of information concomitant with self-report are introduced, and the dimensionality of domains of personality and psychopathology is discussed. Some alternatives to self-report are offered and topics of questionnaire phrasing, response styles, and faking as ongoing issues for self-report measures are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)