Understanding Barriers and Facilitators to Implementation of Psychosocial Care within Orthopedic Trauma Centers: A Qualitative Study with Multidisciplinary Stakeholders from Geographically Diverse Settings

BACKGROUND: Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor\u27s taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change. METHODS: We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N = 79; 20 attendings, 28 residents, 10 nurses, 13 medical assistants, 5 physical therapists/social workers, and 3 fellows) at 3 trauma centers in Texas, Kentucky, and Massachusetts. We used directed and conventional content analyses to derive information on barriers, facilitators, and implementation strategies within 26 CFIR constructs nested within 3 relevant Proctor outcomes of acceptability, appropriateness, and feasibility. RESULTS: Stakeholders noted that implementing psychosocial care within their practice can be acceptable, appropriate, and feasible. Many perceived integrated psychosocial care as crucial for preventing persistent pain and reducing provider burden, noting they lack the time and specialized training to address patients\u27 psychosocial needs. Providers suggested strategies for integrating psychosocial care within orthopedic settings, including obtaining buy-in from leadership, providing concise and data-driven education to providers, bypassing stigma, and flexibly adapting to fast-paced clinics. CONCLUSIONS: Results provide a blueprint for successful implementation of psychosocial care in orthopedic trauma settings, with important implications for prevention of persistent pain and disability

Development and Initial Validation of a Bio-behavioral Measure of Anxiety Sensitivity

Anxiety sensitivity (AS) is a relatively stable individual difference factor reflecting the fear of anxiety-related sensations. AS is a transdiagnostic factor of psychopathology. Despite well-validated self-report methods to measure AS, no study to date has used AS-specific stimuli to measure threat responses from a motoric fashion. Using a dual-task attentional control paradigm (i.e., approach versus avoidance) that employs AS-specific stimuli and motion-tracking technology, we sought to develop an easy-to-use bio-behavioral index of AS in sample of young adults (58.3% female, M age = 25.3, SD = 8.3; range = 18-56 years). Participants completed a self-report measure of AS (ASI-3) and subsequently took part in a virtual reality ball catching game to index their measures of approach and avoidance towards the AS-specific and neutral stimuli presented at either side of the game environment. The ASI-3 total score as well as the subscales cognitive and physical concerns showed significant bivariate correlations with the behavioral engagement with AS-specific stimuli, but not behavioral engagement with the neutral stimuli. After adjusting for age, gender, race, handedness, physical functioning, and negative affectivity, ASI-3 total score and the AS cognitive concern demonstrated significant relations with behavioral engagement with AS-specific stimuli. The present study provides preliminary, yet novel, evidence regarding the association between facets of AS with behavioral responses to AS-specific images. Future work is needed to replicate and extend the current results to clinical samples and test associations over larger periods of time.Psychology, Department o

DIFFERENTIAL EXPLANATORY EFFECTS OF ANXIETY SENSITVITY IN THE RELATION BETWEEN EMOTIONAL NON-ACCEPTANCE AND POSTTRAUMATIC STRESS SYMPTOMS AMONG TRAUMA-EXPOSED TREATMENT-SEEKING SMOKERS

Anxiety sensitivity, defined as the extent to which individuals believe anxiety-related sensations have harmful consequences, may play an important explanatory role in the relation between emotional non-acceptance and the expression of traumatic stress symptoms among trauma-exposed smokers. The current investigation examined whether lower-order facets of anxiety sensitivity (cognitive, physical, and social concerns) differentially explain the relation between emotional non-acceptance and posttraumatic stress symptom clusters (re-experiencing, avoidance, arousal) among trauma-exposed daily smokers (N = 169, 46% female; Mage = 41, SD = 12.3). Anxiety sensitivity and its lower order facets of cognitive and social concerns were found to explain the relations between emotional non-acceptance and avoidance and arousal posttraumatic stress symptoms. Moreover, anxiety sensitivity cognitive concerns explained these relations above and beyond the other two facets. The present findings suggest cognitive-based anxiety sensitivity concerns may play a mechainistic role in the expression of certain posttraumatic stress symptoms among trauma-exposed daily smokers.Psychology, Department o

Anxiety Sensitivity and Smoking Behavior Among Trauma-Exposed Daily Smokers: The Explanatory Role of Smoking-Related Avoidance and Inflexibility

Work suggests anxiety sensitivity (AS) plays an important role in understanding the smoking-trauma association. AS is thought to serve as a transdiagnostic risk factor in both smoking and trauma, resulting in poorer outcomes in both domains. Cognitive inflexibility reflects a lack of ability to disengage attention from one task to another. In relation to smoking, a decrease in smoking-specific avoidance and inflexibility is associated with increased likelihood of smoking abstinence after treatment. Our aim was to examine whether smoking-specific avoidance and inflexibility explains the relation of AS and smoking severity among trauma-exposed smokers. It was hypothesized AS would have a significant indirect effect within this relation. The findings show empirical evidence of the explanatory effect of smoking-specific avoidance and inflexibility in the relation between AS and smoking severity among trauma-exposed smokers. This relation impacted number of cigarettes per day, years of being a daily smoker, number of failed quit attempts, and even heaviness of smoking index.Psychology, Department ofHonors Colleg

The Differential Role of Anxiety Sensitivity and its Components in the Relation Between Emotional Nonacceptance and Anxiety and Depressive Symptoms and Disorders among Latinos in Primary Care

Latinos are the second fastest growing minority group in the United States. Unfortunately, rates of depression and anxiety symptoms among Latinos may be as much as twice the rate of non-Latino White Americans. Due to cultural values such as emotional restraint and perceptions of emotional expression as a sign of weakness, emotional nonacceptance could play a major role in development and maintenance of mood and anxiety problems among the Latino population. Hypothesis. Anxiety sensitivity may explain the associations between emotional nonacceptance and symptoms of anxious arousal, social anxiety, depression and other mood/anxiety disorders. The sub-scales of AS: physical, cognitive and social concerns were expected to be mediators to anxious arousal, depressive symptoms and social anxiety symptoms respectively. AS was found to explain the relations between emotional nonacceptance and all dependent variables: social anxiety, anxious arousal, depressive symptoms, and number of mood/anxiety disorder diagnoses. AS may be an explanatory mechanism in the relation between emotional nonacceptance and a relatively broad array of anxiety and depressive symptoms and clinical disorders. This project was completed with contributions from Monica Garza from Legacy Community Health, Houston.Psychology, Department ofHonors Colleg

Exploratory Factor Analysis of SCL90-R Symptoms Relevant to Psychosis

"nObjective: Inconsistent results have been reported regarding the symptom dimensions relevant to psychosis in symptoms check list revised (SCL90-R), i.e., "psychoticism" and "paranoid ideation". Therefore, some studies have suggested different factor structures for questions of these two dimensions, and proposed two newly defined dimensions of "schizotypal signs" and "schizophrenia nuclear symptoms". We conducted an exploratory factor analysis on the items of these two dimensions in a general population sample in Iran. "nMethod: A total of 2158 subjects residing in Southern Tehran (capital of Iran) were interviewed using the psychoticism and paranoid ideation questions in SCL90-R to assess severity of these symptom dimensions. Factor analysis was done through SAS 9.1.3 PROC FACTOR using Promax rotation (power=3) on the matrix of "polychoric correlations among variables" as the input data. "nResults: Two factors were retained by the proportion criterion. Considering loadings >= 0.5 as minimum criteria for factor loadings, 7 out of 10 questions  from psychoticism ,and 3 out of 6 questions from paranoid ideation were retained, and others were eliminated. The factor labels proposed by the questionnaire suited the extracted factors and were retained. Internal consistency for each of the dimensions was acceptable (Cronbach's alpha 0.7 and 0.74 for paranoid ideation and psychoticism respectively). Composite scores showed a half-normal distribution for both dimensions which is predictable for instruments that detect psychotic symptoms. "nConclusion: Results were in contrast with similar studies, and questioned them by suggesting a different factor structure obtained from a statistically large population. The population in a developing nation (Iran) in this study and the socio-cultural differences in developed settings are the potential sources for discrepancies between this analysis and previous reports

The moderating role of smoking amount per day on the relations between anxiety sensitivity, smoking dependence, and cognitive–affective aspects of smoking among treatment seeking smokers

The current study examined the moderating effects of smoking amount per day on the relation between anxiety sensitivity and nicotine dependence, cigarette smoking outcome expectancies, and reasons for quitting smoking among 465 adult, treatment-seeking smokers (48% female, Mage = 36.6, SD = 13.5). Smoking amount per day moderated the relation between anxiety sensitivity and nicotine dependence, smoking expectancies for negative consequences and appetite control as well as intrinsic reasons for quitting. However, no moderating effect was evident for negative reinforcement expectancies. The form of the significant interactions indicated across dependent variables lower levels of smoking amount per day suppressed the relation between anxiety sensitivity and smoking related dependent variable, such that the positive relation of anxiety sensitivity to smoking dependence and cognitive–affective aspects of smoking is weaker in heavier smokers and more robust in lighter smokers

Posttraumatic Stress and Distress Tolerance: Associations With Suicidality In Acute-Care Psychiatric Inpatients

Trauma and posttraumatic stress disorder (PTSD) symptomatology have been associated with suicidality, including ideation and behavior. The current investigation evaluated, in acute-care psychiatric inpatients, the mediating role of perceived (self-reported) distress tolerance in the association between PTSD symptom severity and suicidality, defined as a) suicidal ideation, intent, or behavior leading to current psychiatric hospitalization; b) self-reported severity of suicidal desire; and c) percentage of days of suicidality during current hospitalization. Participants were composed of 105 adults (55.2% women; mean age, 33.9; SD, 10.9) admitted to a public psychiatric acute-care inpatient hospital in a large metropolitan area; 52.3% of the participants were hospitalized for suicidality. Results indicated that PTSD symptom severity (and severity of each PTSD symptom cluster) may exert an indirect effect on suicidality, specifically suicidality as a basis for current hospital admission and self-reported severity of suicidal desire, through perceived distress tolerance. Effects were documented after controlling for theoretically relevant covariates