COVID-19 and mental health in the UK: depression, anxiety and insomnia and their associations with persistent physical symptoms and risk and vulnerability factors

Objectives Mental health problems and persistent COVID-19 symptoms were prevalent in the context of COVID-19. However, despite the long-observed association between physical symptoms and mental health problems, such association has not been adequately examined in the context of COVID-19. Our understanding of wider patterns of risk and vulnerability factors for mental health also remains limited. This study investigated the associations between general mental health, and persistent physical symptoms, and additional risk and vulnerability factors in the context of COVID-19. Methods Two hundred fourteen adults, living in the UK, recruited via social media, completed the online survey and were included in the analyses. Correlation and regression analyses were conducted to examine the associations of persistent physical symptoms and risk and vulnerability factors with measures of general mental health including depressive symptoms, anxiety and insomnia. Results 78.5% of the participants reported between 1 and 26 persistent symptoms, and about 28%–92% of them associated these symptoms with COVID-19 infection. Persistent physical symptoms were uniquely associated with all measures of mental health, β = .19–.32. Mental health history and worries were the most prominent risk factors, |β| = .12–.43. Conclusions People who experience more persistent physical symptoms post-COVID-19 have poorer mental health. It may be important to consider and discuss the recovery from COVID-19 beyond a negative COVID-19 test. Multidisciplinary interventions that address the complex impact of COVID-19 for people with long COVID are needed

Model and processes of Acceptance and Commitment Therapy (ACT) for chronic pain including a closer look at the self

Acceptance and Commitment Therapy (ACT), is one of the so called “third-wave” Cognitive Behavioral Therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the Psychological Flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to “self” appears underappreciated. Indeed a positive or healthy sense of self seems essential to our wellbeing, and there have been numerous studies of the self in chronic pain. At the same time these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF, with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes

Initial validation of the Self Experiences Questionnaire-2 in people with chronic pain

Purpose: The struggle with sense of self has a fundamental impact on health and wellbeing in people with chronic pain. Acceptance and Commitment Therapy (ACT) particularly includes a process related to sense of self, called self-as-context (SAC). A measure of SAC, called the Self Experiences Questionnaire-8 (SEQ-8) has been developed in people with chronic pain. A brief version of the SEQ can facilitate more efficient assessment in clinical settings, and further research using intensive assessment to produce situation and time-sensitive information on SAC. The aim of the study was to establish a two-item version of the SEQ. Methods: This study used secondary analyses of data from 453 people with chronic pain. Results: The newly validated SEQ-2 demonstrated acceptable reliability, Cronbach’s α= .77, and performed well in assessing SAC, with 88.6% of the variance in the SEQ-8 explained by the SEQ-2. The construct validity of the SEQ-2 was supported by its associations with other theoretically-specified processes, r= .25-.51, p<.001. and measures of functioning, |r|=.18-.40, p<.001. The incremental validity of the SEQ-2 was relatively limited, |β|=.08-.34. Conclusions: The SEQ-2 appears to be an acceptable measure of SAC. The brief version of the SEQ can facilitate the application of individualised research methods and personalised pain treatments, informed by intensive assessment

Change in fatigue in acceptance and commitment therapy‐based treatment for chronic pain and its association with enhanced psychological flexibility

Purpose: Fatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic pain. Methods: This study included 354 adults attending an interdisciplinary ACT‐oriented treatment for chronic pain. T‐tests and analyses of clinically meaningful change were used to investigate participant improvements in fatigue interference after the treatment. Pearson's correlations and hierarchical regressions were conducted to investigate associations between improvement in fatigue interference and improvements in PF processes. Finally, mixed effects models were used to explore associations between baseline fatigue interference and changes in treatment outcome measures. Results: Participants improved in fatigue interference (d = 0.37), pain, some PF processes and daily functioning (d = 0.18–1.08). 39.7% of participants demonstrated clinically meaningfully improvements in fatigue interference. Changes in fatigue interference was associated with changes in pain, PF processes and daily functioning, |r| = 0.20–0.46. Change in fatigue interference was associated with change in pain acceptance independent of change in pain, β = −0.36, p < .001. However, baseline fatigue interference did not predict any treatment outcome. Overall, people with fatigue appeared to benefit from the ACT‐oriented interdisciplinary treatment for chronic pain, and relatively higher levels of fatigue did not appear to impede this benefit. Conclusion: ACT‐based treatments may benefit people with chronic pain and fatigue. Future studies including experimental designs, and studies investigating other PF processes, are needed to better understand the utility of ACT for comorbid fatigue and pain. Significance: This study investigates the association between fatigue interference and psychological flexibility processes in chronic pain, and the first one investigating fatigue interference as a predictor of functioning in chronic pain following Acceptance and Commitment Therapy (ACT)‐based treatment. Findings of the study provide preliminary evidence for the association between ACT and fatigue in people with chronic pain and support

Change in "Self-as-Context" ("Perspective-taking") occurs in acceptance and commitment therapy for people with chronic pain and is associated with improved functioning

Acceptance and commitment therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process referred to as ‘‘self-as-context’’ (SAC). This study investigates whether ACT is associated with an effect on SAC and whether this effect is linked to treatment outcomes in people with chronic pain. Four hundred twelve adults referred to a pain management center participated in the study. Participants completed measures of treatment processes (SAC, pain acceptance) and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon completion of treatment, and at 9-month follow-up. Paired sample t-tests and analyses of meaningful change were conducted to examine changes in processes and outcomes. Regression analyses with residualized change scores from process and outcome variables, and bivariate growth curve modeling were used to examine the association between change in SAC and change in outcomes. Participants significantly improved on all process and outcome variables at post-treatment (d = .38–.98) and 9-month follow-up (d = .24–.75). Forty-two to 67.5% of participants showed meaningful improvements on each outcome at post-treatment and follow-up. Change in SAC was associated with change in outcomes (b = –.21 to –.31; r = –.16 to –.46). Results support a role for change in SAC in treatment as the psychological flexibility model suggested

The psychological functioning in the COVID-19 pandemic and its association with psychological flexibility and broader functioning in people with chronic pain

Aims: People with chronic pain may be particularly vulnerable to the impact of the pandemic COVID-19, and psychological flexibility may protect them. This study investigates psychological functioning in the context of COVID-19, including fear and avoidance in the context of COVID-19, specifically its association with daily functioning, and the role of psychological flexibility, among people with chronic pain. Methods: Responses from 555 adults with chronic pain were collected through a cross-sectional online survey and analysed. Results: Eight out of ten participants reported significant depression and nearly nine out of ten reported significant functional impairment. COVID-19-related fear and avoidance significantly correlated with pain, pain-related disability, depression, and work and social adjustment (r=18-.32), as well as psychological flexibility processes, including pain acceptance, self-as-context, and committed action, |r|=.13-.30. COVID-19-related fear and avoidance and COVID-19-related interference were significant predictors of some measures of daily functioning beyond demographics and pain, β=.09-.14. However, these associations weakened when psychological flexibility processes were factored into the models, with fear of COVID-19 no longer being a significant predictor of pain-related disability or depression, and COVID-19 avoidance no longer a significant predictor of depression. Conclusions: The psychological functioning in the context of COVID-19 appears to be negatively associated with daily functioning in people with chronic pain, and is statistically significant in this regard. Psychological flexibility may have a role in these associations for people with chronic pain in the pandemic

Predictors of outcomes following interdisciplinary acceptance and commitment therapy for chronic pain: profiling psychological flexibility

Background: Growing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult. Aims: This aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT-based pain management programme. Methods: Data from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre- and post-treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre- to post-treatment. Results: Three subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre-treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables. Conclusions: People with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how. Significance: There remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development

Preliminary investigation of the associations between psychological flexibility, symptoms, and daily functioning in people with chronic abdominal pain

Objective: Acceptance and Commitment Therapy, based in the psychological flexibility model, may benefit people with chronic abdominal pain. The current study preliminarily investigates associations between psychological flexibility processes and daily general, social, and emotional functioning in chronic abdominal pain. Methods: An online survey comprising measures of psychological flexibility processes and daily functioning was distributed through social media. Subjects: 89 participants with chronic abdominal pain were included in the analyses. Results: All investigated psychological flexibility processes significantly correlated with pain interference, work and social adjustment, and depression, in the expected directions (|r|=.35-.68). Only pain acceptance significantly correlated with gastrointestinal symptoms, r=-.25. After adjusting for pain in the analyses, pain acceptance remained significantly associated with all outcomes, |β|=.28 to .56, but depression. After adjusting for pain and pain acceptance, only cognitive fusion remained significantly associated with anxiety, β=-.27, and depression, β=.43. When contrasting GI-specific anxiety with psychological flexibility processes, pain acceptance was uniquely associated with pain-related interference and work and social adjustment, and cognitive fusion and committed action were uniquely associated with depression. Conclusions: Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. Acceptance and Commitment Therapy may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain

Initial claims and employment growth: are we at the threshold?

One common threshold is that labor market conditions are improving when weekly unemployment claims fall below 400,000.Unemployment ; Employment ; Labor market

Genetic Relationships Between Two Rare Plant Species, \u3ci\u3eAliciella caespitosa\u3c/i\u3e and \u3ci\u3eA. tenuis\u3c/i\u3e, and Their Putative Progenitor, \u3ci\u3eA. subnuda\u3c/i\u3e

Isolated populations have potential to become new species that should have less genetic variation than their ancestors. Small populations are more likely to lose genetic variation, which is, thus, expected to be greater in ancestors. Aliciella caespitosa and A. tenuis, two endemic species, may be derived from small populations of A. subnuda, a widespread species. Chloroplast DNA sequences were used to test this hypothesis. Allozyme data were used to compare genetic variation and numbers of alleles. Chloroplast data do not support the proposed relationships between A. subnuda and the other two species. Allozyme data were not more variable in A. subnuda. The data suggest that A. tenuis is derived from A. caespitosa, although the former did not show lower allozyme diversity. I detected fewer alleles in A. tenuis. These data suggest that the original population of A. tenuis was not small enough to lose genetic variation relative to its progenitor