The role of fear-avoidance beliefs on low back pain-related disability in a developing socioeconomic and conservative culture : a cross-sectional study of a Pakistani population

Background: The relationship of low back pain, the world’s top disabling condition, with functional disability is often explained by the mediation effect of fear, catastrophizing, and psychological distress. These relationships have not been explored within chronic back pain patients from a low socio-economic, predominantly Muslim country. Thus, it was unclear whether previously established pathways would be consistent in Pakistani pain patients to help guide Pakistani clinicians caring for back pain patients. This cross-sectional study translated English versions of questionnaires within the fear-avoidance model into Urdu, tested the clini-metric properties of the Urdu versions for people with chronic low back pain (CLBP) in Pakistan, and performed mediation analysis to investigate pathways of the fear-avoidance model. Methods: Translation of questionnaires was completed in 4 steps using the forward-backward technique, with subsequent analyses for internal consistency (Cronbach’s α), construct validity (Pearson’s r-value), and test–retest reliability (ICC r-value). Multiple mediation analysis with bootstrapping was performed to analyze pathways within the fear-avoidance model from the Urdu translated questionnaires. Results: A total of 151 people from Pakistan with CLBP completed the questionnaires, with good results for internal consistency (r > 0.85), convergent validity (r > 0.59), and test–retest reliability (ICC r > 0.85). The association of pain with disability was significant (B=2.36, r2 = 0.19, p = 0.19, p<0.001, and the indirect effect of the mediators explained 81% of pain intensity’s total effect on disability. All mediators, apart from physical activity-related fear-avoidance beliefs, were significant mediators of the effect of pain intensity on disability. Conclusion: The Urdu versions of the fear-avoidance questionnaires show good clini-metric properties for use in clinical settings and research in Pakistan. These analyses support existing data for the mediation effect of catastrophizing, psychological distress, and self-efficacy on pain-related disability, and extends these findings to suggest that fear about work may be more important in a relatively lower socioeconomic sample of pain patients

Reductions in movement-associated fear are dependent upon graded exposure in chronic low back pain : an exploratory analysis of a modified 3-item fear hierarchy

Objective: To explore the effectiveness of a modified fear hierarchy on measuring improvements in movement-associated fear in chronic low back pain. Methods: A modified 3-item fear hierarchy was created and implemented based on principles of graded exposure. This study was an exploratory analysis of the modified 3-item fear hierarchy from a larger clinical trial data set. Both groups received pain education and exercise, either bodyweight or strength training. Both groups performed item one on the hierarchy, the squat. Only the strength training group performed item 2, the deadlift. Neither group performed item 3, the overhead press. Analysis of Covariance and stepwise linear regression were used to explore results. Results: Improvement in movement-associated fear was conditional upon graded exposure. Both groups improved in the squat movement (p ≤ 0.05), which both performed. Only the strength training group improved in the deadlift (p ≤ 0.01), and neither improved in the overhead press (p ≥ 0.05). Conclusion: Reductions in movement-associated fear are conditional upon graded exposure, based on the use of a novel modified 3-item fear hierarchy. Further research is needed to understand the utility of this tool in a patient-led approach to co-designing a graded exposure-based intervention

Associations between parents' body weight/shape comments and disordered eating amongst adolescents over time : a longitudinal study

Parents are key influencers of adolescents’ attitudes on weight, shape, and eating, and make more positive than negative comments, with negative comments most impactful. This study examined prospective unique associations of parental positive and negative comments in a community sample of adolescents with paediatric psychosocial quality of life (PED-QoL), Eating Disorder Weight/Shape Cognitions (EDEQ-WS), BMI percentile, and Psychological Distress (K10) scales. Data were from 2056 adolescents from the EveryBODY study cohort. Multiple regressions were conducted for the impacts of parental positive and negative comments on four dependent variables at one year after controlling for their stage of adolescence (early, middle, late). Multiple imputation and bootstrapping were used for handling missing data and violations of normality. Results indicated that positive maternal comments on eating were associated with increased EDCs and better quality of life at one year. Paternal positive weight shape comments were associated with a decrease in psychological distress, but positive eating comments saw a decrease in quality of life. Findings highlight the nuances of parental comments and how these are perceived and interpreted, and could alert health care workers and family practitioners who have weight, shape, and eating conversations to be aware of the potential influence of their communication

Prevalence of parental comments on weight/shape/eating amongst sons and daughters in an adolescent sample

Reports suggest that 12–76% of adolescents have experienced parental comments regarding their weight/shape and/or eating behaviours. Parents may engage in conversations about weight/shape and eating out of concern, even without any ill intent; however, the associations of these comments with subsequent problematic psychosocial and eating behaviours are evidenced. Therefore, an in-depth understanding of the content and prevalence of such comments is needed. To date, adolescent-reported prevalence estimates have not included differentiation between mother or father and sons or daughters, nor have they considered eating-focussed comments. This study considered the prevalence of positive and negative parental commentary regarding weight/shape and eating with a focus on parental origin. A total of 2287 Australian male and female adolescents participated via a self-report survey. Adolescents reported frequent positive comments on weight/shape and on eating, most commonly maternal positive comments on weight/shape (78%; 95% CI 77–80). Daughters reported significantly more maternal comments on weight/shape (positive and negative) as well as more negative eating comments from mothers than did sons. Sons reported significantly more negative weight/shape comments from fathers than did daughters. Some negative comments increased significantly with age. These findings support a notable prevalence of reported parental weight/shape and eating comments directed at their offspring, particularly from mothers

An exploration of how adolescents experience and reason their parents' comments on their weight, shape, and eating

Introduction: Disordered eating among adolescents is of increasing concern given associated physical and mental health sequelae. Cognitions underlying disordered eating are formed in childhood and adolescence. Parents are a significant presence during this period, so it is critical to understand how they influence their adolescent's eating cognitions and behaviors. Methods: Qualitative analysis using interpretative phenomenological analysis (IPA) methodology was employed to consider the lived experiences of 10 Australian adolescents (14-19 years), 60% female, as they engaged with their parents in a range of weight, shape, and eating communications. Results: Our inductive IPA revealed three key themes representing adolescents' experiences and meaning-making: Parents as Influencers-adolescents acknowledged parents are influencers (objects) within a wider context of community and cultural norms (symbols) and can be protective for peer influence on body image ideals; Expression and Perception-the "what" (weight-talk as an object) and the "how" (objects as independent influences) of gendered parental communication related to health and fitness ideals and illustrated diverse interpretations of both verbal and non-verbal expression; and Fertile Soil and Maturity-the adolescent's characteristics and context influence perceptions of communication, a fear of deviating from norms, and an overarching focus on being "healthy" yet not always knowing what that was. Perception of bidirectional communication also offered valuable insights into potential dangers through family loyalty and in-group permissions. Conclusions: Findings highlight implications for the nuanced influence of parental communication and illustrate the pivotal role of parents within the bioecosystem of adolescent development

Exploring associations between positive and negative valanced parental comments about adolescents' bodies and eating and eating problems : a community study

Background: Adolescence is a time of rapid emotional and physical development when foundational self-concepts (including beliefs about one’s weight and shape) are established. Parents are key influencers of adolescent beliefs and behaviours. This study aimed to investigate associations between perceived positive and negative parental comments on weight/shape and eating, with sons’ and daughters’ psychological distress and eating disorder cognitions (EDCs). Methods: A representative mixed-sex sample of 2204 Australian adolescents (12–19 years) from the EveryBODY Study completed an online survey exploring eating behaviours, psychological wellbeing and experiences of parental comments regarding weight, shape and eating behaviours. Results: Correlation analyses revealed that adolescents’ reports of perceived positive parental comments on shape/ weight were significantly associated with lower psychological distress and EDCs only for daughters. All perceived negative parental comments on shape/weight or eating were associated with greater psychological distress and EDCs for both sons and daughters. In the final model of the regression analysis, only perceived parental negative shape/weight and maternal negative eating comments, adolescent stage and biological sex were significantly associated with EDCs. When known contributors such as BMI percentile and psychological distress were included in the regression model, adolescent stage and perceived negative paternal comments were no longer significantly associated with EDCs. Conclusions: Overall, results show perceived negative comments were associated with poorer adolescent mental health, both their specific EDCs and general distress. Findings highlight the importance of raising awareness of potential negative impacts within family systems of comments around weight/shape and eating in these key formative years

The effects of gender, personal trauma history and memory continuity on the believability of child sexual abuse disclosure among psychologists

Gender, a personal history of trauma and attitudes towards continuous vs recovered memories of abuse significantly impact the believability of Child Sexual Abuse (CSA) disclosures in community samples. Yet, whether these variables influence the believability of CSA disclosure and subsequent clinical decisions made by practicing psychologists is underexplored. A vignette of trauma disclosure from a hypothetical adult client was presented via an online survey to 292 registered psychologists. Participants rated the believability of the disclosure, answered an open-ended item regarding treatment planning, and completed the Brief Betrayal Trauma Survey to measure personal trauma history. Results indicated that female psychologists believed disclosures significantly more than male psychologists and that disclosures comprised of continuous memories were believed more than recently recovered memories. A significant interaction between gender and personal trauma history was also revealed. Female psychologists believed disclosures regardless of their personal trauma history, while male psychologists with a personal history of trauma believed disclosures significantly more than male psychologists without personal trauma history. Reported believability of the disclosure, while unrelated to treatment planning, was associated with a reported intention to validate the client's experience. The results support that, similar to community samples, gender and a personal trauma history impact psychologist believability of CSA disclosure. The research further supports that psychologist level of belief then translates into clinical implications

Parenting through the COVID-19 pandemic

The COVID-19 pandemic has presented individuals the world over with a host of confronting realities and challenges without precedent. Parents are arguably in one of the most taxing positions as they face many responsibilities leveled at them as individual adults, but by way of being a parent their circle of concern is inevitably broadened as they renegotiate how and what “parenting” is in the pandemic climate. Parents are finding that multitasking is taking on a whole new meaning as they negotiate a collision of roles—many of which they feel particularly unskilled in undertaking (e.g., a home-schooling teacher, or a guidance or pastoral counselor), in a growingly isolated world full of social distancing, lockdowns, curfews, and quarantining requirements. The nature of many of these new roles, and the inevitable importance of these (e.g., their child’s academic progression and mental wellbeing), and the sheer number of time competition between these make for a highly stressful environment. The pre-COVID-19 capacity to undertake the parenting role meant that many of these tasks were shared between many other adults in the family (i.e., extended or blended grandparents and stepparents, etc.) and the immediate social systems (e.g., teachers, religious leaders, social and sporting groups). With access to these support systems becoming limited during the pandemic, and with many other coping strategies rendered unworkable (e.g., “time out” with friends or engaging in other social activities), parents find themselves at high risk of parental burnout. Such burnout poses a risk to their own physical and mental health, both immediate and long term, and may compromise their capacity to adequately parent, resulting in risks for their children in the form of neglect or abuse (Griffith, 2020; Humphreys, Myint, & Zeanah, 2020). Fortunately for most parents the challenges presented by the COVID-19 pandemic, while still stressful, are experienced in a more balanced way allowing for psychological growth within the family. This chapter will explore the unique positioning of parents within the family unit and how such a structure might impose both a greater scope of concern but also a source of strength. The chapter will consider the imitable stressors experienced by parents and the dynamic coping strategies available to parents to navigate this period. Finally, a reflection on the varying familial outcomes, including parental burnout, family violence, and posttraumatic growth will be undertaken in an attempt to highlight why, and how, families may experience such diversity in positive and negative outcomes during the COVID-19 pandemic

Memory

In this chapter we look at the fascinating nature of memory and how it affects our lives. Memory refers to the processes that allow us to record, store and later retrieve experiences and information. Memory adds richness and context to our lives, but even more fundamentally, it allows us to learn from experience and thus adapt to changing environments

Taking research on the road : examining criminal investigators' strategies using a mixed-methods approach in the field

This case study focuses on a series of studies conducted by an Australian Psychology PhD candidate. The studies centered on an attempt to develop a novel method for decomposing expert decision processes among criminal investigators. The work built on previous research efforts that had a substantial emphasis on qualitative techniques (e.g., Cognitive Task Analysis) by “validating” resultant qualitative descriptions via a new computerized measure, which sought to quantify aspects of expertise. The project was somewhat unique in that it had both a basic emphasis (e.g., eliciting descriptions of cognitive processes) and an applied flavor (i.e., conducted in the field, with some immediate applications in mind). Data were collected from some of the most renowned law enforcement agencies on the planet (e.g., the Federal Bureau of Investigation, the Royal Canadian Mounted Police) and spread across multiple countries (e.g., Australia, the United States, and Canada). Testing was completed in a round-trip whereby qualitative data were transcribed, reduced to thematic descriptions, and coded for agreement during the first leg, whereas quantitative data were collected on the return, incorporating the thematic descriptions as stimuli in the computer task. The case study details numerous practical lessons of relevance to early career researchers, including the importance of preparation and ethical awareness, and the challenges associated with recruiting special samples and testing in the “noise” of naturalistic settings. Ultimately, the piece underlines the importance of being open to a range of research tools, which can be used in harmony to triangulate toward quality evidence while also emphasizing the vulnerability of exploratory and field-based research