Performing the Digital Self: Understanding Location-Based Social Networking, Territory, Space, and Identity in the City

Expressions of territoriality have been positioned as one of the main reasons users alter their behaviors and perceptions of spatiality and sociality while engaging with location-based social networks (LBSN). Despite the potential for this interplay to further our understanding of LBSN usage in the context of identity, very little work has actually been done towards this. Addressing this gap in the literature is one the chief aims of the article. Drawing on an original six-week study with 42 participants utilizing a bespoke LBSN entitled ‘GeoMoments’, our research explores: (1) the way that territoriality is linked to self-identity; and (2) how this interplay affects the interactions between users as well as the environments they inhabit. Our findings suggest that participants affirmed their self-identity by selectively posting and claiming ownership of their neighborhood through the LBSN. Here, the locative decisions made related to risk, hierarchies, and the users’ relationship to the area. This practice then led participants to discover and interact with the digital information overlaying their physical environments in a playful manner. These interactions demonstrate the perceived power structures that are facilitated by identity claims over a virtual area. In the main, our results reaffirm that territoriality is a central concept in understanding LBSN use, while also drawing attention to the temporality involved in user-to-user and user-to-place interactions pertaining to physical place mediated by LBSN

Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry

Huan-Ji Dong,1 Elena Dragioti,1 Marcelo Rivano Fischer,2,3 Björn Gerdle1 1Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden; 3Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, SwedenCorrespondence: Huan-Ji DongPain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-581 85, SwedenTel +46 730488933Email [email protected]: It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight.Objective: This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined.Methods: Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels.Results: A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen’s d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%∼ 24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity.Conclusion: About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.Keywords: obesity, weight loss, chronic pain, pain intensity, pain rehabilitatio

Further validation of the Chronic Pain Values Inventory in a Swedish chronic pain sample

PurposeValue based action is an important process in the psychological flexibility model and is associated with daily functioning in people with chronic pain, but measures of it are not well-developed. The purpose of the present study was to examine the reliability and validity of a Swedish-language version of the Chronic Pain Values Inventory (CPVI) in a large sample of adults seeking treatment for chronic pain.Material and methodsA Swedish version of the CPVI was created and administered alongside other measures of psychological flexibility and pain-related functioning in a convenience sample of 232 patients admitted for treatment at the Pain Rehabilitation Unit at Skåne University Hospital between February 2014 and December 2015. Internal consistency of the CPVI was assessed as was its relationship to theoretically related facets from the psychological flexibility model. The utility of values-related processes in explaining variance in pain-related functioning was also examined by correlations and hierarchical regression analyses.ResultsOverall, this Swedish-language version of the CPVI was found to have satisfactory reliability and validity. The CPVI subscales yielded high levels of internal consistency. Evidence of construct validity in relation to other measures from the psychological flexibility model was observed as well as evidence of clinical utility in relation to measures of pain-related functioning.DiscussionThis brief self-report measure of values-based action seems to yield valid data in Swedish adults suffering from chronic pain. Values based processes appear important within evidence-based treatments for chronic pain, especially Acceptance and Commitment Therapy (ACT), and the CPVI may help assess these, particularly in predictor studies of pain-related functioning and analyses of therapeutic change processes or mechanisms

Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain : the contributions of psychological flexibility

There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility

Treatment of phobic postural vertigo A controlled study of cognitive-behavioral therapy and self-controlled desensitization.

In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive-behavioral therapy is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders. This study compared the effect of additional cognitive-behavioral therapy for a population with phobic postural vertigo with the effect of self-administered vestibular rehabilitation exercises. 39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy. Fifteen patients with self treatment and 16 patients with cognitive-behavioral treatment completed the study. There was significantly larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap Questionnaire and the Hospital Anxiety and Depression scale and its subscales. Cognitive-behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo. A multidisciplinary approach including medical treatment, cognitive-behavioral therapy and physiotherapy is suggested

The mediating role of acceptance in multidisciplinary cognitive behavioral therapy for chronic pain

Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants attended a five-week outpatient multidisciplinary program with self-report data collected at assessment, post-treatment, and at 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to three outcomes: pain interference, pain intensity, and depression. Results indicate that effect sizes for the treatment were within the ranges reported in the CBT for pain literature. Pain-related acceptance was not related to pain intensity, which is in line with past empirical evidence and the treatment objectives in Acceptance and Commitment Therapy (ACT). Otherwise, pain-related acceptance was the strongest mediator across the different indices of outcome. Accumulating results like these suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome. Potential mediators of outcome in a CBT-based treatment for adult chronic pain were investigated using multilevel structural equation modeling. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment. These data may help clinicians and researchers better understand processes of change and improve the choice and development of treatment methods