Stress And Health Interview For Primary Care Patients With Medically Unexplained Symptoms: A Randomized Trial

Trauma, stress, and inhibited emotions contribute to pain and physical symptoms. People may disclose stressors and express emotions when encouraged, which may improve their symptoms. We developed an intensive interview aimed at: 1) raising patient awareness about the links between their stress and health; 2) engaging patients in emotional experiencing and expression processes. We tested its effects on patient attributions of their symptoms, in addition to physical and psychological outcomes in primary care patients with Medically Unexplained Symptoms (MUS). In this study, 75 patients (87% women; 79% White; mean age = 39 years) with MUS (e.g., localized chronic pain, fibromyalgia, irritable bowel syndrome, headaches) were recruited from a family medicine clinic. Participants completed self-report measures of their physical and psychological functioning, in addition to their symptom attributions and motivations to change at baseline and after 6 weeks. Then, participants were randomized (2:1 ratio) to one of two conditions: stress and emotion interview (n = 49) or waitlist control (n = 26) conditions. The interview was a single, 90-minute session in the clinic examination room, in which interviewers obtained patients’ medical and life stress histories. Stress experiences were linked to pain and other health changes over the patients’ lives, and then patients were engaged in an experiential exercise to express emotions (e.g., anger, sadness) related to their stressors. Intent-to-treat analyses indicated that the interview condition led to significantly greater reductions in pain severity, pain interference, global psychological symptoms, and specifically reduced depression and interpersonal sensitivity at follow-up, compared to controls. Sleep problems also improved and contemplation to change decreased with the intervention. Contrary to hypotheses, neither global physical symptoms nor symptom attributions changed differentially between conditions over time. Clinical observations and patient reports indicated that the majority of patients had substantial unresolved victimization, conflict, and/or secrets, which typically had not been disclosed in this setting. Even though patients struggled to express their emotions, they were typically thankful and appreciative of this interview opportunity. Given that no professionals, including psychologists, routinely focus on these emotional issues, these findings provide preliminary evidence for the importance of integrating an emotional component in the assessment and intervention with MUS in primary care

Enhancing mindfulness in a written emotional expression exercise

Written emotional expression has garnered significant evidence as a therapeutic tool for the processing of traumatic life events (Frattaroli, 2006; Pennebaker, 1997). However, its underlying mechanisms are still not fully understood or clearly defined. In this study, we predicted that written emotional expression exercises could serve as a mindfulness process. The goals of this study were (a) to test whether the writing process enhances mindfulness levels and (b) whether we can enhance mindfulness levels by building on a traditional writing instruction. To pilot this exercise, we modified the instructions of the traditional writing exercise to instruct individuals how to exercise mindfulness in their writing. Participants (N = 40) were randofmly assigned to either the traditional-writing group (TG) based on the Pennebaker instructions (Pennebaker, Kiecolt-Glaser, & Glaser, 1988) or to the mindfulness-enhanced group (MG), which incorporated mindfulness-based instructions (Levitt et al., 2004; Hayes & Smith, 2005) for writing about students’ most stressful life experience. The Toronto Mindfulness Scale (TMS) was used to measure reports of curiosity and decentering before and after the writing exercise. Results revealed that decentering increased after participants engaged in the traditional writing exercise but not the mindfulness-enhanced exercise. Contrary to our prediction, curiosity reports did not change significantly overtime, and the mindfulness-enhanced writing did not differentially enhance individuals’ mindfulness levels compared to the traditional writing exercise. These findings provide preliminary evidence that decentering may serve as an underlying mechanism in expressive writing. Future studies should replicate these findings and assess mindfulness changes in expressive writing over the course of several days.M.S., Psychology -- Drexel University, 201

CHOIRBM: An R package for exploratory data analysis and interactive visualization of pain patient body map data

Body maps are commonly used to capture the location of a patient's pain and thus reflect the extent of pain throughout the body. With increasing electronic capture body map information, there is an emerging need for clinic- and research-ready tools capable of visualizing this data on individual and mass scales. Here we propose CHOIRBM, an extensible and modular R package and companion web application built on the grammar of graphics system. CHOIRBM provides functions that simplify the process of analyzing and plotting patient body map data integrated from the CHOIR Body Map (CBM) at both individual patient and large-dataset levels. CHOIRBM is built on the popular R graphics package, ggplot2, which facilitates further development and addition of functionality by the open-source development community as future requirements arise. The CHOIRBM package is distributed under the terms of the MIT license and is available on CRAN. The development version of the package with the latest functions may be installed from GitHub. Example analysis using CHOIRBM demonstrates the functionality of the modular R package and highlights both the clinical and research utility of efficiently producing CBM visualizations

Children of Iraqi Refugees: Risk Profile for Substance Abuse

What is the risk profile of children of Iraqi refugees? Among adult refugees, higher prevalence of mental disorders has been associated with shorter time since resettlement and exposure to more potential traumatic events (PTE). We hypothesized that similar associations would hold in the children of Iraqi refugees

Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults

Chronic pain is prevalent across the life span and associated with significant individual and societal costs. Behavioral interventions are recommended as the gold-standard, evidence-based interventions for chronic pain, but barriers, such as lack of pain-trained clinicians, poor insurance coverage, and high treatment burden, limit patients’ ability to access evidenced-based pain education and treatment resources. Recent advances in technology offer new opportunities to leverage innovative digital formats to overcome these barriers and dramatically increase access to high-quality, evidenced-based pain treatments for youth and adults. This scoping review highlights new advances. First, we describe system-level barriers to the broad dissemination of behavioral pain treatment. Next, we review several promising new pediatric and adult pain education and treatment technology innovations to improve access and scalability of evidence-based behavioral pain treatments. Current challenges and future research and clinical recommendations are offered

Insecurity, distress and mental health: Experimental and randomized controlled trials of a psychosocial intervention for youth affected by the Syrian crisis

Alastair Ager - ORCID 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Background: Strengthening the evidence base for humanitarian interventions that provide psychosocial support to war-affected youth is a key priority. We tested the impacts of an 8-week programme of structured activities informed by a profound stress attunement (PSA) framework (Advancing Adolescents), delivered in group-format to 12-18 year-olds in communities heavily affected by the Syrian crisis. We included both Syrian refugee and Jordanian youth. Methods: We followed an experimental design, comparing treatment youth and wait-list controls over two programme implementation cycles, randomizing to study arm in cycle 2 (ClinicalTrials.gov ID: NCT03012451). We measured insecurity, distress, mental health difficulties, prosocial behaviour and post-traumatic stress symptoms at three time-points: baseline (n = 817 youth; 55% Syrian, 43% female), postintervention (n = 463; 54% Syrian, 47% female), and follow-up (n = 212, 58% Syrian, 43% female). Regression models assessed: prospective intervention impacts, adjusting for baseline scores, trauma exposure, age, and gender; differential impacts across levels of trauma exposure and activity-based modality; and sustained recovery 1 year later. We analysed cycle-specific and cycle-pooled data for youth exclusively engaged in Advancing Adolescents and for the intent-to-treat sample. Results: We found medium to small effect sizes for all psychosocial outcomes, namely Human Insecurity (_ = -7.04 (95% CI: -10.90, -3.17), Cohen's d = -0.4), Human Distress (_ = -5.78 (-9.02, -2.54), d = -0.3), and Perceived Stress (_ = -1.92 (-3.05, -0.79), d = -0.3); and two secondary mental health outcomes (AYMH: _ = -3.35 (-4.68, -2.02), d = -0.4; SDQ: _ = -1.46 (-2.42, -0.50), d = -0.2). We found no programme impacts for prosocial behaviour or post-traumatic stress reactions. Beneficial impacts were stronger for youth with exposure to four trauma events or more. While symptoms alleviated for both intervention and control groups over time, there were sustained effects of the intervention on Human Insecurity. Conclusions: Findings strengthen the evidence base for mental health and psychosocial programming for a generation affected by conflict and forced displacement. We discuss implications for programme implementation and evaluation research. 2017 Association for Child and Adolescent Mental Health.This research was funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme (elrha.org/r2hc), which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. The R2HC programme is funded equally by the Wellcome Trust and the UK Government.sch_iih59pub5032pub

C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomized controlled trial.

Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B =  -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement

Health-Related Quality of Life and Adaptive Behaviors of Adolescents with Sickle Cell Disease: Stress Processing Moderators

The objective of this study was to examine resilience among adolescents with sickle cell disease (SCD), focusing on the interaction of health-related quality of life with stress processing to explain adaptive behavior. Forty-four adolescents with SCD completed paper-and-pencil measures of health-related quality of life, appraisals (hope), pain coping strategies (e.g. adherence), and adaptive behavior. Self-reported health-related quality of life was significantly associated with adaptive behavior, as was adherence. Findings for moderation were mixed. Pain coping strategies moderated the association of health-related quality of life with adaptive behavior such that at lower levels of Coping Strategies Questionnaire (CSQ) Adherence, better quality of life was associated with higher adaptive behavior. Similarly, at higher levels of hope, better quality of life was associated with higher adaptive behavior, and poorer quality of life was associated with lower adaptive behavior. Adolescents with SCD showed resilience, particularly in terms of personal adjustment, that may be explained by their appraisals and stress processing strategies. Interventions to support an optimistic or hopeful outlook and improve adherence to recommendations for medical management of sickle cell pain may result in improved resilience/adaptive behavior