Contextual Parameters Associated with Positive and Negative Mental Health in Recreational Psychedelic Users.

Growing research exploring the utility of psychedelic substances suggests that they not only hold promise for clinical practice but may enhance mental health through recreational use as well. However, given the importance of set and setting for maximizing benefits and minimizing harms of drug use, it is important to develop a foundational understanding of the contextual factors associated with positive and negative mental health in psychedelic users. Accordingly, data were collected using an internet-based survey of psychedelic drug users (n = 511). Hierarchical regression analyses were used to explore to what degree life-time use, frequency of use, dose size, group use, intentions for use, and post-use integration predict mental health in psychedelic users. In particular, using psychedelics with high frequency and to cope with negative affect were found to predict negative mental health. Conversely, using psychedelics in a group setting, with self-expansive intentions, and integrating post-use were found to predict positive mental health. Findings suggest that recreational psychedelic use may either enhance or diminish mental health depending on the contextual parameters of use. Limitations and areas for further research are discussed.

Pilot Examination of the Efficacy of the Internet-Delivered, Preoperative, Preparation Program (I-PPP).

Limited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to compare the Internet-delivered, preoperative program (I-PPP) in alleviating anxiety in children undergoing outpatient surgery delivered alone (I-PPP) and in conjunction with parental presence (I-PPP + parent) to treatment as usual (TAU). 104 children undergoing day surgery procedures at a local hospital and their parents/guardians participated. Primary outcome measures: (a) observer-rated child anxiety and (b) induction compliance. Results demonstrated an interaction between the I-PPP and TAU groups over time, F(1, 64) = 5.11, p = .027, partial η p2 = .07. At anesthetic induction, the I-PPP group demonstrated lower observer-rated anxiety than TAU, F(1, 64) = 4.72, p = .034, η p2 = .07. I-PPP group demonstrated the best anesthesia induction compliance, F(1, 64) = 4.84, p = .031, η p2 = .07. Our findings demonstrate that the I-PPP is an efficacious preoperative preparation intervention for children. The 'real-world' uptake and integration of the I-PPP into pediatric preoperative settings require exploration going forward. Trial retrospectively registered March 2019 (Open Science Registration https://doi.org/10.17605/osf.io/2x8rg ).

Benefits of yoga in the treatment of eating disorders: Results of a randomized controlled trial.

Yoga has begun to be incorporated into the treatment of eating disorders despite limited empirical support for this practice. The purpose of this study was to investigate the efficacy of incorporating Yoga into the treatment of eating disorders. This preliminary randomized controlled trial investigated the benefits of participating in an eight-week Kripalu Yoga program for 53 women with symptoms of bulimia nervosa and binge eating disorder. Compared to waitlist controls, Yoga participants experienced decreases in binge eating frequency, emotional regulation difficulties and self-criticism, and increases in self-compassion. Yoga participants also experienced increases in state mindfulness skills across the eight weeks of the Yoga program. While these results are encouraging and suggest Yoga may have a valuable role to play in the treatment of eating disorders, it is important to stress their tentative nature. Further research, adopting a more rigorous design, is needed to address the limitations of the present study and expand on these findings.

Assessing the Factor Structure of the Integrative Hope Scale.

While some researchers contend that hope is unidimensional, other researchers regard hope to be multidimensional. Schrank, Woppmann, Sibitz, and Lauber's exploratory factor analysis of their Integrative Hope Scale (IHS) found subscales of Trust, Future Orientation, Social Relations, and Lack of Perspective. However, subsequent articles have utilized only the total IHS score. To resolve this issue, a community sample of 288 participants completed the IHS as well as two measures of hedonic well-being (Positive and Negative Affect Schedule; Temporal Satisfaction With Life Scale), a measure of eudemonic well-being (Measure of Actualization of Potential), and a measure of time orientation (the Zimbardo Time Perspective Inventory). One-factor, four-factor oblique, higher order, and bifactor models were compared through confirmatory factor analysis and interpreted using Omega reliability coefficients. While the poorest model fit was for the one-factor model, little reliable variance was found in subscale scores after controlling for a general hope factor with the exception of the Lack of Perspective factor. IHS total and subscale scores were associated with measures of well-being and time orientation. We suggest researchers continue to focus on using the IHS total score, but also report subscale scores, especially for the Lack of Perspective subscale.

Coping with Multiple Sclerosis Scale: Reconsideration of the Factorial Structure.

BACKGROUND: The Coping with Multiple Sclerosis Scale (CMSS) was developed to assess coping strategies specific to multiple sclerosis (MS). Despite its wide application in MS research, psychometric support for the CMSS remains limited to the initial factor analytic investigation by Pakenham in 2001. METHODS: The current investigation assessed the factor structure and construct validity of the CMSS. Participants with MS (N = 453) completed the CMSS, as well as measures of disability related to MS (Multiple Sclerosis Impact Scale), quality of life (World Health Organization Quality of Life Brief Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS: The original factor structure reported by Pakenham was a poor fit to the data. An alternate seven-factor structure was identified using exploratory factor analysis. Although there were some similarities with the existing CMSS subscales, differences in factor content and item loadings were found. Relationships between the revised CMSS subscales and additional measures were assessed, and the findings were consistent with previous research. CONCLUSIONS: Refinement of the CMSS is suggested, especially for subscales related to acceptance and avoidance strategies. Until further research is conducted on the revised CMSS, it is recommended that the original CMSS continue to be administered. Clinicians and researchers should be mindful of lack of support for the acceptance and avoidance subscales and should seek additional scales to assess these areas.

Older Adults and the Fear of Death: The Protective Function of Generativity.

Terror management theory (TMT) posits that cultural worldviews function to allay concerns about human mortality. Preliminary research with older adults has indicated that seniors do not respond to death reminders in the same way as their younger counterparts. The purpose of the current study was to test a developmentally relevant construct that may buffer death anxiety in later life. It was hypothesized that Erikson's concept of generativity may encompass death-denying properties for older adults. One hundred and seventy-nine seniors were recruited to determine if subtle mortality salience inductions would lead participants to rate their own generativity as higher than after a blatant induction, or no induction, after controlling for pre-induction generativity. As expected, participants exposed to subtle death primes rated themselves as having higher levels of generativity than the other two groups after co-varying pre-induction generativity. Explanations are discussed in light of the literatures on TMT and generativity.

Psychometric evaluation and refinement of the Pain Response Preference Questionnaire.

BACKGROUND: The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytical study of the PRPQ produced four empirically supported scales labelled Solicitude, Management, Encouragement and Suppression. A second study produced similar findings, but suggested that the Management and Encouragement scales be combined into a single scale labelled Activity Direction. OBJECTIVES: To use factor analytical methods to evaluate these competing configurations of the PRPQ (ie, three versus four scales) and to further refine the measure. The ability of the PRPQ scales to account for pain severity and disability ratings was also evaluated. METHODS: Chronic pain patients (n=201) completed the PRPQ along with the Pain Catastrophizing Scale (PCS) and self-reports of pain severity and disability. RESULTS: Confirmatory factor analysis indicated that both models tested provided a poor fit to the data. A follow-up exploratory factor analysis was used to further refine the PRPQ scales and resulted in scales labelled Solicitude, Encouragement and Suppression. Supportive of the potential clinical utility of the PRPQ, Suppression was positively associated with pain severity and Solicitude was positively associated with disability. These two scales were also positively associated with the PCS. Supportive of the incremental validity of the PRPQ, a multiple regression analysis indicated that the Solicitude scale accounted for unique variance in disability ratings beyond that accounted for by demographic/clinical variables and the PCS. CONCLUSIONS: The PRPQ has promise as a clinical assessment measure and for advancing research examining the interpersonal context of pain.

Exercise therapy for improved neck muscle function in helicopter aircrew.

INTRODUCTION: To address the high prevalence of neck dysfunction in helicopter aircrew, a 12-wk training program was designed to examine the effects on neck muscular strength and endurance. METHODS: Subjects were recruited from Canadian Forces (CF) helicopter aircrew and randomized into either a neck coordination training program (CTP; N = 10), an endurance training program (ETP; N = 11), or a nontreatment control (CON; N = 8). Baseline assessments determined maximal voluntary contraction (MVC) strength and endurance capacity using a submaximal contraction to fatigue at 70% of their MVC for extension, flexion, and left (Ltflx) and right (Rtflx) lateral flexion. The ETP subjects performed dynamic contractions at 30% of their MVC in the four testing directions using a head harness and Thera-band tubing. The CTP consisted of exercises that focused on strengthening the deep cervical musculature using the mass of the head as resistance and progressing to exercises that incorporated the superficial cervical muscles. RESULTS: Post-intervention, the ETP achieved the only statistically significant increase in maximal force when compared to the CON (14.4%). Improved times to fatigue were achieved by the CTP for flexion (26.34 +/- 20.72 s), Ltflx (23.54 +/- 13.94 s), and Rtflx (28.72 +/- 4.88 s). CONCLUSION: The provision of an ETP and CTP resulted in a positive trend toward improved maximal force and muscular endurance. The greatest improvements in endurance and strength were found for those subjects assigned to the CTP treatment. Our research demonstrates the importance of including a designed and supervised training program into the daily routine of helicopter aviators.

Why the resistance to statistical innovations? Bridging the communication gap.

While quantitative methodologists advance statistical theory and refine statistical methods, substantive researchers resist adopting many of these statistical innovations. Traditional explanations for this resistance are reviewed, specifically a lack of awareness of statistical developments, the failure of journal editors to mandate change, publish or perish pressures, the unavailability of user friendly software, inadequate education in statistics, and psychological factors. Resistance is reconsidered in light of the complexity of modern statistical methods and a communication gap between substantive researchers and quantitative methodologists. The concept of a Maven is introduced as a means to bridge the communication gap. On the basis of this review and reconsideration, recommendations are made to improve communication of statistical innovations.

The reassurance questionnaire: comparison of the latent structure in university, community, and medical samples.

The Reassurance Questionnaire (RQ; Speckens, Spinhoven, Van Hemert, & Bolk, ( 2000 ) is a self-report measure designed to assess the extent to which patients feel reassured by their attending physicians. While the original RQ was validated in Dutch, the invariance of the factor structure has not been examined in the English version of the RQ. In the current study, the English RQ was completed by university (n = 459), community (n = 244), and medical samples (n = 281). Unlike the original one-factor solution found for the Dutch RQ, a two-factor solution for the English RQ was found for all three samples. The two factors were labeled: (1) Doubt in Physician, and (2) Persistent Health Anxiety. Item loadings were invariant across the community and medical samples. Implications of the findings along with directions for future research are discussed.

The Short Health Anxiety Inventory: a systematic review and meta-analysis.

INTRODUCTION: The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts. OBJECTIVE: To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs. METHODS: Direct search of digital databases for papers that cited the original SHAI publication. RESULTS: Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbach's alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry. CONCLUSIONS: The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.

Core cognitions related to health anxiety in self-reported medical and non-medical samples.

The cognitive-behavioural model of health anxiety hypothesizes that the degree of health threat experienced by an individual is a function of the perceived: (1) likelihood of illness; (2) awfulness of illness; (3) difficulty coping with illness; and (4) inadequacy of medical services. While research has examined cognitions in health anxiety, it is not known whether these cognitions predict health anxiety in individuals who do or do not report medical conditions and whether these cognitions are uniquely related to health anxiety. After developing the Health Cognitions Questionnaire to assess these specific cognitions, we examined the extent to which the cognitions predicted health anxiety and poor response to reassurance in a healthy community sample (n = 273) and a sample who self-reported various medical conditions (n = 208). Supporting the cognitive-behavioural model, these cognitions predicted health anxiety and poor response to reassurance in both samples, with some differences observed between those who did or did not report medical conditions. The cognitions were uniquely related to health anxiety even after controlling for depression and general anxiety. Clinical and theoretical implications are discussed. Overall, the Health Cognitions Questionnaire has potential to facilitate further research on the development, maintenance, and treatment of health anxiety.

Health anxiety: comparison of the latent structure in medical and non-medical samples.

The Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002) is a self-report measure designed to assess health anxiety in both medical and non-medical samples. The invariance of the factor structure across these samples has not been examined in the 14-item version of the SHAI. In the current study, the SHAI was completed by a community sample with no serious medical conditions (n=232) and a medical sample with multiple sclerosis (n=245). Factor analysis implied the same two-factor solution for both samples, with the two factors labelled: (1) Thought Intrusion, and (2) Fear of Illness. Item loadings were invariant across the medical and non-medical samples, but the two factors were more strongly correlated in the non-medical sample. Implications of the findings as well as directions for future research are discussed.

A controlled investigation of a cognitive behavioural pain management program for older adults.

BACKGROUND: Although psychosocial treatments for pain have been found to be effective in reducing self-reported pain, physician visits, and in improving mood, the research has largely focused on younger persons. As such, there is a paucity of related studies involving older adults. METHOD: We implemented and evaluated a 10-session psychosocial (i.e. cognitive behavioural orientation) pain management program that was specifically designed for older adults. The intervention was delivered either in the participants' homes or in bookable rooms in seniors' residence buildings. Ninety-five community dwelling seniors with at least one chronic pain condition were assigned to either a treatment or a wait-list control condition. An assessment battery was administered to treatment participants immediately before the program started, immediately post-treatment, and 3-months post-treatment. Comparable data were obtained from control group participants, although 3-month follow-up data were not available for the control group. Outcome variables included pain intensity, coping strategy usage, pain beliefs/appraisals, and perceived life stressors. RESULTS: Although decreases in pain intensity were observed in both the treatment and wait-list control groups, the intervention was found to result in fewer maladaptive beliefs about pain and greater use of relaxation, which is considered to be an adaptive coping strategy. CONCLUSIONS: Although some treatment benefits were identified (e.g. change in pain-related beliefs), future research should test the effectiveness of a cognitive behavioural treatment program tailored for seniors with participants who are experiencing higher pain intensities than those reported by our sample (i.e. those who experience a higher level of pain at baseline may represent a more suitable sample for assessing the effectiveness of our intervention in reducing pain intensity).

The effect of physician-patient collaboration on patient adherence in non-psychiatric medicine.

OBJECTIVE: Factors contributing to treatment adherence are poorly understood but the physician-patient interaction is one factor that is known to affect patient adherence. METHODS: This meta-analysis systematically reviewed the published literature to determine the magnitude of the relationships between physician-patient collaboration and patient adherence. RESULTS: A statistically significant weighted mean effect size of M(d)=0.145 from 48 published studies indicated better physician-patient collaboration is associated with better patient adherence. The relationship between collaboration and adherence was sustained for pediatric and adult populations, chronic and acute conditions, and primary physician and specialists. CONCLUSION: These results emphasize the need for physician-patient collaboration within the medical consultation. PRACTICE IMPLICATIONS: The inclusion of the patient's perspective during the consultation is essential to obtaining cooperation once the patient has left the physician's office.

Patient perceptions of hospital discharge: reliability and validity of a Patient Continuity of Care Questionnaire.

BACKGROUND: Review of the literature reveals a need to develop a questionnaire that measures patient perceptions of factors impacting continuity of care following discharge from hospital. Such a measure has the potential to guide quality improvement initiatives related to continuity of care. OBJECTIVE: Our objective was to develop and examine the psychometric properties of a measure that would meet this need, the Patient Continuity of Care Questionnaire (PCCQ). METHOD: The PCCQ was administered to 204 inpatients 4 weeks after discharge. The questionnaire was assessed by item and principal components analysis. Factors derived from principal components analysis were assessed for internal consistency and construct validity. RESULTS: A principal components analysis resulted in six subscales including perceptions of: (1) relationships with providers in hospital, (2) information transfer to patients, (3) relationships with providers in community, (4) management of written forms, (5) management of follow-up and (6) management of communication among providers. These subscales were internally consistent in our sample and demonstrated construct validity through correlations with other related constructs. CONCLUSION: This initial study supports the reliability and validity of the PCCQ for measuring patient perceptions of factors central to continuity of care. The questionnaire subscales correspond to the theoretical components of continuity of care that have been proposed in the literature, namely informational, relational and management continuity. The subscales may be of value for identifying problems in continuity of care and for evaluating interventions aimed at improving continuity of care for patients after hospital discharge.

Assessing pain in dementia patients with comorbid delirium and/or depression.

Pain in older adults with severe limitations in ability to communicate is often assessed with observational methods. However, many of the behaviors that are used to assess pain often overlap with behavioral manifestations of delirium and depression. Such overlap can make the assessment of pain in patients with comorbid delirium and/or depression especially challenging. In this study, we assessed pain using the Doloplus-II (one of the most established pain assessment methods for seniors with dementia) and examined the extent to which each of its items were also predictive of delirium, depression, and dementia severity. As expected, several Doloplus-II items were found to be related to dementia severity, depression, and/or delirium. Clinicians assessing pain in dementia patients with comorbid depression or delirium should place less emphasis on items that have reduced specificity in identifying pain problems. Instead, assessment should be informed by items with higher specificity as well as other sources of information (e.g., results of physical examinations and information from caregivers). Although in this investigation we used the Doloplus-II to assess pain, it is likely that our findings generalize to other observational pain assessment measures developed for patients with dementia.

Client personality characteristics predict satisfaction with cognitive behavior therapy.

Ratings of treatment satisfaction are a means for cognitive behavior therapy clients to provide their unique personal perspective on their therapy experience. Treatment satisfaction is a variable of growing importance as a predictor of outcome for various medical and psychological treatments including treatments for chronic pain (D. C. Turk et al., 2003). Our goal was to determine whether satisfaction with cognitive behavior therapy sessions varied as a function of patient personality characteristics in a sample of 43 older adults (average age=72.3 years, SD=8.0) participating in a psychosocial pain management therapy program with a cognitive behavioral orientation. Participants completed the NEO Five Factor Inventory (P. T. Costa, Jr. & R. R. McCrae, 1992) prior to the commencement of treatment and a psychometrically valid questionnaire, assessing satisfaction with psychological therapy, after each therapy session. The core personality dimensions of neuroticism, openness, and agreeableness were predictive of aspects of satisfaction with therapy. These findings have the potential of being useful to clinicians concerned with the prediction of response to therapy.

Anxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears?

Fears related to anxiety sensitivity (AS)-illness/injury sensitivity, fear of negative evaluation, and fear of pain-may have important theoretical associations with intolerance of uncertainty (IU). In separate investigations, AS and IU have been independently related to the same anxiety-related psychopathology. AS and IU seem to share a basis in fearing unknown, potentially harmful consequences; however, their inter-relationship remains uncertain. IU regarding a specific stimulus, a physical sensation for example, may result in a variety of interpretations and responses, including the catastrophic appraisals that characterize AS. The association between AS and IU was examined in a sample of 293 undergraduates. Results of confirmatory factor and correlation analyses suggest the two constructs are related, but nonetheless independent. It appears that IU may be a required component of catastrophic misappraisals while being an important construct related to fear and anxiety in its own right. Future research directions and potential applications are discussed.