The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis.

ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.

Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample.

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.

Can body temperature dysregulation explain the co-occurrence between overweight/obesity, sleep impairment, late-night eating, and a sedentary lifestyle?

PURPOSE: Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. METHODS: A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. RESULTS: Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. CONCLUSIONS: An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. LEVEL OF EVIDENCE: Level V, narrative review.

Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis.

Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory - Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS.

Development of the Tinnitus response scales: factor analyses, subscale reliability and validity analyses.

OBJECTIVE: Patients suffering with tinnitus are often advised to accept the noise, but few studies have examined what tinnitus acceptance entails. The present project developed and tested a new instrument to assess the mindfulnessbased constructs of acceptance, control, and defeat, in relation to the experience of chronic tinnitus. METHOD: Initial scale development involved an expert panel. Participants were recruited from the general population and tinnitus support organizations and complete the first version of the Tinnitus Response Scales (TRS) and measures of tinnitus coping, severity and distress, general distress, illness cognitions, and tinnitus and health characteristics. RESULTS: Three interpretable TRS factors were found: acceptance, control and defeat (an Internet sample, N = 273) and confirmed using another sample (hard-copy sample, N = 278). Factors were shown to have high internal consistency and testretest reliabilities and differed in terms of their related cognitions, behaviour, and emotional responses to tinnitus, and their tinnitus characteristics. CONCLUSION: The TRS factors provide an alternative conceptualisation of tinnitus responding. TRS is a brief psychometrically valid measure of tinnitus responding that appears to distinguish between adaptive and non-adaptive responses to tinnitus noise, and should prove useful as a clinical measure.

Development of a Scale to Examine Responses to Bodily Sensations.

OBJECTIVE: Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional, and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies. METHOD: In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1. RESULTS: In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described an acceptance response, and Factor 3 described a sensitization response. In Study 2, the three-factor solution was shown not to be parsimonious. Rather, CFA identified that the 27-item BSRS had two interpretable factors (Defeat and Acceptance) that explained participants' psychological responses to bodily sensations. The Defeat subscale was moderately to strongly correlated with awareness of bodily sensations (i.e., Body Perception Questionnaire-Short Form scores) and depression, anxiety, and stress symptom severity (i.e., Depression Anxiety Stress Scales-21 scores), whereas the Acceptance subscale was unrelated or only slightly negatively correlated to awareness of bodily sensations and depression, anxiety, and stress symptoms. CONCLUSION: The 27-item BSRS provides a psychometrically robust assessment of the way in which people psychologically respond to everyday bodily sensations. The measure can assist researchers to better understand how people psychologically process their salient bodily sensations and how this is linked to psychopathology.

The multiple sclerosis work difficulties questionnaire.

BACKGROUND: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. OBJECTIVE: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). METHODS: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. RESULTS: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. CONCLUSION: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.

Control cognitions and causal attributions as predictors of fatigue severity in a community sample.

Control cognitions and causal attributions of fatigue were examined in relation to Weiner's Causal Attribution theory in a community sample. Participants were 97 females and 43 males, aged 18-83 years. Weiner's dimensions of stability and uncontrollability and physical and psychosocial attributions of fatigue were related to fatigue severity. Escape-avoidance coping mediated between psychosocial causal attributions of fatigue to fatigue; whereas planful problem-solving and exercise moderated between stability cognitions to fatigue and psychosocial attributions of fatigue to fatigue, respectively. This, the cause(s) of fatigue were perceived as stable, uncontrollable, and involving physical and psychosocial factors, participants reported worse fatigue. Taken together, the results suggest that fatigue treatments may be most effective when they are tailored or matched to the belief systems of the individuals with fatigue.

A Comparison of Physical Activity Levels, Sleep Disrupting Behavior, and Stress/Affective Distress as Predictors of Sleep as Indexed by Actigraphy.

BACKGROUND: Several behaviors have been reported to interfere with sleep in otherwise healthy adults, including low physical activity (PA) levels. However, few studies have compared low PA with the other behavioral risk factors of objective sleep impairment, despite the behavior tending to cooccur in highly stressed and affectively distressed individuals. Thus, the authors compared objective and subjective measures of PA and other potential sleep disrupting behaviors as predictors of objective sleep (sleep onset latency, actual sleep time, total sleep duration, awake time, and sleep efficacy) at baseline (T1) and 3 months later (T2). METHODS: A community-derived sample of 161 people aged 18-65 years were asked about PA, other behavior (ie, night eating, electronic device use, watching television, caffeine and alcohol use), stress, affective distress (ie, anxiety, depression), and demographics including shift work and parenting young children in an online questionnaire at T1 and T2. PA and sleep were also monitored for 24 hours each at T1 and T2 using actigraphy. RESULTS: Multiple regression analyses indicated that sleep at T1 was associated with PA (ie, total number of steps, metabolic equivalents/time, time spent travelling) after controlling mean ambient temperature and relevant demographics. At T2, longer sleep onset latency was predicted by parenting young children and night time television viewing; shorter sleep duration was predicted by female gender; and awake time and sleep efficacy were predicted by alcohol intake after controlling T1 sleep measures, demographics, and mean ambient temperature. CONCLUSION: The risk factors for objective sleep impairment included parenting young children and watching television at night, whereas better sleep outcomes were associated with greater engagement with PA.

Mediators and moderators of the stressor-fatigue relationship in nonclinical samples.

OBJECTIVE: Two cross-sectional studies examined statistical mediators and moderators of the stressful life event (SLE)-fatigue relationship. If such factors can be delineated, they might suggest possible avenues for improving current psychological treatments for fatigue. METHODS: In Study 1, 281 (63 males and 218 females) participants, 18 to 70 years, completed a questionnaire asking about stressors, social support, demographics, and fatigue. In Study 2, 609 (225 males and 384 females) participants, 18 to 80 years, answered questions about the abovementioned variables, and sleep quality and use of sleep medications. RESULTS: Younger age, more SLEs, and low social support satisfaction were found to be related to fatigue levels in Study 1. These results were replicated in Study 2, and, additionally, sleep disturbance (i.e., low sleep quality, use of sleep medications) was related to fatigue levels, while age was related to fatigue via the use of sleep medications. The SLE-fatigue relationship was found to be mediated through different mechanisms in males and females: social support dissatisfaction and sleep quality mediated the relationship in females, while sleep quality mediated the relationship in males. CONCLUSION: These results suggest that gender tailoring of psychological treatments may improve their effectiveness in treating fatigue, in particular, by targeting social support satisfaction in females and sleep hygiene in both sexes.

Stress, psychological distress, psychosocial factors, menopause symptoms and physical health in women.

OBJECTIVES: Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women. METHODS: One hundred and sixteen women aged 45-55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health. RESULTS: Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping. CONCLUSIONS: Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.

The impact of a self-efficacy intervention on short-term breast-feeding outcomes.

Maternal self-efficacy for breast-feeding may contribute to success in breast-feeding. This study aimed to increase breast-feeding self-efficacy and actual breast-feeding through an intervention based on Bandura's self-efficacy theory. A total of 90 pregnant women participated in the study. The women who were assigned to a breast-feeding self-efficacy intervention showed significantly greater increases in breast-feeding self-efficacy than did the women in the control group. Furthermore, at 4 weeks postpartum, women in the intervention group showed a trend toward breast-feeding their infants longer and more exclusively than did those in the control group. Greater increases in breast-feeding self-efficacy were associated with a significantly higher level of breast-feeding. Replicating previous research, breast-feeding self-efficacy was significantly related to concurrent breast-feeding behavior, and high antenatal breast-feeding self-efficacy predicted a higher level of later breast-feeding in control-group women. These findings have implications for breast-feeding support programs and for the potential general utility of self-efficacy-based interventions in health education.

Stressful life-events and fatigue in a nonclinical sample.

There is a lack of systematic examination of the relationship between different stressor features and fatigue. Thus, we examined which features of stressors (e.g. frequency, duration, severity, valence, type) were most strongly related to fatigue levels. Eighty-nine participants completed a short fatigue questionnaire and a comprehensive stress interview. High fatigue levels were found to be most strongly related to the number of acute interpersonal stressors and chronic difficulty stressors (<6 months duration) and psychological distress, but no other stressor measure. Thus, acute and chronic stressor frequency counts might be the best measures used in future studies assessing the relationship between stressors and fatigue.

Autism spectrum disorder and interoception: Abnormalities in global integration?

Research over the past three decades has seen a revived interest in the way the human body-and the way in which it is perceived-interacts with aspects of our experience. Consequently, interoception (i.e. the perception of physiological feedback from the body) has recently been shown to be associated with a wide range of cognitive, emotional, and affective functions, making it broadly relevant to the study of autism spectrum disorder. Although limited qualitative accounts and empirical studies suggest that individuals with autism spectrum disorder encounter abnormalities when perceiving and integrating physiological feedback from their bodies, other studies have suggested that people with/without autism spectrum disorder do not differ in interoceptive ability after accounting for alexithymia. In this article, we discuss the newly recognized importance of interoception in autism spectrum disorder with a focus on how deficits in the perception of bodily feedback might relate to the core features and co-occuring psychopathology of autism spectrum disorder. Finally, a new integrated theory is advanced which posits that people with autism spectrum disorder may experience a reduced capacity to integrate interoceptive information that may result in a narrow attentional bodily focus and reduced motivational and behavioral drives.

Direct and indirect relationships between emotional intelligence and subjective fatigue in university students.

OBJECTIVE: The aim of this study was to examine the direct and indirect relationships between emotional intelligence and subjective fatigue. METHODS: One hundred sixty seven university students completed questionnaires assessing subjective fatigue, emotional intelligence, and a range of other psychosocial factors. A series of regression analyses were used to examine the direct and indirect relationships between subjective fatigue and psychosocial factors. RESULTS: Higher emotional intelligence was associated with less fatigue. The psychosocial variables depression, anxiety, optimism, internal health locus of control, amount of social support, and satisfaction with social support each partially mediated between emotional intelligence and fatigue. Additionally, sleep quality partially mediated between emotional intelligence and fatigue. CONCLUSION: These findings regarding the association between subjective fatigue, emotional intelligence, and other psychosocial factors may facilitate an understanding of the aetiology of fatigue and contribute to future research examining interventions aimed at helping individuals cope with fatigue.

Effects of a Mindfulness Intervention on Sports-Anxiety, Pessimism, and Flow in Competitive Cyclists.

BACKGROUND: This study investigated whether mindfulness training increases athletes' mindfulness and flow experience and decreases sport-specific anxiety and sport-specific pessimism. METHODS: Cyclists were assigned to an eight-week mindfulness intervention, which incorporated a mindful spin-bike training component, or a wait-list control condition. Participants completed baseline and post-test measures of mindfulness, flow, sport-anxiety, and sport-related pessimistic attributions. RESULTS: Analyses of covariance showed significant positive effects on mindfulness, flow, and pessimism for the 27 cyclists in the mindfulness intervention condition compared with the 20 cyclists in the control condition. Changes in mindfulness experienced by the intervention participants were positively associated with changes in flow. CONCLUSIONS: Results suggest that mindfulness-based interventions tailored to specific athletic pursuits can be effective in facilitating flow experiences.

HPA axis activation and neurochemical responses to bacterial translocation from the gastrointestinal tract.

Stress can cause migration of indigenous bacterial flora from the gut to the peritoneum, a phenomenon known as bacterial translocation. Destruction of the cell walls of gram-negative bacteria can result in the production of endotoxin (lipopolysaccharide, LPS), which is the likely cause of sepsis. Exogenously administered LPS can activate the hypothalamo-pituitary-adrenal (HPA) axis as well as brain noradrenergic and indoleaminergic systems. Thus, it is possible that activations of these systems associated with laboratory stressors in rats and mice could be attributed to bacterial translocation and LPS production. To test this hypothesis we conducted experiments on the time course of bacterial translocation in response to restraint in mice, while measuring HPA and neurochemical responses. These experiments failed to show good correlations between the occurrence of bacterial translocation and HPA and neurochemical activations, suggesting that the later responses were not linked to bacterial translocation. This conclusion was supported by the observation of normal neurochemical responses to restraint in germ-free mice. In further experiments, translocation of Salmonella typhimurium, a bacterium that readily translocates in unstressed animals, was associated with HPA activation and noradrenergic and indoleaminergic responses, indicating that bacterial translocation can indeed activate the HPA axis and brain amines. However, the above experiments suggest that this is not the mechanism by which restraint activates these systems.

Cannabis use and anxiety: is stress the missing piece of the puzzle?

OBJECTIVE: Comorbidity between anxiety and cannabis use is common yet the nature of the association between these conditions is not clear. Four theories were assessed, and a fifth hypothesis tested to determine if the misattribution of stress symptomology plays a role in the association between state-anxiety and cannabis. METHODS: Three-hundred-sixteen participants ranging in age from 18 to 71 years completed a short online questionnaire asking about their history of cannabis use and symptoms of stress and anxiety. RESULTS: Past and current cannabis users reported higher incidence of lifetime anxiety than participants who had never used cannabis; however, these groups did not differ in state-anxiety, stress, or age of onset of anxiety. State-anxiety and stress were not associated with frequency of cannabis use, but reported use to self-medicate for anxiety was positively associated with all three. Path analyses indicated two different associations between anxiety and cannabis use, pre-existing and high state-anxiety was associated with (i) higher average levels of intoxication and, in turn, acute anxiety responses to cannabis use; (ii) frequency of cannabis use via the mediating effects of stress and self-medication. CONCLUSION: None of the theories was fully supported by the findings. However, as cannabis users reporting self-medication for anxiety were found to be self-medicating stress symptomology, there was some support for the stress-misattribution hypothesis. With reported self-medication for anxiety being the strongest predictor of frequency of use, it is suggested that researchers, clinicians, and cannabis users pay greater attention to the overlap between stress and anxiety symptomology and the possible misinterpretation of these related but distinct conditions.

The multiple sclerosis work difficulties questionnaire (MSWDQ): development of a shortened scale.

BACKGROUND: The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ) is a recently developed, internally consistent and valid 50-item measure of self-reported workplace difficulties in pwMS. OBJECTIVE: In this study, the second-order factor structure of the MSWDQ was assessed, with the aim of developing a short version of the scale. METHODS: Cross-sectional MSWDQ data were obtained along with employment and MS disease information, in a community-based sample of 189 pwMS. Final items for the shortened version were selected to ensure both item breadth and adequacy of psychometric properties. RESULTS: Confirmatory Factor Analysis on the 12 MSWDQ factors yielded a model comprised of three second-order factors termed physical barriers, psychological/cognitive barriers and external barriers, which formed the basis of the shorter 23-item scale, the MSWDQ-23. The MSWDQ-23 showed excellent subscale internal consistencies. It explained 29% of the variance in reduced work hours since diagnosis, 22% of the variance in expectations of withdrawing from work, 24% of the variance in expectations of reduced work hours and 32% of the variance in expectations of changing type of work due to MS. CONCLUSION: The MSWDQ-23 is a brief valid and internally consistent measure of workplace difficulties that can predict both employment outcomes and expectations in pwMS. It is an especially useful tool for clinicians who wish to quickly obtain an indication of the extent of psychological/cognitive, physical and/or external difficulties experienced by individual pwMS in the workplace. Implications for Rehabilitation The MSWDQ-23 is a shortened self-report survey that examines work difficulties in people with MS across three broad domains: psychological/cognitive barriers, physical barriers and external barriers. The MSWDQ-23 is a valid and reliable measure that is capable of predicting various employment outcomes and expectations.