Validation of a needs-based biopsychosocial distress instrument for cancer patients.

OBJECTIVE: People with cancer may experience distress related to diagnoses, disease-related symptoms, and treatment side effects. Assessment of cancer-related needs can facilitate timely triage and intervention and contribute to individualized comprehensive cancer care. This study assessed the internal consistency, test-retest reliability and construct validity of the Cancer Needs Distress Inventory (CaNDI), a self-report, needs-based measure of cancer-related distress. METHODS: A sample of 100 patients (27% male) with various cancer diagnoses completed the CaNDI, Hospital Anxiety and Depression Scale, Brief Symptom Inventory, Functional Assessment of Cancer Therapy-General, and the Paulhus Deception Scales. RESULTS: The CaNDI total and depressive and anxiety subscale scores all demonstrated excellent test-retest reliability and moderate to high correlations with other measures of these constructs. The instrument was minimally confounded by social desirability and provided high sensitivity and specificity in detecting depression and anxiety. CONCLUSIONS: Initial results suggest that the CaNDI has strong psychometric properties and may be a useful addition to cancer patient needs assessment, research and care.

Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study.

OBJECTIVES: To evaluate the effects of a behavioral medicine intervention, relative to an attention control, in preventing chronic pain and disability in patients with first-onset, subacute low back pain (LBP) with limitations in work-role function. DESIGN: A 2-group, experimental design with randomization to behavioral medicine or attention control groups. SETTING: Orthopedic clinic at a Naval Medical Center. PARTICIPANTS: Sixty-seven participants with first-onset LBP of 6 to 10 weeks of duration and impairment in work function, of whom 50 completed all 4 therapy sessions and follow-up 6 months after pain onset. INTERVENTION: Four 1-hour individual treatment sessions of either behavioral medicine, focused on back function and pain education, self-management training, graded activity increases, fear reduction, and pain belief change; or attention control condition, focused on empathy, support, and reassurance. MAIN OUTCOME MEASURES: The primary outcome was proportion of participants classified as recovered, according to pre-established clinical cutoffs on standardized measures, signifying absence of chronic pain and disability at 6 months after pain onset. Secondary analyses were conducted on pain, disability, health status, and functional work category. Intervention credibility and pain belief manipulation checks were also evaluated. RESULTS: Chi square analyses comparing proportions recovered at 6 months after pain onset for behavioral medicine and attention control participants found relative rates of 52% versus 31% in the modified intent-to-treat sample (P=.09) and 54% versus 23% for those completing all 4 sessions and 6-month follow-up (P=.02). At 12 months, 79% of recovered and 68% of chronic pain participants still met criteria for their respective groups (P<.0001). Recovered participants also had higher rates of functional work status recovery at 12 months (recovered: 96% full duty and 4% light duty; chronic pain: 61% full duty, 18% light duty, and 21% medical discharge, respectively; P=.03). CONCLUSIONS: Early intervention using a behavioral medicine rehabilitation approach may enhance recovery and reduce chronic pain and disability in patients with first-onset, subacute LBP. Effects are stronger for participants attending all 4 sessions and the follow-up assessment.

The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study.

Recent studies have found a significant association between PTSD and low heart rate variability (HRV), a biomarker of autonomic dysregulation. Research indicates that respiratory sinus arrhythmia (RSA) biofeedback increases HRV while reducing related pathological symptoms. This controlled pilot study compared RSA biofeedback to progressive muscle relaxation (PMR) as adjunctive interventions for 38 persons with PTSD symptoms in a residential treatment facility for a substance use disorder. Both groups were assessed at pre-intervention and 4-week post-intervention. Group x time interactions revealed significantly greater reductions in depressive symptoms and increases in HRV indices for the RSA group. Both groups significantly reduced PTSD and insomnia symptoms and a statistical trend was observed for reduced substance craving for the RSA group. Increases in HRV were significantly associated with PTSD symptom reduction. Overall, these results provide preliminary support for the efficacy of RSA biofeedback in improving physiological and psychological health for individuals with PTSD.

Expressive writing reduces avoidance and somatic complaints in a community sample with constraints on expression.

DESIGN AND METHODS: This experimental study examined expressive writing (EW) in a community sample with social constraints on self-expression. Gay men (N=62) were assigned randomly to describe gay-related thoughts and feelings (EW) or to write objectively (CTRL). Self-reported symptoms and physician visits were assessed at baseline and 1- and 2-month follow-ups. RESULTS: Significant GroupxTime interaction for somatic symptoms indicated buffering effect of EW. EW reduced gay-related avoidance, relative to CTRL. Avoidance and symptom changes were significantly, positively associated. CONCLUSIONS: Consistent with inhibition theory, EW reduces chronic avoidance and buffers stress-related physical symptoms in stigmatized groups.

Autonomic effects of expressive writing in individuals with elevated blood pressure.

We evaluated systolic and diastolic blood pressure, heart rate variability and skin conductance at baseline, and 1 and 4 months in 38 participants with elevated blood pressure, randomly assigned to expressive writing or control groups. There was a significant interaction such that the very low frequency wave of heart rate variability increased over time only in controls, suggesting potentially protective buffering in expressive writing. Systolic and diastolic blood pressure also decreased significantly from baseline to 1 month in expressive writing. Consistent with inhibition, Anger-In moderated effects of writing on 4-month DBP. Overall, expressive writing demonstrated short-term autonomic benefits and longer-term moderated effects.

Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors.

This study evaluated a theoretically and empirically based model of the progression of acute neck and back pain to chronic pain and disability, developed from the literature in chronic pain, cognition, and stress and trauma. Clinical information and standardized psychosocial measures of cumulative traumatic events exposure (TLEQ), depressed mood (CES-D), pain (DDS), physical disability (PDI), and pain beliefs (PBPI) were collected at baseline from 84 acute back pain patients followed at an Acute Back Clinic over 3 months. Path analysis was used for the longitudinal prediction of perceived pain and disability. The predictive model accounted for 26% of the variance in persistent pain intensity and 58% of the variance in perceived physical disability at 3 months. Greater exposure to past traumatic life events and depressed mood were most predictive of chronic pain; depressed mood and negative pain beliefs were most predictive of chronic disability. More cumulative traumatic life events, higher levels of depression in the early stages of a new pain episode, and early beliefs that pain may be permanent significantly contribute to increased severity of subsequent pain and disability. Replication in a larger sample is desirable to confirm these paths. Early detection of elevated depressive symptoms and high trauma exposure may identify individuals at greater risk for developing chronic pain syndromes who may benefit from early multidisciplinary intervention.

Helplessness and loss as mediators between pain and depressive symptoms in fibromyalgia.

This study evaluated the contribution of condition-specific helplessness and loss to depression in fibromyalgia (FM). Two models were tested. The first model examined whether loss, measured by the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Interference Scale, would mediate the relationship between disability and depression. The second model determined whether condition-specific helplessness and loss would mediate the relationship between pain and depression with disability controlled. Eighty patients with confirmed diagnoses of FM were recruited throughout Southern California from general medical clinics, newspaper advertisements, and rheumatology practices. The study design was cross-sectional, using self-report, observational, and interview measures. A composite measure of depression was adopted, consisting of the Center for Epidemiological Studies-Depression Scale and the Hamilton Rating Scale for Depression. Hierarchical multiple regression analyses were conducted using a path analytic framework to examine each model. In Model 1, loss fully mediated the relationship between disability and depression. In Model 2, condition-specific helplessness mediated the relationship between pain and depression, but the contribution of loss was not significant. The findings confirm the importance of helplessness and demonstrate that the cognitive meaning of having FM plays a more central role in predicting depressive symptomatology than illness-related stressors, such as pain or disability.