The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial.

BACKGROUND: Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness meditation (MM), and behavioral activation (BA). This study aimed to evaluate the relative immediate (pre- to post-treatment) and longer term (pre-treatment to 3- and 6-month follow-ups) effects of group, videoconference-delivered CT, BA, and MM for CLBP. METHODS: This is a secondary analysis of a three-arm, randomized clinical trial comparing the effects of three active treatments-CT, BA, and MM-with no inert control condition. Participants were N = 302 adults with CLBP, who were randomized to condition. The primary outcome was pain interference, and other secondary outcomes were also examined. The primary study end-point was post-treatment. Intent-to-treat analyses were undertaken for each time point, with the means of the changes in outcomes compared among the three groups using an analysis of variance (ANOVA). Effect sizes and confidence intervals are also reported. RESULTS: Medium-to-large effect size reductions in pain interference were found within BA, CT, and MM (ds from - .71 to - 1.00), with gains maintained at both follow-up time points. Effect sizes were generally small to medium for secondary outcomes for all three conditions (ds from - .20 to - .71). No significant between-group differences in means or changes in outcomes were found at any time point, except for change in sleep disturbance from pre- to post-treatment, improving more in BA than MM (d = - .49). CONCLUSIONS: The findings from this trial, one of the largest telehealth trials of psychological treatments to date, critically determined that group, videoconference-delivered CT, BA, and MM are effective for CLBP and can be implemented in clinical practice to improve treatment access. The pattern of results demonstrated similar improvements across treatments and outcome domains, with effect sizes consistent with those observed in prior research testing in-person delivered and multi-modal psychological pain treatments. Thus, internet treatment delivery represents a tool to scale up access to evidence-based chronic pain treatments and to overcome widespread disparities in healthcare. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03687762.

Initial development and psychometric properties of the Therapist Quality Scale.

PURPOSE/OBJECTIVE: This study sought to develop and evaluate the psychometric properties of a brief measure of the quality of therapist treatment delivery that would be applicable for use across different types of psychosocial chronic pain treatments: the Therapist Quality Scale (TQS). RESEARCH METHOD/DESIGN: An initial pool of 14 items was adapted from existing measures, with items selected that are relevant across interventions tested in a parent trial comparing an 8-week, group, Zoom-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic back pain from which data for this study were obtained. A random selection of 25% of video-recorded sessions from each cohort was coded for therapist quality (two randomly selected sessions per group), with 66 sessions included in the final analyses (n = 33 completed pairs). Items were coded on a 7-point Likert-type scale. Exploratory factor analysis (EFA) and reliability estimates were generated. RESULTS: EFA showed a single-factor solution that provided a parsimonious explanation of the correlational structure for both sessions. Eight items with factor loadings of ≥ .60 in both sessions were selected to form the TQS. Reliability analyses demonstrated all items contributed to scale reliability, and internal consistency reliabilities were good (αs ≥ .86). Scores for the eight-item TQS from the two sessions were significantly correlated (r = .59, p < .001). CONCLUSIONS/IMPLICATIONS: The TQS provides a brief measure with preliminary psychometric support that is applicable for use across different types of treatments to rate the quality of the therapist's delivery. The items assess quality in delivering specific techniques, maintaining session structure, and in developing and maintaining therapeutic rapport. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Age progression in hypnosis for pain and fatigue in individuals with disabilities.

The purpose of this paper is to describe in detail a specific age progression approach that we use in our clinical practice and clinical trials in interventions including hypnosis for chronic pain and fatigue in individuals with disabilities. Moreover, we present preliminary evidence regarding the effects of the hypnosis sessions that use age progression suggestions compared to hypnosis sessions that provide different suggestions, as well as to sessions that did not include hypnotic procedures. Findings indicate that age progression suggestions for pain management with individuals participating in hypnosis treatment resulted in substantial immediate reductions in pain intensity, which were greater than pain reductions associated with treatments sessions providing pain education or cognitive therapy. In addition, age progression sessions provided to individuals receiving online hypnosis treatment for fatigue resulted in immediate large reductions in fatigue severity. Although the design of these two studies does not allow to report specific or long-term effects of the age progression techniques, findings indicate that including age progression suggestions to hypnosis protocols for pain and fatigue management is effective for reducing the immediate level of both symptoms. The development and continued evaluation of hypnotic interventions that increase or restore hope in, and optimism, for the future has the potential for enhancing the psychosocial well-being and quality of life of individuals with pain and fatigue.

Attitudes Toward Hypnosis Based on Source of Information and Experience With Hypnosis.

Attitudes and beliefs toward hypnosis are relevant in promoting hypnotic responses, in predicting the efficacy of interventions that include hypnosis, and in reducing iatrogenic effects in hypnotized individuals. The goal of the present study is to test the impact of previous knowledge about hypnosis and past experiences being hypnotized on attitudes and beliefs about hypnosis. A sample of 1,977 Portuguese students participated in the study; they responded to the Valencia Scale of Attitudes and Beliefs Toward Hypnosis-Client Version (VSABH-C) on two different occasions (test-retest method). Significant differences were found (p ≤ 0.001) on participants' attitudes and beliefs about hypnosis depending on the source of knowledge about hypnosis. Results also showed significant differences (p ≤ 0.001) in the multivariate profile analysis of the scale's factors based on whether participants had a previous history of hypnosis and depending on who hypnotized them. Participants who reported no previous knowledge about hypnosis or who acquired their knowledge from nonscientific sources scored significantly higher in the negative factors (fear, memory, magical, and marginal), therefore reporting more negative beliefs. Likewise, these participants scored lower in the positive factors (help, control, collaboration, and interest). Participants who had been previously hypnotized showed higher scores in the positive factors. In addition, when hypnosis had been utilized by a psychologist, these scores were even higher. However, some participants who had been previously hypnotized scored high in some of the negative factors (memory and magical), which indicates that some professionals using hypnosis are fostering some misconceptions about hypnosis.

[Beliefs and attitudes toward hypnosis of Spanish psychologists]. / Creencias y actitudes hacia la hipnosis de los psicólogos españoles.

The aims of this study are to analyze Spanish psychologists' beliefs and attitudes toward hypnosis and to examine the responses obtained in different branches of the Spanish Psychological Association. The results will be useful for this Association in order to know psychologists' needs of training in hypnosis. The Valencia Scale of Attitudes and Beliefs toward Hypnosis-Therapist was applied to 2434 Spanish psychologists. Results indicated that participants, in general, hold correct beliefs about hypnosis and showed a positive attitude toward it. No differences in beliefs and attitudes toward hypnosis were found among different branches of the Association. Because of the fact that there was a low response, it would be worthwhile for the different branches of the Spanish Psychological Association to repeat this research, increasing the sample size and offering scientific information about hypnosis. This would be very helpful to promote the efficacious and non-iatrogenic use of hypnosis.

Case Study: Cognitive Restructuring Hypnosis for Chronic Pain in a Quadriplegic Patient.

This case study reports on a 28-year-old male with spinal cord injury (SCI), quadriplegia, and chronic pain with neuropathic characteristics. The treatment had to be adapted to address the patient's needs, as he was on a respirator and paralyzed from the chin down. The intervention consisted of eight 90-minute sessions. The first four sessions were based on a standardized hypnotic cognitive therapy protocol developed for a randomized controlled trial (RCT). The sessions included training in cognitive restructuring skills and a hypnosis session with suggestions that was audiorecorded. Instructions to practice at home, both with the recording and by using self-hypnosis, were provided as well. Most of the outcome domains assessed (i.e., pain intensity, pain interference, sleep quality) showed clinically meaningful improvements that were maintained (or increased) at one-year follow-up. The patient reported that he was still using self-hypnosis at one-year follow-up. His subjective impression of change was positive and he did not report any negative side effects. Results show that the hypnotic cognitive therapy protocol used is a promising intervention that can benefit individuals with SCI presenting with complex symptomatology. Such therapy helps patients by teaching them effective coping strategies that they can use on their own to manage pain and its effects. In addition, it is important to note that this therapy provided benefits to someone who had not experienced any benefits from numerous medications he had tried before treatment. Therefore, the findings support continued efforts to make this treatment more accessible to patients who could benefit from this approach.

Valencia Model of Waking Hypnosis: Background, Research, and Clinical Applications.

The goal of this article is to provide a comprehensive review of the historical background, methods, and clinical applications of the Valencia Model of Waking Hypnosis (VMWH). The active-alert-waking methods have been developed and used since the 19th century as an alternative when the suggestions for relaxation and drowsiness were not helpful for specific cases, or when the person needed to use hypnotic suggestions in situations that required them to be alert and with their eyes open (i.e. in vivo exposure, sports performance, academic work, etc.). In most of these methods, the hypnotized person keeps their eyes open, and the suggestions given are for alertness, focused attention, mind expansion, and excitement. Physical relaxation is mostly not suggested, but tension or certain physical movements are used to elicit the activation of the hypnotized person. The VMWH consists of a number of methods combined to change attitudes and maximize the effects of the hypnotic suggestions. The procedures have empirical validation, and are straightforward and pleasant for patients as well as easy to learn and apply. It is structured, although its sequence is flexible and can be adapted to the needs of the intervention. Finally, research has revealed that this model has numerous advantages, and is potentially useful in clinical practice. Therefore, its incorporation into therapy may have great benefits for the patients.

Confirmatory Factor Analysis of the Valencia Scale of Attitudes and Beliefs Toward Hypnosis-client Version in a Portuguese Sample.

Research literature about hypnosis highlights the importance of clients' attitudes and beliefs toward hypnosis because they promote hypnotic responses and may predict the effectiveness of hypnotic interventions as well as minimize iatrogenic effects for clients. This study analyzes the factorial structure and psychometric properties with confirmatory methodology of the Valencia Scale of Attitudes and Beliefs Toward Hypnosis-Client Version, using a Portuguese sample. We expected to replicate the results obtained in previous research conducted with samples from various countries. The Portuguese sample comprised 1,977 participants. We found a structure of 8 factors, with an adequate internal consistency and test-retest reliability. Results are similar to those found in exploratory and confirmatory factor analyses with samples from other countries.

The Associations Between Pain-related Beliefs, Pain Intensity, and Patient Functioning: Hypnotizability as a Moderator.

OBJECTIVES: On the basis of the idea that thoughts held about pain may represent "self-suggestions" and evidence indicating that people with higher levels of trait hypnotizability are more responsive to suggestions, the current study evaluated hypothesized moderating effects of hypnotizability on the associations between pain-related thoughts and both pain intensity and pain interference. METHODS: Eighty-five individuals with chronic pain were given measures of hypnotizability, pain intensity, pain interference, and pain-related thoughts (control beliefs, catastrophizing). RESULTS: Analyses supported a moderating role of hypnotizability on the association between control beliefs and pain interference. Specifically, the negative association between pain control beliefs and pain interference were stronger among those with higher trait hypnotizability than between those with lower trait hypnotizability. DISCUSSION: The study findings, if replicated in additional samples of individuals with chronic pain, have important clinical and theoretical implications. For example, if trait hypnotizability is found to predict an individual's response to a particular technique of cognitive therapy-such as focusing on and repeating pain control belief self-statements-measures of hypnotizability could be used to identify individuals who might be most responsive to this technique. The current findings indicate that research to further examine this possibility is warranted.

Psychological and behavioral approaches to cancer pain management.

This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.

Neurophysiology of pain and hypnosis for chronic pain.

In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available.

Impact of a lecture about empirical bases of hypnosis on beliefs and attitudes toward hypnosis among Cuban health professionals.

The aim of this study was to examine whether a lecture on hypnosis can modify attitudes and misconceptions about hypnosis. The sample consisted of 97 health professionals from institutions in Havana City, Cuba. Group 1 consisted of 46 participants who received a lecture on hypnosis. Group 2 consisted of 51 participants who received a lecture about urology. and Beliefs toward Hypnosis-Therapist was applied before and after the lecture. Results indicated that there were significant differences between the groups: Group 1 showed more positive attitudes toward hypnosis. However, both groups showed similar misconceptions about hypnosis and memory, which changed significantly in Group 1 after receiving the lecture about hypnosis but not in Group 2. Therefore, the lecture about hypnosis had a significant impact in correcting participants' misconceptions about memory and hypnosis.

Contributions of four pain domains to the prediction of patient functioning and pain interference

Pain is a multidimensional experience that can vary in intensity, quality and spatial and temporal characteristics. Although there is a great deal of research supporting the importance of pain intensity as a correlate of patient functioning, there is a lack of research examining the importance of the other components of pain, especially the temporal domain. The purpose of this study was to advance the understanding of the role of four pain domains in predicting both pain interference and psychological functioning in a sample of patients with multiple sclerosis. The findings confirmed the significant association between pain intensity and measures of pain interference and psychological functioning, providing additional support for the importance of assessing pain intensity as a key component of chronic pain assessment. None of the other domains showed statistically significant associations with either of the criterion variables. However, we did find non-significant trends for pain temporal patterns to be associated with depressive symptoms. Specifically, there was a trend for patients reporting constant pain to report more depression than those reporting intermittent and variable pain. This suggests the possibility that the temporal pattern of pain may play a role in the impact of pain on depression; however, more research is needed to confirm this finding.

Confirmatory factor analysis of the Valencia Scale on Attitudes and Beliefs toward Hypnosis, Therapist version.

Health professionals' beliefs and attitudes toward hypnosis may make them reluctant to use it or even to foster misapplications and iatrogenic uses of hypnosis. The Valencia Scale on Attitudes and Beliefs toward Hypnosis-Therapist version (VSABH-T) is a specific instrument to evaluate therapists' attitudes and beliefs. The aims of this study are to evaluate the 8-factor structure of the VSABH-T proposed from a confirmatory perspective. The sample comprised 1,661 licensed psychologists who are members of the Spanish Psychological Association for the initial test and 787 for the retest. Results confirmed the 8-factor structure obtained in a previous exploratory study, namely: Fear, Memory, Help, Control, Collaboration, Interest, Magic, and Marginal. The scale also showed adequate psychometric properties, including good internal consistency and test-retest reliability.