Running as Interoceptive Exposure for Decreasing Anxiety Sensitivity: Replication and Extension.

A brief, group cognitive behavioural therapy with running as the interoceptive exposure (IE; exposure to physiological sensations) component was effective in decreasing anxiety sensitivity (AS; fear of arousal sensations) levels in female undergraduates (Watt et al., Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity, 201-219, 2008). Additionally, repeated exposure to running resulted in decreases in cognitive (i.e., catastrophic thoughts) and affective (i.e., feelings of anxiety) reactions to running over time for high AS, but not low AS, participants (Sabourin et al., "Physical exercise as interoceptive exposure within a brief cognitive-behavioral treatment for anxiety-sensitive women", Journal of Cognitive Psychotherapy, 22:302-320, 2008). A follow-up study including the above-mentioned intervention with an expanded IE component also resulted in decreases in AS levels (Sabourin et al., under review). The goals of the present process study were (1) to replicate the original process study, with the expanded IE component, and (2) to determine whether decreases in cognitive, affective, and/or somatic (physiological sensations) reactions to running would be related to decreases in AS. Eighteen high AS and 10 low AS participants completed 20 IE running trials following the 3-day group intervention. As predicted, high AS participants, but not low AS participants, experienced decreases in cognitive, affective, and somatic reactions to running over time. Furthermore, decreases in cognitive and affective, but not in somatic, reactions to running were related to decreases in AS levels. These results suggest that the therapeutic effects of repeated exposure to running in decreasing sensitivity to anxiety-related sensations are not related to decreasing the experience of somatic sensations themselves. Rather, they are related to altering the cognitive and affective reactions to these sensations.

Development and psychometric evaluation of a brief version of the hyperventilation questionnaire: the HVQ-B.

The fear of arousal sensations characterizes some anxiety disorders and is a core feature of an established risk factor for anxiety and related disorders (i.e. anxiety sensitivity; Taylor, 1999). Anxiety sensitivity (AS) refers to a fear of anxiety-related bodily sensations stemming from beliefs that these have catastrophic consequences. Interoceptive exposure (IE; repeated exposure to feared arousal sensations) has been shown to decrease AS. The 33-item Hyperventilation Questionnaire (HVQ; Rapee & Medoro, 1994) measures state levels of cognitive, affective, and somatic responses to IE and arousal induction exercises more generally. The aim of the present set of studies was to develop and evaluate a brief version of the HVQ, the HVQ-B, in order to facilitate its use in research and clinical settings. In Study 1, three existing data sets that used the long version of the HVQ were combined to select the items to be retained for the HVQ-B. In Study 2, the 18-item HVQ-B was administered and its psychometric properties were evaluated. In Study 3, a confirmatory factor analysis (CFA) was performed on the 18 items of the HVQ-B. The HVQ-B demonstrated excellent psychometric properties, and accounted for most of the variance of the questionnaire's longer version. CFA indicated a reasonably good fit of the three-factor measurement model. Finally, the HVQ-B was able to distinguish between responses to arousal induction exercises by high versus low AS participants. The HVQ-B is a useful tool to assess cognitive, affective, and somatic responsivity to arousal sensations in both research and practice.

Demographic and clinical characteristics of free-text writers in chronic pain patient intake questionnaires.

BACKGROUND: Chronic pain is a prevalent and burdensome problem within the Canadian health care system, where the gold standard treatment occurs at multidisciplinary pain facilities. Patient intake questionnaires (PIQs) are standard practice for obtaining health information, with many patients including free-text (e.g., writing in margins of questionnaires) on their PIQs. AIMS: This study aims to quantitatively examine whether and how patients who include free-text on PIQs differ from those who do not. METHODS: We retrospectively analyzed 367 PIQs at a Canadian pain facility in Winnipeg, Canada. Patients were categorized into free-text (i.e., any text response not required in responding to questions) or no free-text groups. Groups were compared on sociodemographics, pain, health care utilization, and depressive symptoms with independent samples t-tests and chi-square analyses. RESULTS: Patients with free-text compared to those without had more sources of pain (6.66 vs. 4.63), longer duration of pain (123.2 months vs. 68.1 months), and a greater proportion of past pain conditions (66.3% vs. 55.2%). Additionally, they had tried more treatments for their pain, had seen more specialists, had tried more past medications, were currently on more medications, and had undergone more tests. No differences were identified for depressive symptoms across groups. CONCLUSIONS: This study is the first to examine patient and health-related correlates of free-text on PIQs at a Canadian pain facility. Results indicate that there are significant differences between groups on pain and health care utilization. Thus, patients using free-text may require additional supports and targeted interventions to improve patient-physician communication and patient outcomes.

Contexte: La douleur chronique est un problème répandu et pénible dans le système des soins de santé au Canada, où le traitement de référence se produit dans un centre multidisciplinaire de la douleur. Les formulaires d'admission du patient sont une pratique courante pour obtenir des renseignements sur la santé, et de nombreux patients y incluent du texte libre (en écrivant, par exemple, dans les marges du formulaire).Objectifs: Cette étude vise àexaminer quantitativement si et comment les patients qui incluent du texte libre sur leur formulaire d'admission diffèrent de ceux qui ne le font pas.Méthodes: Nous avons analysé rétrospectivement 367 formulaires d'admission dans un centre canadien de traitement de la douleur à Winnipeg, au Canada. Les patients ont été classés en deux groupes : avec texte libre (c'est-à-dire ayant inscrit une réponse sous forme de texte non requis au moment de répondre aux questions) ou sans texte libre. Les groupes ont été comparés en ce qui concerne les critères sociodémographiques, la douleur, l'utilisation des soins de santé et les symptômes dépressifs, à l'aide de tests t et chi carré pour échantillons indépendants.Résultats: Les patients avec texte libre par rapport à ceux sans texte libre avaient plus de sources de douleur (6,66 comparativement à 4,63), une plus longue durée de la douleur (123,2 mois comparativement à 68,1 mois) et une plus grande proportion de douleur par le passé (66,3 % comparativement à 55,2 %). De plus, ils avaient essayé d'autres traitements pour leur douleur, avaient vu plus de spécialistes, avaient essayé plus de médicaments par le passé, prenaient à ce moment plus de médicaments et avaient subi plus de tests. Aucune différence n'a été recensée pour les symptômes dépressifs entre les groupes.Conclusions: Cette étude est la première à examiner les corrélats liés au patient et à la santé de l'existence de texte libre sur les formulaires d'admission dans un centre de traitement de la douleur au Canada. Les résultats indiquent qu'il existe des différences importantes entre les groupes en ce qui concerne la douleur et l'utilisation des soins de santé. Ainsi, les patients utilisant le texte libre peuvent avoir besoin de soutien additionnel et d'interventions ciblées pour améliorer la communication patient-médecin et les résultats du patient.

Why do they exercise less? Barriers to exercise in high-anxiety-sensitive women.

Anxiety sensitivity (AS; fear of arousal sensations) is a risk factor for mental and physical health problems, including physical inactivity. Because of the many mental and physical health benefits of exercise, it is important to better understand why high-AS individuals may be less likely to exercise. The present study's aim was to understand the role of barriers to exercise in explaining lower levels of physical exercise in high-AS individuals. Participants were undergraduate women who were selected as high (n = 82) or low (n = 72) AS. High-AS women participated in less physical exercise and perceived themselves as less fit than low-AS women. Mediation analyses revealed that barriers to exercise accounted for the inverse relationships between AS group and physical exercise/fitness levels. Findings suggest that efforts to increase physical exercise in at-risk populations, such as high-AS individuals, should not focus exclusively on benefits to exercise but should also target reasons why these individuals are exercising less.

Cannabis Use in Persons With Inflammatory Bowel Disease and Vulnerability to Substance Misuse.

BACKGROUND: It is unknown whether cannabis users self-medicating their inflammatory bowel disease (IBD) symptoms are more likely to have comorbid mental health or personality risk factors associated with an increased potential for substance misuse compared with recreational cannabis users. METHODS: We surveyed individuals with IBD about their cannabis use, their mental health symptoms, and personality risk factors associated with substance misuse. We compared risk factors for substance misuse between individuals using cannabis to manage IBD symptoms and those using cannabis recreationally. RESULTS: Of 201 persons with IBD who completed the questionnaire, 108 reported lifetime cannabis use. Of those, a larger proportion of Crohn's disease patients used cannabis to manage IBD symptoms (53% [34/64] vs 28% [12/43]; P = 0.010). Individuals self-medicating with cannabis were more likely to use cannabis for coping reasons (P = 0.016) and demonstrated higher levels of impulsivity (P = 0.004) and depressive symptoms (P = 0.012) when compared with individuals using cannabis recreationally. Logistic regression revealed that cannabis was 4.1 times (P = 0.05) and 3.7 times (P = 0.05) more likely to be used for IBD symptoms by smokers and individuals with moderate-severe depressive symptoms, respectively. Individuals high in impulsivity were 4.1 times more likely to use cannabis for their IBD symptoms than those low in impulsivity (P = 0.005). CONCLUSIONS: Persons with IBD self-medicating with cannabis have characteristics associated with increased vulnerability to substance misuse when compared with those using cannabis recreationally. Screening for mental health comorbidities and vulnerability to substance misuse should be undertaken if cannabis is to be used to treat IBD symptoms.

Two Interventions Decrease Anxiety Sensitivity Among High Anxiety Sensitive Women: Could Physical Exercise Be the Key?

A brief group-based cognitive behavioral therapy (CBT), with running as an interoceptive exposure (IE) component, was effective in reducing anxiety sensitivity (AS) levels in undergraduate women (Watt, Stewart, Lefaivre, & Uman, 2006). This study investigated whether the CBT/IE intervention would result in decreases in AS and emotional distress that would be maintained over 14 weeks. Female undergraduates, high (n = 81) or low (n = 73) in AS, were randomized to 3-day CBT plus forty-two 10-min running IE trials (n = 83) or 3-day health education control (HEC) with interactive discussions and problem solving on exercise, nutrition, and sleep (n = 71). The CBT/IE intervention led to decreases in AS, depression, and stress symptoms for high AS participants, which were maintained at 14 weeks. Unexpectedly, HEC participants experienced similar and lasting decreases in AS, depression, and anxiety symptoms. Furthermore, there were no post-intervention differences between CBT/IE and HEC participants in any of the outcomes. Low AS participants experienced few sustained changes. Clinical implications and the possible role of aerobic exercise in explaining outcomes of both interventions are discussed.

The perfectionism model of binge eating: testing unique contributions, mediating mechanisms, and cross-cultural similarities using a daily diary methodology.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining the link between perfectionism and binge eating. This model proposes socially prescribed perfectionism confers risk for binge eating by generating exposure to 4 putative binge triggers: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. The present study addresses important gaps in knowledge by testing if these 4 binge triggers uniquely predict changes in binge eating on a daily basis and if daily variations in each binge trigger mediate the link between socially prescribed perfectionism and daily binge eating. Analyses also tested if proposed mediational models generalized across Asian and European Canadians. The PMOBE was tested in 566 undergraduate women using a 7-day daily diary methodology. Depressive affect predicted binge eating, whereas anxious affect did not. Each binge trigger uniquely contributed to binge eating on a daily basis. All binge triggers except for dietary restraint mediated the relationship between socially prescribed perfectionism and change in daily binge eating. Results suggested cross-cultural similarities, with the PMOBE applying to both Asian and European Canadian women. The present study advances understanding of the personality traits and the contextual conditions accompanying binge eating and provides an important step toward improving treatments for people suffering from eating binges and associated negative consequences.

Psychosocial issues in diabetes self-management: strategies for healthcare providers.

Education and training for diabetes mellitus self-management is widely available and an essential part of many diabetes centres. Nonetheless, the majority of individuals with diabetes do not adhere to optimal self-management recommendations. It is believed that psychosocial issues play an important role in individuals' ability to undertake the extensive behavioural demands involved in managing diabetes. The goal of the present article is to provide an overview of psychosocial issues and suggest strategies for healthcare providers in supporting patients with the challenges of diabetes self-management. First, motivational enhancement strategies have the potential to augment patients' own motivation to engage in health behaviours. Second, behavior modification principles can increase patients' self-efficacy and their experiences of success. Third, managing distressing emotions, including anxiety, depression, distress specifically related to diabetes care, and fear of hypoglycemia, can facilitate motivation and ability to undertake diabetes self-management efforts. Recognizing and addressing psychosocial challenges allows healthcare providers to better support their patients in the demanding tasks of diabetes self-management.