Using patient feedback to adapt intervention materials based on acceptance and commitment therapy for people receiving renal dialysis.

BACKGROUND: Theory-based intervention materials must be carefully adapted to meet the needs of users with specific physical conditions. Acceptance and Commitment Therapy (ACT) has been adapted successfully for cancer, chronic pain, diabetes, irritable bowel syndrome, multiple sclerosis, and a range of other conditions, but not so far for people receiving renal haemodialysis. This paper presents findings from a study to adapt ACT-based intervention materials specifically for renal dialysis. METHODS: Draft written materials consisting of four stories depicting fictitious individuals who used ACT-related techniques to help overcome different challenges and difficulties related to dialysis were adapted using a systematic patient consultation process. The participants were 18 people aged 19-80 years, with chronic kidney disease and receiving renal dialysis. Individual, semi-structured interviews were conducted to elicit participants' views about how the content of the draft materials should be adapted to make them more realistic and relevant for people receiving renal dialysis and about how the materials should be presented and delivered to people receiving renal dialysis. The interview transcripts were analysed using a qualitative adaptation of the Delphi method in which themes are used as a framework for translating feedback into proposals for modifications. RESULTS: The analysis of patient feedback supported the use of patient stories but suggested they should be presented by video and narrated by real dialysis patients. They also indicated specific adaptations to make the stories more credible and realistic. Participant feedback was translated into proposals for change that were considered along with clinical, ethical and theoretical factors. The outcome was a design for a video-based intervention that separated the stories about individuals from the explanations of the specific ACT techniques and provided greater structure, with material organised into smaller chunks. This intervention is adapted specifically for people receiving renal dialysis while retaining the distinctive theoretical principles of ACT. CONCLUSIONS: The study shows the value of consulting patients in the development of intervention materials and illustrates a process for integrating patient feedback with theoretical, clinical and practical considerations in intervention design.

Cost-effectiveness analysis of single-session walk-in counselling.

BACKGROUND: An increasing number of family service agencies and community-based mental health service providers are implementing a single-session walk-in counselling (SSWIC) as an alternative to traditional counselling. However, few economic evaluations have been undertaken. AIMS: To conduct a cost-effectiveness analysis of two models of service delivery, SSWIC compared to being waitlisted for traditional counselling. METHODS: A quasi-experimental design was employed. Data were collected from two community-based Family Service Agencies, one using SSWIC and one using traditional counselling. Participants were assessed at baseline and four weeks after the baseline. Cost-effectiveness was estimated from the societal and payer's perspective. RESULTS: The societal and payer's costs for SSWIC were higher than for those waiting for traditional counselling, and health outcomes were better. SSWIC is not cost-effective compared to being on the waitlist for traditional counselling (or, for a few patients, having received counselling, but after a wait of several weeks). CONCLUSIONS: SSWIC has the potential to reduce the pressure on the mental health care system by reducing emergency visits and wait lists for ongoing mental health services and eliminating costly-no shows at counselling appointments. Long-term studies involving multiple walk-in counselling services and comparison services are needed to support the findings of this study.

Parental self-efficacy in managing food allergy and mental health predicts food allergy-related quality of life.

BACKGROUND: Food allergy has been shown to have a significant impact on quality of life (QoL) and can be difficult to manage in order to avoid potentially life-threatening reactions. Parental self-efficacy (confidence) in managing food allergy for their child might explain variations in QoL. This study aimed to examine whether self-efficacy in parents of food allergic children was a good predictor of QoL of the family. METHODS: Parents of children with clinically diagnosed food allergy completed the Food Allergy Self-Efficacy Scale for Parents (FASE-P), the Food Allergy Quality of Life Parental Burden Scale (FAQL-PB), the GHQ-12 (to measure mental health) and the Food Allergy Independent Measure (FAIM), which measures perceived likelihood of a severe allergic reaction. RESULTS: A total of 434 parents took part. Greater parental QoL was significantly related to greater self-efficacy for food allergy management, better mental health, lower perceived likelihood of a severe reaction, older age in parent and child and fewer number of allergies (all p < 0.05). Food allergy self-efficacy explained more of the variance in QoL than any other variable and self-efficacy related to management of social activities and precaution and prevention of an allergic reaction appeared to be the most important aspects. CONCLUSIONS: Parental self-efficacy in management of a child's food allergy is important and is associated with better parental QoL. It would be useful to measure self-efficacy at visits to allergy clinic in order to focus support; interventions to improve self-efficacy in parents of food allergic children should be explored.

A comparison of walk-in counselling and the wait list model for delivering counselling services.

BACKGROUND: Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. AIMS: To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list. METHOD: Mixed-methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow-ups, and qualitative analysis of interviews with a sub-sample. Five-hundred and twenty-four participants ≥16 years were recruited from two Family Counselling Agencies; the General Health Questionnaire-12 assessed change in psychological distress. RESULTS: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the four-week follow-up compared to the traditional service delivery model. Ten weeks later, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. The qualitative data confirmed participants highly valued the accessibility of the walk-in model, and were frustrated by the lengthy waits associated with the traditional model. CONCLUSIONS: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery not conducive to randomized controlled trials.

Asking women survivors about thoughts or actions involving sex with children: an issue requiring therapist sensitivity.

This article reports findings from the qualitative phase of a mixed-methods study exploring whether current counseling practices with women survivors of child sexual abuse include inquiry about thoughts and behavior involving sex with children. Following an online survey of therapists across Canada, telephone interviews were conducted with a subgroup of 22 therapists. Two main themes emerged: (a) the dilemma for the therapist and (b) strategies to explore the issue. The "dilemma" refers to the therapeutic reasons and ethical responsibility to have this discussion versus the possible negative effects on the client and/or the therapeutic relationship, the discomfort of the therapist, and inadequate training. Strategies to explore the issue are presented including normalizing, ensuring client understanding, and using different types of inquiry.

Validation of the Food Allergy Quality of Life-Parental Burden Questionnaire in the UK.

PURPOSE: Food allergy can have a profound effect on quality of life (QoL) of the family. The Food Allergy Quality of Life-Parental Burden Questionnaire (FAQL-PB) was developed on a US sample to assess the QoL of parents with food allergic children. The aim of this study was to examine the reliability and validity of the FAQL-PB in a UK sample and to assess the effect of asking about parental burden in the last week compared with parental burden in general, with no time limit for recall given. METHODS: A total of 1,200 parents who had at least one child with food allergy were sent the FAQL-PB and the Child Health Questionnaire (CHQ-PF50); of whom only 63% responded. RESULTS: Factor analysis of the FAQL-PB revealed two factors: limitations on life and emotional distress. The total scale and the two sub-scales had high internal reliability (all α > 0.85). There were small to moderate but significant correlations between total FAQL-PB scores and health and parental impact measures on the CHQ-PF50 (p < 0.01). Significantly greater parental burden was reported for the no-time limited compared with the time-limited version (p < 0.01). CONCLUSIONS: The FAQL-PB is a reliable and valid measure for use in the UK. The scale could be used in clinic to assess the physical and emotional quality of life in addition to the impact on total quality of life.

The case for single-session therapy: does the empirical evidence support the increased prevalence of this service delivery model?

BACKGROUND: A significant increase in the number of walk-in counselling clinics offering single-session therapy (SST) prompted this review of the empirical support for the effectiveness of SST. AIMS: The article is intended to (1) increase practitioners' knowledge of the empirical support for the effectiveness of single-session counselling with client populations typically served in community-based mental health and counselling agencies and (2) identify priorities for future research on SST. METHOD: A thorough review of relevant databases was undertaken to locate published studies reporting client outcomes following SST. The focus of the review is research involving clients and presenting problems typically seen in community-based mental health and family counselling agencies. RESULTS: The findings suggest that the majority of clients attending either previously scheduled or walk-in SST find it sufficient and helpful. The studies imply that this model of service delivery leads to perceived improvement in presenting problems in general, and on specific measures of variables such as depression, anxiety, distress level and confidence in parenting skills. CONCLUSIONS: Many of the studies have methodological limitations, and future research requires increased use of standardized measures, control groups and larger and more diverse samples.

Do therapists' beliefs about sexual offending affect counseling practices with women?

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n = 164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.

Patients' experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review.

INTRODUCTION: Cannulation is an essential part of haemodialysis with arteriovenous access. Patients' experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients' experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. METHODS: Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients' experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. RESULTS: This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. CONCLUSIONS: Cannulation is a pervasive procedure that impacts on patients' experiences of haemodialysis. This review illuminates further patients' experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. REGISTRATION: PROSPERO (CRD42019134583).

An exploration of successful psychosocial adjustment to long-term in-centre haemodialysis.

OBJECTIVES: Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit). METHODS: Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts. RESULTS: There were four themes: 1) reaching a state of acceptance, which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment, which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks, which described the benefits of instrumental and emotional support; and 4) building emotional resilience, which described the importance of optimism and positivity. CONCLUSIONS: The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide.

Sustaining walk-in counselling services: an economic assessment from a pilot study.

Introducing single-session walk-in counselling services in a counselling agency virtually eliminated a lengthy wait list and reduced costly no-shows for scheduled counselling. A pilot study found that client distress decreased significantly following the single session, and a high proportion of clients were "ready for change." The service diverts clients from using hospitals and family doctors/walk-in clinics and toward using community social services. It also enables an earlier return to work and usual activities. The social benefits (reduced hospital use and faster return to work) exceed the cost of the service. This information is helping to make the case for sustaining and expanding these services.

Practical ways psychotherapy can support physical healthcare experiences for male survivors of childhood sexual abuse.

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors' abilities to access and benefit from health care. This paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.

Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme.

This study examined whether adding a compassion-focused light touch digital intervention into a commercial multicomponent weight management programme improved eating behaviour, self-evaluation and weight-related outcomes. The compassion intervention significantly reduced binge eating symptomatology and dropout, and improved psychological adjustment and self-evaluation, but did not affect weight outcomes. Compassion, self-reassurance and reductions in shame and self-criticism mediated the effect of the intervention on reductions of binge eating symptomatology. Negative self-evaluation, binge eating symptomatology, susceptibility to hunger and eating guilt were significant predictors of dropout. Findings suggest that compassion-based digital tools may help participants better manage binge eating symptomatology and self-evaluation in weight management interventions.

Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project.

BACKGROUND: Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. IMPACT: The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

Trends in prescribing and self-poisoning in relation to UK regulatory authority warnings against use of SSRI antidepressants in under-18-year-olds.

AIMS: To assess the impact of the UK Medicines and Healthcare products Regulatory Authority (MHRA) warning in December 2003 not to prescribe selective serotonin reuptake inhibitor (SSRI) antidepressants, except fluoxetine, to under-18-year-olds. METHODS: Interrupted time series analysis of prescriptions (UK) and general hospital presentations for nonfatal self-poisoning (three centres in England) for 2000-2006. RESULTS: Following the MHRA warning in December 2003 there were significant decreases in prescribing of SSRI antidepressants (conservative estimate 51%) to young people aged 12-19 years. Surprisingly, this decrease also affected fluoxetine (conservative estimate 20%) and tricyclics (conservative estimate 27%). Nonfatal self-poisoning in this age group following the warning also declined significantly for SSRIs (conservative estimate 44%), but not for fluoxetine, tricyclic antidepressants, or all drugs and other substances. Rates of nonfatal self-harm did not change significantly over the study period. CONCLUSIONS: The reduction in both prescribing and self-poisoning with SSRI antidepressants (except fluoxetine) following the MHRA warning is in keeping with reduced availability of these drugs. There was some evidence of substitution from other SSRIs to fluoxetine for use in self-poisoning. Importantly, overall rates of nonfatal self-harm and self-poisoning did not change, indicating no substitution of method or increases in self-injury.

The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale: Confirmatory Factor Analysis and associations with control, loss of control of eating and weight in overweight and obese women.

OBJECTIVES: The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale (WFSCRS) is based on the original Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCSRS; Gilbert et al., 2004, British Journal of Clinical Psychology, 43, 31) and assesses the inadequate and hated forms of self-criticism and the ability to self-reassure when coping with attempts to control body weight, shape, and eating. The aim of this study was to examine the factor structure, consistency, and reliability of the WFSCRS in overweight and obese women. METHODS: The factorial structure of the WFSCRS was examined through a confirmatory factor analysis in 724 overweight and obese women participating in a commercial weight management programme. The scale's construct and convergent validity were also examined. RESULTS: The WFSCRS had a three-factor structure, similar to the FSCSRS, which fitted the data well. The WFSCRS had high internal reliability, construct, and discriminant validity. The scale was positively associated with measures of shame, body image, eating-related difficulties, symptoms of anxiety, depression, and stress, and body mass index (BMI). The two forms of self-criticism were significantly associated with higher BMI, and this effect was mediated by increased loss of control over eating (for both forms) and decreased flexible control over eating (for the hated self form). CONCLUSIONS: The WFSCRS is a valid measure for assessing self-reassurance and two denigratory forms (inadequate self and hated self) of self-criticism in people who are overweight and obese. PRACTITIONER POINTS: The WFSCRS was developed to measure weight/shape and eating-related self-criticism and self-reassurance. The WFSCRS was examined in a large sample of overweight and obese women attending a community-based weight management programme. The WFSCRS presented a three-factor structure measuring two forms of self-criticism (inadequate self and hated self) and the ability to be self-reassuring. The two forms of self-criticism and self-reassurance are differentially associated with BMI, through the mediating effect of loss of control over eating and flexible control over eating.

The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults.

INTRODUCTION: Obesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m2). METHODS AND ANALYSIS: The study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions. ETHICS AND DISSEMINATION: Ethical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17-0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals. TRIAL REGISTRATION NUMBER: ISRCTN88405328.

Validation of the English Version of the Scale for Psychosocial Factors in Food Allergy and the Relationship with Mental Health, Quality of Life, and Self-Efficacy.

Background. The Scale for Psychosocial Factors in Food Allergy (SPS-FA) is based on the biopsychosocial model of health and was developed and validated in Chile to measure the interaction between psychological variables and allergy symptoms in the child. We sought to validate this scale in an English speaking population and explore its relationship with parental quality of life, self-efficacy, and mental health. Methods. Parents (n = 434) from the general population in the UK, who had a child with a clinical diagnosis of food allergy, completed the SPS-FA and validated scales on food allergy specific parental quality of life (QoL), parental self-efficacy, and general mental health. Findings. The SPS-FA had good internal consistency (alphas = .61-.86). Higher scores on the SPS-FA significantly correlated with poorer parental QoL, self-efficacy, and mental health. All predictors explained 57% of the variance in SPS-FA scores with QoL as the biggest predictor (ß = .52). Discussion. The SPS-FA is a valid scale for use in the UK and provides a holistic view of the impact of food allergy on the family. In conjunction with health-related QoL measures, it can be used by health care practitioners to target care for patients and evaluate psychological interventions for improvement of food allergy management.

Specialized inpatient trauma treatment for adults abused as children: a follow-up study.

OBJECTIVE: The authors investigated outcome at discharge and at follow-up assessments for adults abused as children who completed a 6-week inpatient program for traumatic stress recovery. METHOD: Participants were assessed at admission, discharge, and 3, 6, and 12 months postdischarge on measures of global symptom severity, posttraumatic stress disorder (PTSD), and disrupted beliefs. Two wait-list comparison groups were also assessed at two points in time for comparison with the discharge and 3-month postdischarge assessments of the treatment group. RESULTS: Relative to admission, the mean scores on all outcome measures for the treatment group were improved at discharge and at 6 and 12 months. Relative to a wait list group, the treatment group was significantly improved at discharge. After 3 months, the scores for the treatment group were not different from those of a wait list group because of deterioration in the treatment group. Age, source of income, and number of axis II disorders were associated with differing patterns of PTSD symptom change over time. Between 32% and 45%, depending on outcome measure, met stringent criteria for clinically significant change at 12 months postdischarge. CONCLUSIONS: At discharge from a specialized inpatient treatment program, adults with a history of abuse during childhood showed improvement relative to a wait list group. Scores tended to deteriorate in the 3 months following discharge but rebounded to discharge levels by 12 months postdischarge. Although many abused adults benefited from specialized inpatient treatment, a substantial proportion did not show clinically significant change 1 year later.

Providing dental care to survivors of childhood sexual abuse: treatment considerations for the practitioner.

BACKGROUND: Adults who experienced childhood sexual abuse frequently find dental treatment difficult to tolerate. Increased understanding of common long-term effects of this trauma may help dental professionals to respond more sensitively to patients who have experienced it. METHODS: The authors recruited 58 men and 19 women with self-reported histories of childhood sexual abuse from social agencies serving this population and interviewed the participants about their experiences with health care professionals, including dentists. The authors analyzed interview transcripts using the constant comparative method to identify main themes and patterns. RESULTS: Participants reported aspects of dental treatment that can be particularly difficult for them and offered ideas about how dental health professionals could make the experience more tolerable for them. The data analysis produced suggestions about how dentists might respond sensitively to patients who frequently cancel appointments, are distressed by certain body positions, need a sense of control and fear judgment. The authors also report participants' thoughts about questions from dental practitioners regarding a history of childhood sexual abuse. CONCLUSIONS: Adults who report a history of childhood sexual abuse are more likely to experience dental treatment more positively when dental professionals have some understanding of the long-term effects of such abuse, including how it can affect dental treatment interactions. Such knowledge enables dental professioinals to respond to their needs in a sensitive manner.