Atrial septal defect-associated pulmonary hypertension with decompensated heart failure: outcomes after fenestrated device closure.

BACKGROUND: Up to 90% of adults with untreated atrial septal defect will be symptomatic by 4th decade, and 30-49% will develop heart failure. 8-10% of these patients have pulmonary arterial hypertension with a female predominance regardless of age. We aimed to demonstrate that fenestrated closure can be safely performed in patients with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension with improved outcome. METHODS: Transcatheter fenestrated atrial septal defect closures (Occlutech GmbH, Jena, Germany) were performed on a compassionate-use basis in 5 consecutive adult patients with atrial septal defect-associated pulmonary arterial hypertension and severe heart failure with prohibitive surgical mortality risks. Change in systemic oxygen saturation, 6-minute walk test, NYHA class, echocardiographic and haemodynamic parameters were used as parameters of outcome. RESULTS: All patients were female, mean age 48.8 ± 13.5 years, followed up for a median of 29 months (max 64 months). Significant improvements observed in the 6-minute walk test, and oxygen saturation comparing day 0 time point to all other follow-up time points data (B = 1.32, SE = 0.28, t (22.7) = -4.77, p = 0.0001); and in the haemodynamic data (including pulmonary vascular resistance and pulmonary pressure) (B = -0.60, SE = 0.22, t (40.2) = 2.74, p = .009). All patients showed improved right ventricular size and function along with NYHA class. There were no procedure-related complications. CONCLUSION: Fenestrated atrial septal defect closure is feasible in adults with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension. It results in sustained haemodynamic and functional improvement.

Clinical hypnosis can reduce lower urinary tract symptoms in individuals with chronic pain.

STUDY PURPOSE: Lower urinary tract symptoms (LUTS) can occur in chronic pain populations at high rates and drastically affect quality of life. Hypnosis is a nonpharmacological treatment used in chronic pain known to have beneficial implications to health outside of pain reduction. This study evaluated the potential for hypnosis to reduce LUTS in a sample of individuals with chronic pain, if baseline LUTS severity affected outcomes, and specific LUTS that may respond to hypnosis. METHODS: Sixty-four adults with chronic pain and LUTS at a level of detectable symptom change (American Urological Association Symptom Index, AUASI 3) participated in an 8-week group hypnosis protocol. Participants completed validated assessments of LUTS, pain, and overall functioning before, after, 3- and 6-months posttreatment. Linear mixed effects models assessed improvement in LUTS over time while accounting for known factors associated with outcome (e.g., age, gender). The interaction of baseline symptom severity and treatment assessed the potential effect of baseline symptoms on change scores. RESULTS: Participants experienced significant and meaningful improvements in LUTS following group hypnosis (p = 0.006). There was a significant interaction between baseline symptom severity and treatment (p < 0.001), such that those with severe symptoms experienced the most pronounced gains over time (e.g., an 8.8 point reduction). Gains increased over time for those with moderate and severe symptoms. Changes in LUT symptoms occurred independently of pain relief. CONCLUSIONS: This pilot study suggests hypnosis has the potential to drastically improve LUTS in individuals with chronic pain, even when pain reduction does not occur. Results provide initial evidence for the treatment potential of hypnosis in urologic pain (and possibly non-pain/benign) populations, with randomized trials needed for definitive outcomes.

The Relative Contributions of Live and Recorded Online Mindfulness Training Programs to Lower Stress in the Workplace: Longitudinal Observational Study.

BACKGROUND: Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many "online" or "digital mindfulness" programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. OBJECTIVE: The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. METHODS: Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful's One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. RESULTS: A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=-0.32, 95% CI -0.35 to -0.30, SE=0.01, t2393.25=-24.99, P<.001, Cohen d=-1.02). Participation in live programs drove the decrease in stress (B=-0.03, SE=0.01, t3258.61=-3.03, P=.002, d=-0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. CONCLUSIONS: Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels.

Interactional synchrony and negative symptoms: An outcome study of body-oriented psychotherapy for schizophrenia.

OBJECTIVE: We sought to assess the efficacy of a manualized body-oriented psychotherapy (BPT) intervention for schizophrenia, by focusing on improvement of negative symptoms and on changes in interactional synchrony. We also explored aspects of a phenomenological theory of schizophrenia, which states that negative symptoms should be understood within an encompassing disturbance of subjectivity and intersubjectivity. METHOD: Sixteen persons with schizophrenia participated in 10 weeks of BPT. General psychiatric symptomatology and negative symptoms were assessed before and after therapy. Interactional synchrony was assessed via cross-correlations of movements between patient and interviewer in interviews conducted before and after therapy. RESULTS: Psychiatric symptomatology and negative symptoms significantly improved with a medium effect size. We also demonstrated a significant increase in interactional synchrony with a strong effect size. Post hoc analyses showed a significant increase only with open-ended interviews conducted by the same interviewer. Furthermore, we explored the correlation between negative symptoms and interactional synchrony, finding a large inverse relationship. CONCLUSIONS: BPT for schizophrenia may effectively reduce patients' negative symptoms and psychiatric symptomatology. Moreover, it may yield some recovery of pre-reflective social relations. Further evidence of the specific relation between negative symptoms and interactional synchrony would support a phenomenologically informed holistic view of schizophrenia.

Identifying Predictors of Psychological Problems Among Adolescents With Congenital Heart Disease for Referral to Psychological Care: A Pilot Study.

Background: The lifelong care of patients with congenital heart disease (CHD) typically begins at a young age, giving paediatric cardiologists a unique perspective on the mental health of their patients. Our aim was to describe and predict reported psychological problems among adolescents with CHD. Methods: A retrospective review was performed on patients aged 12-17 years who presented to the congenital cardiology clinic during a 1-year timeframe. The presence of psychological problems was collected along with CHD class, clinical history, developmental delay, and patient demographics. We described the prevalence of psychological problems and then, using machine learning algorithms, trained and tested optimal predictive models. Results: Of the 397 patients who met inclusion criteria, the lifetime prevalence of any reported psychological problem was 35.5%. The most prevalent reported problems were attention-deficit/hyperactivity disorder (18.9%), anxiety (17.6%), and depression (16.1%). Contrary to our expectations, we could not predict the presence or absence of any psychological problem using routine clinical data. Instead, we found multivariate models predicting depression and attention-deficit/hyperactivity disorder with promising accuracy. Prediction of anxiety was less successful. Conclusions: Approximately 1 of 3 adolescents with CHD presented with the lifetime prevalence of 1 or more psychological problems. Congenital cardiac programmes are in a position of influence to respond to these problems and impact their patients' mental health as part of a comprehensive care plan. The discovered models using routine clinical data predicted specific psychological problems with varying accuracy. With further validation, these models could become the tools of routine recommendations for referral to psychological care.

Contexte: Le traitement à vie des patients atteints d'une cardiopathie congénitale commence habituellement dès un jeune âge. Ainsi, les cardiologues pédiatriques ont un point de vue unique sur la santé mentale de leurs patients. Notre objectif était de décrire et de prédire les troubles psychologiques signalés chez les adolescents atteints d'une cardiopathie congénitale. Méthodologie: Nous avons effectué une revue rétrospective des dossiers de patients âgés de 12 à 17 ans qui se sont présentés dans une clinique de cardiologie pour anomalies congénitales sur une période d'un an. Nous avons recensé toute présence de problèmes psychologiques, en plus de la classe de la cardiopathie congénitale, des antécédents cliniques, des retards de développement et des caractéristiques démographiques des patients. Nous avons également décrit la prévalence des troubles psychologiques; puis, à l'aide d'algorithmes d'apprentissage automatique, nous avons donné une formation sur des modèles prédictifs optimaux et les avons testés. Résultats: Chez les 397 patients qui avaient répondu aux critères d'inclusion, la prévalence de la survenue d'un problème psychologique au cours de leur vie s'élevait à 35,5 %. Les troubles signalés le plus souvent étaient le trouble déficitaire de l'attention avec hyperactivité (TDAH) (18,9 %), l'anxiété (17,6 %) et la dépression (16,1 %). Contrairement à nos attentes, nous n'avons pas pu prédire la présence ou l'absence de troubles psychologiques à l'aide des données cliniques courantes. Nous avons par contre découvert des modèles multivariés pouvant prédire la dépression et le TDAH avec une précision prometteuse. Toutefois, les prédictions relatives à l'anxiété se sont avérées moins exactes. Conclusion: La prévalence de la survenue d'au moins un problème psychologique chez les adolescents atteints de cardiopathie congénitale au cours de leur vie était d'environ un adolescent sur trois. Dans le cadre d'un plan de soins complet, les programmes en cardiologie congénitale se trouvent en position d'influence pour répondre à ces problèmes et ainsi améliorer la santé mentale des patients. Par ailleurs, les modèles que nous avons découverts à l'aide des données cliniques courantes ont permis de prédire des problèmes psychologiques en particulier, mais avec une précision variable. Après une validation plus poussée, nous pourrions recommander ces modèles de façon systématique afin d'orienter les patients vers des soins psychologiques.

Preprocedural Anxiety in Adults With Congenital Heart Disease: The PANIC Study.

Background: Preprocedural anxiety may have detrimental effects both cognitively and physiologically. Objectives: The objective of this study was to determine the association between state (situational) and trait (persistent in everyday life) anxiety and differences between the adult congenital heart disease (ACHD) and acquired heart disease populations. Methods: The State-Trait Anxiety Inventory and financial stress scale were administered to adults with acquired and CHD at 4 tertiary referral centers in the United States prior to cardiac catheterization. Student's t-test and least absolute shrinkage and selection operator regression analyses were used to assess differences in anxiety between groups and identify the optimal model of predictors of anxiety. Results: Of the 291 patients enrolled, those with CHD (n = 91) were younger (age 41.3 ± 16.3 years vs 64.7 ± 11.3 years, P < 0.001), underwent more cardiac surgeries (P < 0.001), and had higher levels of trait anxiety (t[171] = 2.62, P = 0.001, d = 0.33). There was no difference in state anxiety between groups (t[158.65] = 1.37, P = 0.17, d = 0.18). State anxiety was singularly associated with trait anxiety. Trait anxiety was negatively associated with age and positively associated with state anxiety and financial stress. Patients with CHD of great complexity were more trait (F[2,88] = 4.21, P = 0.02) and state anxious (F[2,87] = 4.59, P = 0.01), though with relatively small effect size. Conclusions: Trait anxiety levels are higher in the ACHD population and directly associated with state anxiety. Specialists caring for ACHD patients should not only recognize the frequency of trait anxiety but also high-risk subgroups that may benefit from psychological or social interventions to reduce preprocedural anxiety.

Delivery of a Group Hypnosis Protocol for Managing Chronic Pain in Outpatient Integrative Medicine.

Although strong evidence exists for using individual hypnosis to treat pain, evidence regarding group applications is limited. This project evaluated changes in multiple outcome measures in persons with chronic pain treated with 8 weeks of group hypnosis. Eighty-five adults with diverse chronic pain etiologies completed an 8-session, structured group hypnosis treatment. Pain intensity, pain interference, and global health were evaluated at baseline, posttreatment, and 3- and 6-months posttreatment. Linear mixed effects models assessed changes in outcomes over time. In a model testing, all three outcome measures simultaneously, participants improved substantially from pre- to posttreatment and maintained improvement across follow-up. Analyses of individual outcomes showed significant pre- to posttreatment reductions in pain intensity and interference, which were maintained for pain intensity and continued to improve for pain interference across follow-up. The findings provide compelling preliminary evidence that a group format is an effective delivery system for teaching individual skills in using hypnosis for chronic pain management. Larger randomized controlled trials are warranted to demonstrate equivalence of outcomes between treatment modes.

Gender differences in the experience of interstitial cystitis/bladder pain syndrome.

Aims: This study assessed gender differences in a debilitating urologic pain condition, interstitial cystitis/bladder pain syndrome (IC/BPS). We aimed to (1) evaluate how pain, symptom, and distress profiles of IC/BPS may differ between genders and (2) obtain in-depth firsthand accounts from patients to provide additional insight into their experiences that may explain potential gender differences. Methods: A mixed methods approach combined validated patient-reported outcome measures with a single timepoint 90-min focus group. Tests of summary score group differences between men and women were assessed across questionnaires measuring urologic symptoms, pain, emotional functioning, and diagnostic timeline. Qualitative analysis applied an inductive-deductive approach to evaluate and compare experiences of living with IC/BPS Group narratives were coded and evaluated thematically by gender using the biopsychosocial model, providing insight into the different context of biopsychosocial domains characterizing the male and female experience of IC/BPS. Results: Thirty-seven participants [women (n = 27) and men (n = 10)] completed measures and structured focus group interviews across eight group cohorts conducted from 8/2017 to 3/2019. Women reported greater pain intensity (p = 0.043) and extent (p = 0.018), but not significantly greater impairment from pain (p = 0.160). Levels of psychological distress were significantly elevated across both genders. Further, the duration between time of pain symptom onset and time to diagnosis was significantly greater for women than men (p = 0.012). Qualitative findings demonstrated key distinctions in experiences between genders. Men appeared not to recognize or to deter emotional distress while women felt overwhelmed by it. Men emphasized needing more physiological treatment options whilst women emphasized needing more social and emotional support. Interactions with medical providers and the healthcare system differed substantially between genders. While men reported feeling supported and involved in treatment decisions, women reported feeling dismissed and disbelieved. Conclusion: The findings indicate different pain experiences and treatment needs between genders in persons experiencing urologic pain and urinary symptoms, with potential intervention implications. Results suggest gender health inequality in medical interactions in this urologic population needing further investigation.

Unifying treatment for mild anxiety and depression in preadolescence.

Anxiety disorders in children and adolescents are prevalent and, if left untreated, can lead to comorbid psychological disorders, substance use, poor socioemotional functioning, and academic and occupational underachievement. Subthreshold presentations of anxiety in youth could become problematic if overlooked, resulting in the aforementioned negative outcomes. Thus, it is important to treat such presentations, including with evidence-based treatments such as cognitive-behavioral therapy (CBT). However, because of not meeting the diagnostic criteria for which many CBT protocols were developed, subthreshold presentations of emotional problems could be an especially good match for transdiagnostic treatments like the Unified Protocol for Children (UP-C). Few studies have addressed this application of the UP-C to subthreshold emotion disorders; thus, this study aimed to preliminarily examine in a systemic case analysis (a) the efficacy of the UP-C for a preadolescent patient with mild anxiety/depression, and (b) the clinical utility of assessing both nomothetic and idiographic outcomes. Pre-post and time series outcome data demonstrated significant decreases in symptoms of depression, irritability, and negative reactions to events and significant increases in emotion identification and ownership of emotions. A network analysis of time series data described dynamics between parent and child ratings as well as the importance of child-rated anxiety and parent ratings of child's ownership of emotions. This case study provides evidence for the efficacy of the UP-C with a preadolescent who displayed subclinical symptoms of an emotional disorder. Furthermore, this case study demonstrates the usefulness of nomothetic and idiographic assessments for treating psychological disorders in youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine.

BACKGROUND: Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services. OBJECTIVE: We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States. METHOD: Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic's telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later. RESULTS: Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 - 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [-0.03 - 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = -1.00 [-1.56 - -0.44], SE = .29, t(799) = -3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 - 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite. CONCLUSION: We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

Deconstructing criterion a of the alternative model for personality disorders.

The construct composition of the Level of Personality Functioning Scale (LPFS; Criterion A) of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders (American Psychiatric Association, 2013) was examined in a clinical vignette rating study. Multiple indices of level of personality functioning, psychiatric and psychosocial impairment, Criterion B maladaptive personality traits, and conceptually divergent variables (intellectual level, socioeconomic status, and likability) were used to deconstruct the LPFS. Most variables were highly intercorrelated, but partial correlational analyses showed the LPFS possesses meaningful personality construct variance not fully explained by severity of pathological traits, psychiatric and psychosocial impairment, or the conceptually divergent variables. This exploratory study offers initial evidence that the LPFS contains substantive LPF variance beyond PD severity. Results are framed and discussed in terms of the known conceptual and empirical overlap between Criterion A and Criterion B as well as the differing ways a dimension of personality disorder (PD) severity may be interpreted. We propose the LPFS is more than statistical artifact created by empirical covariation but less than a true latent dimension of PD severity. The LPFS may be understood as a methodologically pragmatic but theoretically substantive dimension of PD severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Styles of Experiencing Hypnosis: A Replication and Extension Study.

Beyond hypnotizability, there may be different styles of experiencing hypnosis relevant to both basic research and clinical practice. Previous research has demonstrated the presence of inward attentive and dissociative subtypes among more highly hypnotizable individuals during a group protocol. With a sample of undergraduate students, we successfully replicated the presence of these 2 subtypes among those who were relatively more hypnotizable. Inward attentive and dissociative subtypes did not differ in their overall experience of the depth of the relationship with the hypnotist, though the dissociative subjects reported elevated everyday dissociative experiences. We then explored features of each subtype, noting possible altered memory experience in the dissociative style and reduced experience of rationality in both the inward attentive and dissociative styles. We discuss the scientific and clinical implications of this line of research.

Hypnosis for refractory severe neuropathic pain: A case study.

Chronic pain not only has the greatest negative effect on quality of life compared with other chronic health problems but also contributes to the greatest disability worldwide. Management of chronic neuropathic pain is particularly challenging given its association with other pain processes, the fact that less than half of patients respond to a single pain medication, and the lack of evidence regarding combination therapy (i.e. a treatment regimen that combines several scheduled pain medications) safety and efficacy. Given these challenges, there is a growing interest in the application of complementary and alternative medicine (CAM) therapies such as yoga, acupuncture, and hypnosis. We present the case of a 67-year-old male with severe diabetic neuropathy refractory to first, second, and third-line treatments. His disabling pain precipitated premature retirement, contributing to severe depression with suicidality requiring hospitalization. Ultimately, he experienced relief through an integrative health regimen, and he identified hypnosis as the most effective therapy for his pain. Through individual and group sessions, recordings, and daily self-hypnosis, he improved both his chronic pain symptomatology and quality of life, simultaneously decreasing opioid use. Simulation modeling analysis of his pain ratings over time showed that they reliably decreased after engaging in hypnosis, r = -.33, p =.001. A growing body of research suggests that hypnosis is beneficial as part of an integrative treatment approach to chronic pain and enhances the efficacy of other therapies. Our medically challenging case study supports that hypnosis may serve as a viable and durable treatment for chronic neuropathic pain.

Clinical Hypnosis for Chronic Pain in Outpatient Integrative Medicine: An Implementation and Training Model.

Introduction: Clinical hypnosis for pain management cultivates specific skills to enhance general self-regulation and address pain. Hypnosis is well suited to integrative medicine settings; however, questions persist about its feasibility. This article describes a financially viable hypnosis practice model implemented in an integrative medicine clinic, providing initial feasibility data about rates of referral, participation, reimbursement, and provider retention. The specific processes required to establish and implement hypnosis services were detailed, including instruction in billing, reimbursement data, and a training model to enhance reach of services. Materials and methods: Insurer reimbursement data and operational costs were examined from three hypnosis groups conducted between September 2017 and March 2018. Furthermore, information on referral patterns and enrollment in treatment was collected from program initiation in September 2017 to January 2019. Provider retention in training with the expansion of supervision in the program's second year was also examined. Results: Of 258 individuals referred to hypnosis, 124 (48%) enrolled in group treatment. Analysis of insurer reimbursement over a subset of enrollees from three completed groups (N = 26) indicated an average collection of $95.85 per patient per session, equating to $706.86 per patient for the eight-session treatment. This extrapolates to $4,926.82 in total per seven-person group for the entirety of the eight-session treatment. After an annual training workshop, provider retention significantly increased (to 81% of eligible trained providers) with the initiation of twice-monthly clinical supervision focusing on transitioning from training to practice. Conclusion: This analysis indicates that a training- and practice-based research model of clinical hypnosis is feasible and financially sustainable in an integrative medicine setting.

Qualitative Analysis of Treatment Needs in Interstitial Cystitis/Bladder Pain Syndrome: Implications for Intervention.

BACKGROUND: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition carrying substantial psychosocial burden. Psychological treatment for IC/BPS is little studied, and there are barriers to its use in clinical management. Whether psychological treatments benefit patients with IC/BPS is unclear and we do not know if such treatments would meet patient needs. AIMS: Incorporating patient-reported needs and acknowledging diversity in pain experiences can inform patient-centered interventions for IC/BPS. This project characterized the experience of living with IC/BPS and patient perceptions of needs in its treatment, with the goal of informing patient-centered treatment for IC/BPS. METHODS: Using both quantitative and qualitative methods, 27 females with IC/BPS participated in a focus group and completed validated self-report assessments evaluating urinary symptoms, pain, and emotional functioning. Focus groups were audio recorded and transcribed, then coded and analyzed using an iterative inductive/deductive approach. Linear regression models evaluated the relationship between psychological functioning and symptom severity. RESULTS: We conducted six focus groups between 8/2017-12/2017. Five major themes emerged from qualitative analysis: managing physical symptoms, emotional symptoms, impact on daily life and socio-contextual factors, responding to illness, and addressing needs in treatment. The physiological and emotional consequences of IC/BPS were reported, highlighting their impact on interpersonal relationships and challenges obtaining appropriate treatment for IC/BPS. Quantitative analysis showed depression levels were significantly associated with worsened IC/BPS symptomology, after controlling for known confounding factors. CONCLUSION: Individuals with IC/BPS could benefit from tailored psychological interventions focusing on pain management, emotion regulation, communications skills, along with sexual dysfunction and intimacy fears.

GRATITUDE WHILE DRINKING, GRATITUDE WHILE RECOVERING: A STUDY OF ALCOHOL USE DISORDERS.

Background: For decades researchers have debated whether those diagnosed with alcohol use disorders can return to non-problematic drinking. Now, recovery researchers are measuring aspects of wellbeing in addition to aspects of pathology, producing surprising findings that have added to the debate. Recent studies show that some with alcohol use disorders who continue to drink endorse high levels of positive psychosocial functioning. Objectives: Employ trait gratitude as a marker of wellness to answer the following questions: how do individuals who continue to drink but endorse high gratitude at follow-up differ from peers at baseline? Does trait gratitude correlate differently with demographic, psychosocial, and clinical factors for abstinent members of Alcoholics Anonymous (AA) versus actively drinking non-AAs? Methods: 275 individuals with alcohol dependence were assessed for trait gratitude at 2.5-3-year follow-up in a naturalistic, longitudinal study. The sample was assessed on psychosocial and clinical indicators at baseline and follow-up. Results: Drinkers who endorsed high gratitude had higher socioeconomic status, greater levels of positive spirituality, more stable personality indicators, less addiction severity, fewer negative life events, and fewer psychiatric symptoms than their peers at baseline. For actively drinking non-AAs, trait gratitude correlated differently, and positively, with years of education, income, and purpose in life compared with sober AA members. For AA members, gratitude correlated with AA involvement and length of sobriety. Discussion: Across multiple domains, a subset of drinkers report doing relatively well despite meeting criteria for alcohol dependence. Trait gratitude correlates differently with other constructs for AAs versus non-AAs, indicating that gratitude for recovery might be contextually sensitive, operating differently within and without the structure of AA.

Clinical Hypnosis in Postoperative, Adult-Onset Dysphagia: A 2-Year Empirical Case Study.

Dysphagia, the perceived impediment to swallowing food, is a common postsurgical symptom that can have debilitating consequences. This study presents the successful treatment of severe esophageal dysphagia with a problem-focused and patient-centered approach to hypnosis, informed by long-term empirical follow-up. The authors describe a case history involving significant and persistent difficulty swallowing for which no medical or surgical treatment could be found. Over the course of 10 sessions, the patient was assessed, treated with imaginal exposure, and instructed in self-hypnosis. Outcomes were measured at treatment conclusion, and 6-, 9-, and 18-month follow-ups. Following hypnosis, the patient exhibited significant and reliable change (RC) in visceral hypersensitivity (RC = -3.16, p = .002), emotional distress (RC = -2.21, p= .03), subjective well-being (RC = 4.14, p< .0001), and posttraumatic symptoms (RC = -3.33, p= .001). Gains were maintained at 18-month follow-up.

Interpersonal synchrony feels good but impedes self-regulation of affect.

The social benefits of interpersonal synchrony are widely recognized. Yet, little is known about its impact on the self. According to enactive cognitive science, the human self for its stability and regulation needs to balance social attunement with disengagement from others. Too much interpersonal synchrony is considered detrimental for a person's ability to self-regulate. In this study, 66 adults took part in the Body-Conversation Task (BCT), a dyadic movement task promoting spontaneous social interaction. Using whole-body behavioural imaging, we investigated the simultaneous impact of interpersonal synchrony (between persons) and intrapersonal synchrony (within a person) on positive affect and self-regulation of affect. We hypothesized that interpersonal synchrony's known tendency to increase positive affect would have a trade-off, decreasing a person's ability to self-regulate affect. Interpersonal synchrony predicted an increase in positive affect. Consistent with our hypothesis, it simultaneously predicted a weakening in self-regulation of affect. Intrapersonal synchrony, however, tended to oppose these effects. Our findings challenge the widespread belief that harmony with others has only beneficial effects, pointing to the need to better understand the impact of interaction dynamics on the stability and regulation of the human self.

Moving and Reflective Functioning Under Stress.

According to mentalization theory, reflective functioning is a core feature of healthy affect regulation which involves interactions among implicit and explicit processes across multiple systems of the individual in relation with others. Mother-infant interactions point to the role of whole body movement as a feature of developing affect regulation, promoting self-organization. Using behavioral imaging technology, we examined the legacy of whole body movement in adults undergoing an interpersonal stress task (Trier Social Stress Test; TSST). Movement was assessed as a multidimensional system over time, allowing for examination of rigid recurrence and self-organized determinism in movement dynamics (Multidimensional Recurrence Quantification Analysis). Reflective functioning was assessed using an automated analysis of transcripts. We found flexible yet self-organized movement uniquely predicted reflective function. Self-reported personality organization, assessed at least one week prior, showed some bivariate relationship with indices of movement dynamics, while self-reported attachment styles did not. Using novel methodology, this study demonstrated the cooccurrence of reflective functioning and specific movement dynamics. The authors suggest theoretical approaches from phenomenology to understand these findings and call for further research.