Mobile assessment of experiential avoidance, mood, stress, and attendance in cardiopulmonary rehabilitation.

OBJECTIVES: This study utilized mobile ecological momentary assessment (EMA) to examine the dynamic relationships among experiential avoidance (EA), mood, and cardiopulmonary rehabilitation (CVPR) attendance. METHOD: Participants (n = 47; 40.4% female; 80.1% White; 85.1% Cardiac, 14.9% Pulmonary) were recruited from CVPR during their first 2 weeks of the program. They completed daily EMA prompts to assess momentary mood and EA for 2 weeks using a smartphone device. Multilevel modeling (MLM) was employed to investigate the impact of EA and mood on next-week attendance and the within-person within-prompt correlates, antecedents, and consequences of EA. RESULTS: Greater EA and negative mood significantly predicted worse next-week CVPR attendance rates. Within the same EMA prompt individuals with higher EA also reported greater negative affect and perceived stress, while individuals with lower EA reported greater positive mood. In addition, lagged analyses showed that EA was negatively related to next-day positive mood scores. CONCLUSIONS: EA appears to be an important targetable mechanism negatively related to CVPR program attendance and mood in CVPR patients. The present study builds upon previous research supporting EA as a dynamic and fluid emotion-regulation process, suggesting EA's impact on mood and behavior may be best understood through repeated real-time measurement methodology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Educational Scholarship and Technology: Resources for a Changing Undergraduate Medical Education Curriculum.

Returning to the original emphasis of higher education, universities have increasingly recognized the value and scholarship of teaching, and medical schools have been part of this educational scholarship movement. At the same time, the preferred learning styles of a new generation of medical students and advancements in technology have driven a need to incorporate technology into psychiatry undergraduate medical education (UGME). Educators need to understand how to find, access, and utilize such educational technology. This article provides a brief historical context for the return to education as scholarship, along with a discussion of some of the advantages to this approach, as well as several recent examples. Next, the educational needs of the current generation of medical students, particularly their preference to have technology incorporated into their education, will be discussed. Following this, we briefly review the educational scholarship of two newer approaches to psychiatry UGME that incorporate technology. We also offer the reader some resources for accessing up-to-date educational scholarship for psychiatry UGME, many of which take advantage of technology themselves. We conclude by discussing the need for promotion of educational scholarship.

Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments.

Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.

Comparison of pain, functioning, coping, and psychological distress in patients with chronic low back pain evaluated for spinal cord stimulator implant or behavioral pain management.

OBJECTIVE: Subgroups of patients with chronic low back pain may exhibit differences in self-reported measures of pain, functioning, coping, and psychological distress. The present study compared subgroups of patients with chronic low back pain referred either for pre-spinal cord stimulator (SCS) psychological evaluations or for behavioral pain management (BPM). DESIGN: Measures from comprehensive pain, functioning, and psychological assessments were compared using multivariate ancova. SETTING: Tertiary care medical outpatient pain management center. SUBJECTS: One hundred and two patients (64% female, mean age = 53.7, standard deviation = 14.3) with chronic low back pain diagnoses were evaluated either as possible candidates for SCS (N = 73) or as part of treatment planning for BPM (N = 29). METHODS: These groups were compared on measures of pain, interference, disability, pain-related anxiety, pain coping, pain catastrophizing, depression, post-traumatic stress symptoms, affective distress, and interpersonal distress assessed using standardized scales. It was hypothesized that the two groups would report similar levels of pain, functioning, and coping, but pre-SCS patients would report fewer psychological symptoms of psychological distress compared with BPM patients in order to gain approval for SCS. RESULTS: Consistent with hypotheses, BPM and pre-SCS patients reported similar pain, functioning, and coping, but pre-SCS patients reported fewer psychological symptoms. CONCLUSIONS: Pre-SCS patients possibly underreport psychological symptoms perhaps to gain SCS approval for SCS. Separate norms and cutoffs for pre-SCS psychological evaluations may be needed to better identify risks of unsuccessful outcomes. Validity scales for measures of psychological distress also could be developed to detect biased reporting. Alternatively, referring clinicians may have referred patients for BPM who were more psychologically distressed and perceived as more in need of psychosocial intervention than those referred for pre-SCS evaluations. Further investigation of clinical referral decisions and assessment bias is warranted to clarify the meaning of these differences and how they apply to patient outcomes.

Effects of conscious sedation on patient recall of anxiety and pain after oral surgery.

OBJECTIVE: This study examined the effect of conscious ("moderate") sedation with amnestic effects and local anesthetic, versus local anesthetic alone, on recall of pain and anxiety related to surgical tooth extraction. Greater anxiety and pain were hypothesized in the local anesthesia-alone group. STUDY DESIGN: Patients undergoing tooth extraction, receiving moderate sedation plus local anesthetic (n = 27) or local anesthetic alone (n = 27), were assessed on trait dental anxiety, preextraction state pain and anxiety, anticipated pain and anxiety, and 1-month recall of pain and anxiety. RESULTS: Patients with moderate sedation, compared with those administered only local anesthetic, recalled less procedural pain and anxiety after 1 month. The local anesthetic-alone group reported more preextraction pain and anticipated more procedural anxiety. CONCLUSIONS: Moderate sedation had the desired effect of lower recalled pain and anxiety associated with extraction, even 1 month later. Anticipating moderate sedation also prompts expectation of less anxiety during the procedure.

Interaction of intensity and order regarding painful events.

While stimulus intensity obviously affects degree of pain responding, presentation order effects of stimuli of different intensities on acute pain responses are under-researched. The present study examined the effects of manipulating presentation order of lower and higher pain stimulus intensity. Using 96 undergraduates, this investigation employed a 2 x 2 mixed research design, with pain stimulus sequence as a between-subjects variable and pain stimulus trial as a repeated measure. When the greater pain stimulus intensity was presented last, verbal report of pain was higher. Also, performance of a cognitive task was interrupted the least when the lower stimulus intensity was presented last. Heart rate, however, was highest when the greater stimulus intensity was presented first, and pain tolerance was greatest when the lower stimulus intensity was presented first. Results are discussed in relation to adaptation-level effects, and implications for pain experienced in clinical settings are suggested.