Presleep cognitions in patients with insomnia secondary to chronic pain.

This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The three most frequently reported presleep cognitions were general pain-related thoughts (36%), thoughts about the experimental procedure (27%), and negative sleep-related thoughts (26%). Stepwise multiple regression analyses found the presleep thoughts pertaining to pain and environmental stimuli were significantly associated with sleep continuity, independent from the effects of depression and nightly pain severity. Pain severity was found to be positively associated with Wake After Sleep Onset Time. These results are consistent with cognitive-behavioral models of primary insomnia and suggest the content of presleep cognitive arousal may contribute to sleep disturbance secondary to pain.

Sleep quality and presleep arousal in chronic pain.

This study was designed (1) to characterize the extent and nature of sleep complaints of chronic pain patients and (2) to examine the factors that predict sleep quality. A heterogeneous sample of 51 outpatients with benign, chronic pain was recruited from newspaper and pain clinic advertisements. Patients completed a variety of self-report instruments including the Multidimensional Pain Inventory, the Pittsburgh Sleep Quality Index, the Pre-Sleep Arousal Scale, and the Beck Depression Inventory. Sleep complaints were reported by 88% of the sample. Presleep cognitive arousal, rather than pain severity, was found to be the primary predictor of sleep quality.

Hostility, dieting, and nutrition attitudes in overweight and weight-cycling men and women.

OBJECTIVE: Relationships were examined between hostility, weight status, weight cycling, dieting behaviors, and nutrition attitudes. METHOD: Data were derived from the RENO Diet-Heart Study (RDHS), a 5-year prospective natural history (descriptive) study of weight fluctuations, behavior patterns, and cardiovascular (CVD) risk factors. Overweight versus normal-weight and weight-cycling versus non-weight-cycling men and women were compared on overt and covert hostility. RESULTS: Overweight subjects scored significantly higher than normal-weight individuals on covert but not overt hostility. Similarly, subjects with a history of weight fluctuation scored significantly higher on covert hostility than subjects without a history of weight cycling. Subjects who reported more hostility scored higher on measures of eating disinhibition, hunger, and dietary helplessness. DISCUSSION: The relationships among hostility, dieting behaviors, and nutrition attitudes could not be explained on the basis of general distress alone. The findings supported the hypothesis that the relationship between hostility and health is mediated by the association between hostility and health-related behaviors.

Smoking cessation after surgery. A randomized trial.

BACKGROUND: Cigarette smoking is the greatest cause of preventable mortality in the United States. Because most smokers would like to quit and most hospitals are smoke free, surgical admissions represent a window of opportunity for tobacco cessation interventions. METHODS: A total of 324 patients (98% men), aged 25 to 82 years, who were current smokers and who underwent noncardiac surgery were enrolled in a randomized controlled trial at the Veterans Affairs Medical Center, San Francisco, Calif. One hundred sixty-eight participants (52%) received a multicomponent intervention designed to increase self-efficacy and coping skills that included face-to-face in-hospital counseling, viewing a smoking cessation videotape, self-help literature, nicotine replacement therapy, and 3 months of telephone follow-up. One hundred fifty-six participants (48%) received self-help literature and brief counseling lasting 10 minutes. Serum or saliva cotinine levels were measured to confirm self-reported smoking cessation. RESULTS: At 12 months of follow-up, the self-reported quit rate was 27% among the intervention group and 13% among the comparison group (relative risk, 2.1; 95% confidence interval, 1.2-3.5; P < .01). Based on biochemical confirmation, 15% of the intervention group, compared with 8% of the comparison group, quit smoking at 12 months (relative risk, 2.0; 95% confidence interval, 1.0-3.9; P = .04). CONCLUSIONS: A smoking cessation intervention targeted at smokers hospitalized for noncardiac surgery can increase long-term quit rates. Surgical hospitalizations provide an opportunity to reach smokers who want to quit smoking.

Psychosocial correlates of eczema in a non-treatment-seeking population.

Data from the Vietnam Experience Study were used to examine psychosocial correlates of eczema. Based upon the results of dermatologic examinations, three groups of male veterans were identified: (a) subjects with eczema (n = 80), (b) subjects with tinea (n = 282), and (c) subjects with no medical diagnosis (n = 176). These three groups were compared on measures of anxiety, depression, hostility, and social support. The Diagnostic Interview Schedule (Version III-A) was used to determine diagnoses of anxiety and depression and level of social support. MMPI Scales 2 and 7, the Wiggins content scale of Depression, and the Cook-Medley Hostility Scale were used to assess anxiety, depression, and hostility. Eczema subjects did not differ from tinea or no-disease control groups on dependent measures. These results are contrasted with previous studies of treatment-seeking patients, which showed greater prevalence of anxiety and depression among individuals with eczema. Directions for future research are suggested.

Dietary helplessness and disinhibition in weight cyclers and maintainers.

OBJECTIVE: The primary purpose of this study was to compare obese versus nonobese adults and weight cyclers versus maintainers on measures of dietary helplessness, nutrition concern, dietary restraint, and disinhibition. METHOD: Dietary helplessness, nutrition concern, dietary restraint, and disinhibition were assessed in 385 healthy obese and nonobese men and women in the RENO Diet-Heart Study, a 5-year prospective investigation of cardiovascular risk factors, weight cycling, and lifestyle. RESULTS: The results indicated that dietary helplessness and disinhibition were significantly greater in obese individuals, subjects with a history of weight cycling, and weight fluctuators (prospectively measured). Women were found to score significantly higher than men on measures of dietary helplessness, disinhibition, and cognitive restraint. DISCUSSION: The role of nutrition attitudes is discussed in relation to dietary self-regulation, weight fluctuation, and management of body weight.

New directions for the education of clinical psychologists: The primary care setting, the VA's PRIME program, and the in-depth generalist model.

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an "in-depth generalist" (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.

Preventing relapse in the treatment of nicotine addiction: current issues and future directions.

Although smoking-cessation rates have continued to increase, the vast majority of smokers who quit eventually relapse. Between 1974 and 1985, over 1.3 million smokers quit during each of those years. However, 75% to 80% of those individuals resumed smoking within six months. This article describes the dynamic phenomenon of smoking relapse within the context of cyclical episodes of smoking and quitting during an individual's lifetime. Theories of the determinants of smoking relapse are reviewed and methods designed to prevent relapse are described. Smoking relapse is discussed in terms of three aspects of tobacco addiction: (1) biological-addiction mechanisms, (2) conditioning processes, and (3) cognitive-social learning factors. The major determinants of smoking relapse are reviewed, including nicotine withdrawal, stress, weight gain, social influences, conditioning factors, causal attributions, and environmental variables. A transtheoretical-developmental model is explored in the longitudinal investigation of the natural history of slips (lapses) and relapse episodes. Relapse prevention interventions are described that emphasize self-awareness, self-regulation, self-efficacy, affect regulation, social support, and lifestyle balance. Recent developments in pharmacological adjuncts to treatment are also examined. It is concluded that innovative relapse prevention methods need to be designed for hard-core smokers with histories of cessation failures, substance abuse and/or psychiatric impairment. These and other recommendations for future research on smoking relapse and relapse prevention are discussed.

Affect regulation, nicotine addiction, and smoking cessation.

Numerous investigators have examined the role of negative affective states and affect regulation in the initiation and development of cigarette smoking behavior, smoking cessation, and relapse prevention. Affect regulation refers to any attempt to alleviate negative mood states by means of pharmacologic-, cognitive-, behavioral- or environmental-change methods. The psychological construct/process of affect regulation is examined in relation to (1) the initiation, development, and maintenance of the cigarette smoking habit; (2) the process of quitting smoking; and (3) the long-term maintenance of smoking abstinence versus relapse. Various psychosocial factors and physiological mechanisms are explored that have been hypothesized to be links between negative mood states, nicotine addiction, and smoking cessation. Implications for smoking cessation treatment are discussed in the areas of (1) the use of pharmacologic agents, such as clonidine, in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.

Preventing relapse in the treatment of nicotine addiction: current issues and future directions.

Although smoking-cessation rates have continued to increase, the vast majority of smokers who quit eventually relapse. Between 1974 and 1985, over 1.3 million smokers quit during each of those years. However, 75% to 80% of those individuals resumed smoking within six months. This article describes the dynamic phenomenon of smoking relapse within the context of cyclical episodes of smoking and quitting during an individual's lifetime. Theories of the determinants of smoking relapse are reviewed and methods designed to prevent relapse are described. Smoking relapse is discussed in terms of three aspects of tobacco addiction: (1) biological-addiction mechanisms, (2) conditioning processes, and (3) cognitive-social learning factors. The major determinants of smoking relapse are reviewed, including nicotine withdrawal, stress, weight gain, social influences, conditioning factors, causal attributions, and environmental variables. A trans-theoretical-developmental model is explored in the longitudinal investigation of the natural history of slips (lapses) and relapse episodes. Relapse prevention interventions are described that emphasize self-awareness, self-regulation, self-efficacy, affect regulation, social support, and lifestyle balance. Recent developments in pharmacological adjuncts to treatment are also examined. It is concluded that innovative relapse prevention methods need to be designed for hard-core smokers with histories of cessation failures, substance abuse and/or psychiatric impairment. These and other recommendations for future research on smoking relapse and relapse prevention are discussed.

Hostility as a health risk factor: relationships with neuroticism, Type A behavior, attentional focus, and interpersonal style.

In order to investigate further the psychological construct of hostility measured on the Cook-Medley (Ho) Scale as a health risk factor, the present study examined relationships between hostility assessed on the Ho Scale and several measures of neuroticism, Type A behavior, and attentional and interpersonal style, using bivariate and hierarchical multiple regression analyses. Subjects were 204 psychologically normal, physically healthy males. Significant relationships were found between hostility, neuroticism, attentional overload, and interpersonal alienation. The present study provided normative data on several important health-related psychological dimensions in a sample of healthy normals. The findings also provided further support for the relationship between the hostility construct measured on the Ho Scale and measures of neuroticism as possible dimensions of disease-prone personality.

Affect regulation, nicotine addiction, and smoking cessation.

Numerous investigators have examined the role of negative affective states and affect regulation in the initiation and development of cigarette smoking behavior, smoking cessation, and relapse prevention. Affect regulation refers to any attempt to alleviate negative mood states by means of pharmacologic-, cognitive-, behavioral- or environmental-change methods. The psychological construct/process of affect regulation is examined in relation to (1) the initiation, development, and maintenance of the cigarette smoking habit; (2) the process of quitting smoking; and (3) the long-term maintenance of smoking abstinence versus relapse. Various psychosocial factors and physiological mechanisms are explored that have been hypothesized to be links between negative mood states, nicotine addiction, and smoking cessation. Implications for smoking cessation treatment are discussed in the areas of (1) the use of pharmacologic agents, such as clonidine, in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.

The Nutrition Attitude Survey: associations with dietary habits, psychological and physical well-being, and coronary risk factors.

Attitudes play an important role in the adoption and maintenance of a variety of health habits. In the present study, the Nutrition Attitude Survey (NAS) was developed to measure attitudes pertaining to the adoption of a low-fat, low-cholesterol diet. Factor analysis identified four primary attitudinal factors: Helpless and Unhealthy, Food Exploration, Meat Preference, and Health Consciousness. For a community sample of 415 healthy men and women, relationships were examined among these attitudinal factors and dietary habits, family food patterns, medical and psychological symptoms, and traditional coronary risk factors. For both men and women, the Helpless and Unhealthy factor was associated with increased meat consumption, weight, emotional distress, reported medical and psychological symptoms, total cholesterol, and low-density lipoprotein cholesterol. The Food Exploration factor was more characteristic of younger men and women and positively associated with men's reported involvement in family food preparation activities. For both sexes, Meat Preference scores were positively associated with meat consumption and inversely associated with consumption of meatless meals, beans, and fruit. Health Consciousness factor scores were associated with less meat consumption, more meatless meals, and better overall dietary adherence scores for both men and women. Overall, the findings provide initial support for the reliability and predictive validity of the NAS and underscore the importance of assessing and addressing the attitudes and preferences of participants in dietary intervention programs.

Co-occurrent use of cigarettes, alcohol, and coffee in healthy, community-living men and women.

Previous studies have examined intra-individual aggregation in the use of cigarettes, alcohol, and coffee by examining the co-occurrent use of any pair of these three substances. A recent literature review failed to find a single investigation that studied use of all three in the same sample. In the present study, co-occurrent use of all three of these substances was examined in crossvalidated subsamples of 226 male and 245 female healthy, community-living, middle-class Americans. A log-linear analysis was used to compare the proportion of smokers, ex-smokers, and nonsmokers categorized as users of more or less amounts of coffee and alcohol. Although most of the intercorrelations were not strong, the results indicate that for both sexes, smokers and ex-smokers were more likely than nonsmokers to drink greater amounts of alcohol and coffee. Furthermore, for smokers, ex-smokers, and nonsmokers, a majority of individuals who reported drinking more alcohol also reported drinking more coffee. Interestingly, the coffee and alcohol consumption levels of ex-smokers resembled those of smokers more than those of nonsmokers. Also, ex-smokers reported drinking more wine and decaffeinated coffee than either smokers or nonsmokers. Finally, the number of cigarettes smoked per day (daily quantity) was positively related to total alcohol and coffee consumption in men, but not in women. Further studies are recommended to examine the role of individual differences in the development, maintenance, and modification of these three appetitive habits and their co-occurrence.

Type A behavior, attentional style, and symptom reporting among adult men and women.

Type A behavior and its components (measured on the JAS) were examined in relation to attentional style and symptom reporting in 294 healthy adult men and women. The results showed that for both men and women the JAS Type A, Job Involvement, and Hard Driving factors were all associated with self-reported attentional effectiveness as measured by the Nideffer Test of Attentional and Interpersonal Style. However, a fourth JAS factor, Speed and Impatience, was associated with Nideffer measures of cognitive overload. For both men and women, the Type A, Speed and Impatience, and Hard Driving factors were all positively associated with the number of medical and psychological symptoms reported on the Cornell Medical Index. In addition, acute psychological distress (Hopkins SCL-90R) was associated with Type A behavior for men and with Speed and Impatience for both sexes. Attention differences did not account for the observed positive relationships between Type A factors and symptom reporting with one exception; attentional overload (internal) appeared to partially explain the relationships between symptom reporting and Speed and Impatience in women. In summary, Type As described themselves as having a broader attentional focus and reported more naturally occurring physical and psychological symptoms than did Type Bs.

Behavioral treatment of hyperlipidemia: techniques, results, and future directions.

The present review examines the role of several target behaviors in the treatment of hyperlipidemia, including diet, exercise, cigarette smoking, Type A pattern, and medication adherence. Modification of the typical American diet (high in cholesterol, fat, and sodium) is emphasized in the treatment of hyperlipidemia since a multitude of laboratory, clinical, and epidemiological studies have shown that diet plays a crucial role in the pathogenesis of this condition and an increase in coronary risk. Factors affecting patient compliance such as health beliefs and family support are discussed in terms of their impact on behavior change efforts aimed at reducing plasma lipids through dietary and drug regimens. Intervention studies are reviewed in the behavioral treatment of hyperlipidemia. These programs have focused on diet modification, exercise, and medication adherence to reduce plasma lipids and coronary risk. The role of other target behaviors (i.e., Type A pattern and smoking) is explored not only in determining coronary risk but also in terms of their direct impact on plasma lipids. Further research is necessary to clarify the relationship between these target behaviors and plasma lipid levels and to investigate the effects of innovative family- and group-based intervention procedures in promoting and maintaining habit change related to coronary risk reduction.

Physical exercise rehabilitation: long-term dropout rate in cardiac patients.

The long-term dropout rate was examined in a physical exercise rehabilitation program in which 203 cardiac patients were followed for 40 months. The dropout curve was found to be downward-sloping and negatively accelerated with most of the dropouts occurring during the first 3 months. This dropout rate appeared to resemble the group release curve previously found in the treatment of addictive behaviors. Implications of the present findings are discussed in terms of the development of strategies to facilitate long-term compliance.