Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial.

BACKGROUND: Current clinical guidelines identify several psychological treatments for irritable bowel syndrome (IBS). IBS patients, however, have elevated trauma, life stress, relationship conflicts, and emotional avoidance, which few therapies directly target. We tested the effects of emotional awareness and expression training (EAET) compared to an evidence-based comparison condition-relaxation training-and a waitlist control condition. METHODS: Adults with IBS (N=106; 80% female, Mean age=36 years) were randomized to EAET, relaxation training, or waitlist control. Both EAET and relaxation training were administered in three, weekly, 50-minute, individual sessions. All patients completed the IBS Symptom Severity Scale (primary outcome), IBS Quality of Life, and Brief Symptom Inventory (anxiety, depressive, and hostility symptoms) at pretreatment and at 2 weeks posttreatment and 10 weeks follow-up (primary endpoint). KEY RESULTS: Compared to waitlist controls, EAET, but not relaxation training, significantly reduced IBS symptom severity at 10-week follow-up. Both EAET and relaxation training improved quality of life at follow-up. Finally, EAET did not reduce psychological symptoms, whereas relaxation training reduced depressive symptoms at follow-up (and anxiety symptoms at posttreatment). CONCLUSIONS & INFERENCES: Brief emotional awareness and expression training that targeted trauma and emotional conflicts reduced somatic symptoms and improved quality of life in patients with IBS. This emotion-focused approach may be considered an additional treatment option for IBS, although research should compare EAET to a full cognitive-behavioral protocol and determine which patients are best suited for each approach. Registered at clinicaltrials.gov (NCT01886027).

Factors Associated with Healthcare Utilization Among Arab Immigrants and Iraqi Refugees.

Arab migrants-both immigrants and refugees-are exposed to pre- and post- migration stressors increasing their risk for health problems. Little is known, however, about rates of, or factors associated with, healthcare utilization among these two groups. A sample of 590 participants were interviewed approximately 1 year post-migration to the United States. Factors associated with healthcare utilization, including active and passive coping strategies, were examined using logistic regressions. Compared to national healthcare utilization data, immigrants had significantly lower, and refugees had significantly higher rates of healthcare utilization. Being a refugee, being married, and having health insurance were significantly associated with medical service utilization. Among refugees, less use of psychological services was associated with the use of medications and having problem-focused (active) strategies for dealing with stress. Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than did immigrants.

Lack of understanding in fibromyalgia and rheumatoid arthritis: the Illness Invalidation Inventory (3*I).

BACKGROUND: Patients with rheumatic diseases may face 'discounting' (denying and patronising) or 'lack of understanding' because of having symptoms without external clinical signs, but instruments to assess such invalidation experiences are lacking. OBJECTIVES: To develop and evaluate the Illness Invalidation Inventory (3*I), to compare invalidation experiences of two groups of patients who differ in visual signs and laboratory findings-rheumatoid arthritis (RA) and fibromyalgia-and to examine the association of invalidation with health status. METHODS: A questionnaire (eight items with respect to five sources: spouse, family, medical professionals, work environment and social services) was constructed. It was completed by 142 patients with RA and 167 patients with fibromyalgia. RESULTS: Principal axis factoring with oblimin rotation yielded two factors with high internal consistency (α>0.70): 'discounting' (five items) and 'lack of understanding' (three items). Patients with fibromyalgia experienced significantly more discounting and lack of understanding from their family, medical professionals, colleagues and social services than did patients with RA. Both patient groups experienced more invalidation from social services, colleagues and family than from medical professionals and spouses. More discounting and lack of understanding correlated with poorer mental well-being and social functioning in both patient groups. Discounting correlated with more physical disability and pain in patients with RA. CONCLUSIONS: The 3*I is a brief, reliable instrument for assessing patients' perceptions of invalidation from different sources, which differ between patient groups and are associated with health status. Future validation research should clarify the clinical impact of invalidation on treatment adherence and outcome.

Increased non-transferrin bound iron in plasma-depleted SAG-M red blood cell units.

BACKGROUND AND OBJECTIVES: Non-transferrin bound iron (NTBI) is associated with increased morbidity in a number of transfusion-dependent disease states such as the severe haemoglobinopathies. We hypothesized that this may be related to excess NTBI present in plasma-depleted red blood cell units that are free of clear haemolysis. MATERIALS AND METHODS: The level of NTBI was determined using the bleomycin assay in samples from 20 stored plasma-depleted red cell units, at approximate 5-day intervals up to day 33 after donation. Forty units of fresh-frozen plasma (FFP) and 40 units of platelet concentrates were used as negative controls, and samples from 12 units of FFP were also serially assessed. RESULTS: Median [interquartile range (IQR)] NTBI was 0 microm (0-0.35) in samples taken from units 3-10 days after donation. Thereafter, the levels of NTBI increased, becoming significant (median 3.05; IQR: 0.05-6.7 microm) 17-22 days after donation. After 30 days, NTBI was detectable in all red cell units. NTBI was undetectable in platelet concentrates and FFP. CONCLUSIONS: Increased levels of NTBI become detectable 17-22 days after donation and increase further with storage time. This excess NTBI may promote bacterial infection in iron-loaded individuals.

Optimistic explanatory style and dispositional optimism in HIV-infected men.

OBJECTIVE: This study examined associations of two types of optimism (Peterson and Seligman's optimistic explanatory style and Scheier and Carver's dispositional optimism) with each other as well as with symptoms and immune status among human immunodeficiency virus (HIV)-infected men. METHOD: We related both types of optimism to HIV symptoms and to CD4 counts in a cross-sectional study of 78 men, and to change in CD4 counts in a 2-year prospective study of a subsample of these men. RESULTS: Analyses controlled for age, education, employment status, duration since diagnosis, and azidothymidine (AZT) use. The two types of optimism were only minimally related to each other (r=.25). Cross-sectionally, higher levels of both types of optimism were associated with having fewer HIV symptoms, but a more optimistic explanatory style was related to having poorer immune status (lower CD4). Prospectively, an optimistic explanatory style was a substantial predictor of greater decline in CD4 counts after 2 years, after controlling for baseline CD4. Dispositional optimism was unrelated to CD4 counts. Neither health behaviors nor coping strategies mediated these relationships, and the relationships of optimistic explanatory style (and to a lesser extent, dispositional optimism) were independent of negative affectivity. CONCLUSIONS: These optimism measures tap different types of optimism, and although both are related to better subjective health in HIV-infected men, an optimistic explanatory style predicts greater decline in immune status over time. This latter relationship may be related to the unique stress and life experiences associated with having HIV.

Favorable attitudes toward testing for chromosomal abnormalities via analysis of fetal cells in maternal blood.

PURPOSE: The NICHD Fetal Cell Isolation Study (NIFTY) was a multicentered project to isolate fetal cells from maternal blood to detect fetal chromosomal abnormalities. The project included a psychosocial component, which is the basis of this article. We examined the attitudes of high-risk pregnant women toward the availability of a maternal blood test to identify fetal chromosomal abnormalities, how women would respond to hypothetical normal and abnormal maternal blood testing results, and the factors associated with a woman's preference to have an invasive procedure in response to a normal maternal blood test. METHODS: High-risk pregnant women (N = 854) planning to have prenatal diagnostic invasive testing (amniocentesis or chorionic villus sampling) completed a survey. RESULTS: The women highly favored maternal blood testing. Almost all women would seek invasive testing after an abnormal blood test. Only half of the women would seek invasive testing after a normal blood test; these women were older, more willing to terminate their pregnancy, and valued the increased accuracy of invasive testing more highly than women who would not have invasive testing after a normal maternal blood test. CONCLUSIONS: Women having invasive diagnostic testing welcome a noninvasive procedure that uses fetal cells in maternal blood, and its availability would decrease invasive testing by approximately 50%. Research needs to examine the attitudes and anticipated responses of other risk groups as well as the effects of information about maternal blood test sensitivity and specificity on attitudes and responses.

Stress, emotional skill, and illness in children: the importance of distinguishing between children's and parents' reports of illness.

This study examined relationships of stress (negative event frequency during the last year) to reports of illness among 92 children, aged 10 to 13 years. Children's health status was reported separately by children and parents, and children's skill in identifying and communicating their feelings was tested for direct and buffering relationships on illness reports. Analyses controlled for demographics and negative affect of both children and parents, and children's verbal ability was also tested for confounding. Results showed that stress correlated positively with children's poor health, whether the children's health status was reported by children or by parents. Children's emotional skill was correlated with better health when health was reported by children, but with worse health when health was reported by parents. Further, moderator analyses indicated that the relationship between negative event frequency and children's poor health as reported by parents held only for children with high levels of skill in identifying and communicating feelings. These findings suggest that negative life events impair children's health, but that the health reports of children and parents are quite different, and parents' views may be affected by children's skill in communicating their internal states.

Alexithymia and polysomnographic measures of sleep in healthy adults.

OBJECTIVE: This study examined associations between alexithymia and objective characteristics of sleep (latencies, stages, and amount and patterning of REM sleep) that may contribute to subjective reports of poor sleep quality and impaired dream recall among alexithymic people. METHODS: Fifty healthy, normally sleeping adults from the community completed the 20-item Toronto Alexithymia Scale and slept uninterrupted for one night in the laboratory while polysomnography was conducted. Various measures of sleep latency, sleep stages, and REM sleep-related variables were obtained, and analyses correlated these sleep measures with alexithymia, controlling for age, sex, and level of depressed affect. RESULTS: Higher alexithymia scores were significantly related to increased stage 1 (light) sleep and decreased stage 3/4 (deep) sleep. Alexithymia was unrelated to overall sleep efficiency or percentage of stage 2 sleep. Alexithymia was related to more frequent REM episodes and more stage 1 sleep during and immediately after REM episodes but was unrelated to the absolute amount of REM sleep. Alexithymia was also related to an earlier onset of the first REM episode. CONCLUSIONS: Alexithymia is associated with more light sleep and less deep sleep, which may contribute to subjective reports of poor sleep and increased sleepiness, fatigue, and somatic symptoms. Although alexithymia is not associated with an overall reduction of REM sleep, the increased frequency of episodes of REM that are interrupted and followed by light sleep rather than complete awakenings may contribute to limited dream recall.

The relationship of alexithymia characteristics to dreaming.

OBJECTIVE: In two studies, we tested two hypotheses about the relationship of alexithymia to dreaming; that dreams of alexithymic people are barren and rarely recalled, and that the dreams are unregulated and nightmarish. METHODS: Study 1 was a retrospective survey of dreaming among several hundred young adults, and Study 2 was a 1-week, prospective diary study of 153 young adults in which recall, content, and length of dreams were assessed. RESULTS: Across both studies, the externally oriented thinking (EOT) facet of the Toronto Alexithymia Scale (TAS)-20 correlated with different dream characteristics than the difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) facets, even after statistically controlling for the other facets. Greater EOT was related to an increased frequency of nights without dream recall, having shorter dreams, having dreams rated as boring and lacking vividness, and not believing in the importance of dreams. In contrast, greater DIF or DDF was related to an increased frequency of nights with disturbing dreams, and having dreams rated as bizarre and aggressive. CONCLUSION: We find support for both hypotheses, but different facets of the multidimensional alexithymia construct account for the two types of dream reports.

Alexithymia, gender, and hemispheric functioning.

It has been hypothesized that alexithymia is related to an impairment of the right hemisphere or a deficiency in interhemispheric transfer. We used the Toronto Alexithymia Scale-20 (TAS-20) and the tactile finger localization task of Zeitlin et al. to test these relationships on nonclinical samples of college men and women, and also considered the role of short-term memory. Among 47 men, the TAS-20 facets of difficulty identifying feelings or difficulty describing feelings were correlated with poorer performance by the right compared with the left hemisphere in uncrossed trials and poorer interhemispheric transfer of information on crossed trials; short-term memory was not related. Thus, both hemispheric hypotheses were supported for men. However, among 58 women, alexithymia was completely unrelated to either index of hemispheric functioning; instead, poorer short-term memory (specifically digits backwards) strongly predicted poorer interhemispheric transfer. We conclude that deficiencies in right hemisphere function and interhemispheric transfer may contribute to alexithymia in men, but not in women.

Earliest Pleistocene hominid cranial remains from Dmanisi, Republic of Georgia: taxonomy, geological setting, and age.

Archaeological excavations at the site of Dmanisi in the Republic of Georgia have uncovered two partial early Pleistocene hominid crania. The new fossils consist of a relatively complete cranium and a second relatively complete calvaria from the same site and stratigraphic unit that yielded a hominid mandible in 1991. In contrast with the uncertain taxonomic affinity of the mandible, the new fossils are comparable in size and morphology with Homo ergaster from Koobi Fora, Kenya. Paleontological, archaeological, geochronological, and paleomagnetic data from Dmanisi all indicate an earliest Pleistocene age of about 1.7 million years ago, supporting correlation of the new specimens with the Koobi Fora fossils. The Dmanisi fossils, in contrast with Pleistocene hominids from Western Europe and Eastern Asia, show clear African affinity and may represent the species that first migrated out of Africa.

Quality assurance of CFU-GM assays: inter-laboratory variation despite standard reagents.

To investigate the hypothesis that commercial kits for CFU-GM (colony forming unit granulocyte-macrophage) assay will reduce the interlaboratory variation noted by many workers, we carried out a quality assurance exercise in 2 parts. There were 8 participants in the first study and each performed CFU-GM assays using their in-house method and a commercial kit (Stem Cell CFU Kit, Gibco) in parallel. In the second exercise there were 10 participants and each performed CFU-GM with in-house methods and with a different commercial medium (Methocult GF H4534, Stem Cell Technologies). Twelve samples of cryopreserved peripheral blood progenitor cells (PBPC) were analysed by each participant in each part of the study. A very wide range of results was found for the different in-house methods, but standardizing the clonogenic assay with the commercial kits did not reduce the variation seen. To improve the reproducibility of CFU-GM assays between laboratories, scrupulous attention should be paid to all the steps involved in the assays, as little progress will be made by using commercial medium in isolation from efforts to reduce other sources of variation.

The diagnostic meaning of "nervous breakdown" among lay populations.

Two studies investigated the nature of nervous breakdown (NB): a mental illness commonly referred to by individuals not professionally related to the field of mental health. The clinical profile of NB was first surveyed among 121 undergraduates using a symptom checklist. Descriptive statistics and analysis of variance indicated NB is a time-limited condition that presents with primarily anxious and depressed features, associated with a series of external precipitating stressors (e.g., interpersonal, employment, and financial losses). Dimensions significantly uncharacteristic of NB included psychoticism, somatization, phobic anxiety, and mania. These results were replicated in a community sample of 189 adults from urban and suburban areas of a large metropolitan city. Respondents held a relatively unitary view of NB: Combined-sample cluster analysis (N = 310) revealed 2 groups with similar symptom profiles that differed primarily with regard to level of distress associated with disorder. Thus, among this population, NB is not an amorphous term for generalized psychiatric disturbance.

The relationships of cognitive coping and pain control beliefs to pain and adjustment among African-American and Caucasian women with rheumatoid arthritis.

OBJECTIVE: Ethnic groups may experience or report pain differently; thus, we compared ethnic differences on pain coping strategies and control beliefs, and the relationships of these variables to health status, among women with rheumatoid arthritis (RA). METHODS: Using a sample of 100 women (48 African-American, 52 Caucasian), we related pain coping strategies and control beliefs to pain severity, activity levels, and affective state, controlling for socioeconomics, behavioral impairment, and disease activity. RESULTS: Ethnic groups did not differ in pain severity or negative affect, but African-Americans were less physically active. African-Americans used more coping techniques involving diverting attention and praying/hoping; Caucasians used more coping techniques involving ignoring pain. The relationships of praying/hoping and reinterpreting pain to RA adjustment differed by ethnic group. In contrast, ignoring pain, coping statements, and stronger control beliefs predicted better health status, and diverting attention predicted more pain for all patients. CONCLUSION: There are ethnic differences in the use of coping strategies that should be acknowledged when helping RA patients cope with their disease, but control beliefs and several coping strategies predict pain and adjustment, regardless of ethnicity.

Effect of osteopathic manipulative treatment of length of stay for pancreatitis: a randomized pilot study.

There have been few randomized, controlled studies of the effects of osteopathic manipulative treatment (OMT). In this outcomes research study, the authors randomly assigned patients with pancreatitis to receive standard care plus daily OMT for the duration of their hospitalization (n = 6) or to receive only standard care (n = 8). Osteopathic manipulative treatment involved 10 to 20 minutes daily of a standardized protocol, using myofascial release, soft tissue, and strain-counterstrain techniques. Attending physicians were blinded as to group assignment. Results indicated that patients who received OMT averaged significantly fewer days in the hospital before discharge (mean reduction, 3.5 days) than control subjects, although there were no significant differences in time to food intake or in use of pain medications. These findings suggest the possible benefit of OMT in reducing length of stay for patients with pancreatitis.

Health status in sickle cell disease: examining the roles of pain coping strategies, somatic awareness, and negative affectivity.

People with sickle cell disease (SCD) vary in their pain, activity levels, and medical care. We examined how coping (Coping Strategies Questionnaire), somatic awareness, and illness worry were related to these health indices in 70 African-American adults with SCD. Negative Thinking/Passive Adherence and/or somatic awareness was positively correlated with pain episode frequency, duration, or severity, after controlling for demographics and disease severity and positively correlated with activity reduction or hospitalization frequency after also controlling for pain. Self-reported negative affectivity was correlated with both psychological and SCD measures; and controlling for negative affectivity eliminated several, but not all, relationships. Examination of the Negative Thinking/Passive Adherence factor suggested a distinction between Negative Thinking and Passive Adherence, which was partially supported by their different relationships. We conclude that negative thinking, passive coping, and somatic awareness are related to several measures of poor health in SCD but that some relationships are better accounted for by general measures of negative affectivity.

Five-year follow-up for adverse outcomes in males with at least minimally positive angiograms: importance of "denial" in assessing psychosocial risk factors.

The purpose of this study was to test the role of "denial" (spouse/friend minus self-ratings on parallel versions of the same questionnaire) in diluting the predictive value of emotional distress for cardiac events (deaths, new MIs, and/or revascularizations). One hundred forty-four men with no history of prior revascularization who had at least minimally positive diagnostic coronary angiograms, and someone they selected as "someone who knows you well," completed parallel versions of the Ketterer Stress Symptom Frequency Checklist (KSSFC). They were followed up by phone an average of 59.7 months after recruitment. Length of follow-up, baseline cardiac risk factors, and a number of baseline-obtained psychosocial risk factors were tested as prospective predictors of combined events (death by any cause, new MIs, and/or revascularizations) and current anginal frequency. Only spouse/friend observed anxiety on the KSSFC predicted current anginal frequency (p = 0.001). On the self-report version of the KSSFC, patients with one or more events reported less anger (p = 0.031), depression (p = 0.008), and anxiety (p = 0.003). These results may be attributable to "denial" because there were no differences in spouse/friend ratings, and difference scores (spouse/friend minus patient) on the KSSFC scales, particularly anger, were also related to events: AIAI (p = 0.002); depression (p = 0.063); and anxiety (p = 0.010). Denial may be a major limiting factor in accurately assessing emotional distress in cardiac populations, and may help account for a number of the previous findings.

The relationship of alexithymia to subjective and biomedical measures of disease.

Although alexithymia is found in patients with various somatic disorders, it is unclear whether alexithymia is related to organic disease, or just to illness behavior. In 2 studies of patients, the authors related alexithymia (using the Toronto Alexithymia Scale-20 for assessment) to both subjective reports and biomedical measures of disease. In Study I, alexithymia was correlated with symptoms, but not CD4 counts, among adults who had tested positive for the human immunodeficiency virus. In Study 2, alexithymia was associated with the presence or absence of chest pain during exercise testing, but not with ischemic heart disease. These studies suggest that alexithymia, especially difficulty identifying and/or describing feelings, is related to increased illness behavior, but alexithymia may not be related to the presence or severity of organic disease.

Health effects of emotional disclosure in rheumatoid arthritis patients.

This study examined the effects of emotional disclosure of stressful events on the pain, physical and affective dysfunction, and joint condition of patients with rheumatoid arthritis (RA). Patients were randomly assigned to talk privately about stressful events (disclosure group, n = 36) or about trivial topics (control group, n = 36) for 4 consecutive days. Disclosure resulted in immediate increases in negative mood. At 2 weeks the 2 groups did not differ on any health measure, but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities. There was no main effect of disclosure on pain or joint condition, but among the disclosure patients, those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints. This study concludes that, among RA patients, verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning.