Usefulness of a Positive Psychology-Motivational Interviewing Intervention to Promote Positive Affect and Physical Activity After an Acute Coronary Syndrome.

Most patients are not able to achieve recommended levels of physical activity following an acute coronary syndrome (ACS). Existing interventions to promote activity have not focused on promoting psychological well-being, which is independently linked to superior cardiac health. To address this gap, we developed and tested a combined positive psychology-motivational interviewing (PP-MI) intervention in post-ACS patients to assess its feasibility and explore potential benefits in an initial randomized trial. We compared a 12-week, phone-delivered, PP-MI intervention to an attention-matched, MI-based health education control condition among 47 post-ACS patients with low baseline health behavior adherence. Feasibility/acceptability were assessed through rates of session completion and participant session ratings; we also explored between-group differences in positive affect, other self-reported outcomes, and accelerometer-measured physical activity, through mixed effects regression models, at 12 and 24 weeks. PP-MI participants completed a mean of 10.0 (standard deviation 2.2) sessions (84%), and mean participant ratings of sessions' ease/utility were >8/10, above a priori thresholds for success. Compared with the control condition, PP-MI was associated with greater improvements in positive affect at 12 and 24 weeks (12 weeks: estimated mean difference [EMD] = 3.90 [SE = 1.95], p = 0.045, effect size [ES] = 0.56; 24 weeks: EMD = 7.34 [SE = 2.16], p <0.001, ES = 1.12). PP-MI was also associated with more daily steps at 12 weeks (EMD = 1842.1 steps/day [SE = 849.8], p = 0.030, ES = 0.76) and greater moderate-vigorous activity at 24 weeks (EMD = 15.1 minutes/day [SE = 6.8], p = 0.026, ES = 0.81). In conclusion, PP-MI was feasible in post-ACS patients and showed promising effects on well-being and physical activity; additional studies are needed to confirm these findings.

Correction: Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease.

[This corrects the article DOI: 10.1371/journal.pone.0123861.].

Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease.

INTRODUCTION: Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) can profoundly affect quality of life and are influenced by stress and resiliency. The impact of mind-body interventions (MBIs) on IBS and IBD patients has not previously been examined. METHODS: Nineteen IBS and 29 IBD patients were enrolled in a 9-week relaxation response based mind-body group intervention (RR-MBI), focusing on elicitation of the RR and cognitive skill building. Symptom questionnaires and inflammatory markers were assessed pre- and post-intervention, and at short-term follow-up. Peripheral blood transcriptome analysis was performed to identify genomic correlates of the RR-MBI. RESULTS: Pain Catastrophizing Scale scores improved significantly post-intervention for IBD and at short-term follow-up for IBS and IBD. Trait Anxiety scores, IBS Quality of Life, IBS Symptom Severity Index, and IBD Questionnaire scores improved significantly post-intervention and at short-term follow-up for IBS and IBD, respectively. RR-MBI altered expression of more genes in IBD (1059 genes) than in IBS (119 genes). In IBD, reduced expression of RR-MBI response genes was most significantly linked to inflammatory response, cell growth, proliferation, and oxidative stress-related pathways. In IBS, cell cycle regulation and DNA damage related gene sets were significantly upregulated after RR-MBI. Interactive network analysis of RR-affected pathways identified TNF, AKT and NF-κB as top focus molecules in IBS, while in IBD kinases (e.g. MAPK, P38 MAPK), inflammation (e.g. VEGF-C, NF-κB) and cell cycle and proliferation (e.g. UBC, APP) related genes emerged as top focus molecules. CONCLUSIONS: In this uncontrolled pilot study, participation in an RR-MBI was associated with improvements in disease-specific measures, trait anxiety, and pain catastrophizing in IBS and IBD patients. Moreover, observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD-and that its regulation may contribute to counteracting the harmful effects of stress in both diseases. Larger, controlled studies are needed to confirm this preliminary finding. TRIAL REGISTRATION: ClinicalTrials.Gov NCT02136745.

The Relaxation Response Resiliency Enhancement Program in the Management of Chronic Refractory Temporomandibular Joint Disorder: Results from a Pilot Study.

OBJECTIVES: This is an open-pilot study to evaluate the feasibility, acceptability and efficacy of a pain-specific version of an established mind-body medicine program, the Relaxation Response [RR] Resiliency Program [R3P], in patients with chronic temporomandibular disorder [TMD]. METHODS: Male and female with at least a six-month history of pain involving the masticatory muscles were sought in the Orofacial Pain Centers of the Massachusetts General Hospital [MGH] or through an advertisement sent to MGH employees from 2008 to 2010. Eligible participants underwent the R3P intervention [eight group sessions] after standard medical management. Pre- and post-group patients underwent objective measures of impairment [vertical and lateral range of motion with and without pain, temporomandibular joint and muscle pain palpation, and algometer measures] and completed psychosocial measures [Symptom Severity Index, Perceived Stress Scale, the Symptom Checklist-90-Revised and Short Form 36 Health Survey]. RESULTS: Twenty-four subjects [16 females, 90% from MGH Orofacial Pain Centers,10% from among MGH employees], mean age 38 years, met eligibility criteria and participated in the study. The intervention was highly feasible and accepted by patients, as evidenced by a 92% rate of completion. Paired t-test analyses revealed improvement on self-reported pain measures: pain intensity [p<0.02], pain frequency [p<0.002], pain duration [p<0.027], pain tolerability [p<0.009] and on several objective tests. CONCLUSIONS: The pain specific R3P is efficacious in reducing objective and subjective symptoms in patients with chronic refractory TMD. The comprehensive intervention, which combines educational information about pain with RR, cognitive behavioral and resiliency-enhancement skills, is accepted by patients and may be more efficacious than other treatments with fewer elements.

Pain assessment in patients with low back pain: comparison of weekly recall and momentary electronic data.

UNLABELLED: Electronic data collection for monitoring pain has become increasingly popular in clinical research. Past research has shown that electronic diaries improve the timeliness of receipt of data, contribute to higher rates of compliance, and are preferred by patients over paper diaries, and this research suggests that electronic diaries that capture current pain at the moment of reporting result in more reliable ratings than recalled pain ratings. This study compared differences of momentary pain intensity ratings on an electronic visual analog scale (VAS) with weekly recalled pain on a 0 to 10 scale. We asked 21 patients with chronic low back pain to monitor their current pain at least once a day by using a VAS for up to 1 year with a palmtop computer. They were also called once a week and asked to rate their recalled weekly pain orally on a numeric scale from 0 to 10. Patients entered data electronically on average 357 times, for an average of 7.8 times a week. We found that (1) weekly recalled pain agreed highly (r > .90) with averaged momentary pain assessments, (2) neither frequency of electronic monitoring nor variability in momentary pain ratings (high standard deviations) contributed to degree of agreement between momentary and recalled pain, and (3) a ceiling effect was observed in VAS pain ratings as compared with numeric pain ratings. These findings suggest that, among many individuals, weekly recalled pain might be just as useful as momentary data collected through electronic data entry. PERSPECTIVE: Some believe that remembered pain is problematic because of recall bias and that data from frequent momentary pain ratings with electronic diaries are more valid. This study demonstrates that recalled pain is as valid as momentary data for many patients.

Electronic diaries for monitoring chronic pain: 1-year validation study.

Electronic data collection for monitoring pain has become increasingly popular in clinical research. However, no direct comparison has been made between electronic diaries and self-report paper diaries or phone interviews. We asked 36 patients with chronic low back pain to monitor their pain for 1 year; 20 of them used both a palmtop computer and paper diaries, and 16 used paper diaries alone. All patients were called once a week and asked to rate their pain. Regression analyses with a measurement error model were run on hourly pain scores recorded by both palmtop computer and paper diaries. Ratings of pain intensity were highly reliable between data recorded with a palmtop computer and with data from paper diaries. Patients who monitored their pain with the palmtop computer entered data on average 6.75 times a week and were 89.9% compliant with daily monitoring throughout the year. Two-way messaging available through the palmtop computer seemed to encourage continued use of the device. Internal consistency of reporting and correlations with phone reports and standardized measures were highly significant, suggesting that data from electronic diaries are both reliable and valid. Patients using electronic diaries preferred them to paper diaries and showed much higher rates of compliance and satisfaction over the 1-year trial.