Accessing support before or after a parent dies from cancer and young people's current wellbeing.

PURPOSE: To examine differences in distress and unmet needs between bereaved adolescent and young adult (AYA) offspring who accessed support before and after being bereaved by parental cancer, and to explore aspects of their cancer experience that influenced their help-seeking. METHODS: Phase 1: Surveys completed by AYAs (11-26 years) bereaved by parental cancer were subjected to analysis of covariance examining differences in distress and unmet needs between those who accessed support before (n = 159) and after (n = 212) parental bereavement. Phase 2: Semi-structured interviews explored the cancer experiences of bereaved offspring (n = 8) and factors that influenced their decision to seek support. RESULTS: Phase 1: There were no significant group differences in distress and unmet needs; however, older and female AYAs reported higher levels of distress and unmet needs. Interestingly, individuals who accessed support pre-bereavement were older on average (M = 17.35 years, SD = 3.26) than those who accessed support post-bereavement (M = 15.73 years, SD = 3.26). Phase 2: Three themes emerged centred on socio-emotional developmental changes during and after the cancer trajectory. These related to: participants' meaning-making and changes in understanding of the cancer experience, changing relationships and desires to fit in, and understanding of their own emotional needs. CONCLUSIONS: While no differences were found in unmet needs and distress between those who sought support pre- or post-bereavement, those seeking support pre-bereavement were older on average. Social and emotional development impacts how bereaved offspring access psychosocial support. Awareness of these issues can assist in improving support by ensuring services are age appropriate and families are sufficiently supported.

The Pain Course: exploring the feasibility of an internet-delivered pain management programme for adults with spinal cord injury.

STUDY DESIGN: Single-group feasibility clinical trial. OBJECTIVES: This study examined the feasibility and outcomes of a modified version of a validated internet-delivered pain management programme, the Pain Course, for adults with SCI. SETTING: Nationwide in Australia. METHODS: Sixty-eight adults participated in the programme, which comprises five online lessons and homework tasks that are systematically released over 8 weeks. Participants were supported through the course with weekly contact from a clinical psychologist. RESULTS: Eighty-five percent of participants provided data at post-treatment and 76% of participants completed all five lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M = 93.16 min; SD = 52.76 min) was required per participant to provide the course. Preliminary evidence of clinical improvements in pain-related disability (ds ≥ 0.53.; avg. improvement ≥ 20%; Mdiff ≥ 7.77), depression (ds ≥ 0.44.; avg. improvement ≥ 24%; Mdiff ≥ 2.44), anxiety (ds ≥ 0.41.; avg. improvement ≥ 26%; Mdiff ≥ 1.8) and average pain intensity (ds ≥ 0.46.; avg. improvement ≥ 13%; Mdiff ≥ 0.71) were observed at post-treatment, which were maintained or further improved to 3-month follow-up. These improvements were reflected in overall improvements in self-reported satisfaction with life (ds ≥ 0.31; avg. improvement ≥ 25%; Mdiff ≥ 2.16) CONCLUSION: These findings highlight the potential of carefully developed internet-delivered interventions as an approach for overcoming barriers and increasing access to psychosocial care for adults with SCI. SPONSORSHIP: iCare Lifetime Care and Support Authority and the Australian National Health and Medical Research Council.

Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity?

BACKGROUND: Clinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder. METHOD: A survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism. RESULTS: Results demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity. CONCLUSION: These findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.

Short message service prompts for skills practice in Internet-delivered cognitive behaviour therapy for chronic pain - are they feasible and effective?

BACKGROUND: Patients face numerous challenges adopting skills taught within pain self-management programmes. The present study reports the acceptability and preliminary outcomes of supplementing an Internet-delivered cognitive behavioural therapy (iCBT) course for chronic pain, the Pain Course, with brief automated short message service (SMS) prompts that encourage skills practice. METHODS: Participants were recruited from the Waitlist Control Group of a large randomized controlled trial and provided access to the Pain Course over 8 weeks, with the addition of SMS prompts. Fifteen SMS prompts were created to encourage the use of self-management skills during the course. Participants were sent one random SMS prompt each business day. The acceptability of the SMS was assessed and clinical outcomes of participants who received prompts (n = 56) compared with a historical group who previously received the course without prompts (n = 139). RESULTS: SMS prompts were rated highly with 85% reporting them to be very helpful or helpful and that they would recommend them to others. Clinical improvements for those receiving SMS, at post-treatment and 3-month follow-up (disability, d = 0.44; 0.58; anxiety d = 0.50; 0.51; depression, d = 0.78; 0.79 and average pain d = 0.49; 0.54), were consistent with participant who had received the course previously without SMS (ps >0.05). CONCLUSIONS: Brief automated SMS prompts were an acceptable adjunct to iCBT for chronic pain but did not result in any additional clinical benefit. Further research is needed to systematically evaluate the potential of SMS prompts to increase skills practice and facilitate treatment outcomes. WHAT DOES THIS STUDY ADD?: Automated short message service (SMS) messages are an acceptable means of prompting skills practice during iCBT for chronic pain. SMS prompts did not improve clinical outcomes of an established clinician-supported iCBT programme.

Randomized trial of the effects of cholesterol-lowering dietary treatment on psychological function.

PURPOSE: Epidemiological studies have suggested that cholesterol lowering could affect psychological functioning. This study was designed to test whether cholesterol-lowering diets adversely affect mood and cognitive function.5.2 mM [198 mg/dL]) to either a low-fat diet, a Mediterranean diet, or a waiting-list control. Cholesterol levels, psychological well-being (depression, anxiety, hostility), and cognitive function were assessed at baseline, 6 weeks, and 12 weeks. RESULTS: Total serum cholesterol levels fell significantly more in the intervention groups (8.2% reduction) than in the control group (P <0.001). All three groups showed a modest improvement in psychological well-being during the 12-week treatment period, but there were no differences among the groups. There were no between-group differences on three measures of cognitive function, but for a fourth measure, which involved the task with the greatest processing load, the two intervention groups did significantly worse (P <0.001) than the control group. The change in performance was correlated with the change in total serum cholesterol level (r = 0. 21, P = 0.01). CONCLUSIONS: Two dietary interventions that successfully lowered serum cholesterol levels had no adverse effect on mood. There was some evidence for a relative impairment in cognitive function in the treated groups in one of four cognitive tests, but additional studies will be required to determine the relevance of this finding.

A comparison of the effect of mindfulness and relaxation on responses to acute experimental pain.

BACKGROUND: This study aimed to investigate the efficacy of mindfulness training in comparison with relaxation training on pain, threshold and tolerance during the cold pressor task. METHODS: Undergraduate psychology students (n = 140) were randomly assigned to receive reassuring or threatening information about the cold pressor. Participants were then re-randomized to receive mindfulness or a control intervention: relaxation training. RESULTS: Analyses confirmed that the threat manipulation was effective in increasing worry, fear of harm and expectations of pain, and reducing coping efficacy. Interaction effects revealed that mindfulness was effective in increasing curiosity and reducing decentring under conditions of high threat but not low threat. Other interactions on cognitive variables (attentional bias to pain and self-focus) confirmed that mindfulness and relaxation appeared to exert influences under different conditions (i.e. mindfulness: high threat; and relaxation: low threat). Despite these cognitive effects being discerned under different conditions, there were no differences between mindfulness and relaxation on pain, tolerance or threshold in either threat group. CONCLUSIONS: These results show that a single, brief session of mindfulness based on body scanning is not sufficient to change the way in which individuals approach an experimental pain task in comparison with relaxation, which has previously been shown to be ineffective.