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PubMed2006

Recurrent abdominal pain, medical intervention, and biofeedback: what happened to the biopsychosocial model?

Recurrent abdominal pain (RAP) is a significant and common problem among pediatric populations. Based on results from randomized controlled trials there are no established efficacious treatments for this disorder. Biofeedback (BFB) and other psychological treatments offer logically appealing alternatives or adjuncts to medical interventions and there is some evidence to support their use. This paper presents a typical case of RAP that exemplifies how the lack of integration of the biopsychosocial model may result in less than optimal treatment. Specifically, it demonstrates that the patient was exposed to potentially risky treatments that lack evidence to support their use and were not beneficial. Although there was evidence of psychological involvement early in the treatment, this was only attended to following numerous medical trials and exploratory surgery over three years. The patient was finally referred for BFB and during a course of seven sessions over five months that variously included heart rate variability and skin temperature feedback along with extensive home practice of paced breathing and hand warming the patient achieved significant symptom reduction and improved coping abilities. This case vividly illustrates the need for multidisciplinary collaboration and full implementation and integration of the biopsychosocial model of health and illness.

Abdominal Pain↗
PubMed1986

Self-regulation in an undergraduate psychology course: results from a performance examination.

Forty-four undergraduate students enrolled in a psychology course entitled "Biofeedback and Self-Regulation" over a period of three semesters. Twenty percent of each student's grade in the course was derived from the level of self-regulation skills, as measured in an individual performance examination. Results show students can develop impressive self-regulation skills in a course format. Results also indicate that the performance examination measures abilities which are altogether different from those utilized in written examinations.

Adult↗
PubMed1996

Self-efficacy predicting outcome among fibromyalgia subjects.

OBJECTIVES: This study examined whether pretreatment self-efficacy and pre- to post-treatment changes in self-efficacy predict post-treatment tender point index, disease severity, pain, and physical activity. METHODS: One hundred nine subjects with fibromyalgia were assessed before and after a 6-week training intervention. Measures included tender point index, physician ratings of disease severity, the visual analog scale for pain, the Physical Activities subscale of the Arthritis Impact Measurement Scales, and the Arthritis Self-Efficacy Scale. RESULTS: Pretreatment self-efficacy significantly predicted post-treatment physical activity, with higher self-efficacy associated with better physical activity outcome. Changes in self-efficacy significantly predicted post-treatment tender point index, disease severity, and pain; improvements in self-efficacy were associated with better outcomes on each measure. CONCLUSIONS: Higher levels of self-efficacy are associated with better outcome, and may mediate the effectiveness of rehabilitation-based treatment programs for fibromyalgia.

Activities of Daily Living↗
PubMed1989

Self-regulatory treatment of headache in the elderly.

We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.

Adaptation, Psychological↗
PubMed1992

The effectiveness of psychological interventions for the rehabilitation of low back pain: a randomized controlled trial evaluation.

Forty-five low back pain patients were randomly assigned to either a standard inpatient rehabilitation program or the standard program with additional psychological components. The standard program emphasized education, support, and physical reconditioning through exercise. Patients receiving the psychological program were given additional training in relaxation and other coping skills and received contingent reinforcement for exercise. Both programs included reduction of medication intake and an emphasis on family involvement after discharge. Measures of functional status were taken prior to the program, at discharge from the 3-week inpatient program, and at a 6-month follow-up appointment. These data revealed that patients improved their overall functioning at discharge and maintained these gains at the follow-up assessment. A similar pattern of findings was obtained for self-reported pain and interference. Furthermore, 81% of the patients had returned to work or were engaged in active job retraining by the follow-up. Using a conservative measure of full-time return to the same or an equivalent job, 57% were employed by the follow-up. Patient improvement, however, was not differentially affected by treatment group assignment, suggesting that the psychological treatment failed to add to the effectiveness obtained by the standard rehabilitation program. Results are discussed in the context of improving patient outcomes from rehabilitation for low back pain.

Adaptation, Psychological↗
PubMed2004

Stress management: what is it?

Stress management (SM) is a widely used term with a seemingly obvious meaning. The research literature contains many studies evaluating its effectiveness, but it is not clear how many different forms of SM exist and how efficacious they are for which target problem. One hundred and fifty-three studies on SM were analyzed to determine consensus in definitions and therapy protocols. Results showed that a typical delivery format exists (mostly group form, 8-10 sessions in length and multitechnique), but the number of techniques used was very large, techniques were inconsistently labeled are often poorly described. It is concluded that in outcome research, the term "stress management" is operationally defined with such variability that comparisons of SM outcome studies are not meaningful at this time.

Adaptation, Psychological↗
PubMed2000

[Psychological concepts and treatments for chronic pain and somatoform syndromes].

Chronic pain syndromes and somatic syndromes not fully explained by organic pathology are common complaints presented by patients in general health care. Studies have shown the major role of psychological factors in the etiology of these disorders leading to new conceptualization of illness and cognitive behavioral approaches to treatment. Chronic pain and somatoform symptoms are dependent on individual resources of stress prevention strategies, coping skills, environmental influences on symptoms and dysfunctional cognitions and beliefs about illness. Psychological concepts, treatment approaches and specific interventions are demonstrated.

Adaptation, Psychological↗
PubMed1991

Psychosocial support for cosmonauts.

Based on a meeting with members of the Psychological Support Group for cosmonauts, along with several referenced documents, the author summarizes the Soviet experience in dealing with psychological and interpersonal factors related to long-duration space missions. Cosmonaut selection and training procedures following the principle of "neuropsychological resistance" formulated by F.D. Gorbov. Inflight monitoring uses the macroanalysis of crew speech characteristics as an indicator of psychological state. Psychosocial problems include "asthenia" and interpersonal tension. Support efforts focus on enhancing behavioral and autonomic adaptation, planning flexible work/rest schedules, improving the space station environment, arranging relevant free time activities, and helping crews readjust to Earth postflight. Attention is paid to changes in cosmonaut preferences and sensitivities as the mission progresses. The use of support activities is believed to be positively associated with the health and performance of cosmonaut space crews.

Adaptation, Psychological↗
PubMedDate not supplied

Stress reduction with heart transplant patients and their families: a multidisciplinary approach.

Stress reduction is an important part of the treatment plan for heart transplant patients at Loyola University Medical Center, Maywood, Illinois. This individualized stress reduction program is offered to both patient and family members through the complementary efforts of the social work and occupational therapy departments. The objectives of this program are to educate the participants in a variety of coping and stress reducing techniques to help prepare them for the multitude of stressors encountered during the entire transplant experience. Patients and family members have positively responded to this program, both verbally and in practice.

Adaptation, Psychological↗
PubMedDate not supplied

[Psychological diagnosis of pain and pain treatment in the elderly].

Chronic pain is one of the most common complaints in the elderly, associated with much impairment of quality of life. Up to now clinical research has focused little attention on pain in old age. Pain is often classified as an inevitable epiphenomena in the elderly. But present studies show that differences between older and younger patients appear less important than similarities. The studies also make evident that proved psychological pain management is transferable to elderly patients. The knowledge of effective psychological treatment in case of chronic pain in the elderly has been seldom realized in clinical practice.

Adaptation, Psychological↗