Journal of Clinical Psychology in Medical Settings最新文献

Chronic pain is common, complex, undertreated, and linked with lower quality of life. The primary care setting provides an opportunity to standardize screening for chronic pain and distress and facilitate early intervention via integrated psychological treatment. This study describes the use of a digital pain and distress screener to improve identification of those who could benefit from integrated psychological treatment to manage chronic pain in primary care. An electronic pain and distress screening tool was implemented in an academic internal medicine clinic at an urban hospital. Data regarding screening completion, percentage of positive screens, and number of integrated psychology referrals were pulled from the electronic medical record. 1,676 unique pain and distress screenings were completed between March 2024 and January 2025. Forty-three percent of patients screened positive (n = 837). Thirty-nine patients were referred for integrated psychological treatment and 20 completed at least one visit. Older adult patients completed the digital pain and distress screener at similar rates to other digital screenings with positive screening rates similar to the known prevalence of comorbid pain and distress. Referral rates were low though a high proportion of referrals began treatment. With modifications to workflow, the pain and distress screening could facilitate early and effective intervention.

Chronic pain (CP) and hazardous/harmful drinking (HD) commonly co-occur. HD contributes to the onset and severity of CP, while CP severity predicts alcohol use disorder relapse. Integrated treatments for CP and HD are needed in rural areas, where CP and alcohol-related consequences occur at higher rates and treatment accessibility is lower. This study assessed the acceptability and feasibility of an app-based cognitive-behavioral intervention for CP and HD. Participants (n = 32) were rural residents reporting CP and HD (mean age = 49.81, SD = 8.79). Participants were randomized to intervention or assessment-only control. Self-report questionnaires at baseline and 12-week follow-up assessed program acceptability, pain, alcohol involvement, and functioning. Timely recruitment and low attrition (3.2%) supported procedure feasibility, while app engagement suggested intervention feasibility and acceptability. Descriptive statistics suggest reductions in pain (37% reduction in median pain in intervention group vs. 10% in control group). Changes in alcohol-related behavior were not consistent across outcomes and warrant further study (e.g., no change in median heavy drinking episodes in intervention, with 77% reduction in control; 60% reduction in alcohol consequences in intervention vs. 27% in control). This mobile intervention is feasible and acceptable for rural residents and may help address CP and functioning among those who engage in HD.

Despite the prevalence of chronic pain among patients presenting to primary care, access to evidence-based psychological intervention remains limited. Mobile health (mHealth) interventions offer scalable alternatives, but little is known about how specific engagement behaviors relate to clinical outcomes. This secondary analysis explored the value of distinct engagement components as predictors of pain outcomes across two pilot trials of an eight-week mHealth program for adults (N = 39) with co-occurring chronic pain and hazardous drinking. Engagement indices included skills library access, skill reviews, homework surveys completed, videos opened and completed, and frequency of instant messaging coaching sessions. Pain outcomes were assessed with the Pain, Enjoyment of Life, and General Activity (PEG) scale at baseline and 12-16 weeks post-baseline. Analyses included partial correlations controlling for trial and descriptive analyses from median split cross-tabulations to examine associations between engagement and achievement of clinical improvement in pain. Higher engagement with skills reviews, completion of homework surveys, and number of videos completed emerged as indices most highly associated with a greater likelihood of achieving ≥ 30% pain reduction. Frequency of coaching sessions, however, did not appear to be linked with outcomes. Findings suggest that certain engagement behaviors--particularly videos completed--may be predictive of clinical benefit, underscoring the potential importance of depth and quality of engagement. These results highlight specific engagement indices that may be important to track and potentially enhance to improve clinical outcomes for mHealth interventions for chronic pain.

To compare the effectiveness of Cognitive Behavioral Therapy (CBT), Biofeedback and their combination on pain catastrophizing, sleep quality, and headache-related disability among patients with chronic daily headache (CDH).In a randomized controlled trial conducted at a tertiary care hospital in North India, 100 patients diagnosed with CDH were randomly assigned to four groups: CBT (n = 25), Biofeedback (n = 25), Combined CBT + Biofeedback (n = 25) and Treatment-as-Usual (TAU; n = 25). Assessments were conducted at baseline, post-intervention, and at a 2-month follow-up using the Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Migraine Disability Assessment Scale (MIDAS). Significant time effects were observed for all outcomes-pain catastrophizing (F = 147.39, p < .001, η²ₚ = 0.67), sleep quality (F = 92.68, p < .001, η²ₚ = 0.56), and headache-related disability (χ² = 99.10, p < .001). Time × group interactions were also significant for PCS (p = .026) and PSQI (p = .048), indicating differential patterns of improvement across interventions. Post-hoc analyses revealed that the combined CBT + BFB group showed the greatest and most sustained improvements in pain catastrophizing and sleep quality. Headache-related disability decreased significantly in all intervention groups. CBT and Biofeedback are effective psychological interventions for managing chronic headache, with their integration producing superior and sustained outcomes. The findings highlight the utility of multimodal interventions that target both cognitive-emotional and physiological processes in chronic headache management.

Chronic pain is common among military service members, retirees, and families, yet non-pharmacologic options in primary care are limited. This pilot study evaluated the feasibility, and outcomes of Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) delivered by integrated Behavioral Health Consultants (BHCs) in a Military Health System (MHS) clinic. This prospective, observational pragmatic pilot study recruited 44 Department of Defense beneficiaries (M age = 44.5 years [SD = 9.3 years]; 75% female; 50% Caucasian; 47.7% military family members, 38.6% retirees) with chronic pain (≥ 12 weeks). As part of usual care, participants received BCBT-CP, a modular skills-based intervention delivered within the Primary Care Behavioral Health model. Measures included the Defense and Veterans Pain Rating Scale (DVPRS), the Pain, Enjoyment of Life, and General Activity (PEG-3) scale, and the Behavioral Health Measure (BHM-20), assessed at baseline, during treatment, and 3- and 6-months after the baseline assessment. Feasibility was high, with 44 of 45 approached patients enrolling in the study. These participants attended a median of 3 appointments (IQR 2-6) over 52 days (IQR 22-110.5). Significant improvements were observed on DVPRS pain intensity (p < .001) and interference with activity, sleep, and stress. PEG total and subscales also improved (p < .05). No significant changes were detected on the BHM-20. Follow-up outcome data suggested partial loss of gains due to small sample size and attrition. Using BHCs to implement BCBT-CP in MHS primary care is feasible and improves short-term pain outcomes. Larger trials should test strategies to sustain benefits.

The concept of dyadic coping (DC) describes ways in which couples cope with stress together, including, for example, supportive DC (i.e., supporting a partner's individual coping efforts) or delegated DC (i.e., taking over tasks from one's partner). Previous research has primarily focused on DC in relation to chronic physical illnesses, foremost cancer. However, stress related to neurocognitive or physical conditions differs with regard to symptoms, course of progression, and associated psychological and social challenges. The current study aims to examine how DC in individuals with early-stage dementia differs from DC in individuals with a visual impairment or in a healthy condition, as well as how DC differs between their partners. Data from two studies were first matched with a sample of couples facing early-stage dementia (n = 37). Couples facing a visual impairment and healthy couples served as control groups. The Dyadic Coping Inventory was used to assess the DC exchanged. Analyses of variance and covariance as well as post hoc tests were used to test for differences in DC. Results show that partners of persons with early-stage dementia report receiving less supportive DC than partners in couples facing a visual impairment or healthy couples, as well as less delegated DC than partners in healthy couples. We did not find any differences on any DC domains in the persons with early-stage dementia compared to persons with visual impairment or persons in healthy couples. This study shows that DC of partners in couples facing early-stage dementia differs from partners in couples facing a visual impairment or healthy couples. Partners should avoid overprotective behaviors that could diminish the sense of self-efficacy of the person with early-stage dementia. Besides methodological suggestions, suggestions are made how tailored interventions, like facilitating participation and portioning tasks, may help improve DC, relationship functioning, and mental health.

This study evaluated results from a novel psychology clinic integrated within a pediatric sports medicine (SM) program. Participants included 151 patients (mean age = 14.86, 62.25% female) seen for an initial psychology visit. Patients completed self-report measures, and referral and patient characteristics were abstracted via medical record. The sample was heterogeneous in terms of demographic variables and illness- or injury-related factors. Most common referral reasons were anxiety, general coping, depression, and pain. Adjustment and anxiety disorders were the most common diagnoses, while pain management, sleep, school, and eating were also common areas of difficulty. Rates of previous mental health (MH) treatment (52.98%), attention-deficit/hyperactivity disorder (ADHD) diagnosis (15.23%) or attention concerns (10.60%), and history of suicidal ideation (SI, 23.65%) were high. Youth in this sample endorsed poorer health-related quality of life (HRQOL) than comparative samples. Findings support the potential benefit of integrated psychological care to address a variety of MH challenges in pediatric SM.

Psychology training concentrates on psychological theory, clinical assessment, diagnosis, intervention, research, interpersonal skills, diversity and ethics. Emphasis is on increasing scientific and professional knowledge about human behavior and psychologists learn to support behavioral change, form and maintain relationships, teach others to improve coping skills, promote decision-making and personal potential, while supporting individual development. It is rare that psychologists are provided education on the business aspects of psychology, which focuses on coding, billing, productivity expectations and understanding how our work translates into collections for our academic health centers. This article outlines ways in which productivity is measured, discusses reimbursement for services, outlines billing and coding challenges, puts forth recommendations on how to best utilize time for maximum benefit and discusses the importance of advocacy for psychologists and our work in academic health centers.

Pain is a common symptom in patients with cancer accompanied by anxiety, depression, and worsening Quality of Life (QoL). Cognitive-Behavioral Therapy (CBT) has proven to be effective in the management of these symptoms, although access to it faces multiple barriers. While Videoconferencing can be an option, its application in patients with cancer and chronic pain in Latin America remains limited. To evaluate the preliminary feasibility and acceptability of CBT via videoconferencing to improving pain, anxiety, depression, and quality of life in Mexican patients with cancer and chronic pain. This pilot feasibility study used a pre-experimental design with a single group and pre-test and post-test measurements. Patients received a five-session psychological intervention via videoconferencing. The feasibility criteria were: eligibility rate ≥ 50%, enrollment rate ≥ 50%, attendance rate ≥ 70%, & ≥ 80% of the acceptability items ≥ 8. Ten participants were enrolled and agreed to participate completing all 5 sessions (attendance rate = 100%). Participants reported high elegibility rate (71.4%), acceptability of the intervention (99%), comprehensibility (95%) and usefulness (94%). The majority (99%) indicated that they would recommend the psychological intervention to others. Exploratory analyses showed changes in pain improvement (d = .899), anxiety symptoms (d = 1.36), depression symptoms (d = .755), and quality of life (d = .788). CBT via videoconferencing represents a viable and well-accepted alternative for the psychological treatment of patients with cancer and chronic pain in Mexico. This modality could expand access to care when face-to-face intervention is not possible.

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, 'Empathy is about truly connecting-the dominant healthcare professional view', included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, 'Empathy cannot be taught; it is something that you have', focussed on behavioural, outcome-oriented aspects; Factor 3, 'Empathy requires communication that goes both ways', prioritised behavioural and cognitive aspects; and Factor 4, 'Lack of empathy makes patients feel abandoned-the dominant patient view', reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically informed healthcare for FMS.