Journal of Clinical Psychology in Medical Settings最新文献

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.

Chronic pain and eating problems frequently co-occur, with disordered eating behaviors such as emotional eating, food restriction, and appetite fluctuation contributing to adverse outcomes. However, there are no validated screening tools specifically designed for assessing eating problems in chronic pain populations. This study aimed to validate two brief eating disorder measures, the Eating Attitudes Test-8 (EAT-8) and Eating Disorder Examination-Questionnaire-8 (EDE-Q8), for English-speaking adults presenting for chronic pain treatment. Participants included 173 adults seeking treatment at a pain evaluation service. Participants completed the EAT-8 and EDE-Q8 alongside self-report clinical measures. Demographic and clinical data were extracted from medical records. Statistical analyses assessed internal reliability, construct validity, and differences in eating disorder measures by BMI and eating disorder history. Both the EAT-8 and EDE-Q8 demonstrated acceptable internal reliability (McDonald's omega ≥ 0.7) and strong construct validity, with significant correlation between the two measures (r = 0.77). Scores varied significantly by BMI and eating disorder history, with higher scores observed among participants with obese BMI or a history of eating disorders. However, less than 20% of participants felt the measures fully captured their experiences, suggesting potential gaps in assessing eating problems specific to chronic pain. The EAT-8 and EDE-Q8 are valid and reliable tools for identifying disordered eating behaviors in chronic pain patients. However, these measures may not capture the full spectrum of eating problems unique to this population. Future research should refine screening tools to better assess eating behaviors as they relate to chronic pain.

Food allergy (FA) is a chronic condition that can markedly affect family quality of life (QoL). Children's food neophobia (FN) may increase dietary management difficulties and parental stress, while maternal personality traits can shape family adjustment. This study examined the associations between maternal neuroticism, child FN, and the perceived impact of FA on family QoL, also considering the influence of child age. Sixty-three Portuguese mothers of children with physician-diagnosed FA completed a sociodemographic and clinical questionnaire and validated self-report measures: the Food Neophobia Scale for Children, the NEO Five-Factor Inventory, and the Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF). Preliminary correlations guided predictor selection, followed by multiple linear regression models (enter method) for each FAQLQ-PF subscale: Emotional Impact, Food Anxiety, and Dietary/Social Limitations. Higher maternal neuroticism, greater child FN, and older child age were significantly associated with a greater perceived impact of FA on family QoL. The models explained 35.5% of the variance in Emotional Impact, F (3, 58) = 12.19, p < .001; 35.5% in Food Anxiety, F (3, 58) = 12.19, p < .001; and 32.9% in Dietary/Social Limitations, F (3, 56) = 10.66, p < .001. These findings underscore the need to integrate psychological screening and tailored psychosocial support into allergy care, addressing both maternal emotional traits and child eating behaviors to promote adaptive family functioning.

Sleep-related deaths are a preventable cause of infant mortality. Pediatricians can promote infant safe sleep practices; however, communication barriers may arise, especially for patients of color. This study examined how patient race and ethnicity relate to the length and quality of safe sleep discussions with pediatric residents. Sixteen pediatric residents completed questionnaires on safe sleep knowledge and attitudes. Observations were conducted during 102 well-baby visits to measure time spent discussing safe sleep and frequency of effective communication skills used by residents. In descriptive analyses, residents spent less time discussing safe sleep with Black and other patients of color compared to White patients. In multivariate models, caregiver receptiveness, rather than client race and ethnicity, predicted time discussing infant safe sleep. However, when receptiveness was removed from the model, caregiver race and ethnicity did predict time discussing infant safe sleep such that providers spent less time talking to Black caregivers and caregivers of color. Race and ethnicity did not predict resident use of MI skills. Residents may experience communication challenges when discussing infant safe sleep, particularly with patients of color. Client receptiveness and race appear to be important variables with regard to patient-provider communication about infant safe sleep.

The way in which behavioral health providers (BHPs) in integrated primary care settings function and what is needed for their success has not been systematically examined. The present study used direct observation to capture integrated BHPs' clinical activities, workflows, and team interactions. Observations took place in seven integrated primary care clinics in a single health system. The model of integration combined components of the Primary Care Behavioral Health model and the Collaborative Care Model. A trained Research Service Professional (RSP) observed 13 BHPs each during one typical clinical day in an integrated primary care clinic. Data collection methods included surveys, process maps, time tracking, and field notes. We used quantitative and qualitative analysis to describe BHPs' activities. During the days observed, BHPs conducted 77 patient visits and many other activities, including supervising learners. BHPs' clinical time was divided among direct patient care (56%), administrative tasks (29%), and consultation with team members (15%). Process maps revealed similar workflows across BHPs/practices with differences in completing screening, rooming, and scheduling patients. BHPs supervising learners saw on average more patients per day than BHPs on their own (5.1 vs. 7.6). BHPs interacted with all practice team members, and most frequently with medical providers, social workers, care managers, and nurses. BHPs provide clinical care to primary care patients on a wide variety of concerns and spend time on other important team-based tasks. Recommendations for optimizing workflows, reimbursement models, and team-based care from these observations are provided.

Nursing and direct care staff face significant psychological and physical challenges, including high workloads, emotional labour, and staff shortages, which increase the risk of burnout and stress-related conditions. Resilience is a protective factor that mitigates these effects. This study evaluated the efficacy of a 28-day digital resilience training programme tailored to the needs of nursing and direct care staff. One hundred twenty participants working in German healthcare settings were randomly assigned to an experimental group or a waitlist control group. Experimental group participants received a programme consisting of twice-daily video-based exercises, reflections, and relaxation activities over four weeks. Outcomes were assessed at baseline (T1), post-intervention (T2), and three months follow-up (T3). Resilience (primary outcome) was measured using the Resilience Scale, and perceived stress (secondary outcome) was measured using the Perceived Stress Questionnaire (PSQ). Compared to the control group, experimental group participants demonstrated significant improvements in resilience from T1 to T3 (p < .001, d = 0.6) and substantial reductions in percieved stress (PSQ total score, p < .001, d = - 1.4). No significant changes were observed in the control group. The digital programme effectively enhanced resilience and reduced the perception of stress, aligning with prior research on resilience training in healthcare. Despite stress reduction showing a larger effect size, resilience remained the theoretically grounded primary outcome. The flexible, scalable design of the digital programme accommodates challenges like shift work, offering a practical solution for improving nurse staff's mental health. Clinical Trial Registration: German Clinical Trials Register (DRKS), Identifier: DRKS00030973.