Journal of Clinical Psychology in Medical Settings最新文献

We investigated whether attachment insecurity (anxiety and avoidance) moderated the association between satisfaction with social support and pain disability. We also tested whether the relationship between insecure attachment and pain disability was serially mediated by pain catastrophising and psychological inflexibility. A large-scale cross-sectional correlational design was employed. Data were collected using an online survey. Correlation, serial mediation and moderated regression analyses were used. Data from 894 people with self-reported chronic pain were analysed. Based on correlations, age, depression, and pain intensity were included as covariates. No direct effect of satisfaction with social support on pain disability was observed in the moderation. Attachment anxiety was positively associated with pain disability (b = 1.20, t = 2.03, p < .05), but attachment avoidance was not (b = -0.08, t = -0.13, p = .90). The association between attachment anxiety and pain disability was partially mediated by pain catastrophising and psychological inflexibility (c = 1.21, t = 4.37, p < .001; a1db2 = 0.33, t = 5.15, p < .001). The relationship between attachment avoidance and pain disability was fully mediated by pain catastrophising and psychological inflexibility (c = 0.15, t = 0.54, p = .59; a1db2 = 0.13, t = 2.24, p < .05). This study provided initial evidence that pain catastrophising and psychological inflexibility mediate the association between insecure attachment and pain disability. Follow-up research using a longitudinal design is recommended.

Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for insomnia, yet multiple barriers limit utilization. Digital CBT-I may present a solution, though related reviews have focused on Internet-based delivery rather than app use. The high utilization of health apps and prevalence of sleep apps indicate the need to equip clinicians with app-specific research. Toward this end, we reviewed efficacy and quality data on self-management CBT-I smartphone apps, revealing efficacy research on eleven apps, five of which were publicly available. While preliminary, these efficacy studies showed consistent positive findings. When examining quantitative quality indicators for the five publicly available apps, two had consistent data. Overall, two apps, CBTi Coach and Insomnia Coach, had positive, empirical findings across all efficacy and quality assessment approaches. We provide recommendations to guide clinician decision making regarding CBT-I self-management apps based on the literature and publicly available methods of app evaluations.

Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0-17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ = .324), better agreement for neurodevelopmental concerns (κ = .511), and low sensitivity of referring providers (Se = .326) and parents (Se = .366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders.

Amidst broad changes to the somatic disorder diagnoses, DSM-IV pain disorder was absorbed into DSM-5's somatic symptom disorder (SSD) as a specifier. However, clinical research testing of its use for the chronic pain population has been limited and its utility remains inconclusive. Using the exemplar of fibromyalgia, this article evaluates the validity, reliability, clinical utility, and acceptability of the SSD pain specifier. The diagnosis appears to have moderate validity but low specificity for the fibromyalgia population. The pain specifier has neither undergone sufficient field testing nor been evaluated for use by medical providers, with available data suggesting low reliability. Further research is needed to establish clinical utility via assessment of differential treatment outcomes. Concerns about social, legal, and economic consequences of classifying pain patients with a mental health diagnosis are outstanding. The current SSD criteria should be used with caution among the fibromyalgia patient population until its application for chronic pain has been further researched.

Mental health disparities between racial/ethnic minority groups and non-Latinx Whites in the United States persist despite significant efforts aimed at decreasing these disparities. Efforts to address mental health disparities have largely focused on individual (e.g., stigma, help-seeking, health behaviors) and structural (e.g., public policy, interventions, addressing poverty) level factors. In contrast, this paper considers how processes at the interactional level (i.e., interactions between patients and providers) are also an important contributor to racial/ethnic disparities in mental health. Specifically, social psychological research has demonstrated how biases, including stereotypes, prejudice, and discrimination, can affect patient-provider interactions and contribute to mental health disparities. This narrative review of empirical studies that examine interactional processes between patients and mental health providers identified eleven studies to be included. Concepts represented in the studies are summarized and additional frameworks that can help explain how disparities are maintained are proposed. Last of all, practical suggestions for mitigating provider bias during patient-provider interactions are provided based on the findings from the narrative review.

Psychologists in academic medicine face pressure to juggle multiple roles, and research is often limited by a lack of available resources and funding. In other academic settings, student-led psychology research teams that utilize a tiered mentorship approach are able to produce advances in meaningful research while supporting the development of future professionals in the field. This article identifies the barriers of implementing a tiered mentorship model into an academic medicine setting and reviews a case study of how the model can be effectively adapted and evaluated to promote a self-sustaining, student-led psychology research team.

With mental health needs consistently increasing in our communities and medical centers, we want to ensure that institutions are aware of the benefit and value that psychologists bring to their system and provide several pathways for consideration and structure to understand how to support the salaries and careers of psychologists working within AHCs. Leadership and administration within Academic Health Centers (AHC) often do not understand the value and measurement of productivity for psychologists being added to the medical teams. The current article aims to present varied structural models and demonstrate how productivity is reviewed for psychologists across different institutions and departments. The authors will outline the many roles that psychologists serve within academic health centers as well as the value those roles bring to the system. The overarching goal is to provide an educational article that serves as a tool for recruitment of psychologists that leaders and faculty can refer to when approaching administration in AHCs to understand the systems and roles of psychologists within medical settings. This information can be utilized to help create new positions for psychologists, aid in recruitment efforts and provide transparency for faculty currently working within AHCs who may not be aware of the varied opportunities.

Coaching in academic medicine may be used for performance improvement as well as personal and professional growth and development. Medical faculty used to advising and mentoring learners may find it challenging to transition to coaching. Limited information is available about educating physicians to take on the role of coaching. We investigated a faculty coach training program at an academic medical center, using qualitative methods to explore how participants' perceptions of the training aligned with the elements of Self-Determination Theory (SDT) and Intentional Change Theory (ICT) that were taught using the principles of Experiential Learning Theory (ELT). Based on findings that illuminated understanding and practice of coaching, it may be summarized that the application of experiential learning may be an effective approach in helping faculty embrace the principles of SDT and ICT and make the shift to transformational coaching.

To explore the experiences and preferences of patients and healthcare professionals regarding the development of an app to provide psychological intervention to improve emotion regulation in the context of bariatric surgery (BS). Sixteen people (6 patients who underwent BS and 10 professionals) participated in two separate focus group sessions. We performed a content analysis of transcribed focus group discussions to extract and organize categories, subcategories and areas. Both sets of stakeholders provided information about how to develop and implement an app. According to participants' comment, content should include information (i.e., nutrition, exercise) and emotional regulation skills. Patients and professionals mentioned that the app should include visual information, continuous emotional assessments and peer contact. It was also mentioned that the app should be used before and after BS and its contents should be developed by a multidisciplinary team (i.e., collaboration of endocrinologist, nutritionists and psychologists). Participants in both focus groups considered technology to be useful in the context of BS, especially as part of blended interventions (combining face-to-face and online sessions). Patients and professionals seem to be receptive towards the use of technology in a BS context. Specific recommendations are identified for designing and implementing app solutions for BS. More efforts should be made in the future to develop and implement evidence-based apps according to patients and professionals' needs.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.