Journal of Clinical Psychology in Medical Settings最新文献

Optimism, defined as the tendency to expect positive outcomes and view challenges as manageable, plays a vital role in the lives of individuals with chronic illnesses, including multiple sclerosis. Given its potential benefits, measuring optimism through validated tools like the Life Orientation Test-Revised (LOT-R) is essential for both research and clinical practice. This study aims to validate the Spanish version of the LOT-R within a sample of MS patients, assessing its psychometric properties and exploring its potential utility in clinical settings. This study included 179 patients with Relapsing-Remitting Multiple Sclerosis (PwMS). Confirmatory factor analysis (CFA) was performed to assess the factor structure of the LOT-R. Model fits were evaluated by the χ2/df value, comparative fit index (CFI), and root mean square error of approximation (RMSEA). The LOT-R showed good psychometric characteristics in our sample of PwMS. The CFA's for both models (the two correlated factors model and the second-order factor model) yielded a good model fit. Cronbach's alpha and McDonald's omega were acceptable. Optimism was significantly correlated with quality-of-life scores, resilience, and fear of relapse scale. In general terms, the LOT-10 has satisfactory psychometric properties and is suitable for measuring dispositional optimism in Spanish-speaking patients with multiple sclerosis.

Few studies have examined effects of intrinsic motivation (IM) on adaptive behaviors among adolescents with type 1 diabetes (T1D), although greater IM has been associated with less diabetes-related family conflict (FC) and increased regimen adherence. Greater FC has also been associated with disordered eating behaviors (DEBs). We examined the moderating role of IM between FC and DEBs in a culturally diverse sample of youth with T1D. 226 adolescents (Mage = 15.03, 59.3% female, 65.8% Hispanic, 19.0% Black, MA1c = 8.19%, 74.30% eligible for subsidized health insurance) completed pre-visit screening measures assessing IM, FC, and DEBs. Gender, race, ethnicity, A1c, BMI, and insurance status were obtained from medical records and treated as covariates. Black youth had higher rates of DEBs (p < .01) and A1c levels (p < .001) than White youth. Significant correlations were observed across study variables. Accounting for covariates, IM moderated the relationship between FC and DEBs, whereby the effect of FC on DEBs emerged strongest at low IM (p < .001). As IM levels increased, the effect of FC on DEBs decreased, making the relationship between FC and DEBs non-significant. Greater IM for diabetes management attenuates the association between FC and DEBs. Promoting IM may decrease FC and DEBs in youth with T1D.

Psychologists in inpatient settings may be called upon to evaluate patients mental health when patients request to terminate interventions or refuse to engage in life- sustaining treatments. Although rates of distress are high in patients experiencing acute and chronic illness, especially as symptoms impact quality of life, less has been written on the nuances of assessing how affective symptoms may influence treatment decisions. This article describes some of the challenges health care providers may face in situations in which patients appear to be actively or passively withdrawing from care. We offer suggestions for assessment and considerations for referrals and resources to guide providers in conceptualization and intervention within these situations. This paper can ideally serve as a guide to aid psychologists to assist the medical team, the patient, and their family with appropriate decision-making regarding terminating medical care and to ensure these decisions were not unduly influenced by a potentially treatable and modifiable mood concern.

Although common, insomnia is often undertreated and underrecognized in primary care settings. Few studies have examined primary care provider (PCP) perspectives to better understand the context of insomnia assessment and treatment. The purpose of the current study was to examine Veterans Affairs (VA) provider knowledge and practice regarding the assessment and treatment of insomnia by utilizing qualitative inquiry. We recruited PCPs at a VA healthcare facility located in the southeastern United States to engage in a qualitative descriptive study of their perspectives on the management of insomnia in the primary care setting. Participants completed a demographic form and semi-structured interviews. Interview data were analyzed using a rapid qualitative analysis approach. 12 PCPs participated in semi-structured interviews. Themes were knowledge gaps in appropriate assessment, treatment, and documentation practices. Providers tended to focus on the event that precipitated insomnia rather than factors that perpetuate it and relied heavily on sleep hygiene recommendations. Systemic barriers, such as time constraints, also impeded the highest quality of care. PCPs may benefit from additional training on factors that maintain insomnia and on evidence-based treatments for insomnia. There may also be an opportunity to develop tools such as shared decision-making aids to increase referrals to evidence-based treatments. Development of strategies to facilitate assessment and treatment of insomnia disorder in the context of busy, fast-paced primary care settings may be beneficial to veterans and civilians with sleep disorders.

Between 60 and 80% of adults with osteogenesis imperfecta (OI) experience chronic pain and associated interference. Currently available pain therapies often provide marginal efficacy. Mindful self-compassion (MSC) has emerged as a promising intervention for coping with chronic pain. We conducted a single-center 8-week pilot intervention study to assess the feasibility and acceptability of a MSC program among adults with OI and co-occurring chronic pain. Individuals attended the validated MSC course consisting of 8 weekly virtual 2-h sessions. Participants completed a battery of validated questionnaires assessing pain, various aspects of well-being, and physical function at baseline and post-intervention. Participants wore the ActiGraph GT9X Link watch to measure sleep duration and sleep efficiency. Seven adults with OI and co-occurring pain participated in the MSC program. The program was feasible, as indicated by high attendance and high questionnaire completion rates. Participants reported a mean ± standard deviation (SD) of 3.5 out of 5 ± 0.4 on the Intervention Acceptability Framework. 86% (6/7) of participants found the MSC program to be acceptable. While our pilot study was not powered to show efficacy, we observed a decrease in pain interference on the PROMIS pain interference questionnaire (mean 55.9 ± 5.5 at baseline vs. 50.0 ± 7.3 at 8 weeks). Implementation of the MSC program is feasible as a potential therapeutic option to address chronic pain in OI.

This case study describes the implementation of trauma-informed and culturally informed cancer care, for a 40-year-old Ukrainian female with recurrent follicular lymphoma, displaced to the United States in the Spring of 2022 following the Russian invasion of Ukraine. The patient was referred to the psychosocial oncology service at an NCI-designated Comprehensive Cancer Center for evaluation and treatment of depression and anxiety. Stressors, along with the chronic trauma of fearing for her family's safety and the stress of being displaced from Ukraine, compounded her emotional burden. A modified form of trauma-informed care adapted for use with refugee and immigrant populations was applied, in addition to evidence-based treatments including Acceptance and Commitment Therapy, Cognitive Processing Therapy, and other cognitive behavioral techniques. At the conclusion of therapy, significant improvements were reported across physical function, social engagement, and emotional well-being. This case highlights the importance of flexibility in treatment modalities and the need to consider that the trauma of an ongoing and unpredictable war may require more therapeutic support than the experience of cancer.

In individuals with inflammatory bowel disease, pain is common. Alongside the experience of pain, pain catastrophizing occurs via rumination, magnification, and helplessness-this process often impacts an individual's health-related quality of life. With that said, there is a shortage of inflammatory bowel disease research examining temporal changes in the relationship between pain and health-related quality of life and potential mediators of this association. The objective of this study is to investigate the longitudinal serial mediation effects of pain catastrophizing and pain coping on the relationship between pain and health-related quality of life. An archival dataset included participants diagnosed with inflammatory bowel disease recruited at the gastrointestinal tertiary care clinic at Hotel Dieu Hospital in Kingston, Ontario. Pain, health-related quality of life, pain catastrophizing, and coping were measured. Through data analysis, it was discovered that present pain predicted future pain catastrophizing, which later predicted illness-focused coping. Illness-focused coping then predicted lower levels of health-related quality of life. Overall, this study provides a perspective on the broader implication that pain catastrophizing and coping have on the experience of pain and health-related quality of life in those with inflammatory bowel disease, suggesting a starting point for clinical intervention.

Palliative care professionals are exposed to emotionally intense situations. Stress, anxiety, and burnout can impact the dimension of care through the loss of motivation. Expressive writing in the general population effectively promotes emotion regulation through meaning-making. This study aimed to evaluate the impact of Expressive writing on the meaning change in the perception of traumatic professional events in multi-professional palliative care settings in Italy. We conducted a prospective study with longitudinal qualitative methodology, following an ad-hoc expressive writing protocol. The study involved the selection of 10 various palliative care professionals working in hospices, hospital palliative care units, and community palliative care. We identified six main themes that shifted meaning throughout the four writing sessions: description of the phenomena, strong emotions, health workers' elaborations, processing feelings, improvement strategies, and interior resources. Expressive writing is effective in helping palliative care professionals process intense emotions and feelings related to a traumatic event, stimulating critical self-reflection and self-care, and supporting meaning-making.

The objective of this study is to examine the associations among asthma, depression, and anxiety with sleep outcomes among youth in Puerto Rico and determine whether age moderates the associations. Data came from surveys of 333 youth aged 10-17 living in Puerto Rico. Predicted probabilities derived from logistic regression models were used to assess the associations of asthma, depression, and anxiety with sleep outcomes. Models included interactions between age group (10-13 vs 14-17) and asthma, depression, and anxiety when predicting sleep outcomes. The predicted probability of obtaining a sufficient amount of sleep was 15.9 percentage-points higher among those with asthma compared to those without asthma (p = 0.009), 21.9 percentage-points higher among older youth with asthma compared to older youth without asthma (p = 0.004), and 33.9 percentage-points lower among younger youth with depression compared to younger youth without depression (p = 0.019). There were no significant differences in the predicted probabilities of perceived sleep quality according to asthma, depression, or anxiety status. Findings suggest that age moderates the associations among asthma, depression, and sleep among youth in Puerto Rico. Younger youth with depression may be at increased risk for poor sleep outcomes.

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.