Alexandra L. Terrill

Overview of persistent pain in older adults.

With the shifting age demographics of the U.S. population, more psychologists will be asked to provide clinical services to older adults. Given the high prevalence of persistent pain in aging, in many cases this will mean providing empirically supported interventions for pain and the interference it creates. The purpose of this review is to provide a broad overview of the scope and impact of persistent pain in older people and to discuss mechanisms by which persistent geriatric pain can lead to suffering and disability. We consider the unique context of pain in older adulthood and review differences between older and younger people in terms of pain perception, the social network, beliefs about pain, pain-related coping, and adherence to pain medication. Finally, we discuss special issues affecting pain management in older adults, including dementia, polypharmacy, and barriers to accessing adequate pain care. This review also highlights a need for greater provider training in pain management to meet the needs of a changing U.S. population.

Effects of a Tailored Positive Psychology Intervention on Well-Being and Pain in Individuals With Chronic Pain and a Physical Disability: A Feasibility Trial.

Objectives:To determine the feasibility, acceptability, and efficacy of a computer-based positive psychology intervention in individuals with a physical disability and chronic pain. Methods:Individuals with spinal cord injury, multiple sclerosis, neuromuscular disease, or postpolio syndrome and chronic pain were randomly assigned to a positive psychology or a control condition. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises. Participants in the control group were instructed to write about life details for 8 weeks. Participants completed online well-being and pain-related questionnaires at baseline, posttreatment, and at the 2.5-month follow-up, and rated treatment satisfaction at posttreatment. Results:Ninety-six participants were randomized and 68 (70%) completed follow-up assessments. Participants in the positive psychology intervention group reported significant pretreatment to posttreatment improvements in pain intensity, pain control, pain catastrophizing, pain interference, life satisfaction, positive affect, and depression. Improvements in life satisfaction, depression, pain intensity, pain interference, and pain control were maintained to the 2.5-month follow-up. Participants in the control group reported significant pretreatment to posttreatment improvements in life satisfaction, and pretreatment to follow-up improvements in pain intensity and pain control. Significant between-group differences, favoring the treatment group, emerged for pretreatment to posttreatment improvements in pain intensity and pain control. Participants were similarly satisfied with both treatments. Discussion/Conclusions:The results support the feasibility, acceptability, and potential efficacy of a computer-based positive psychology intervention for improving well-being and pain-related outcomes in individuals with physical disabilities and chronic pain, and indicate that a full trial of the intervention is warranted.

Resilience, age, and perceived symptoms in persons with long-term physical disabilities

Resilience may mitigate impact of secondary symptoms such as pain and fatigue on quality of life in persons aging with disability. This study examined resilience in a large sample of individuals with disabling medical conditions by validating the Connor–Davidson Resilience Scale, obtaining descriptive information about resilience and evaluating resilience as a mediator among key secondary symptoms and quality of life using structural equation modeling. Results indicated that the measure’s psychometric properties were adequate in this sample. Resilience was lowest among participants who were middle-aged or younger, and participants with depression. Resilience mediated associations between secondary symptoms and quality of life.

Look on the bright side: do the benefits of optimism depend on the social nature of the stressor?

Growing evidence suggests that a number of personality traits associated with physical disease risk tend to be social in nature and selectively responsive to social as opposed to non-social stimuli. The current aim was to examine dispositional optimism within this framework. In Study 1, optimism was projected into the Interpersonal Circumplex and Five Factor Model revealing significant interpersonal representation characterized by high control and affiliation. Study 2 demonstrated that higher dispositional optimism attenuated cardiovascular responses to a social (speech) but not non-social stressor (cold pressor) task. Optimism-related attenuation of reactivity to the social vs. non-social stressor contributes further evidence to an emerging picture of psychosocial risk as largely reflecting person × social environment interactions.

Modeling Secondary Health Conditions in Adults Aging With Physical Disability

Objectives: To test a conceptual model of secondary health conditions, age, and function in persons aging with long-term physical disabilities. Methods: Surveys were collected from 1,862 adults with spinal cord injury, neuromuscular disease, multiple sclerosis, or post-polio syndrome. Structural equation modeling was used to build a model describing relationships among physical and psychosocial secondary health conditions, pain, functional impairments, chronic medical conditions, and age. Results: In total, 12 individual symptom or function domains (latent factors) were identified, grouped into 5 broader factors. Increasing age was associated with greater rates of physical and health problems and poorer function, and showed curvilinear relationships with pain and psychosocial difficulties. Discussion: These data support a biopsychosocial model of secondary health conditions in adults aging with physical disability and suggest a five-factor approach for conceptualizing secondary conditions and their impact. Results also emphasize the importance of age in symptom severity and impact.

The 7-Item Generalized Anxiety Disorder Scale as a Tool for Measuring Generalized Anxiety in Multiple Sclerosis

BACKGROUND Generalized anxiety disorder (GAD) is common in multiple sclerosis (MS) but understudied. Reliable and valid measures are needed to advance clinical care and expand research in this area. The objectives of this study were to examine the psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in individuals with MS and to analyze correlates of GAD. METHODS Participants (N = 513) completed the anxiety module of the Patient Health Questionnaire (GAD-7). To evaluate psychometric properties of the GAD-7, the sample was randomly split to conduct exploratory and confirmatory factor analyses. RESULTS Based on the exploratory factor analysis, a one-factor structure was specified for the confirmatory factor analysis, which showed excellent global fit to the data (χ(2) 12 = 15.17, P = .23, comparative fit index = 0.99, root mean square error of approximation = 0.03, standardized root mean square residual = 0.03). The Cronbach alpha (0.75) indicated acceptable internal consistency for the scale. Furthermore, the GAD-7 was highly correlated with the Hospital Anxiety and Depression Scale-Anxiety (r = 0.70). Age and duration of MS were both negatively associated with GAD. Higher GAD-7 scores were observed in women and individuals with secondary progressive MS. Individuals with higher GAD-7 scores also endorsed more depressive symptoms. CONCLUSIONS These findings support the reliability and internal validity of the GAD-7 for use in MS. Correlational analyses revealed important relationships with demographics, disease course, and depressive symptoms, which suggest the need for further anxiety research.

Predictors of anxiety in multiple sclerosis.

PURPOSE/OBJECTIVES The aims of this study were to (1) identify the predictors of symptoms of anxiety, and (2) evaluate the differential association of somatic and nonsomatic symptoms of depression on anxiety over time in persons with multiple sclerosis (MS). METHOD/DESIGN Participants were 513 persons with MS who previously enrolled in a study exploring the experience of living with MS and completed a 4-month follow-up survey. The main outcome measure used was the Hospital Anxiety and Depression Scale-Anxiety. Demographic, disease-associated variables (time since onset of MS, Expanded Disability Status Scale Mobility, pain, and fatigue), and Time 1 psychological variables were entered into a hierarchical regression model to examine predictors at baseline for anxiety symptoms at Time 2. RESULTS A large portion of the sample was White (92%), female (82%), and had relapsing-remitting MS (57%). After adjusting for demographic and disease related variables, anxiety (β <.001), employment (β = .07), and nonsomatic depressive symptoms (β = .10) at baseline significantly predicted anxiety at Time 2, ps < .05. Interactions revealed significant effects for time since onset of MS and somatic symptoms as well as time since onset and nonsomatic symptoms, ps < .05. Nonsomatic symptoms were more linked to anxiety early in the disease and somatic symptoms were more prominently linked to anxiety later in the disease. CONCLUSIONS Findings suggest that nonsomatic symptoms of depression and employment predict anxiety in MS. The relationship between different aspects of depression and anxiety may change over the course of the disease.

Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities

ObjectivesThe aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. DesignThis study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. ResultsThe first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (&khgr;210 = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: &bgr; = −0.13, P < 0.001) and on distress (indirect effect: &bgr; = 0.10, P = 0.01). Happiness showed a significant direct effect on pain intensity (&bgr; = −0.20, P < 0.001). A third model exploring the happiness components meaning, pleasure, and engagement fitted well (&khgr;24 = 9.65, P = 0.05, root-mean-square error of approximation = 0.055). Pain intensity acted as a significant mediator but only mediated the effect of meaning on pain interference (indirect effect: &bgr; = −0.07, P = 0.05) and on distress (indirect effect via pain interference: &bgr; = −0.04, P = 0.05). Only meaning (&bgr; = −0.10, P = 0.05), but neither pleasure nor engagement, had a significant direct effect on pain intensity. ConclusionsParticipants who reported greater happiness reported lower pain interference and distress through happiness’ effects on pain intensity. Experiencing meaning and purpose in life seems to be most closely (and negatively) associated with pain intensity, pain interference, and distress. Findings from this study can lay the groundwork for intervention studies to better understand how to more effectively decrease pain intensity, pain interference, and distress.

Positive emotion communication: Fostering well-being at end of life

OBJECTIVE Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. METHODS A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. RESULTS Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. CONCLUSION We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. PRACTICE IMPLICATION This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research.

Association between age, distress, and orientations to happiness in individuals with disabilities

PURPOSE/OBJECTIVE To determine how age and distress are associated in individuals with disabilities, and how happiness and its components (meaning, pleasure, and engagement) mediate or moderate this relationship. RESEARCH METHOD/DESIGN These were cross-sectional analyses of survey data from 508 community-dwelling adults with a variety of self-reported health conditions and functional disabilities. Measures included the Orientations to Happiness Questionnaire and items from the Behavior Risk Factor Surveillance System. RESULTS Greater distress was associated with lower global happiness in both mediation and moderation models. The mediation model showed that middle-aged participants (age: 45-64) scored lowest in global happiness, and the effect of age on distress was partially mediated by happiness. None of the happiness components mediated the relationship of age on distress. The moderation model showed a significant interaction effect for age and global happiness on distress, where younger participants low on happiness were significantly more distressed. Of the three happiness components, only meaning was significantly associated with distress. There was a significant interaction between age and meaning, where participants who were younger and scored low on the meaning scale reported significantly higher distress. CONCLUSIONS/IMPLICATIONS Findings from this study lay groundwork for the development of clinical interventions to address distress in individuals with functional disabilities. Middle-aged and younger people with disabilities may be particularly affected by lower levels of happiness and might benefit from psychological interventions that focus on increasing overall well-being and providing meaning and purpose in life.