Elwood Robinson

Spouse-assisted coping skills training in the management of osteoarthritic knee pain.

OBJECTIVE To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain, psychological disability, physical disability, pain-coping, and pain behavior in patients with osteoarthritis (OA) of the knees. METHODS Eighty-eight OA patients with persistent knee pain were randomly assigned to 1 of 3 conditions: 1) spouse-assisted pain-coping skills training, (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement (CST), or 3) an arthritis education-spousal support (AE-SS) control condition. All treatment was carried out in 10 weekly, 2-hour group sessions. RESULTS Data analysis revealed that at the completion of treatment, patients in the spouse-assisted CST condition had significantly lower levels of pain, psychological disability, and pain behavior, and higher scores on measures of coping attempts, marital adjustment, and self-efficacy than patients in the AE-SS control condition. Compared to patients in the AE-SS control condition, patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies. CONCLUSION These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients.

Spouse-assisted coping skills training in the management of knee pain in osteoarthritis : Long-term followup results

OBJECTIVE To evaluate the long-term effects of a spouse-assisted coping skills intervention in patients with osteoarthritis (OA) of the knees, and to evaluate how pre- to posttreatment changes in marital adjustment and self-efficacy relate to long-term improvements in pain, psychological disability, physical disability, pain coping, and pain behavior. METHODS A followup study was conducted with 88 OA patients who had been randomly assigned to 1 of 3 treatment conditions: 1) spouse-assisted coping skills training (spouse-assisted CST), 2) a conventional CST intervention with no spouse involvement, and 3) an arthritis education-spousal support (AE-SS) control condition. To evaluate long-term outcome, comprehensive measures of self-efficacy, marital adjustment, pain, psychological disability, physical disability, pain coping, and pain behavior were collected from these individuals at 6 and 12 months posttreatment. RESULTS Data analysis revealed that, at 6-month followup, patients in the spouse-assisted CST condition scored higher on measures of coping and self-efficacy than those in the AE-SS control group. At 6-month followup, patients who received CST without spouse involvement showed a significantly higher frequency of coping attempts and reported higher levels of marital adjustment than those in the AE-SS control group. At 12-month followup, patients in the spouse-assisted CST condition had significantly higher overall self-efficacy than those in the AE-SS control condition. In addition, patients in both the spouse-assisted CST and CST only conditions tended to show improvements in physical disability at the 12-month followup. Individual differences in outcome were noted at the 12-month followup. Patients in the spouse-assisted CST condition who reported initial (pre- to posttreatment) increases in marital adjustment had lower levels of psychological disability, physical disability, and pain behavior at 12-month followup. However, for patients in the conventional CST and AE-SS control conditions, increases in marital adjustment occurring over the initial phase of treatment were related to increases in pain and decreases in scores on the Pain Control in Rational Thinking factor of the Coping Strategies Questionnaire. Finally, patients in the spouse-assisted CST condition who showed pre- to posttreatment increases in self-efficacy were more likely to show decreases in pain, psychological disability, and physical disability at 12-month followup. CONCLUSIONS These findings suggest that spouse-assisted CST can enhance self-efficacy and improve the coping abilities of OA patients in the long term. Individual differences in the long-term outcome of spouse-assisted CST were noted, with some patients (those showing increases in marital satisfaction and self-efficacy) showing much better outcomes than others.

Perceived racial/ethnic harassment and tobacco use among African American young adults.

We examined the association between perceived racial/ethnic harassment and tobacco use in 2129 African American college students in North Carolina. Age-adjusted and multivariate analyses evaluated the effect of harassment on daily and less-than-daily tobacco use. Harassed participants were twice as likely to use tobacco daily (odds ratio = 2.01; 95% confidence interval=1.94, 2.08) compared with those with no reported harassment experiences. Experiences of racial/ethnic harassment may contribute to tobacco use behaviors among some African American young adults.

Pain coping strategies that predict patients' and spouses' ratings of patients' self-efficacy

&NA; This study examined the relationship of pain coping strategies to osteoarthritis patients’ ratings of self‐efficacy and to spouses’ ratings of the patients’ self‐efficacy. Subjects, 130 individuals having osteoarthritis of the knees and persistent knee pain, completed a pain coping strategies measure (the Coping Strategies Questionnaire), a measure of self‐efficacy (the Arthritis Self‐Efficacy Scale), and a measure of pain (the McGill Pain Questionnaire). Two sets of regression analyses were conducted, one examining the degree to which pain coping strategies predicted patients’ self‐efficacy ratings, and the other examining the degree to which coping strategies predicted spouses’ ratings of the patients’ self‐efficacy. Several pain coping strategies were found to predict a significant proportion of variance in patients’ ratings of self‐efficacy: (i) ignoring pain sensations was related to higher self‐efficacy for pain; (ii) coping self statements were related to higher self‐efficacy for controlling other arthritis symptoms (e.g., fatigue or mood symptoms; and (iii) catastrophizing was related to lower self‐efficacy for pain, and self‐efficacy for other arthritis symptoms. Pain coping strategies were also found to predict a significant proportion of variance in spouses’ ratings of the patients’ self‐efficacy. Specifically: (i) diverting attention was related to lower spousal ratings of self‐efficacy for pain; (ii) praying or hoping was related to lower spousal ratings of self‐efficacy for function; and (iii) catastrophizing was related to lower spousal ratings of self‐efficacy for control of fatigue or mood symptoms. The findings regarding coping strategies were particularly interesting in that they were obtained even after controlling for pain intensity and demographic variables. The pain coping strategies identified are potentially important targets for cognitive‐behavioral assessment and treatment efforts. Interventions designed to increase the use of adaptive pain coping strategies and decrease the use of maladaptive pain coping strategies could enhance self‐efficacy, reduce pain, and improve the physical and psychological functioning of individuals having osteoarthritis.

Depression, Suicidal Ideation, and Attempts in Black Patients With Sickle Cell Disease

There is a strong relationship between suicidal ideation, suicide attempts, and depression. Rates of successful suicides are relatively high among the chronically ill compared to other populations but are reduced with treatment. Depression and suicide rates also often differ among blacks as compared to other populations. Using survey methods, we evaluated self-reported rates of depression, suicidal ideation, and suicide attempts in 30 male and 37 female black patients with sickle cell disease (SCD). SCD is a condition characterized by chronic, unpredictable pains and psychosocial distress. Thirty-six percent of the sample self-reported depression in the past 30 days, while 22 percent of the sample exhibited scores on the Beck Depression Inventory indicative of mild or greater depression (mean BDI, 8.31 +/- 7.79). Twenty-nine percent of patients indicated an episode of suicidal ideation and 8%, a suicidal attempt in their lifetime. Thirty-three percent reported treatment by a mental health professional. We conclude that there is a continuing need for mental health services in the management of depressed affect and risk for suicide among patients with SCD. Standards of clinical care must remain flexible to accommodate the mental health needs of this population of patients.

The effects of implementing program consequences with a group of individuals who engaged in sensory maintained hand mouthing

This study evaluated whether a multicomponent treatment package could be successfully implemented with individuals who engage in self-injurious hand mouthing maintained by sensory consequences in the context of both individual and small group settings. Three ambulatory individuals with profound mental retardation participated on an individual basis followed by treatment within a group setting. Generalization of the intervention results to the natural living environment was then analyzed. Using an ABAB experimental design, the effectiveness of brief response interruption followed by the introduction of a preferred leisure item to reduce hand mouthing during 15-min intervention sessions was analyzed. Results of these experiments showed that the intervention could be successfully implemented during individual and small group sessions and during group sessions conducted in the natural environment. The benefits and limitations of this intervention strategy and future research are discussed.

Misestimation of Peer Tobacco Use : Understanding Disparities in Tobacco Use

Blacks experience disproportionately elevated rates of tobacco-related morbidity and mortality. Blacks experience delayed smoking initiation relative to other racial/ethnic groups, highlighting the importance of examining smoking correlates occurring in late adolescence/early adulthood. The current study reports data collected as part of an ongoing collaborative effort to assess alcohol and drug use on the campuses of historically black colleges and universities (HBCUs). Two-thousand, two-hundred, seventy-seven African-American subjects, aged 20.3 +/- 3.9 (range 18-53), completed the CORE Alcohol and Drug survey and a brief demographic questionnaire. Results indicated that 90% of all subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase in the risk of smoking. These data highlight the need to correct misinformation regarding smoking norms among students at some HBCUs.

The relative effectiveness of cognitive restructuring and coping desensitization in the treatment of self-reported worry

Abstract This clinical outcome study compared two therapeutic methods for the reduction of self-reported worry with a placebo and waiting-list control. In cognitive restructuring, participants were trained to realistically reevaluate imaginally presented worry situations. In coping desensitization, participants were taught to use relaxation in response to worry images within a coping framework. Progressive relaxation alone was used as the placebo condition. On the basis of questionaire measures of anxiety and self-reported worry, greater anxiety and worry reductions were found in the cognitive restructuring group, followed by minimal changes in the coping densensitization group, and no changes in the placebo and waiting-list control. Subjects in the restructuring condition also reported significant increases in attention and decreases in frequency of thought intrusions.

The effects of physical and mental stress on cardiovascular reactivity in a group of African American female college students

This research combined two studies to investigate stress reactivity in worriers and nonworriers. The first studies compared changes in blood pressure, heart rate, and skin temperature elicited by mental stress (mental arithmetic) in eight worriers and eight nonworriers. The second study extended the first by adding a physical stressor (cold pressor) to the methodology while investigating 13 worriers and 14 nonworriers. Results of these two studies indicated that during mental stress, worriers had a significantly greater increase in systolic blood pressure and heart rate than nonworriers. This particular response to mental stress suggests that worry may well have a physiological concomitant. The cognitive nature of worry is believed to influence the sympathetic nervous system via beta-adrenergic receptors. The effects of chronic worry on an individuals response to an acute laboratory stressor are discussed.