Jeannie A. Sperry

Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: A case example

Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral treatment that targets ineffective control strategies and experiential avoidance—the unwillingness to accept negative thoughts, feelings, and emotions. Although ACT has been suggested as an effective treatment for panic, substance use, pain, and mood disorders, there are no published reports on the use of ACT for treating adolescent disorders such as anorexia nervosa. This case summarizes the successful adoption of ACT techniques in the treatment of a 15-year-old female with anorexia nervosa. It also shows how ACT techniques can be successfully combined with, and set the stage for, more standard cognitive-behavioral interventions.

Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population

The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67-73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.

Insomnia Symptoms, Nightmares, and Suicidal Ideation in Older Adults

OBJECTIVES Prior research has found that insomnia symptoms and nightmares are associated with suicidal ideation, suicide attempts, and death by suicide. However, to the best of our knowledge, no research has examined the relation between insomnia symptoms, nightmares, and suicidal ideation in older adults. The current project aimed to fill this void by investigating the relation between insomnia symptoms, nightmares, and suicidal ideation in an older adult sample. METHOD The study utilized a cross-sectional design. The sample consisted of 81 older adult patients (age ≥ 65 years) recruited from a family medicine clinic. The participants were asked to complete surveys about their sleep, symptoms of depression, and suicidal ideation. RESULTS Insomnia symptoms, but not nightmares, were significantly related to suicidal ideation. In addition, insomnia symptoms were related to suicidal ideation independent of nightmares. Furthermore, the relation between insomnia symptoms and suicidal ideation was mediated by depressive symptoms. DISCUSSION These findings have implications for the identification and treatment of suicidal ideation in older adults.

Valued directions: Acceptance and commitment therapy in the treatment of alcohol dependence

This case study describes the treatment of a middle-aged, Caucasian male for alcohol dependence. Treatment focused on using the valued directions component of Acceptance and Commitment Therapy (ACT), a relatively new and promising intervention for substance use disorders. Rather than merely setting a treatment goal to “stop drinking,” we helped the client identify valued life directions that promote an environment to support sobriety and put a plan into action for the client to “start living.” Treatment resulted in improved quality of life and near 100% sobriety. The positive results of this clinical case complement the preliminary findings of a randomized clinical trial currently conducted to evaluate ACT in the treatment of polysubstance abuse. We discuss our treatment approach in relation to existing cognitive-behavioral interventions for alcohol dependence.

Pain-Related Anxiety in the Prediction of Chronic Low-Back Pain Distress

This study evaluated the relation of particular aspects of pain-related anxiety to characteristics of chronic pain distress in a sample of 76 individuals with low-back pain. Consistent with contemporary cognitive–behavioral models of chronic pain, the cognitive dimension of the Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert, and Gross, 1992, Pain 50: 67–73) was uniquely predictive of cognitive-affective aspects of chronic pain, including affective distress, perceived lack of control, and pain severity. In contrast, the escape and avoidance dimension of the PASS was more predictive of behavioral interference in life activities. Overall, the findings are discussed within the context of identifying particular pain-related anxiety mechanisms contributing to differential aspects of pain-related distress and clinical impairment.

Rumination, Magnification, and Helplessness: How do Different Aspects of Pain Catastrophizing Relate to Pain Severity and Functioning?

Objectives:Although there is a large body of research on the relationship between pain catastrophizing and functioning among individuals with chronic pain, little is known about the potential differential impact of specific aspects of pain catastrophizing. The current study evaluates the relationship between the Rumination, Helplessness, and Magnification subscales of the Pain Catastrophizing Scale and pain-related outcomes. Materials and Methods:In total, 844 patients who were admitted to a chronic pain rehabilitation program completed survey measures of pain, catastrophizing, quality of life (QOL), and depression. Results:A series of analyses were conducted entering the 3 subscales simultaneously in a predictive model after pain intensity and demographic variables (ie, age, sex, pain duration, current opioid use). The Helplessness subscale accounted for unique variance in the prediction of pain severity, pain-related interference, mental and physical health-related QOL, and depressed mood. Magnification was significantly related to physical and mental health-related QOL and depressed mood. The Rumination subscale was not uniquely associated with any of the outcome measures beyond that which was accounted for by pain severity, magnification, or helplessness. Discussion:Pain catastrophizing is a multifaceted construct, and different domains of catastrophizing are uniquely related to pain-related outcomes. This study represents the first to evaluate the functioning of these subscales in a large, diagnostically heterogeneous sample of chronic pain patients.

Control Strategies and Suicidal Ideation in Older Primary Care Patients with Functional Limitations

Objectives: Failure to adapt to limitations in control may place older adults at risk for suicidal behavior. The present study examined the relation between control strategies, depressive symptoms, and suicidal ideation in older adults with health-related limitations. Methods: Cross-sectional study of 50 older adult (aged 65–94) primary care patients with health-related limitations. Results: Compensatory primary control strategies characterized by seeking help from others were associated with lower levels of suicidal ideation, independent of depressive symptoms. Selective primary control strategies (e.g., persistence) were also associated with reduced suicidal ideation independent of depressive symptoms, but only when a low level of compensatory primary control strategies was endorsed. Selective secondary control strategies were associated with higher suicidal ideation, whereas compensatory secondary control strategies (e.g., goal disengagement) were unrelated in this sample after controlling for covariates. Conclusions: Findings demonstrate that primary care patients with functional limitations who are not striving to meet their goals, either through persistence or by seeking help from others, are at elevated risk of suicidal thinking.

Patient Satisfaction with Medical Student Participation in a Family Practice Clinic

Medical visits frequently include medical students, transforming the role of the patient into a medical educator as well as a person seeking care. Ensuring patient satisfaction with this arrangement is important for maintaining student access to clinical training. This study was conducted in an academic family medicine center where third-year medical students participate directly in outpatient visits. Two hundred twenty-two patients completed a nine-item survey assessing their satisfaction with their medical visits. Satisfaction ratings were compared between those patients that were seen by a medical student prior to seeing their physician and those patients who saw only their physician. Patients who saw both a medical student and their physician reported a higher rate of prolonged visits. There were no significant differences between the groups regarding satisfaction with wait time, satisfaction with time spent with their physician, addressing their medical concerns, or global satisfaction with their visits.

Addressing Communication Skill Deficits in Fourth-Year Medical Students: An Intensive Remediation Curriculum

Communication skills can be taught and learned, and are assessed as part of the standard medical school curriculum. At West Virginia University, fourth-year medical students are required to pass the Clinical Performance Exam (CPX), in which students demonstrate clinical skills with simulated patients. A remediation curriculum has been instituted to facilitate experiential and didactic learning in provider-patient communication for students failing the Relationship/Communications section of the CPX. Thus far, the three students who have completed this intense curriculum have subsequently passed the CPX and successfully matriculated. Students report that the experiential component of the remediation has been the most effective learning tool. This curriculum has gained such credibility that the authors have been charged with adapting the course components to allow for inclusion of more students. Future direction of the curriculum is discussed.