Leanne Wilson

Brief group cognitive-behavioral intervention for temporomandibular disorders

&NA; Temporomandibular disorders (TMD) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck, and the soft tissue and bony components of the temporomandibular joint. Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem. In this report we present results from a randomized clinical trial which compared, at 3‐ and 12‐month follow‐ups, the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive‐behavioral (CB) intervention delivered to small groups of patients before usual TMD treatment began. The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment. A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction. Patients who participated in the CB intervention followed by usual treatment showed greater long‐term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment. The benefits of CB intervention were not seen when the CB and UT groups were compared at 3‐month follow‐up. During the 3–12‐month follow‐up interval, however, the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve, as hypothesized. During this same follow‐up interval, the CB group also showed a strong trend toward continued improvement in pain interference. Such effects were not observed for depression, somatization, or clinical measures of jaw range of motion. Additionally, as hypothesized, dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention. Intent to treat analyses were also performed to assess generalizability of the results.

The clinical significance of treatment gains resulting from exposure-based interventions for agoraphobia: A reanalysis of outcome data **

We reanalyzed outcome data from a series of studies investigating the efficacy of exposure-based treatments for agoraphobia. Applying statistical criteria developed by Jacobson, Follette, and Revenstorf (1984) to determine clinically significant change whenever possible, the reanalysis of 11 data sets yielded an average improvement rate across all data sets of 58%. The percentages of clinets who actually recovered in response to exposure-based treatments was considerably lower: Only 27% of the clients ended therapy with little or no residual agoraphobic behavior. Generally, the treatment gains that were made were maintained over the course of various follow-up periods. Discussion focused on methodological issues such as criteria for good outcome measures and the pros and cons of standardized versus a priori measures of clinical significance, clinical issues involving the implications of these findings, and suggestions in the literature for how to increase treatment efficacy.

Somatization and pain dispersion in chronic temporomandibular disorder pain

&NA; We investigated the relationship between somatic and psychological symptoms and pain reported during a clinical examination for 220 patients with chronic temporomandibular disorder (TMD) pain, The clinical examination involved palpation of the muscles of the face and neck, as well as intraoral sites and non‐TMD‐related placebo sites. A distinction was drawn between somatization — the tendency to report numerous somatic symptoms — and psychological distress manifested by report of numerous affective and cognitive symptoms. Somatization was assessed with the Somatization scale of the SCL‐90‐R; cognitive/ affective distress was assessed with the non‐somatic items of the Anxiety and Depression scales. Heightened somatization and high‐intensity pain were strong predictors of widely dispersed muscle palpation pain during the clinical examination. High‐somatization patients were 3 times more likely than low‐somatization subjects to report having a painful placebo site. Pain dispersion was more closely linked to report of number of somatic symptoms than to report of affective and cognitive symptoms of psychological distress.

Temporal organization of recall during posthypnotic amnesia.

Amnesia suggestions were administered to 35 subjects of low, medium, and high hypnotic susceptibility who had learned a word list while hypnotized The method encouraged subjects to organize the words sequentially. Organization of recall was measured on recall trials conducted before, during, and after suggested amnesia. Highly hypnotizable subjects showed a breakdown in temporal organization during amnesia, followed by a recovery of this organization after the suggestion was canceled Posthypnotic amnesia apparently involves a disruption in the contextual relationships among memory items.

Effect of temporomandibular disorder pain duration on facial expressions and verbal report of pain.

&NA; This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non‐verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non‐verbal behavior would increase with duration of pain. Thirty‐six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration Symbol= 2 months). Subjects completed questionnaires assessing depression, anxiety, somatization, daily hassles and pain coping strategies. They were videotaped during a resting baseline and 2 painful conditions: experimental cold pressor pain and the clinically relevant pain of palpation of the masticatory muscles and temporomandibular joint; tapes were coded for facial expression using the Facial Action Coding System. Visual analog scale (VAS) ratings of the aversiveness and intensity of ongoing TMD pain were collected at baseline, and similar ratings of cold pressor and clinical examination pain were gathered after the painful stimulus. Recent onset and chronic cases did not differ on self‐report measures of anxiety, depression, somatization or daily stress. Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self‐report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline. The findings suggest that verbal and non‐verbal expressions of pain may be differentially reinforced over the course of a chronic pain condition, such that non‐verbal pain facial expressions become more frequent with time, while verbal reports of pain remain relatively constant. Figure. No caption available

Beliefs About Forensic Hypnosis

Abstract The beliefs people hold about hypnosis have an impact on the behavior of a witness who is hypnotized and on juries who hear these witnesses and weigh hypnotically influenced testimony. Students in Experiment 1 and registered voters from the community in Experiment 2 responded to questions about forensic hypnosis. Over 70% of the students as compared to about 50% of the community members were favorable toward the use of hypnosis by police for memory enhancement. In both groups, however, twice as many people reported that they would put less faith rather than more faith in the testimony of someone who had been hypnotized. A substantial portion of the students firmed common myths about the effects of hypnosis on memory and behavior.