Louise Sharpe

A reformulated cognitive–behavioral model of problem gambling: A biopsychosocial perspective

With most Western countries expanding the availability of gambling facilities in recent decades, considerable research interest has developed in those people who develop problematic levels of gambling. In the recent decade, a large body of research has been conducted into the determinants of gambling behavior in an attempt to understand this complex social and psychological problem. Research has varied in its nature from investigating underlying biological, psychological, or social factors that are hypothesized to contribute to gambling behavior. Evidence now exists that biological, psychological, and social factors are all relevant to the development of problematic levels of gambling. However, the theoretical explanation for gambling has lagged behind the advances in empirical work in recent years. The purpose of the current paper is to provide a review of the major research findings in the area of gambling and propose a biopsychosocial model that integrates diverse areas of research. The model described is empirically derived, and it is hoped it will stimulate future research work that investigates not only individual factors and their relationship to gambling, but also the interactions between different variables.

The course of depression in recent onset rheumatoid arthritis: the predictive role of disability, illness perceptions, pain and coping.

BACKGROUND This study aimed to investigate the course of depression for patients with recently diagnosed rheumatoid arthritis (RA) and to investigate predictors of depression. METHODS Twenty-two patients with a history of recently diagnosed RA of less than 2 years were assessed on a variety of clinical outcome and process measures on six assessment occasions over a 21-month period. These 22 patients constituted the control group of a controlled trial and received standard outpatient clinic treatment during follow-up. RESULTS Patients became significantly more depressed over time. A set of five factors were found to consistently predict depression at the following assessment. These were initial level of depression, disability, pain, beliefs about the consequences of arthritis and coping strategies. CONCLUSIONS The results confirm the importance of psychological factors in early RA and their relative independence from physical findings. This is the first study to document the importance of illness perceptions in recent onset RA.

A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity

&NA; This study examined the efficacy of a cognitive and behavioural intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty‐three participants with a diagnosis of classical or definite rheumatoid arthritis, who were seropositive and had less than 2 years of disease history were recruited into the trial. All participants received routine medical management during the study, although half were randomly allocated to receive an adjunctive psychological intervention. All pre‐ and post‐treatment assessments were conducted blind to the allocation. Analyses were conducted of treatment completers and also by intention‐to‐treat. Significant differences were found between the groups at both post‐treatment and 6‐month follow‐up in depressive symptoms. While the CBT group showed a reduction in depressive symptoms, the same symptoms increased in the Standard group. At outcome but not follow‐up, the CBT group also showed reduction in C‐reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6‐month follow‐up compared with the Standard group, indicating physical improvements above those achieved with standard care. These results indicate that cognitive‐behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical morbidity

Selective attention to pain-related information in chronic musculoskeletal pain patients

Cognitive‐behavioural models of chronic pain contend that appraisals of harm affect the individuals response to pain. It has been suggested that fear of pain and/or anxiety sensitivity predispose individuals to chronicity. According to this view, pain is maintained through hypervigilance towards painful sensations and subsequent avoidance. The present study investigates the nature of cognitive biases in chronic pain patients. A sample of 169 consecutive patients referred to a specialist pain management centre participated in the study. Questionnaires measuring different aspects of pain and a computerised version of the Dot‐Probe Task were administered. Four types of words related to different dimensions of pain and matched, neutral words were used as stimuli. Reaction times in response to the stimuli were recorded. A factorial design 3×4×2×2 and ANOVAs were employed to analyse the data. Chronic pain patients showed a cognitive bias to sensory pain words relative to affective, disability, and threat‐related words. However, contrary to expectations, those high in fear of pain responded more slowly to stimuli than those less fearful of pain. These results suggest that patients with chronic pain problems selectively attend to sensory aspects of pain. However, selective attention appears to depend upon the nature of pain stimuli. For those who are highly fearful of pain they may not only selectively attend to pain‐related information but have difficulty disengaging from that stimuli. Theoretical and clinical implications of the data are discussed.

A trial of two cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. II: Treatment-specific changes in coping and problem-solving skills

SummaryChanges in coping skills and problem-solving skills were examined in two groups of schizophrenic patients. The groups received either coping skills enhancement or problem-solving treatments to reduce their drugresistant residual psychotic symptoms. The coping skills group showed significant increases both in the number of positive coping strategies used and in their efficacy, whereas the problem-solving group showed a decrease in these measures during treatment. Both groups showed significant improvements in problem-solving skills. Changes in coping but not problem solving were significantly related to decreases in psychotic symptoms during treatment. It was concluded that treatment involving the teaching of coping skills had a specific treatment effect.

The role of threat-expectancy in acute pain: effects on attentional bias, coping strategy effectiveness and response to pain

Abstract The aims of this study were threefold. Firstly, to investigate the effect of increasing threat‐expectancy on attentional biases towards pain‐related words. Secondly, to determine the interaction between threat‐expectancy and the effectiveness of two coping strategies on pain threshold and tolerance. Thirdly, to investigate the relationship between fear of pain and the experimental manipulations. One hundred undergraduate psychology students were randomly assigned to receive either threat‐increasing or reassuring information about the cold pressor task. After reading the information, all participants completed the dot‐probe task for four categories of pain‐related words. Following the dot‐probe task, participants were randomly allocated to one of two coping strategy conditions (focusing on affective vs sensory aspects of pain). Participants then completed the cold pressor task while engaging in the relevant coping strategy. There was a significant effect of threat on bias towards affective vs sensory pain words. Participants in the threat condition showed a stronger bias towards affective pain words. In contrast, the no‐threat condition displayed a stronger bias towards sensory pain words. Significant interaction effects were observed between threat and coping strategy for threshold and tolerance. These results indicated that focusing on sensory pain sensations was helpful in the absence of threat, however, in the presence of threat was relatively unhelpful in comparison to focusing on the affective components of pain. The present results provide support for the fear‐avoidance model of pain [Vlaeyen JWS, Linton SJ. Fear‐avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317–332] and confirm the importance of threat‐expectancy in hypervigilance towards pain and fear avoidance.

Is there a potential role for attention bias modification in pain patients? Results of 2 randomised, controlled trials

Summary Attention bias modification resulted in positive outcomes compared to placebo in 2 randomised, controlled trials in patients with acute and chronic pain. Abstract Potential applications of attention bias modification (ABM) for acute and chronic pain patients are investigated. In study 1, 54 acute back pain patients (46 of whom completed the study) were recruited at their initial physiotherapy session and randomised to receive 1 session of ABM or placebo. Patients were followed up 3 months later. Participants who were randomised to receive ABM reported less average (P = 0.001) and current pain (P = 0.008) and experienced pain for fewer days (P = 0.01) than those who received placebo. In study 2, 34 chronic pain patients were recruited and randomly assigned to receive either 4 sessions of ABM (n = 22) or placebo (n = 12), followed by 8 sessions of cognitive behavioural treatment (CBT). After ABM, there was a significant group‐by‐time effect for disability. By 6‐month follow‐up, differences had emerged between the 2 training groups, such that the ABM group had shown greater reductions in anxiety sensitivity and disability than the placebo group. Although the results of these studies show that there is potential in the application of ABM to pain conditions, the mechanisms of treatment could not be established. Neither group showed an initial bias towards the word stimuli or a training effect, and only in the acute pain group were changes in biases related to outcome. Nonetheless, the fact that 2 independent samples showed a positive effect of ABM on clinical outcomes suggests that ABM is worthy of future study as an intervention for pain patients.

Selective attention towards painful faces among chronic pain patients: Evidence from a modified version of the dot-probe

ABSTRACT Evidence that patients with chronic pain selectively attend to pain‐related stimuli presented in modified Stroop and dot‐probe paradigms is mixed. The pain‐related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronic pain, relative to healthy controls, show selective attention for pictures depicting painful faces. To do so, 170 patients with chronic pain and 40 age‐ and education‐matched healthy control participants were tested using a dot‐probe task in which painful, happy, and neutral facial expressions were presented. Selective attention was denoted using the mean reaction time and the bias index. Results indicated that, while both groups shifted attention away from happy faces (and towards neutral faces), only the control group shifted attention away from painful faces. Additional analyses were conducted on chronic pain participants after dividing them into groups on the basis of fear of pain/(re)injury. The results of these analyses revealed that while chronic pain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronic pain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed.

Panic Attacks and Perception of Inspiratory Resistive Loads in Chronic Obstructive Pulmonary Disease

RATIONALE Panic attacks are common in chronic obstructive pulmonary disease (COPD), and the prevalence of panic disorder is at least 10 times higher than in the general population. In the current study, we examined resistive load perception in patients with COPD with and without panic attacks. OBJECTIVES We tested competing hypotheses, based on conflicting results of earlier studies, that those patients with COPD with panic attacks or panic disorder would show either heightened or blunted perception of dyspnea as the magnitude of inspiratory resistive loads increased. METHODS We compared 20 patients with COPD with panic attacks or panic disorder, 20 patients without panic, and 20 healthy, age-matched subjects using an inspiratory resistive load-testing protocol. MEASUREMENTS AND MAIN RESULTS We administered a diagnostic interview for panic attacks and panic disorder. We measured perceived dyspnea in response to increasing inspiratory resistive loads (modified Borg scale) and several respiratory variables. Dyspnea ratings increased linearly for all groups as the size of resistive loads increased. No significant differences were found between groups on the respiratory variables. Patients with COPD with panic attacks or panic disorder rated their level of dyspnea significantly higher than did other subjects. CONCLUSIONS Patients with COPD with panic attacks showed heightened sensitivity to inspiratory loads. The result reinforces the influence of psychological factors on symptom perception in this disease.

Prevention of panic attacks and panic disorder in COPD

This study examined whether cognitive behavioural therapy (CBT) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease (COPD). 41 patients with COPD, who had undergone pulmonary rehabilitation, were randomised to either a four-session CBT intervention condition (n = 21) or a routine care condition (n = 20). Assessments were at baseline, post-intervention, and at 6-, 12- and 18-month follow-ups. Primary outcomes were the rates of panic attacks, panic disorder and anxiety symptoms. Secondary outcomes were depressive symptoms, catastrophic cognitions about breathing difficulties, disease-specific quality of life and hospital admission rates. There were no significant differences between the groups on outcome measures at baseline. By the 18-month follow-up assessment, 12 (60%) routine care group participants had experienced at least one panic attack in the previous 6 months, with two (17%) of these being diagnosed with panic disorder, while no CBT group participants experienced any panic attacks during the follow-up phase. There were also significant reductions in anxiety symptoms and catastrophic cognitions in the CBT group at all three follow-ups and a lower number of hospital admissions between the 6- and 12-month follow-ups. The study provides evidence that a brief, specifically targeted CBT intervention can treat panic attacks in COPD patients and prevent the development and worsening of panic-spectrum psychopathology and anxiety symptoms.