Patricia L. Dobkin

Counterbalancing Patient Demands With Evidence: Results From a Pan-Canadian Randomized Clinical Trial of Brief Supportive-Expressive Group Psychotherapy for Women With Systemic Lupus Erythematosus

Objective: To evaluate the effect of Brief Supportive-Expressive Group Psychotherapy as an adjunct to standard medical care in reducing psychological distress, medical symptoms, and health care costs and improving quality of life in women with systemic lupus erythematosus (SLE). Methods: A randomized clinical trial was conducted with 133 SLE female patients from 9 clinics across Canada. Clinical and psychosocial measures were taken at baseline, posttreatment, and 6 and 12 months posttreatment. Outcomes assessed were psychological distress, quality of life, disease activity, health service utilization, and diminished productivity. Results: Intention-to-treat analyses revealed that there were no clinically important group differences on any of the outcome measures. Conclusion: Although both groups improved over time on several measures (e.g., decreases in psychological distress, stress, and emotion-oriented coping), these changes could not be attributed to the psychotherapeutic intervention. Thus, evidence does not support the referral of these patients to this type of intervention.

A study of barriers to the engagement of significant others in adult addiction treatment

Using the focus group methodology, this study identified personal and structural barriers to the engagement of significant others in an outpatient addictions treatment program. Twenty-eight significant others (family members, other kin, and friends) associated with 21 patients participated in one of three focus group sessions. The cut-and-paste technique was used to analyze the narrative data. Improving communication and reconnecting patients with a supportive community were forms of support identified. Patients willingness to accept support and therapists invitation to involve significant others in the treatment were identified as necessary precursors to their initial involvement. Providing educational and therapeutic support to significant others were endorsed as important elements in maintaining their involvement. Offering a diversity of therapeutic services beyond standard office hours, providing home visits and child care were viewed as facilitators for their involvement. It became apparent that support providers tended to resent having their own needs ignored. Feelings of isolation, fatalism, loneliness, ignorance, and fear were expressed by significant others. Theoretical and practical implications of the findings are discussed.

Measuring Differences Between Patients' and Physicians' Health Perceptions: The Patient-Physician Discordance Scale

We report on the development and validation of an instrument to assess discordance between physicians and their patients on evaluations of health-related information: the Patient–Physician Discordance Scale (PPDS). The 10-item questionnaire is designed to be employed across chronic diseases and can be used in clinical practice and research. It measures the extent of patient–physician discordance on five aspects of the patientls health status and five aspects of the office visit. A prospective study with 200 outpatients with inflammatory bowel disease and their treating physicians revealed that the 10-item discordance scores had good construct validity and satisfactory convergent validity. Overall discordance and the three subscales, discordance on symptoms and treatment, well-being, and communication and satisfaction, identified by factor analysis, had acceptable internal consistency. Patient and physician ratings demonstrated moderate-to-high concurrent validity. Study limitations and directions for future research with PPDS are discussed.

PREDICTORS OF OUTCOME IN DRUG TREATMENT OF ADOLESCENT INPATIENTS

Little is known about for whom treatment is most effective and how to match adolescent clients to substance-abuse treatments. 280 adolescents treated in a multifaceted program participated. Of these, 128 did not complete treatment prior to termination of the 2-mo. inpatient phase. They were significantly different from clients who completed treatment measures of alienation, social maladaptation, aggression, and lower occupational status of the father. Of those who completed inpatient treatment and remained in the study at 1-mo. postdischarge (n = 69) two groups were formed, those who improved and those who either remained the same or worsened in terms of substance abuse. For those who unproved factors which differentiated them were identification with middle-class values, tendency to be older, initial difficulty identifying emotions, and depressive symptoms at intake. Clients who did not change or worsened were distinguished by more social anxiety, depressive symptoms, and troubling thoughts at intake. These results suggest that individual characteristics may identify cases who are more likely to benefit from treatment.

The relationship between exercise participation and depressed mood in women with fibromyalgia

Fibromyalgia (FM) is a chronic, widespread musculoskeletal pain disorder, with unknown organic etiology and no known pharmacologic treatment shown to be consistently effective. The present study examined the relationship between regular weekly exercise participation and depressed mood among women with FM. Seventy women with a diagnosis of FM were evaluated at baseline and at the three-year follow-up. At each assessment participants were interviewed, underwent a medical examination, and completed questionnaires assessing depressed mood, health status and daily functioning. Thirteen per cent of the women at baseline and 18% at follow-up reported doing no leisure physical activity. Depressed mood was significantly lower at follow-up compared to baseline. Engaging in more weekly leisure physical activity was associated with better functional ability at both assessments. A hierarchical multiple regression analysis revealed that after controlling for baseline depression, higher depressed mood scores at the three-year follow-up was associated with younger age, lower household income, less improvement in daily functioning and less participation in weekly leisure physical activity. These results support the claims that exercise can improve mental as well as physical health, underlining the importance of its integration into the comprehensive treatment of fibromyalgia.

Group psychotherapy for medical patients

Increasingly, the psychosocial needs of medical patients are being recognized and addressed by physicians. The biopsychosocial model of health and illness has been integrated into medical students training; medical journals are publishing results of studies demonstrating mind/body links; and randomized clinical trials are being conducted using adjunct psychosocial interventions aimed at improving medical patients outcomes. The purpose of this review paper is to increase the visibility of a promising treatment approach which has been developed for patients living with chronic diseases. First, group psychotherapy for medical patients is described. Second, selected clinical trials involving group psychotherapy are presented. Cancer, AIDS, coronary heart disease and arthritis are used as examples. Finally, the methodological challenges of evaluating this type of intervention are summarized. Implications of integrating group psychotherapy into standard medical care for patients mental and physical health, physician-based care, and costs to the medical system are discussed.

Family Factors Affecting Bone Marrow Transplantation

Bone marrow transplantation (BMT) is the last resort for children with leukemia for whom conventional treatments have failed. The case presented herein is one of an adolescent girl whose parents were unable to cope with the extreme challenge of BMT. Couple- and family-related data collected prior to the BMT showed this family was at risk. Indeed, throughout the ordeal the patient seriously regressed and her parents reactions appeared to exacerbate her condition. At discharge, when left alone, the patient manifested somatic symptoms which required her parents to attend to her needs. How family factors may influence BMT outcome is discussed.

PRELIMINARY VALIDITY OF THE BARRIERS TO TREATMENT ADHERENCE QUESTIONNAIRE IN FIBROMYALGIA: COMBINING QUANTITATIVE AND FOCUS GROUP DATA

The goals of this study were to (1) provide preliminary reliability and validity of the Barriers to Treatment Adherence Questionnaire, developed for patients with fibromyalgia, and (2) examine barriers to adherence and general adherence to multimodal treatment during a 3-mo. period. A secondary goal was to explore in a focus discussion group format patients perceptions of the adherence process and ways of managing the treatment program. 39 fibromyalgia patients were followed while participating in a combined outpatient program of physiotherapy, occupational therapy, nursing, and cognitive behavioral therapy. The Barriers to Treatment Adherence Questionnaire demonstrated good reliability. Construct validity of the Barriers to Treatment Adherence Questionnaire was supported through significant positive correlations with the General Adherence Scale at Months 1 and 3. In addition, a significant change was observed in scores on the Barriers to Treatment Adherence Questionnaire for the physiotherapy component of treatment, with scores decreasing between Months 2 and 3. Addressing barriers to improve adherence may maximize the benefit of treatment programs.