Sarah J. Miller

The therapeutic relationship in e-therapy for mental health: a systematic review.

Background E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

The relationship between body image, age, and distress in women facing breast cancer surgery.

OBJECTIVES Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery. METHODS Older (≥ 65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific). RESULTS Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (ps < 0.01); and, (3) age moderated the relationship between body image and emotional distress (ps < 0.06). SIGNIFICANCE OF RESULTS The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.

Hypnosis--there's an app for that: a systematic review of hypnosis apps.

Abstract This study systematically reviews the hypnosis apps available via iTunes that were compatible with iPhone or iPad. Of 1455 apps identified on iTunes, 407 met inclusion criteria and were further reviewed. Most common hypnosis app targets were weight loss (23%), boosting self-esteem (20%), and relaxation/stress reduction (19%); 83% of apps delivered hypnosis via audio track, and 37% allowed tailoring. Less than 14% of apps reported disclaimers. None of the apps reported having been tested for efficacy, and none reported being evidence based. Although apps have the potential to enhance hypnosis delivery, it seems as though technology has raced ahead of the supporting science. Recommendations from clinical researchers and policy makers are needed to inform responsible hypnosis app development and use.

The Relationship between Breast Cancer Anxiety and Mammography: Experiential Avoidance as a Moderator

Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β = .31, p < .01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R 2 Δ = .04, p = .07), suggesting that a womans level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations.

Motivational interviewing to improve health screening uptake: A systematic review

OBJECTIVE Health screenings, physical tests that diagnose disease, are underutilized. Motivational interviewing (MI) may increase health screening rates. This paper systematically reviewed the published articles that examined the efficacy of MI for improving health screening uptake. METHODS Articles published before April 28, 2015 were reviewed from PubMed, PsycINFO, and CINAHL. Study methodology, participant demographics, outcomes and quality were extracted from each article. RESULTS Of the 1573 abstracts, 13 met inclusion criteria. Of the 13 studies, 6 found MI more efficacious than a control, 2 found MI more efficacious than a weak control yet equivalent to an active control, and 3 found MI was not significantly better than a control. Two single arm studies reported improvements in health screening rates following an MI intervention. CONCLUSIONS MI shows promise for improving health screening uptake. However, given the mixed results, the variability amongst the studies and the limited number of randomized trials, it is difficult to discern the exact impact of MI on health screening uptake. PRACTICE IMPLICATIONS Future research is needed to better understand the impact of MI in this context. Such research would determine whether MI should be integrated into standard clinical practice for improving health screening uptake.

Colonoscopy-Specific Fears in African Americans and Hispanics

Although fears of colonoscopy may deter African Americans and Hispanics from having a screening colonoscopy, little is known about these fears. This study examined the proportion of African Americans and Hispanics who experience colonoscopy-specific fears and identified factors associated with these fears. Data were collected at an academic hospital in New York City between 2008–2010. African Americans (N = 383) and Hispanics (N = 407) who received a recommendation for a screening colonoscopy completed a questionnaire that assessed: colonoscopy-specific fears, demographics, and psychological variables. Presence of colonoscopy-specific fears was endorsed by 79.5% of participants. Being female (p < 0.001), speaking English (p < 0.001), having greater perceived risk of colorectal cancer (CRC) (p < 0.01), greater worry about risk of CRC (p < 0.01), greater fear of CRC (p < 0.001) and lower levels of self-efficacy of having a colonoscopy (p < 0.01) were associated with greater colonoscopy-specific fears. Results can inform interventions designed to assuage fears in African Americans and Hispanics.

Bowel Prep Quality in Patients of Low Socioeconomic Status Undergoing Screening Colonoscopy With Patient Navigation

The effectiveness of colonoscopy is directly affected by the quality of the patient’s bowel preparation. Patients with lower socioeconomic status (SES) are at increased risk of having suboptimal bowel prep quality. Patient navigators can play a key role in clarifying bowel prep instructions. The aim of the present study was to examine the quality of bowel prep and its predictors among individuals of low SES undergoing screening colonoscopy with patient navigation. Participants (N = 607) were individuals of low SES who completed a screening colonoscopy with patient navigation. Demographic information was collected after the participants received a primary care referral for a screening colonoscopy. After the colonoscopy was completed, medical charts were reviewed to document the colonoscopists’ bowel prep quality ratings. A total of 6.8% (41/607) of the sample had poor bowel prep, which significantly correlated with having a colonoscopy that did not reach the cecum. If fair preps were included, approximately 19.3% (117/607) of our cohort would be considered to have suboptimal bowel prep. Our suboptimal bowel prep rates were better than those reported from other low SES samples.

Low-dose computed tomography lung cancer screening as a teachable moment for smoking cessation among African American smokers: A feasibility study.

Abstract Low-dose computed tomography (LDCT) screening may be a teachable moment for smoking cessation among African Americans. African Americans have been understudied within the context of LDCT and smoking cessation. The study objective was to evaluate the feasibility of recruiting African Americans to a future longitudinal trial and to obtain sample size estimates for that trial. Participants (N = 18) were African Americans eligible for LDCT screening who completed a questionnaire at three time points. Self-efficacy and intention to quit smoking were compared. The results of the current study show that it is feasible to recruit African Americans eligible for LDCT.

Abstract B60: Racial/ethnic differences in pregnant women's knowledge of the relationship between breast cancer risk and breastfeeding

Objectives: Breastfeeding reduces the risk of breast cancer, particularly triple negative breast cancer. Yet black women, who are at greater risk of developing triple negative breast cancer, are the least likely racial group to breastfeed. Little is known about black women9s knowledge of the link between breast cancer and breastfeeding. Given the link between BC and breastfeeding, among other benefits to breastfeeding, it is critical to understand why black women are the least likely racial group to breastfeed. The current study was designed to describe pregnant women9s knowledge of the breastfeeding and breast cancer link and other psychosocial variables among three racial/ethnic groups (black, white and Hispanic). It is hypothesized that pregnant black women will have lower knowledge about the benefits of breastfeeding, including knowledge about the link between breastfeeding and breast cancer than either white or Hispanic women. It is further hypothesized that, compared to other racial groups, black women will have lower intentions to breastfeed, poorer attitudes toward breastfeeding, lower self-efficacy, and lower levels of social influence/support to breastfeed. Methods: This research study was Institutional Review Board-approved and conducted in accordance with prevailing ethical principles. Pregnant women 18 years or older (N=93; 48.4% black; 28.0% Hispanic) were recruited during a prenatal visit at the OB/GYN practice of an urban hospital. The practice primarily serves underinsured women. The one-time, anonymous self-report survey was comprised of questions that captured each participant9s socio-demographic information such as age, race/ethnicity, education level and income as well as their breastfeeding knowledge, intentions, attitudes, and social influences (i.e., baby9s father, maternal/paternal grandmother opinion and preference for infant feeding). Results: Less than 40% of both black and white women were aware of the relationship between breastfeeding and breast cancer risk reduction, in comparison to 64.7% of Hispanic women. The opinions of the baby9s father and their doctor about breastfeeding were regarded the most important to black women. Contrary to our hypotheses, all women reported high intentions to breastfeed but most women indicated that they intended to breastfeed for less than 12 months. Black women also had the highest levels of positive breastfeeding attitudes and self-efficacy. Conclusions: The benefits of breastfeeding for long-term maternal health such as reduced risk of BC, including triple negative breast cancer in black women, have been documented in the literature; yet black women are least likely to breastfeed. The current study demonstrates that women have low knowledge about the link between BC and breastfeeding, particularly black and white women. These findings support the need for targeted interventions educating black women about the protective benefits of breastfeeding, particularly breast health, as a strategy to reduce their incidence and mortality of breast cancer. Despite our hypotheses, black women had higher rates of self-efficacy, breastfeeding attitudes, breastfeed intent, and medical mistrust. Future research efforts need to further explore why black women have the lowest breastfeeding rates, yet high rates of intentions, self-efficacy and attitudes about breastfeeding. Citation Format: Jamilia Sly, Sarah Miller, Rhoda Sperling, Fahimeh Sasan, Holly Loudon, Elizabeth Howell, Lina Jandorf. Racial/ethnic differences in pregnant women9s knowledge of the relationship between breast cancer risk and breastfeeding. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B60.