Recent research: six studies on management, health messages, behavioural activation, ACT, expressive writing, and wellbeing
Last updated on 30th March 2010
Here are mixed bag of psychotherapy-relevant studies. Foy & colleagues' meta-analysis highlights the value to patients/clients of having good communication between their primary care physician and their mental health professional. The second paper I mention - free full text - by Mollen et al is a bit of a wake-up call for me. The authors write " ... we will discuss why people conform to social norms and then extend this knowledge to the field of health communication and behaviour change. We will elaborate on the advantages and disadvantages of using social norm messages, and then offer alternatives for the use of social norms in health communication messages ... Clearly, there is a substantial evidence suggesting that, when unhealthy behaviour is highly prevalent, descriptive norms should not be conveyed in health promotion campaigns. In such cases, injunctive norms offer an alternative and promising approach to promote health behaviour change." Whoops, it looks like I should stop hammering on about how poor our exercise, diet and other health behaviours often are, and shift to an "injunctive" or "motivational interviewing" set of comments instead.
MacPherson et al give a new spin to the well-documented value of behavioral activation for depression in their paper "Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms." In what seems an important paper with much more general relevance than just to pain management, Vowles & McCracken discuss the value of " ... acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility." They show that changes in these variables during their pain management intervention were "consistently and significantly" related to improvements in functioning, while changes in more traditional variables like physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training were " ... essentially unrelated to treatment improvements." See the Bath Centre for Pain Services for more about their work.
Pachankis & Goldfried publish on "Expressive writing for gay-related stress: psychosocial benefits and mechanisms underlying improvement." adding to the large literature both on the often detrimental effects of keeping emotionally charged "secrets" and on the frequent benefits of expressive writing. See January's posts for three on "Writing (& speaking) for resilience & wellbeing". Finally ten Doesschate et al write on "Health related quality of life (HRQOL) in recurrent depression: a comparison with a general population sample." They conclude that even in people whose depression has remitted "HRQOL is lower than in the general population which emphasizes that also in this phase of recurrent depression HRQOL deserves attention ... These findings imply that residual symptoms should be treated aggressively and HRQOL enhancement therapies should be developed." Further reason to consider wellbeing-enhancement as a worthwhile strategy to consider in the recovery phase of depressive (and anxiety) disorders.
Foy, R., S. Hempel, et al. (2010). "Meta-analysis: Effect of Interactive Communication Between Collaborating Primary Care Physicians and Specialists." Annals of Internal Medicine 152(4): 247-258. [Abstract/Full Text]
Background: Whether collaborative care models that enable interactive communication (timely, 2-way exchange of pertinent clinical information directly between primary care and specialist physicians) improve patient outcomes is uncertain. Purpose: To assess the effects of interactive communication between collaborating primary care physicians and key specialists on outcomes for patients receiving ambulatory care. Data Sources: PubMed, PsycInfo, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Web of Science through June 2008 and secondary references, with no language restriction. Study Selection: Studies that evaluated the effects of interactive communication between collaborating primary care physicians and specialists on outcomes for patients with diabetes, psychiatric conditions, or cancer. Data Extraction: Contextual, intervention, and outcome data from 23 studies were extracted by one reviewer and checked by another. Study quality was assessed with a 13-item checklist. Disagreement was resolved by consensus. Main outcomes for analysis were selected by reviewers who were blinded to study results. Data Synthesis: Meta-analysis indicated consistent effects across 11 randomized mental health studies (pooled effect size, -0.41 [95% CI, -0.73 to -0.10]), 7 nonrandomized mental health studies (pooled effect size, -0.47 [CI, -0.84 to -0.09]), and 5 nonrandomized diabetes studies (pooled effect size, -0.64 [CI, -0.93 to -0.34]). These findings remained robust to sensitivity analyses. Meta-regression indicated studies that included interventions to enhance the quality of information exchange had larger effects on patient outcomes than those that did not (-0.84 vs. -0.27; P = 0.002). Limitations: Because collaborative interventions were inherently multifaceted, the efficacy of interactive communication by itself cannot be established. Inclusion of study designs with lower internal validity increased risk for bias. No studies involved oncologists. Conclusion: Consistent and clinically important effects suggest a potential role of interactive communication for improving the effectiveness of primary care-specialist collaboration.
Mollen, S., R. A. C. Ruiter, et al. (2010). "Current issues and new directions in Psychology and Health: What are the oughts? The adverse effects of using social norms in health communication." Psychology & Health 25(3): 265 - 270. [Free Full Text]
We are continuously influenced by other people. We are influenced by what they do, what they say and what they do not say. Other people's behaviour guides our own actions because it provides social proof regarding what is considered appropriate or inappropriate conduct in a given situation ... Social norms are important predictors of behaviour and their predictive role is the context in which they are generally discussed. However, in this editorial, we will not focus on the predictive role of social norms. Rather, we will discuss why people conform to social norms and then extend this knowledge to the field of health communication and behaviour change. We will elaborate on the advantages and disadvantages of using social norm messages, and then offer alternatives for the use of social norms in health communication messages ... Clearly, there is a substantial evidence suggesting that, when unhealthy behaviour is highly prevalent, descriptive norms should not be conveyed in health promotion campaigns. In such cases, injunctive norms offer an alternative and promising approach to promote health behaviour change. However, to date, most experimental research on the use of descriptive versus injunctive norms has focused on environmental issues, such as littering (Reno, Cialdini, & Kallgren, 1993) and energy conservation (Schultz et al., 2007). Research on the potentially adverse effects of unhealthy descriptive majority norms on health behaviour and injunctive social norms as a possible alternative is thus imperative. Such research can contribute substantially to the field of health psychology by providing evidence-based indications for the responsible communication of social norms in health promotion practice.
MacPherson, L., M. T. Tull, et al. (2010). "Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms." J Consult Clin Psychol 78(1): 55-61. [PubMed]
OBJECTIVE: Depressive symptoms are associated with poor smoking cessation outcomes, and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. In this pilot study, we examined whether a behavioral activation treatment for smoking (BATS) can enhance cessation outcomes. METHOD: A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years of age; 48.5% were women; 72.7% were African American) seeking smoking cessation treatment were randomized to receive either BATS paired with standard treatment (ST) smoking cessation strategies including nicotine replacement therapy (n = 35) or ST alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at Session 4 for each treatment condition. Participants completed a baseline assessment; furthermore, measures of smoking cessation outcomes (7-day verified point-prevalence abstinence), depressive symptoms (Beck Depression Inventory-II; Beck, Steer, & Brown, 1996), and enjoyment from daily activities (Environmental Reward Observation Scale; Armento & Hopko, 2007) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. RESULTS: Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59, 95% CI [1.22, 10.53], p = .02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = -1.99, SE = 0.86, p = .02) than did those in ST. CONCLUSIONS: Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds.
Vowles, K. E. and L. M. McCracken (2010). "Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes." Behaviour Research and Therapy 48(2): 141-146. [Abstract/Full Text]
Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.
Pachankis, J. E. and M. R. Goldfried (2010). "Expressive writing for gay-related stress: psychosocial benefits and mechanisms underlying improvement." J Consult Clin Psychol 78(1): 98-110. [PubMed]
OBJECTIVE: This study tested the effectiveness of an expressive writing intervention for gay men on outcomes related to psychosocial functioning. METHOD: Seventy-seven gay male college students (mean age = 20.19 years, SD = 1.99) were randomly assigned to write for 20 min a day for 3 consecutive days about either (a) the most stressful or traumatic gay-related event in their lives or (b) a neutral topic. We tested an exposure-based hypothesis of written emotional expression by asking half of the participants who were assigned to write about gay-related stress to read their previous day's narrative before writing, whereas the other half did not. Posttest and 3-month follow-up outcomes were assessed with common measures of overall psychological distress, depression, physical health symptoms, and positive and negative affect. Gay-specific social functioning was assessed with measures of gay-related rejection sensitivity, gay-specific self-esteem, and items regarding openness and comfort with one's sexual orientation. RESULTS: Participants who wrote about gay-related stress, regardless of whether they read their previous day's writing, reported significantly greater openness with their sexual orientation 3 months following writing than participants who wrote about a neutral topic, F(1, 74) = 6.66, p < .05, eta(2) = .08. Additional analyses examined the impact of emotional engagement in the writing, severity of the expressed topic, previous disclosure of writing topic, tendency to conceal, and level of perceived social support on mental health outcomes. CONCLUSIONS: The findings suggest that an expressive writing task targeting gay-related stress can improve gay men's psychosocial functioning, especially openness with sexual orientation. The intervention seems to be particularly beneficial for those men who write about more severe topics and for those with lower levels of social support. The findings suggest future tests of expressive writing tasks for different aspects of stigma-related stress.
ten Doesschate, M. C., M. W. Koeter, et al. (2010). "Health related quality of life in recurrent depression: a comparison with a general population sample." J Affect Disord 120(1-3): 126-32. [PubMed]
BACKGROUND: In the acute phase major depressive disorder (MDD) is a disabling disease. We compared HRQOL in patients with remitted MDD (rMDD) with a community sample and longitudinally assessed the relation between depressive symptoms and HRQOL in recurrently depressed patients. METHODS: We used 12-month data of patients from the Depression Evaluation Longitudinal Therapy Assessment (DELTA) study. HRQOL was assessed with the Medical Outcome Short Form (SF-36). Remission was determined with the Structured Clinical Interview for DSM-IV and depressive symptoms were assessed with the Beck Depression Inventory. Patients' mean SF-36 scores were compared with those of an age- and sex-matched Dutch reference population. The longitudinal relation between levels of SF-36 and levels of depressive symptomatology was assessed with a repeated measures linear regression analysis using the mixed models module. RESULTS: In patients with rMDD in the remitted phase, especially in women, both physical and mental HRQOL was lower than in a Dutch population sample. An increase in the level of depressive symptoms corresponded to a decrease in all scales of the SF-36. CONCLUSION: Also in remitted rMDD patients, especially in women, HRQOL is lower than in the general population which emphasizes that also in this phase of recurrent depression HRQOL deserves attention. Furthermore, in patients with rMDD a higher depressive symptom severity level is associated with a lower HRQOL. These findings imply that residual symptoms should be treated aggressively and HRQOL enhancement therapies should be developed.