The Importance of the Treatment Rationale for Pain in Animal-Assisted Interventions: A Randomized Controlled Trial in Healthy Participants.

Animal-assisted interventions (AAIs) is a promising treatment approach for pain, but possible mechanisms still need to be elucidated. This study set out to investigate the analgesic effects of an animal provided with a treatment rationale in a randomized controlled trial employing a standardized experimental heat-pain paradigm. We randomly assigned 128 healthy participants to: dog treatment (DT), placebo treatment (PT), dog and placebo treatment (DPT), and no treatment (NT). Primary outcomes were heat-pain tolerance and the corresponding self-reported ratings of pain unpleasantness and intensity. Results revealed no differences in heat-pain tolerance between the conditions. However, participants in the DT condition experienced heat-pain as significantly less unpleasant at the limit of their tolerance compared to participants in the NT condition (estimate = -0.96, CI = -1.58 to 0.34, P = .010). Participants in the DT condition also showed lower ratings of pain intensity at the limit of their tolerance compared to participants in the NT condition (estimate = -0.44, CI = -0.89 to 0.02, P = .060). This study indicates that a dog has analgesic effects on pain perception when integrated into the treatment rationale. We assume that providing a treatment rationale regarding the animal is important in AAIs for pain. PERSPECTIVE: This study shows that the presence of an animal is not sufficient for animal-assisted interventions (AAIs) to have an analgesic effect on pain unless they are provided with a treatment rationale. This could imply that not only the animal but also contextual factors are important in AAIs. TRIAL REGISTRATION: Clinical Trials NCT04361968.

Animal-Assisted Psychotherapy for Pediatric Chronic Pain: Case Series of an Open Pilot Study to Test Initial Feasibility and Potential Efficacy.

Objective: Chronic pain is a common complaint in children and adolescents, placing an enormous burden on individuals, their families, and the healthcare system. New innovative approaches for the treatment of pediatric chronic pain (PCP) are clearly warranted, as drop-out rates in intervention studies are high and it can be difficult to engage patients with PCP in therapy. Here, animal-assisted interventions (AAIs) might be promising, since there is preliminary evidence for the approach in adults with chronic pain, and AAIs are generally known to foster the therapeutic motivation of patients. To date, however, AAIs have not been examined in pediatric chronic pain. Methods: The aim of this open pilot study was to examine the initial feasibility of recruitment and potential efficacy of an animal-assisted group psychotherapy (including horses, rabbits, chickens, goats, and a dog), providing case reports of three children with chronic pain. We applied a mixed-methods approach, including the conductance of semi-structured interviews and assessment of quantitative pre-post data with a focus on pain severity, avoidance behavior, pain acceptance, and ability to defocus from the pain. Results: The three participating girls (age: 9-12 years) reported chronic pain in the head and abdomen. The process of recruitment turned out to be challenging. All three children reported reduced pain-related disability and pain-related distress, as well as an increased ability to accept pain and to defocus from the pain. The qualitative data revealed that patients and their parents had a positive attitude towards AAIs. Conclusion: Our initial open pilot study is the first to investigate AAIs in the context of pediatric chronic pain. Notably, we had difficulties in the recruitment procedure, mostly due to the Covid-19 situation. Based on three case reports, we found some first indication that AAI approaches might be associated with symptom changes. Future randomized-control studies with larger sample sizes are clearly warranted. Clinicaltrialsgov Identifier: NCT04171336.

Adjustment in third culture kids: A systematic review of literature.

Third Culture Kids (TCKs) are children of expatriates who live in a culture other than their country of nationality or their parent's country of nationality for a significant part of their childhood. Past research has indicated that adjustment is a key factor in the success of global mobility. However, current research in the area of TCK adjustment is lacking. This systematic review aims to present and summarize all available published scientific data on the adjustment of internationally mobile children and adolescents who relocate with their families. We aim to understand factors related to TCK adjustment, highlight lacking research areas, and define areas of interest for future research. The eligibility criteria for inclusion in the review were: traditional TCKs; aged 7-17 years; measures taken during the relocation; outcome variables of wellbeing, psychological adjustment or social adjustment, or socio-cultural adjustment or adjustment. An initial search across eight databases in December 2021 yielded 9,433 studies, which were included in COVIDENCE and reviewed independently by two researchers at each phase. We finally included 14 studies in this study, 10 of which presented quantitative data. Extracted quantitative and qualitative studies were abstracted, and the main findings are presented using a consistent grid of codes: an initial computerized lexical scan (Leximancer) of all included papers generated a preliminary list of topics and their frequencies. We refined these initial topics using the most prominent theories around the topics of TCK, adjustment, and the extracted theories from selected papers and created a codebook. Then we abstracted the quantitative data from the selected studies and organized the statistically significant findings according to the codes. Lastly, we abstracted and synthesized the findings from qualitative studies. Efforts were made to present the available data within a reading grid, which enhances the understanding of mechanisms specific to the sample population and also makes it apparent where more research is needed. Specifically, findings suggest a need for a more inclusive multi-trajectory adjustment model and a better definition of the ecological sample. The coding system for the extraction and analysis in this systematic review may be a guide for researchers planning future studies on TCK adjustment. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151071, identifier: CRD42020151071.

Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study.

OBJECTIVE: COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge. METHODS: This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge. RESULTS: Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only. CONCLUSION: COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies.