A pilot test of Internet-delivered brief interactive training sessions for depression: Evaluating dropout, uptake, adherence, and outcome.

OBJECTIVE: Uptake, adherence, and dropout rates for Internet-based programs for depression are in need of improvement. Excessive user burden (eg, heavy content, extended duration) may undermine engagement and precipitate dropout. To address this problem, an alternative format was proposed: Brief Interactive Training Sessions (BITS). BITS target a narrow behavioral health skill and require 3-4 hours to complete. A depression-focused version of BITS that provides training in cognitive distortion/restructuring was tested. PARTICIPANTS: Fifty-two depressed college students were randomly assigned to BITS or to a wait-list. METHODS: Students competed pre-and post-test (7 week) assessments of depression and cognitive distortions. RESULTS: Uptake rate was 83%. Among study completers, adherence was 96%. The dropout rate did not improve. Compared to the control group, the experimental group reported a significant reduction in depression and in cognitive distortions. CONCLUSIONS: The BITS format is a promising vehicle for improving uptake and adherence while achieving positive clinical outcomes.

Adherence versus striving to adhere to vegan, vegetarian, or pescatarian diets: Applying a goal-centered, self-regulatory framework.

Adherence to plant-rich diets remains low despite numerous health benefits accruing to such practices. We sought to distinguish college students who report high adherence to a plant-rich diet ("Sustainers") from those who are less successful ("Strivers"). Sustainers more strongly endorsed multiple ethical dietary motives and indicated stronger allegiance to their values compared to Strivers, who rated health reasons more highly. Sustainers scored better on seven factors relating to effective dietary goal pursuit. Results underscore the importance of motivational factors in the maintenance of plant-based eating.

A goal-systems perspective on plant-based eating: keys to successful adherence in university students.

OBJECTIVE: To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems. DESIGN: A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits. SETTING: Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools. PARTICIPANTS: University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents). RESULTS: Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report 'To manage or treat a medical condition' as motivation and almost seven times more likely to report 'To align with my ethical beliefs' as motivation compared with non-adherents. However, these participants were 94 % less likely to report 'To maintain and/or improve my health' as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet. CONCLUSIONS: Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.

Examining the Adjustment Patterns of Adults With Multiple Chronic Pain Conditions and Multiple Pain Sites: More Pain, No Gain.

The present study examined how multiple chronic pain conditions and pain sites are associated with sociodemographics, chronic pain adjustment profiles, and emotional distress. A total of 2,407 individuals who reported at least 6 months of having consistent pain severity, pain interference, and/or emotional burden due to pain were recruited through random digit dialing across the United States. Participants' chronic pain adjustment profiles (ie, pain intensity, pain interference, emotional burden, pain catastrophizing, pain coping, pain attitudes, and social resources) were assessed. Anxiety and depressive symptoms were also measured using a subsample of 181 participants who provided 3-month follow-up data. More than 60% of individuals with chronic pain reported having multiple pain conditions. Middle-aged single women with fibromyalgia, disability and of low socioeconomic status reported a greater number of pain conditions and pain sites. Structural equation modeling revealed that a higher number of pain conditions and sites were associated with more dysfunctional chronic pain adjustment profiles. The subsample analyses showed that reporting a greater number of pain conditions predicted a higher level of depression and anxiety 3 months later, controlling for pain-related anxiety and depressive symptoms, pain severity and interference at baseline. Having multiple pain conditions and sites may represent a psychosocial barrier to successful adjustment to chronic pain. PERSPECTIVE: This article argues for the importance of assessing the number of co-occurring chronic pain conditions and bodily areas that are affected by pain in both pain research and clinical settings. Measuring and incorporating such information could potentially enhance our nascent understanding of the adjustment processes of chronic pain.

Addressing Item-Level Missing Data: A Comparison of Proration and Full Information Maximum Likelihood Estimation.

Often when participants have missing scores on one or more of the items comprising a scale, researchers compute prorated scale scores by averaging the available items. Methodologists have cautioned that proration may make strict assumptions about the mean and covariance structures of the items comprising the scale (Schafer & Graham, 2002 ; Graham, 2009 ; Enders, 2010 ). We investigated proration empirically and found that it resulted in bias even under a missing completely at random (MCAR) mechanism. To encourage researchers to forgo proration, we describe a full information maximum likelihood (FIML) approach to item-level missing data handling that mitigates the loss in power due to missing scale scores and utilizes the available item-level data without altering the substantive analysis. Specifically, we propose treating the scale score as missing whenever one or more of the items are missing and incorporating items as auxiliary variables. Our simulations suggest that item-level missing data handling drastically increases power relative to scale-level missing data handling. These results have important practical implications, especially when recruiting more participants is prohibitively difficult or expensive. Finally, we illustrate the proposed method with data from an online chronic pain management program.

Psychosocial and demographic correlates of employment vs disability status in a national community sample of adults with chronic pain: toward a psychology of pain presenteeism.

BACKGROUND: Although chronic pain is a source of work-related disability, relatively little research has addressed the psychological factors that differentiate individuals in chronic pain who leave the workforce from those who remain on the job despite their pain. OBJECTIVE: The present study examined a small set of attitudinal and coping-related factors as potential correlates of pain-related disability vs continued part- or full-time employment over and above the role of well-known risk factors. METHODS: A large sample of adult men and women with chronic pain drawn from across the United States (N = 1,293) by means of random digit dialing was subdivided into two groups: working (N = 859) and on disability (N = 434). Both groups were interviewed (by telephone) to complete a set of instruments (called the Profile of Chronic Pain: Extended Assessment battery) measuring pain attitudes and coping methods. RESULTS: Logistic regression analysis revealed that continued employment status was inversely related to pain severity and was positively related to higher education and being Hispanic. After controlling for severity and demographic factors, belief in a medical cure and catastrophizing tendencies were significant inverse predictors, and task persistence was a positive predictor of continued employment. CONCLUSIONS: Results revealed both demographic and attitudinal predictors of continued employment and highlight the value of harnessing insights from the psychology of work engagement to better understand the processes underlying pain presenteeism. Interventions designed to keep persons with pain in the active work force should build upon and extend the present findings.

Cross-cultural adaptation and validation of the profile of chronic pain: screen for a Brazilian population.

OBJECTIVE: To translate the original English version of the Profile of Chronic Pain: Screen (PCP:S) into Brazilian Portuguese and examine basic psychometric properties of the translated version. We investigated ceiling and floor effects, internal consistency, factor structure, convergent validity, and the ability of the Brazilian PCP:S (B-PCP:S) to discriminate persons with pain who were either employed or not working, or in treatment or not in treatment. METHODS: The Brazilian Portuguese version of the Profile of Chronic Pain: Screen (B-PCP:S) was administered to a sample of 414 adults (men = 67). Pain catastrophizing was also assessed. Subsamples with special conditions (working despite pain [N = 116] vs not working due to pain [N = 122], and not receiving treatment for pain [N = 119] vs receiving treatment [N = 119]) were identified to investigate the discriminative properties of B-PCP:S. RESULTS: For the B-PCP:S, Cronbach's α values were 0.76 (severity), 0.88 (interference), and 0.87 (emotional burden). Confirmatory factor analysis supported the original, English language three-factor structure, with the comparative fit index = 0.93, root mean square error of approximation = 0.075, and normed fit index = 0.93. Significant correlations were found between pain intensity, pain interference, and emotional burden, and a criterion measure of catastrophizing (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). B-PCP:S scores (severity, interference, and emotional burden) were higher in subjects under a doctor's care for pain and in those not working due to pain. CONCLUSION: This B-PCP:S version was found to be a reliable instrument, with basic evidence of validity for the evaluation of pain severity, interference, and emotional burden in Brazilian Portuguese adults. The profile of B-PCP:S scores was similar to that observed in the original version.

A randomized controlled evaluation of an online chronic pain self management program.

Internet-based educational and therapeutic programs (e-health applications) are becoming increasingly popular for a variety of psychological and physical disorders. We tested the efficacy of an online Chronic Pain Management Program, a comprehensive, fully self-directed and self-paced system that integrates social networking features and self-management tools into an interactive learning environment. Of 305 adult participants (196 women, 109 men), a total of 162 individuals with chronic pain were randomly assigned unsupervised access to the program for approximately 6 weeks; 143 were assigned to the wait-listed control group with treatment as usual. A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter. All recruitment, data collection, and participant involvement took place online. Participation was fully self-paced, permitting the evaluation of program effectiveness under real-world conditions. Intent-to-treat analysis that used linear growth models was used as the primary analytic tool. Results indicated that program utilization was associated with significant decreases in pain severity, pain-related interference and emotional burden, perceived disability, catastrophizing, and pain-induced fear. Further, program use led to significant declines in depression, anxiety, and stress. Finally, as compared to the wait-listed control group, the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management. Study limitations are considered, including the recognition that not all persons with chronic pain are necessarily good candidates for self-initiated, self-paced, interactive learning.

Psychosocial correlates of chronic pain and depression in young adults: further evidence of the utility of the Profile of Chronic Pain: Screen (PCP: S) and the Profile of Chronic Pain: Extended Assessment (PCP: EA) battery.

OBJECTIVE: The goals of the present studies were 1) to determine the psychometric utility and norms of the Profile of Chronic Pain: Screen (PCP: S) in young adults (ages 17-24) with self-reported pain and 2) to compare non-, mildly-, and clinically-depressed young adults with chronic pain in their patterns of pain attitudes and pain beliefs as assessed by the Profile of Chronic Pain: Extended Assessment (PCP: EA) battery. METHODS: Participants in the first study included 2,475 male and female college students drawn from undergraduate introductory psychology classes in a large western (U.S.) university. Study 2 participants were 275 male and female introductory psychology students, screened for chronic pain and depression from a cohort of 1,266 students. RESULTS: Study 1 results confirmed the utility of the PCP: S as a screening tool for pain problems in young adults. Study 2 revealed that, although not differing in pain severity, clinically depressed participants differed from their nondepressed and mildly depressed peers in terms of enhanced catastrophizing tendencies and greater perceived disability. Both depressed groups scored lower on control beliefs than the nondepressed group. Moreover, the clinically depressed students reported the highest scores on pain-induced fear, differing from both the mildly depressed and the nondepressed. Finally, the three groups did not differ in their belief in a medical cure. CONCLUSIONS: Results suggest that depressed young persons with chronic pain demonstrate a pattern of negative attitudes and beliefs that could compromise their ability to flexibly adjust to changing life circumstances.

Psychosocial aspects of pain-related life task interference: an exploratory analysis in a general population sample.

OBJECTIVE: To assess perceptions of the interfering effects of chronic pain upon the frequency of eight activities of daily living, and to examine the psychosocial correlates of these perceptions. The areas assessed included social life, recreation, sleep, household chores, working at a paid job, self-care, exercise, and routine physical activities. DESIGN: A telephone survey of U.S. English-speaking adults was conducted using a random digit dialing recruitment procedure. The data are cross-sectional. PARTICIPANTS: A national sample of adult men and women aged 25-80 years was recruited. A total of 9,759 persons were screened for the presence of chronic pain. Of the 3,050 found eligible, a total of 2,407 adults with chronic pain completed measures of pain interference and its psychosocial correlates. MEASURES: Participants provided responses to the Profile of Chronic Pain: Screen (PCP: S) and to the Profile of Chronic Pain: Extended Assessment (PCP: EA) battery. The PCP: S measures key aspects of chronic pain, and the PCP: EA assesses pain attitudes and beliefs, coping, and positive and negative social responses to pain. RESULTS: Regression analyses revealed that pain severity, along with factors assessed by the PCP: EA (including catastrophizing, fear of pain, guarding, and control beliefs), accounts for 16-40% of the variance in perceptions of functional task interference. CONCLUSIONS: Although pain severity is consistently related to life task interference, several psychosocial variables make incremental contributions to the perception of pain's deleterious influence on daily task functioning.

Evaluating chronic pain impact among patients in primary care: further validation of a brief assessment instrument.

OBJECTIVE: To evaluate the psychometric properties of the Profile of Chronic Pain: Screen (PCP:S) in primary care. The PCP:S is a brief assessment device designed to gauge pain severity, interference, and emotional burden. DESIGN: Questionnaire survey with short-term reliability and validity follow-up. METHODS: Two hundred and forty-four outpatients (52% female) with chronic pain recruited from five primary care settings completed the 15-item PCP:S at an initial testing session. Approximately 1 week later, two subgroups participated in a retest reliability and validity follow-up. The battery of follow-up questionnaires included a measure of social desirability response bias and several instruments designed to provide convergent validity for the PCP:S. RESULTS: Retest reliability, internal consistency, factor structure, and social desirability bias were all found to be acceptable. Likewise, preliminary evidence suggests that, by virtue of its correlation with established measures of pain adjustment, the PCP:S is a valid pain assessment device. CONCLUSIONS: Although the PCP:S was initially developed and validated using a national community sample of adults with chronic pain who provided data via telephone interviews, the present findings support its use as a brief and psychometrically sound paper-and-pencil measure for the assessment of three key components of chronic pain in primary care.

Psychological "resilience" and its correlates in chronic pain: findings from a national community sample.

The display of effective functioning despite exposure to stressful circumstances and/or internal distress is often termed 'resilience'. The study of resilience is believed to provide information about the nature of illness adaptation that is distinct from that obtained via the analysis of clinically impaired groups. In recent years, the concept of resilience has seen only limited exploration in the chronic pain literature. This article describes a multi-step procedure that first identifies resilience among chronic pain sufferers selected from a national sample of adults and then examines a set of its psychological correlates. Using the Profile of Chronic Pain:Screen (PCP:S), administered to a national sample of adults with chronic pain, a resilient subsample was identified on the basis of high scores on a Severity scale (at least 1 SD above the mean) combined with low scores (at least 1 SD below the mean) on scales assessing Interference and Emotional Burden. An age- and gender-matched non-resilient subsample was then selected who scored high (at least one standard deviation above the mean) on Severity, Interference, and Emotional Burden. The results of a series of comparisons between the resilient and non-resilient groups revealed significant differences favoring resilient individuals in coping style, pain attitudes and beliefs, catastrophizing tendencies, positive and negative social responses to pain, and health care and medication utilization patterns. The findings provide a preliminary foundation for further research aimed at understanding the nature and causal underpinnings of resilience in persons with chronic pain.

The development and preliminary validation of the Profile of Chronic Pain: Extended Assessment Battery.

The aim of the present research was the development and validation of a set of instruments, collectively called the Profile of Chronic Pain: Extended Assessment Battery (PCP:EA), designed to be administered to adults (between the ages of 25 to 80) after establishing the existence of a chronic pain problem. The final 86-item version of the PCP:EA consisted of 33 single items assessing: pain location and severity, pain characteristics (e.g. worst daily pain), medication use, health care status, the identity of the most important person in the patient's life, and functional limitations in 10 areas of daily living. In addition, the PCP:EA includes 13 multi-item subscales addressing aspects of coping (guarding, ignoring, task persistence, and positive self-talk), catastrophizing, pain attitudes and beliefs (including disability beliefs, belief in a medical cure for pain, belief in pain control, and pain-induced fear), and positive (tangible and emotional) and negative (insensitivity and impatience) social responses. Data were obtained from two national samples which were recruited and screened via a random-digit dialing telephone interview procedure. Stratified sampling was employed to assure equal gender and age group representation across three age groupings (25-44; 45-64; 65-80). Two survey studies provided strong evidence for the hypothesized factor structure, internal consistency, independence from response bias, and validity of the PCP:EA. Moreover, the presence of normative data enhance the diagnostic and prescriptive utility of the instrument.

Comparing the experiential and psychosocial dimensions of chronic pain in african americans and Caucasians: findings from a national community sample.

OBJECTIVES: To ascertain whether non-Hispanic African American and Caucasian chronic pain sufferers differ or converge in their self-reports of pain experience and pain adjustment. RESEARCH DESIGN: A telephone survey of U.S. English-speaking adults selected via random-digit dialing procedures and constrained to locate persons with chronic pain within selected gender by age groupings. SUBJECTS: A national sample of 2,407 participants contained a total of 214 non-Hispanic African Americans. A sample of 214 non-Hispanic Caucasians was randomly selected from the larger set of 1,935 Caucasian participants to serve as a comparison group for the present study. MEASURES: Participants provided responses to interviewer questions that assessed pain experience (severity, interference, and emotional burden) and psychosocial outcomes (coping, attitudes and beliefs, catastrophizing, social support and hindrance, pain's interference with daily life activities, treatment status, and medication taking). RESULTS: Although African American and Caucasian adults with chronic pain did not differ significantly in pain severity, interference, emotional burden, or current treatment status, multivariate analyses revealed differences in several domains of psychosocial functioning. Compared to Caucasians, African Americans reported greater pain-related interference with daily living, deficiencies in coping, and counterproductive attitudes and beliefs. African Americans also reported greater impatience and insensitivity from the most important person in their lives. CONCLUSIONS: Psychosocial dimensions of chronic pain differed between community-residing African American and Caucasian adults surveyed as part of a national sample.

The Assessment of Adult Health Care Orientations: Development and Preliminary Validation of the Multidimensional Health Profile-Health Functioning Index (MHP-H) in a National Sample.

This paper describes the development and preliminary validation of the Multidimensional Health Profile-Health Functioning Index (MHP-H), a 69-item self-report instrument designed to assess a variety of behaviors, perceptions, attitudes, and beliefs presumed to influence health status and the pursuit of lay and professional health care. The MHP-H briefly measures adult health history, health habits, health care utilization, health beliefs and attitudes, and response to illness (help-seeking behaviors). A national sample of adults (N = 673) was assessed, comprising 3 age groupings (18-32, 33-50, and 51-89) crossed with gender and then further subdivided into several subsamples for purposes of reliability and validity assessment. In addition, a group of spouse "key informants" was also recruited. Preliminary validation of single-item indicators as well as confirmatory factor analyses of multi-item scales was achieved. The present findings support the psychometric and practical utility of the MHP-H and warrant its use by health psychologists in a variety of research and applied settings.

The development and preliminary validation of a brief measure of chronic pain impact for use in the general population.

From a biopsychosocial perspective, assessing chronic pain's psychological impact should involve at minimum the measurement of pain severity, functional interference, and pain-related emotional burden. This article details the development of a brief instrument, the 15-item Profile of Chronic Pain: Screen (PCP:S), designed to address these three key elements in a national (US) sample of over 2400 individuals recruited via random digit dialing. Retest reliability, internal consistency, and preliminary validity were excellent. The scales also demonstrated minimal social desirability response bias. A series of confirmatory factor analyses on several distinct samples revealed a stable, 3-factor solution reflecting pain severity, interference, and emotional burden. Finally, national norms were developed by gender and three age groups. In view of its strong psychometric properties, the PCP:S has the potential to serve as a brief, cost-effective assessment tool for identifying individuals whose chronic pain merits more detailed psychosocial evaluation.

Social support and social norms: do both contribute to predicting leisure-time exercise?

OBJECTIVE: To clarify the contribution of social support and social norms to exercise behavior. METHODS: A sample of 363 college students completed a questionnaire that assessed social support and social negativity from friends, descriptive and injunctive social norms related to friends, perceived behavioral control, attitude, intention, and leisure-time exercise. RESULTS: Esteem social support was the strongest predictor of total and strenuous leisure-time exercise (P < .001), and descriptive norm was a significant (P < .01 predictor of strenuous leisure-time exercise. CONCLUSION: Social support and social norms contribute independently to our understanding of variation in the frequency of strenuous leisure-time exercise.