Time to gain trust and change--experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity.

The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients' well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients' special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.

Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children.

OBJECTIVE: Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers' experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years. RESEARCH DESIGN AND METHODS: The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD. RESULTS: Mothers' experiences of divorce (odds ratio 3.6, 95% CI 1.4-9.6, P < 0.05) and violence (2.9, 1.0-7.8, P < 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes. CONCLUSIONS: The results support the beta-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.

Psychological stress may induce diabetes-related autoimmunity in infancy.

OBJECTIVE: In retrospective studies, a number of disparate environmental factors (including experiences of serious life events) have been proposed as trigger mechanisms for type 1 diabetes or the autoimmune process behind the disease. Psychosocial stress in families may affect children negatively due to a link to hormonal levels and nervous signals that in turn influence both insulin sensitivity/insulin need and the immune system. Our aim was to investigate whether psychological stress, measured as psychosocial strain in families, is associated with diabetes-related autoimmunity during infancy. RESEARCH DESIGN AND METHODS: The first 4,400 consecutive 1-year-old children from a large prospective population-based project participated in the study. Parents completed questionnaires at birth and at 1 year, including various measures of psychosocial stress (e.g., parenting stress) and sociodemographic background. Blood samples drawn from the children at 1 year were analyzed for type 1 diabetes-associated autoantibodies toward tyrosine phosphatase and GAD. Antibodies toward tetanus toxoid were used as non-diabetes-related control antibodies. RESULTS: Psychosocial factors, i.e., high parenting stress (odds ratio 1.8 [95% CI 1.2-2.9], P < 0.01), experiences of a serious life event (2.3 [1.3-4.0], P < 0.01), foreign origin of the mother (2.1 [1.3-3.3], P < 0.001), and low paternal education (1.6 [1.1-2.3], P < 0.01) were associated with diabetes-related autoimmunity in the child, independent of family history of diabetes. CONCLUSIONS: Psychological stress, measured as psychosocial strain in the family, seems to be involved in the induction, or progression, of diabetes-related autoimmunity in the child during the 1st year of life.

Psychosocial correlates of parenting stress, lack of support and lack of confidence/security.

The purpose of the current study was to identify important correlates of parenting stress, frequently conceptualized as a mediator of suboptimal family function, and of social support and confidence/security, often regarded as buffers. Potential correlates of these concepts were assessed in questionnaires at delivery and at one year, in a sample of 16,000 families in Sweden. Predictors (1) of parenting stress were parental dissatisfaction and poor child sleeping patterns; (2) of lack of support included lack of confidence/security, parents born abroad, single motherhood, and maternal health problems; and (3) of lack of confidence/security were lack of support and serious life events. Mothers lacking social support or confidence/security exhibited significantly higher stress. Although parenting stress is a complex phenomenon certain risk factors can be emphasized, such as sleep problems which appear more important than child health problems. These risk factors can be used both in efforts to prevent stress and in studies of stress effects.

Intergenerational family relations and sexual risk behavior in young women.

PURPOSE: To more fully understand the associations between family variables and sexual behavior of young women. STUDY DESIGN AND METHODS: Forty-two female clients of an urban youth agency (16 to 25 years of age) were interviewed about intergenerational stories and contact with extended families. Individuation was measured by self-report using the intergenerational individuation subscale of the Personal Authority in the Family System Questionnaire. Self-report questions were used to gain information about the young women's sexual risk behavior. Data were analyzed using Pearson correlation, independent t-tests, and multiple regression. Family stories were analyzed for themes of resilience or vulnerability. RESULTS: Young women who perceived their connection with previous generations in a resilient light tended to be more individuated and report less risky sexual behaviors. CLINICAL IMPLICATIONS: These results may give direction in the design of family interventions for reducing sexual risk taking and enhancing positive health behavior. Interventions would include promoting a healthy degree of attachment between adolescents and their families, exploration of family of origin issues, and referral for more intensive services when needed.

Mothers' attachment insecurity and diabetes-related autoantibodies in their infants.

Psychological stress may, via hormonal levels, increase insulin resistance. The aim of this study was to investigate whether mothers' attachment insecurity is associated with the induction or progression of diabetes-related autoimmunity in early childhood. Adult attachment interviews were conducted with 18 mothers of infants who were positive, and 32 mothers of infants who were negative, for glutamic acid decarboxylase, selected from ABIS, a large prospective population-based project. The proportion of children with insecure mothers was larger, but not significantly so, in the autoantibody-positive group than in the negative group. If an association exists between maternal attachment insecurity and diabetes-related autoimmunity during infancy, it does not appear to be strong.

Could parenting stress and lack of support/confidence function as mediating mechanisms between certain environmental factors and the development of autoimmunity in children?: a study within ABIS.

Despite extensive research, the etiology of type 1 diabetes is still to a large extent unknown. We would like to propose psychoimmunology as one possible pathway. Psychological mechanisms are directly linked to hormonal and nervous signals, which increase the need for insulin and affect the immune system. Disparate factors of social, environmental, and medical character have been associated with the onset of type 1 diabetes or with the autoimmune process leading to the disease-for instance, parental age, maternal infections, delivery mood, need for neonatal intensive care, and low socioeconomic status. Our results, based on the analyses of 4337 nonselected newborn children and their mothers, show that all these risk factors were also associated with psychological mechanisms (defined as lack of social support/confidence and high parenting stress). These results support the hypothesis of psychological mechanisms as mediating variables between a number of disparate risk factors and the development of type 1 diabetes.