Cognitive behavioral therapy to reduce persistent postsurgical pain following internal fixation of extremity fractures (COPE): Rationale for a randomized controlled trial.

Background: Approximately half of all patients who undergo surgical repair of extremity fractures report persistent postsurgical pain (PPSP) at 1-year post-surgery. Psychological factors such as anxiety, depression, catastrophization, poor coping, high somatic complaints, and pessimism about recovery are risk factors for the development of PPSP. It is possible that interventions such as cognitive behavior therapy (CBT) that target psychological factors may reduce the incidence of PPSP in this population. Aims: The current report reviews the role of psychological factors in the development of PPSP and discusses the rationale and protocol development for a multi-site randomized-controlled trial investigating the effectiveness of CBT in reducing PPSP in patients with surgically treated extremity fractures.

Contexte: Près de la moitié des patients qui sont opérés pour des fractures aux extrémités font état de douleur postopératoire persistante un an après la chirurgie. Des facteurs psychologiques tels que l'anxiété, la dépression, la catastrophisation, une piètre capacité d'adaptation, une somatisation élevée et le pessimisme quant à la récupération sont des facteurs de risque pour le développement de la douleur postopératoire persistante. Il est possible que des interventions ciblant les facteurs psychologiques, telles que la thérapie cognitivo-comportementale (TCC), puissent réduire l'incidence de la douleur postopératoire persistante dans cette population.Objectifs: Le présent rapport examine le rôle des facteurs psychologiques dans le développement de la douleur postopératoire persistante et discute de la justification et du développement d'un protocole pour un essai contrôlé randomisé multisite portant sur l'efficacité de la TCC pour réduire la douleur postopératoire persistante chez les patients ayant été opérés pour des fractures aux extrémités.

Modifying interpretation biases: Effects on symptomatology, behavior, and physiological reactivity in social anxiety.

BACKGROUND AND OBJECTIVES: The present study investigated the effects of computerized interpretation training and cognitive restructuring on symptomatology, behavior, and physiological reactivity in an analogue social anxiety sample. METHODS: Seventy-two participants with elevated social anxiety scores were randomized to one session of computerized interpretation training (n = 24), cognitive restructuring (n = 24), or an active placebo control condition (n = 24). Participants completed self-report questionnaires focused on interpretation biases and social anxiety symptomatology at pre and posttraining and a speech task at posttraining during which subjective, behavioral, and physiological measures of anxiety were assessed. RESULTS: Only participants in the interpretation training condition endorsed significantly more positive than negative interpretations of ambiguous social situations at posttraining. There was no evidence of generalizability of interpretation training effects to self-report measures of interpretation biases and symptomatology or the anxiety response during the posttraining speech task. Participants in the cognitive restructuring condition were rated as having higher quality speeches and showing fewer signs of anxiety during the posttraining speech task compared to participants in the interpretation training condition. LIMITATIONS: The present study did not include baseline measures of speech performance or computer assessed interpretation biases. CONCLUSIONS: The results of the present study bring into question the generalizability of computerized interpretation training as well as the effectiveness of a single session of cognitive restructuring in modifying the full anxiety response. Clinical and theoretical implications are discussed.

Alexithymia and eating disorders: a critical review of the literature.

Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.

Joint attention in toddlerhood predicts internalizing problems at early school age.

The authors examined the longitudinal relation between joint attention and socioemotional functioning in a low-risk, typically developing sample of children when the children were toddlers and again during the early school-age years. Fifty-eight mothers and their children were observed in the home or laboratory engaging in 1 unstructured and 4 semistructured tasks designed to assess joint attention episodes when the children were toddlers. Approximately 4 years later, the mother-child dyads were contacted again and mothers completed the Child Behavior Checklist as a measure of their children's socioemotional outcome at the early school years. The authors found that lower frequencies of joint attention episodes at toddlerhood predicted higher internalizing behaviors at early school age. Preliminary findings are discussed in terms of their theoretical implications for work on early mother-child interactions and children's typical and atypical sociemotional development.

Joint attention in parent-child dyads involving children with selective mutism: a comparison between anxious and typically developing children.

Although joint attention processes are known to play an important role in adaptive social behavior in typical development, we know little about these processes in clinical child populations. We compared early school age children with selective mutism (SM; n = 19) versus mixed anxiety (MA; n = 18) and community controls (CC; n = 26) on joint attention measures coded from direct observations with their parent during an unstructured free play task and two structured tasks. As predicted, the SM dyads established significantly fewer episodes of joint attention through parental initiation acts than the MA and CC dyads during the structured tasks. Findings suggest that children with SM may withdraw from their parents during stressful situations, thus missing out on opportunities for learning other coping skills. We discuss the implications of the present findings for understanding the maintenance and treatment of SM.

An investigation of control among parents of selectively mute, anxious, and non-anxious children.

The authors examined parent­child interactions among three groups: selectively mute, anxious, and non-anxious children in different contexts. The relation between parental control (granting autonomy and high power remarks), child factors (i.e., age, anxiety, verbal participation), and parent anxiety was investigated. Parental control varied by context but parents of children with SM were more controlling than parents in the comparison groups in all contexts. Regression analyses indicated that child and parent anxiety predicted parental control, with increased anxiety associated with increased control. Older child age predicted less parent control. Group categorization moderated the relation between age and high power remarks, such that age was not a significant predictor for children with SM. Finally child-initiated speaking predicted high power remarks over and above other variables. These results support previous theories that parents take over for their children when they fail to meet performance demands, especially when the child or parent is anxious.

Establishment of joint attention in dyads involving hearing mothers of deaf and hearing children, and its relation to adaptive social behavior.

Mounting evidence points to joint attention as a mediating variable in children's adaptive behavior development. Joint attention in interactions between hearing mothers and congenitally deaf (n = 27) and hearing (n = 29) children, ages 18-36 months, was examined. All deaf children had severe to profound hearing loss. Mother-child interactions were coded for maternally initiated and child-initiated success rates in establishing joint attention; mothers completed ratings of their children's adaptive behavior. Hearing mother-deaf child dyads had significantly lower maternally initiated success rates. No significant between-group differences on child-initiated success rates were shown. Maternal ratings of adaptive behavior were significantly lower for deaf children, and related positively and significantly to both child-initiated and maternally initiated success rates. The findings suggest that mother-child interactions that are low in successful establishment of joint attention might mediate the development of socioemotional problems evident in deaf children with hearing families.