Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self-efficacy Questionnaire.

BACKGROUND: To facilitate efficient screening and reduce the length of comprehensive self-report batteries, a four-item short form of the Pain Catastrophizing Scale (PCS) and a two-item short form of the Pain Self-Efficacy Questionnaire (PSEQ) have been developed and evaluated in samples of patients with arm and upper extremity pain. AIMS: The first aim of this study was to evaluate these short forms in a heterogeneous sample of patients seeking treatment for chronic musculoskeletal pain, using a priori criteria for determining adequate internal consistency, construct validity and sensitivity to change. In addition, the findings of past studies were used to identify items suitable for new and potentially stronger short forms of these measures. METHOD: Data were provided by 280 patients who completed the original PCS and PSEQ as part of an interdisciplinary rehabilitation programme. RESULTS: The previously developed four-item PCS and the newly developed six-item short form of the PCS both met the internal consistency and construct validity criteria. They did not meet the criterion regarding sensitivity to change. However, similar to what was obtained using the original PCS, large effect sizes were found when using these short forms to examine pre-treatment to post-treatment changes in catastrophizing. For the PSEQ, the new four-item short form was clearly superior to the other alternatives and met all three criteria. CONCLUSION: The strongest short forms of the PCS and PSEQ could facilitate the assessment of pain catastrophizing and self-efficacy in situations in which the use of the longer original measures is not feasible.

Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy.

Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented. Only a small number of studies have purposively studied the application of ACT within the cancer setting, but this nonetheless presents useful pilot data. The data demonstrate potential clinical- and cost-effectiveness for a range of patients, including those with psychological comorbidity. Within the context of wider cancer adjustment, ACT offers an intervention framework to appropriately build upon the strong empirical base already established for Mindfulness within this specific patient population. The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment.

Laboratory testing protocol for the impact of dispersed petrochemicals on seagrass.

To improve the effectiveness of oil spill mitigation, we developed a rapid, logistically simple protocol to detect petrochemical stress on seagrass. Sections of leaf blades from Zostera muelleri subsp. capricorni were exposed to the water accommodated fraction (WAF) of non-dispersed and dispersed Tapis crude oil and fuel oil (IFO-380) for 5h. Photosynthetic health was monitored by assessing changes in effective quantum yield of photosystem II (ΔF/F(m)(')) and chlorophyll a pigment concentrations. Loss of total petroleum hydrocarbons (TPH) was measured using an oil-in-water fluorometer, whilst GC-MS analyses quantified the hydrocarbon components within each treatment. Few significant differences were detected in the chlorophyll a pigment analyses; however, ΔF/F(m)(') appeared sensitive to petrochemical exposure. Dispersing both types of oil resulted in a substantial increase in the TPH of the WAF and was generally correlated with a greater physiological impact to the seagrass health, compared with the oil alone.

A linkage map for CRINKLED PETAL: a homeotic gene of Clarkia tembloriensis (Onagraceae).

Homeotic mutations in flowers lead to the development of floral organs in abnormal locations. In most laboratory-induced examples of this type of mutation, two adjacent whorls of organs are affected, resulting in two whorls of abnormal organ formation. However, the crinkled petal mutant of Clarkia tembloriensis is interesting because it is a naturally occurring mutation and it affects only the second whorl of organs, producing sepaloid petals. In this study one wild-type population (Cantua Creek-2) and one crinkled petal mutant population (Red Rocks) were compared using 181 different primers in random amplified polymorphic DNA (RAPD) analysis. Bulk DNA from each parent population and their subsequent crosses were used to compare the genetic differences between the two populations and to search for molecular markers linked with the CRINKLED PETAL locus. A linkage map was developed for the CRINKLED PETAL gene, and markers were discovered which flanked both sides of the locus.

Affairs of the heart: patients' personal constructions of a cardiac event and their effect on lifestyle change.

The issue of why people do not always make appropriate lifestyle changes in response to a cardiac event has and continues to be of central importance to health practitioners. This paper addresses this issue from the perspective of the lived experience of persons who have suffered an acute myocardial infarction (AMI). The experiences of 10 persons admitted to the coronary care unit (CCU) of a South African clinic were richly described, making use of the grounded theory methodology. These descriptions were then used as a basis for the development of a contextualist theory of the experience of heart attacks. A central feature of the results was that the disease was mainly attributed to stress by the participants. This was in contrast to the explanations offered by the medical profession, who attribute this more to other modifiable risk factors such as smoking, high blood cholesterol, high blood pressure, and lack of exercise. This tension between lay and professional constructions of the aetiology of the condition is deemed to be of import in the recovery process. The paper further alludes to the goodness of fit which exists between the proposed grounded theory and the personal construct theory of George Kelly. The importance of personal constructions of the event is then used as the basis for a proposed intervention process aimed at addressing the difficulties AMI patients' experience in making and sustaining lifestyle changes.

Prognostic awareness and the terminally ill.

The authors rated patients who were in advanced stages of cancer and in their final few weeks of life on their level of awareness of their medical prognosis (N = 200, mean age = 71.0 years). The authors measured prognostic awareness with a semistructured interview, dividing patients into those acknowledging No Awareness, Partial Awareness, and Complete Awareness. The authors also administered a semistructured interview for depressive disorders, along with an assessment of various demographic and social support measures. Nineteen patients (9.5%) denied awareness of both their terminal prognosis and foreshortened life expectancy. Thirty-four patients (17%) were placed in the partial awareness category, with the remaining 147 patients (73.5%) reporting complete awareness. Depression was nearly three times greater among patients who did not acknowledge their prognosis, as compared with those who demonstrated partial or complete acknowledgment (chi2 = 7.094), P = 0.029). In addition to depression, male patients, older patients, and those having "intense social contact" were associated with lower ratings of prognostic awareness. Dying patients differ in respect to their capacity to acknowledge their prognosis. Prognostic disavowal is most likely to arise in patients with underlying psychological distress and emotional turmoil.

Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide.

BACKGROUND: In jurisdictions that permit euthanasia or physician-assisted suicide, patients with cancer comprise the largest group to die by these methods. We investigated the personal attitudes toward these practices of patients receiving palliative care for advanced cancer. METHODS: Seventy patients (32 men and 38 women; median survival, 44.5 days) took part in a survey using in-depth semistructured interviews. The interviews were audiotaped for transcription and content analysis of themes. RESULTS: Most participants (73%) believed that euthanasia or physician-assisted suicide should be legalized, citing pain and the individual's right to choose as their major reasons. Participants who were opposed to legalization cited religious and moral objections as their central concerns. Forty (58%) of the 69 participants who completed the entire interview also believed that, if legal, they might personally make a future request for a hastened death, particularly if pain or physical symptoms became intolerable. Eight of these individuals (12%) would have made such a request at the time of the interview. These 8 participants differed from all others on ratings of loss of interest or pleasure in activities, hopelessness, and the desire to die (Ps<.02). They also had a higher prevalence of depressive disorders (P<.05). However, they did not differ on ratings of pain severity. CONCLUSIONS: Many patients with advanced cancer favor policies that would allow them access to both euthanasia and physician-assisted suicide if pain and physical symptoms became intolerable. For patients who would actually make requests for a physician-hastened death, however, psychological considerations may be at least as salient as physical symptoms.

Cognitive-behavioral treatment of insomnia secondary to chronic pain.

Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive-behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions.

Why it is crucial to understand thinking and feeling: An analysis and application to drug abuse.

Behavior analysis has long accepted the legitimacy of the analysis of private events in a natural science of behavior. However, the topic has languished as a focus of empirical research in either applied or basic arenas. We argue that recent empirical work examining the bidirectional nature of verbal relations may shed light on the role of private events in complex human behavior. Skinner argued that although it would be possible to analyze private events, we need not, because thoughts and feelings were viewed as co-occuring products of the same contingencies that are responsible for changes in overt responses. However, the bidirectional transformation of stimulus function inherent in verbal behavior changes the way that private events participate in complex behavioral episodes for verbal organisms. We examine why we have reached such a conclusion, with special emphasis on the role of self-awareness. Finally, we conclude with an application of our analysis to the problem of substance abuse.

Rural health professionals' satisfaction with a rehabilitation mobile outreach program.

OBJECTIVE: To assess the extent to which rural physicians and allied health professionals are satisfied with consultation services provided by an interdisciplinary rehabilitation outreach team. DESIGN: Descriptive survey. SETTING: A rehabilitation outreach team that travels to 14 rural communities in eastern and northern Ontario, Canada. SUBJECTS: Thirty-six rural physicians (response rate, 53.7%) and 62 allied health professionals (response rate, 92.5%) involved in the care of patients referred to the program. MAIN OUTCOME MEASURE: Consumer satisfaction questionnaire. RESULTS: Most respondents (94.7%) indicated that they were satisfied with the interdisciplinary consultation, with comparable rates of satisfaction reported by physicians and allied health professionals. The highest satisfaction ratings were given to items addressing the clarity of recommendations provided by team members and the quality of the team's interaction with patients. The lowest ratings were associated with the waiting time between visits. Of all the individual disciplines on the team, physiatry was rated as most important for rural consultations. However, in open-ended comments, respondents indicated that the interdisciplinary aspect of the service was its most valued characteristic, whereas infrequent visits were the greatest drawback. CONCLUSION: The interdisciplinary outreach approach to rehabilitation consultation receives high satisfaction ratings from rural health professionals who refer patients to the outreach team, which supports this model as a way to enhance rehabilitation services in rural communities.

The radish (Raphanus sativus L.) mitochondrial cox2 gene contains an ACG at the predicted translation initiation site.

The mitochondrial cox2 gene has been sequenced from radish (Raphanus sativus L.). The gene is interrupted by a 1346-bp group-II intron and contains an ACG codon as the predicted translation initiation site. Analysis of cox2 cDNAs indicates that the ACG codon is not converted to an AUG codon in the mRNA, although 15 other RNA editing sites were identified. The cox2 gene from Raphanus raphanistrum, and other varieties of R. sativus, also contain an ACG as the predicted start codon; plants in the closely related genus, Brassica, do not. Western-blot analyses indicate that cox2 proteins in radish mitochondria are the same size as those found in Brassica mitochondria and different from cox2 proteins in plants where cox2 is nuclear-encoded. This finding, along with the observation that cox2 sequences are not present in the nuclear genome of radish, suggests that ACG is utilized as the radish cox2 initiation codon.

Depression, Hopelessness, and suicidal ideation in the terminally ill.

This study investigated the mediational hypothesis of hopelessness in predicting suicidal ideation in a group of 196 patients with advanced terminal cancer. Each patient underwent a semistructured interview to assess hopelessness and suicidal ideation, and also completed the Beck Depression Inventory (short form). Hopelessness was correlated more highly with suicidal ideation than was the level of depression. In multiple linear-regression analyses, hopelessness contributed uniquely to the prediction of suicidal ideation when the level of depression was controlled. For health care providers attending to the needs of dying patients, hopelessness appears to be an important clinical marker of suicidal ideation in this vulnerable patient population.

Why behavior analysts should study emotion: the example of anxiety.

Historically, anxiety has been a dominant subject in mainstream psychology but an incidental or even insignificant one in behavior analysis. We discuss several reasons for this discrepancy. We follow with a behavior-analytic conceptualization of anxiety that could just as easily be applied to emotion in general. Its primary points are (a) that languageable humans have an extraordinary capacity to derive relations between events and that it is a simple matter to show that neutral stimuli can acquire discriminative functions indirectly with no direct training; (b) that private events can readily acquire discriminative functions; (c) that anxiety disorders seem to occur with little apparent direct learning or that the amount of direct learning is extraordinarily out of proportion with the amount of responding; and (d) that the primary function of anxious behavior is experiential avoidance. We conclude that the most interesting aspects of anxiety disorders may occur as a function of derived rather than direct relations between public events and overt and private responses with avoidance functions. Implicit in this conclusion and explicit in the paper is the assertion that anxiety is a suitable subject for behavior-analytic study.

"Are you depressed?" Screening for depression in the terminally ill.

OBJECTIVE: This study compared the performance of four brief screening measures for depression in a group of terminally ill patients. The methods included 1) a single-item interview assessing depressed mood, 2) a two-item interview assessing depressed mood and loss of interest in activities, 3) a visual analog scale for depressed mood, and 4) the Beck Depression Inventory-Short Form. METHOD: Semistructured diagnostic interviews for depression were administered to 197 patients receiving palliative care for advanced cancer. The interview diagnoses served as the standards against which the screening performance of the four brief screening methods was assessed. RESULTS: Single-item interview screening correctly identified the eventual diagnostic outcome of every patient, substantially outperforming the questionnaire and visual analog measures. CONCLUSIONS: Brief screening measures for depression are important clinical tools for terminally ill patients. For diagnostic purposes, however, they do not approach the validity of a single-item interview that asks, in effect, "Are you depressed?"

Cognition in behavior therapy: agreements and differences.

The issue of cognition has often been divisive among behavior therapists. Typically the debate has centered around the causal status of cognition. Cognitive psychologists have argued for the causal efficacy of cognition, while behavior analysts have argued against it. These disputes are not entirely empirical matters. In part, they reflect irreconcilable differences at the level of theory and philosophy. Such differences may make theoretical integration impossible. However, in this paper we examine the potential for reconciliation of the cognitive and behavioral wings of behavior therapy when the issue of cognition is approached as a shared content area, rather than at the level of theory and philosophy. Behavior therapy has always been comprised of very diverse theoretical positions. Historically they found common ground around a set of shared values centered on an empirical science of clinical work. We will argue that this core of shared values still exists, and that even controversial topics can provide an arena for reconciliation when we focus on the core values that initially brought us together.

Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment.

Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders.

Resurgence of derived stimulus relations.

Resurgence has been shown in human and nonhuman operant behavior, but not in derived relational responses. The present study examined this issue. Twenty-three undergraduates were trained to make conditional discriminations in a three-choice matching-to-sample paradigm. The training resulted in three equivalence classes, each consisting of four arbitrarily configured visual stimuli. The same 12 stimuli were then reorganized, and the conditional discrimination training was repeated such that three new classes were possible. In a subsequent test of derived relations, most subjects showed response patterns that were consistent with the altered conditional discriminations. Subjects were then exposed to conditional discrimination trials under extinction. Most subjects continued to respond consistently with the most recently reinforced conditional discrimination trials. During the next phase, subjects were exposed to symmetry and equivalence trials. Responses consistent with the most recent training produced feedback saying that the responses were incorrect, whereas other responses produced no feedback. Most subjects showed a resurgence of responding that was consistent with their earlier training. Finally, subjects were exposed to conditional discrimination trials carried out in extinction. Most subjects continued to show a resurgence of responding that was consistent with their early training.

The euthanasia debate: attitudes, practices and psychiatric considerations.

OBJECTIVE: To review the current status of the euthanasia debate by examining public and physician attitudes towards euthanasia, the practice of euthanasia in the Netherlands, recent developments in Canada and other countries, psychosocial considerations related to the desire for death in terminally ill patients, and the roles that psychiatrists may be asked to play in the event of legislative reform involving discriminalization. METHODS: A literature review was conducted focusing on recent surveys regarding physician and patient attitudes towards euthanasia, the role of psychiatrists and empirical data pertaining to the mental state of patients who request physician-hastened death. RESULTS: Psychiatric morbidity among patients requesting physician-hastened death is considerable. CONCLUSION: As a special case of suicide, euthanasia and physician-assisted suicide are of particular relevance to mental health professionals.