Effectiveness of virtual reality for pediatric pain distraction during i.v. placement.

The objective of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (i.v.) placement. Twenty children (12 boys, 8 girls) requiring i.v. placement for a magnetic resonance imaging/computed tomography (MRI/CT) scan were randomly assigned to two conditions: (1) VR distraction using Street Luge (5DT), presented via a head-mounted display, or (2) standard of care (topical anesthetic) with no distraction. Children, their parents, and nurses completed self-report questionnaires that assessed numerous health-related outcomes. Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition; by contrast, no significant differences were detected within the VR condition. Significant associations between multiple measures of anticipatory anxiety, affective pain, i.v. pain intensity, and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception. There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v. placement: an adequate level of presence, no simulator sickness, and significantly more child-, parent-, and nurse-reported satisfaction with pain management. VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain, and anxiety in children undergoing acute medical interventions. However, further research with larger sample sizes and other routine medical procedures is warranted.     

Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations.

This study compared distraction, an anesthetic (eutectic mixture of local anesthetics [EMLA]), and typical care during pediatric immunizations. Participants were 39 4th graders receiving a 3-injection vaccination series over a 6-month period. Children displayed low distress despite reporting moderate anxiety and pain. Distraction resulted in more nurse coaching and child coping and less child distress than did EMLA or typical care on an observational measure. EMLA did not result in increased child coping or decreased distress. In fact, the nurse coached more, and trends suggested that children coped more with typical care than with EMLA. Whereas participant ratings and heart rate did not differ among conditions, all 3 conditions demonstrated improvements over time with these measures. Satisfaction ratings suggested that children preferred the treatments to typical care, whereas the nurse appreciated aspects of each of the conditions. Finally, distraction was more economical than EMLA.     

Helping Children and Caregivers Cope with Repeated Invasive Procedures: How Are We Doing?

This paper discusses recent developments in the medical and psychological management of child behavioral distress during invasive (i.e., needle stick) procedures for diagnosis and treatment of chronic pediatric disorders. Along with a review of relevant studies from the medical, pediatric psychology and behavior analysis literatures, representative data are presented from recent research on pediatric procedural pain management. The impact of increasing use of implanted subcutaneous intravenous catheters (ports) and decreased reliance on intravenous cannulation is discussed. Similarly, the effects (and limitations) of more frequent use of topical anesthesia to prepare needle sites also are presented. The continuing need for adjunctive, nonpharmacological (i.e., cognitive and behavioral) interventions for procedural pain is emphasized, and recent studies on distraction and counter-conditioning-based treatments are described. Future research is encouraged on (1) behavioral interventions in relation to day-to-day contextual variables that modulate treatment effects and (2) the development of efficient screening measures to identify children and families who are least likely to cope effectively with repeated procedures, allowing them to be given greater priority for allocation of limited resources for psychosocial intervention.     

Infant Distress During Immunization: A Multimethod Assessment

The purpose of this study was to comprehensively describe infant procedural distress and pain across assessment modalities, and to compare similarities and differences across measures. A multimethod assessment of distress was conducted to investigate infants (N = 37) undergoing routine immunizations. Measures of infant distress included Parent report, nurse report, infant heart rate, and an observational measure of infant distress. Parents rated their infant's distress and pain significantly higher than did nurses. Observational and physiological ratings of infant distress were found to vary significantly by phase, and there were no correlations between adult ratings of pain and distress and physiological ratings. Findings suggest that infant procedural distress can be assessed in a number of manners. The discordance between these measures emphasizes the need for multimethod assessment of pediatric procedural distress in both research and clinical settings. Given the differences between parent and nurse ratings, clinicians should be aware that different assessment methods might lead to different conclusions about infant procedural distress.     

Meta-analysis of psychological interventions for chronic low back pain.

The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.     

Effects of attentional direction, age, and coping style on cold-pressor pain in children

This study assessed the relative efficacy of two imagery-based attentional strategies for modifying pain experience in children. Children aged 7-14 years (n = 120) were randomly assigned to one of three conditions: distraction, sensory-focussing or control (no imagery). The distraction condition prompted children to focus their attention externally; the sensory-focussing condition prompted the child to focus internally on physical sensations. Self-report measures of pain coping style preferences and imagery ability were completed. Children's pain tolerance and perceptions of pain intensity were assessed using a 10 degrees C cold-pressor task. Results showed pain intensity ratings after 1 min were lower for both intervention conditions than for the controls. Younger children (7-9 years) showed higher pain tolerance in the distraction condition than in the sensory-focussing condition, whereas both interventions were equally effective for older children (10-14 years). Among older children, coping style interacted with the intervention type: in the sensory-focussing condition, pain tolerance was negatively associated with self-reported distraction-based coping style, whereas in the distraction condition this association was positive. The results are interpreted with reference to current models of attention. The implications for use of attentional strategies in helping children to cope with clinical pain are discussed.     

What we talked about at the pediatrician's office: Exploring differences between healthy steps and traditional pediatric primary care visits

Healthy Steps for Young Children (HS) is a program designed to enhance pediatric primary care experiences for children birth to 3 years and their families by pairing a developmental specialist with a pediatric provider during well‐child visits. This study examined the impact of HS on content discussed during well‐child visits by providers, HS Specialists, and families. The impact of HS on pediatric outcomes, including timeliness of well‐child visits and immunizations, also was examined. Using retrospective medical review, records of 40 children enrolled in HS were compared with records of 36 demographically matched controls. A developmental topics checklist was used to analyze content of well‐child visits. Attendance at well‐child visits, receipt of immunizations, and healthcare utilization also was evaluated. Important developmental topics were discussed more often during well‐child visits of children enrolled in HS than for children who were not enrolled. Children enrolled in HS received timelier well‐child visits and immunizations. No differences between groups were found in the number of sick or emergency room visits. Integrating HS Specialists into pediatric primary care well‐child visits allows for discussion of important developmental topics while also impacting pediatric health outcomes.     

Positive Psychology Interventions for Chronic Physical Illnesses: A Systematic Review

Positive health focuses on enhancing health along with curing illness to bring about well-being. Treatment for physical illness generally involves drug therapy, while the psycho-social aspects, specifically the positive psychology perspectives, are largely ignored; nevertheless, a growing number of investigations are now studying the effects of positive psychology interventions on health outcomes. The objective of this paper is to systematically review positive psychology interventions in chronic physical illness. A literature search through the databases of EBSCO, PubMed and PsycINFO, reference lists of significant papers and grey literature was conducted following four criteria set for this review. The number of studies selected finally that acceded to the criteria was 14. These studies were analysed by focusing on the study characteristics, kinds of intervention and outcomes of positive psychology interventions. Overall findings reveal that different intervention programmes have been devised by combining various exercises, writing is the most commonly used method for administration and positive psychology interventions are considered feasible and acceptable by patients, but findings about their usefulness are inconclusive. Suggestions for future research, clinical practice and application in communities have been provided which may be useful for clinicians, practitioners and caregivers.     

Quantifying the effects of the differential outcomes procedure in humans: A systematic review and a meta‐analysis

We present a systematic review and a meta‐analysis comparing the differential outcomes procedure to a nondifferential outcomes procedure among clinical and nonclinical populations. Sixty distinct experiments were included in the systematic review, 43 of which were included in the meta‐analysis. We calculated pooled effect sizes for accuracy (overall accuracy, test accuracy, transfer accuracy) and acquisition outcomes (latency, errors, and trials to mastery). The meta‐analysis revealed significant medium‐to‐large effect sizes for all three accuracy measures (pooled effect size range, 0.57 to 1.30). We found relatively greater effect sizes among clinical populations (effect size = 1.04). The single‐subject experimental literature included in the systematic review was consistent with the findings from the group studies, demonstrating improvements in accuracy and speed of learning for the majority of participants. Moderator and subgroup analyses suggest that discrimination difficulty may induce relatively larger differential outcomes effects. The results indicate that the differential outcomes procedure can be a valuable addition to reinforcement‐based interventions.     

Characteristics of Children Presenting to a Behavioral Treatment Program for Pediatric Headache

This study examined headache characteristics and psychological variables associated with pediatric headache in a specialty treatment clinic. Children were referred by pediatric neurologists to a hospital-based pediatric behavioral medicine clinic for behavioral treatment in conjunction with medical management of the pain. Headache typology of the children indicated that 1/3 of the sample reported at least daily headaches, and a large percentage of patients described experiencing headaches that lasted for more than a day (26%). Child and parent report of pain revealed a fairly high level of correspondence for headache activity. Regarding other psychological characteristics, children in this study endorsed higher than expected levels of somatization even after adjusting for headache symptoms. Compared with children's report, parents' report showed only slightly higher levels of secondary gain experienced by children because of pain. Gender differences were not found. The implications of these findings for improving our understanding of pediatric headache are discussed.     

Pain in children: A review of the literature from a developmental perspective

Abstract

This article presents a review of the current psychological literature about pediatric pain. Prevalence and types of pain problems encountered in children are considered briefly, followed by a developmental perspective on the experience of pain in children, encompassing physical, cognitive, social and behavioral factors. A discussion of the clinical significance of pain in children includes its use in differential diagnosis and the impact of pain on a developing child. Recommendations are made for assessing pain and factors relevant to managing its effects in children. The review concludes with an overview of clinical techniques for management, and recommendations for future research.     

Positive aspects of voice-hearing: a qualitative metasynthesis

Voice-hearing occurs in clinical and non-clinical samples, and the role of spiritual and cultural frameworks of understanding for percipients has received increased attention. This review aimed to identify and synthesise the existing qualitative literature relating to positive aspects of voice-hearing experiences, and to make recommendations based on these findings for clinical practice and future research. Qualitative papers that included positive aspects of voice-hearing were identified by undertaking a systematic search of six electronic databases, resulting in 22 papers. The quality of each paper was assessed and the meta-ethnographic approach was used to extract and synthesise the data. Six themes were identified relating to voices providing safety and protection, guidance, creating psychological and emotional well-being, providing companionship, facilitating personal growth and development, and connecting hearers to religious or spiritual belief systems. The findings suggest positive aspects of voice-hearing that may have clinical and research implications.     

Visual stimuli in distraction strategies for increasing pain tolerance

Recent experimental studies in pain control have questioned the value of pleasant affect in strategies employing distraction. It appears that pleasant affect may have been systematically confounded with task complexity or novelty in past research that found pleasant imagery or slides effective in increasing pain tolerance with the cold pressor test. The present study was a follow-up to a study conducted by this author (Greenstein, 1984) in which unpleasant slides had significantly increased pain tolerance above pleasant slide level. In the present study, 69 college students (35 females, 34 males) rated either the pleasant or unpleasant slides used in the original study on their perceived pleasantness, complexity, and uniqueness (novelty). Results indicated that the unpleasant slides were rated significantly more complex (P<0.001) and unique (P<0.001) than the pleasant slides. Additionally, as in the earlier study, ratings of the unpleasant slides on pleasantness deviated significantly farther from neutrality than did ratings of the pleasant slides (t=5.04,P<0.001). Thus the unpleasant slides were also perceived as being more significant (i.e., pertinent) than were the pleasant slides. The results indicate that affect was confounded with other stimulus characteristics in the Greenstein (1984) pain control study and probably in a significant number of other studies as well. Researchers are cautioned to control for the stimulus characteristics of visual distraction strategies used in pain control studies. The assumption that pleasantness,per se, contributes to strategy effectiveness is no longer tenable; future research must demonstrate an independent effect. Further, the implication that stimulus significance may increase the effectiveness of distraction strategies opens up a potentially fruitful avenue of research in pain control.     

A META-ANALYSIS ON THE MALLEABILITY OF AUTOMATIC GENDER STEREOTYPES

This meta-analytic review examined the efficacy of interventions aimed at reducing automatic gender stereotypes. Such interventions included attentional distraction, salience of within-category heterogeneity, and stereotype suppression. A small but significant main effect ( g  = .32) suggests that these interventions are successful but that their scope is limited. The intervention main effect was moderated by publication status, sample nationality, and intervention type. The meta-analytic findings suggest several issues worthy of further investigation, such as whether (a) other categories of intervention not yet identified or tested could be more effective, (b) suppression necessarily produces ironic effects in automatic stereotyping, (c) various indirect measures are differentially sensitive to stereotype change, and (d) automatic stereotypes about men differ in their malleability from those about women.     

Pain Intensity,Psychological Inflexibility,and Acceptance of Pain as Predictors of Functioning in Adolescents with Juvenile Idiopathic Arthritis: A Preliminary Investigation

Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disease associated with pain and maladjustment. This study investigated whether pain, acceptance of pain, and psychological inflexibility uniquely predicted functional disability, anxiety, general quality of life (QOL), and health-related quality of life (HQOL) among adolescents with JIA. Twenty-three adolescents with JIA and pain were recruited from a pediatric rheumatology clinic. Participants completed self-report measures pertaining to the key study variables. A series of multiple regression analyses demonstrated that higher pain uniquely predicted higher functional disability. Greater psychological inflexibility uniquely predicted higher anxiety, lower general QOL, and lower HQOL. Increases in acceptance of pain were found to be uniquely related to increases in general QOL. These data confirm prior findings that pain impacts functioning, and provide preliminary findings that psychological inflexibility and acceptance may be important targets of psychological intervention for youth with JIA and pain to improve functioning and QOL.     

Does Engaging in a Group-Based Intervention Increase Parental Self-efficacy in Parents of Preschool Children? A Systematic Review of the Current Literature

As the preschool years are a formative period for long-term physical and mental health, this period is recognised as an important window for early effective intervention. Parenting behaviour is a key factor to target in order to optimise child development. Group-based interventions for parents are considered efficient and cost effective methods of early intervention and have been found to improve child behaviour and adjustment. Self-efficacy is key to behaviour change and as such parental self-efficacy should be a consideration in interventions aimed at influencing parenting behaviour. Therefore, the purpose of this systematic review was to examine the impact of group-based early interventions for parents of preschool children on parental self-efficacy. Nine databases were searched (ASSIA, CINAHL, EMBASE, Maternity and Infant Care, Ovid Medline, PsycINFO, Pubmed, Science Direct and Web of Science). Studies were included if they were a randomised controlled trial of a group-based intervention for parents of preschool children and measured change in parental self-efficacy. Fifteen studies were identified. Although changes in parental self-efficacy following a group-based intervention were noted in the majority of studies reviewed, the methodological quality of the studies included in the review means these findings have to be interpreted with caution; only seven studies were rated to be methodologically adequate. Further research is needed to understand the mechanisms by which these interventions may improve parental self-efficacy. Studies specifically examining the impact of such interventions on paternal self-efficacy are also warranted.     

Active and passive distraction using a head-mounted display helmet: effects on cold pressor pain in children.

OBJECTIVE: The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain. DESIGN: Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order. MAIN OUTCOME MEASURES: Pain threshold and pain tolerance. RESULTS: Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold. CONCLUSION: Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of children's distress during painful medical procedures are discussed.     

The effects of distraction on performance in the chronically obese: Restraint, obesity, and neuroticism

The present study was conducted in order to assess the effect of distraction on the proof-reading performance of obese restrained and unrestrained eaters. Chronically obese subjects were categorized as restrained or unrestrained and assigned to conditions of distraction and no distraction. Results support the notion that restrained vs unrestrained eaters in the obese class differentially respond to external cues in their non-eating behavior. The pattern of the interaction suggested that distraction facilitates the performance of unrestrained eaters and inhibits the performance of restrained eaters. These results support previous research findings that some characteristics of the obese may be due to the over-representation of restrained eaters in that class. Also, neuroticism was found to be correlated with restraint. Additional analyses indicated that neuroticism moderated the restraint x distraction interaction. The relationship between neuroticism and restraint as well as the therapeutic implications of the study are discussed.     

Evaluating the effectiveness of psychosocial interventions for individuals with visible differences: a systematic review of the empirical literature

The objective of this review was to systematically identify and evaluate all known studies testing empirically the efficacy of psychosocial intervention programmes for adults with visible differences. Twelve papers met the inclusion criteria. None of the papers demonstrated adequately the clinical effectiveness of the interventions. The review concluded that further research was needed to demonstrate adequately the effectiveness of existing interventions, and a greater number of Randomised Controlled Trials and experimental studies were required to increase the methodological validity of intervention studies.