Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients

OBJECTIVE: To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES: The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS: Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION: These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.     

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

Rumination is independently associated with poor psychological health: Comparing emotion regulation strategies

Objective: Emotion regulation (ER) strategies are related to psychological health, with most work examining reappraisal and suppression. Yet, emerging findings suggest that rumination may have stronger relationships with psychological health, namely depression, than other ER strategies. This paper replicated and extended this work by testing whether rumination was independently associated with a range of poor psychological health risk indicators and outcomes. In addition, it explored whether the reason why rumination is so deleterious to health is because it underlies the stress–health relationship.

Design: Participants (n = 218) completed measures online.

Main outcome measures: Surveys assessed ER strategies (reappraisal, suppression, proactive coping, emotion support seeking, and rumination), health risk indicators (hostility, optimism, self-esteem), health outcomes (depression, poor sleep quality, anxiety) and perceived chronic stress.

Results: Multivariate regression analyses revealed rumination as the only ER strategy with a consistent independent effect on all the health risk indicators and outcomes. Bootstrapping analyses revealed indirect effects of perceived chronic stress on all the health variables via rumination.

Conclusion: Rumination had a deleterious relationship with psychological health, perhaps because rumination underlies the relationship between stress and psychological health. Results have implications for interventions, particularly emphasizing the need to target ruminative thinking after stressful experiences.     

An examination of post-traumatic growth in Canadian and American ParaSport athletes with acquired spinal cord injury

ObjectivesThe study was guided by two research questions: (1) Does participation in ParaSport following acquired spinal cord injury (SCI) influence people's perceptions of post traumatic growth (PTG)? (2) What specific dimensions of PTG, if any, do ParaSport athletes report experiencing?DesignA phenomenological approach was adopted to understand ParaSport athletes' perceptions and experiences of PTG and sport participation following acquired SCI.MethodTwelve participants with acquired SCI who integrated, reintegrated, or attempted to integrate into sport completed a survey and participated in a semi-structured interview to assess their perceptions of acquired SCI, involvement in ParaSport, and PTG.ResultsFive general dimensions of growth emerged from the data including: (a) injury relevant processing; (b) appreciation for life; (c) reactive behavior as a result of attempted integration into ParaSport; (d) relating to others and (e) health and well-being. Participants reported increased physical functioning and independence related to their involvement in sport. Emotional and psychological gains were also associated with ParaSport including re-establishment of self-identity, improved clarity and perception of life, changed priorities, greater confidence, and enhanced social relationships.ConclusionsParticipation in ParaSport following acquired SCI may provide physical, emotional, and psychological health benefits, which should be considered in the development and implementation of sport related interventions to encourage PTG. Clinicians and rehabilitation specialists may use information from the present study to help individuals improve their identity, build relationships, and develop an appreciation for life after incurring a SCI.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Characteristics of Personal Networks Associated with Physical and Psychological Quality of Life Among Demobilized Individuals from the Colombian Armed Conflict

The study identifies relationships between the characteristics of personal networks of demobilized individuals and their quality of life, through the evaluation of a sample of 102 ex‐combatants from a demilitarized zone in Colombia's Caribbean coast. The data was processed using centrality values calculation and statistical analysis through the Pearson correlation coefficient. Results showed moderate levels of nodality, proximity and intermediation degrees regarding small, closed networks with an unsatisfied high demand for support resources. Quality of life showed medium performance levels, with inverse relationships between mental health (p = .009 < .05) and vitality (p = .011 < .05) and intermediation. Positive feedback related significantly to general health (p = .041 < .05), while negative interactions showed inverse relationships to physical functioning (p = .012 < .05), physical role (p = .005), mental health (p = .001 < .05), and emotional role (p = .009 < .05). In conclusion, among the highly cohesive personal networks, there were less observations of social support that fosters increased energy and psychological health, given that access to this support is limited to a small number of members of the personal network. Copyright © 2013 John Wiley & Sons, Ltd.     

Personal Control in Chronic Pain Sufferers During Acute Interpersonal Stress

Among individuals with Rheumatoid Arthritis (RA), pain-associated stress can severely impact wellbeing. Psychological attributes, such as a sense of personal mastery, may attenuate the effects of chronic pain on life quality. We tested the hypothesis that a high sense of mastery would predict lower pain, perceived stress, fatigue, and mean arterial pressure (MAP) than would a low sense of mastery during an acute, interpersonal stressor.Seventy-four individuals with RA completed a psychophysiological laboratory session involving MAP measurements, as well as self-ratings of stress, joint pain, and fatigue. Measurements were collected before, during, and after an interpersonal stressor. To assess personal mastery, exploratory and confirmatory factor analyses were conducted on the Pearlin Mastery Scale based on recommendations by Reich and Zautra (1991)The Pearlin Mastery Scale yielded two distinct factors: fatalism and control. Both fatalism and control were significant predictors of the wellbeing variables. Individuals with a highly fatalistic style demonstrated higher general levels of mean arterial pressure (F(1) = 3.41, p<.1) and reported greater joint pain (F(1) = 4.72, p<.05) across all periods. Individuals with a high sense of control also evidenced lower MAP (F(1) = 3.73, p<.1) and reported less stress (F(1) = 7.44, p<.01) and fatigue (F(1) = 5.16, p<.05). Neither fatalism nor control were related to objective measures of disease severity (r's = -.10, p=NS and -.02, p=NS, respectively).RA patients with a high level of personal mastery, as evidenced by scores on two distinct indices, experience lower MAP, and report less pain, stress and fatigue. Although fatalism and control were not related to objective disease state, they seem to play an important role in the experience of wellbeing for people with RA.     

Clarifying the Role of Psychological Pain in the Risks of Suicidal Ideation and Suicidal Acts among Patients with Major Depressive Episodes

The role of psychological pain in the risk of suicide was explored using a three‐dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three‐dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.     

Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure

Abstract

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms.

Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5?±?11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant.

Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.     

Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report

Objective: The role of self-conscious emotions (SCEs) including shame, guilt, humiliation and embarrassment are of increasing interest within health. Yet, little is known about SCEs in the experience of chronic pain. This study explored prevalence and experience of SCEs in chronic pain patients compared to controls and assessed the relationship between SCEs and disability in pain patients.

Design and measures: Questionnaire assessment comparing musculoskeletal pain patients (n = 64) and pain-free control participants (n = 63). Pain was assessed using the McGill Pain Questionnaire; disability, using the Roland–Morris Disability Questionnaire; and six SCEs derived from three measures (i) Test of Self-Conscious Affect-3 yielding subscales of shame, guilt, externalisation and detachment (ii) The Brief Fear of Negative Evaluation Scale and (iii) The Pain Self-Perception Scale assessing mental defeat.

Results: Significantly greater levels of shame, guilt, fear of negative evaluation and mental defeat were observed in chronic pain patients compared to controls. In the pain group, SCE variables significantly predicted affective pain intensity; only mental defeat was significantly related to disability.

Conclusion: Findings highlight the prevalence of negative SCEs and their importance in assessment and management of chronic pain. The role of mood in this relationship is yet to be explored.     

Children's Coping with Recurrent Headache

We investigated the relationships among perceptions of control over pain, gender, and coping responses in 57 school-aged children receiving services at a specialized pediatric headache clinic. Perceptions of control and gender interacted to predict frequency of active and negative coping responses. A wide range of coping strategies was reported, but only minimal gender or perceived control differences were found in the frequency and helpfulness of individual coping strategies. Results are discussed within the context of recent stress and coping models within the pediatric chronic illness literature.     

Different Associations of Health Related Quality of Life with Pain,Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.     

Anger as driving factor of moral courage in comparison with guilt and global mood: A multimethod approach

Although moral courage is a highly desirable behavior whose determinants need to be understood, research has largely neglected the emotions involved in moral courage. Does anger about the norm violation or (anticipated) guilt enhance such interventions even if general mood does not? As previous studies have often failed to overcome the limitations of self‐reported emotions and the use of behavior intention measures, we used a multimethod emotion measurement while observing real behavior. By realizing a real theft scenario in the laboratory (N = 68), we found that anger but neither guilt nor general mood predicted intervention behavior. Our findings complement and expand previous studies by showing that people who experience and express anger more strongly are able to overcome the psychological barrier of potential negative (social) consequences in a situation in which a fast and immediate intervention is needed, whereas others stand and watch. Copyright © 2014 John Wiley & Sons, Ltd.     

The relationship between family support; pain and depression in elderly with arthritis

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.     

The role of maladaptive anger in self-criticism: A quasi-experimental study on emotional processes

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a quasi-experimental design, the present study compared n = 23 anger-prone under-graduate students to n = 22 controls on process indices of contempt, fear, shame, anger and global distress, as well as on their access to underlying need, as participants were working through personalized self-critical content. This was achieved using a single-session enactment from emotion-focused therapy, augmented with a standardized procedure for priming participants to focus on their unmet needs. Findings suggested that this work on self-criticism reduced for both groups distress, fear and shame, as well as increased assertive anger (McNemar tests significant at p = .05). More centrally, anger-prone individuals expressed more self-contempt (t(1, 44) = 3.65; p < .05), and they had more difficulty in accessing their underlying need (χ² = 5.35; p < .05), when compared to controls. These results have implications for clinical work with anger-prone individuals, and clarify key features in the use of enactment interventions when working towards emotional resolution. The present study also demonstrates the use of personalized stimuli in the context of clinically relevant quasi-experimental research on emotional processes.     

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.     

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

The Interactive Effects of Chronic Pain, Guilt, and Perfectionism on Work Outcomes

Two studies were conducted examining the interactive effects of chronic pain, perceived perfectionism (e.g., self- and socially prescribed), and guilt on job tension and job satisfaction. It was hypothesized that chronic pain would have its most adverse effects on these work outcomes when concurrently coupled with high levels of perceived perfectionism and guilt. In both studies, the results supported the interaction effect of Chronic Pain × Socially Prescribed Perfectionism × Guilt on tension and satisfaction in the expected direction. As predicted, the results also indicated a Chronic Pain × Guilt × Self-Oriented Perfectionism interaction on job tension. Implications for theory and practice, strengths and limitations, and avenues for future research are provided.