Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

Psychological interventions for arthritis pain management in adults: a meta-analysis.

CONTEXT: The psychosocial impact of arthritis can be profound. There is growing interest in psychosocial interventions for managing pain and disability in arthritis patients. OBJECTIVE: This meta-analysis reports on the efficacy of psychosocial interventions for arthritis pain and disability. DATA SOURCES: Articles evaluating psychosocial interventions for arthritis were identified through Cochrane Controlled Trials, EMBASE, Ovid MEDLINE, and Ovid PsycINFO data sources. STUDY SELECTION: Randomized controlled trials testing the efficacy of psychosocial interventions in arthritis pain management were reviewed. DATA EXTRACTION: Twenty-seven randomized controlled trials were analyzed. Pain intensity was the primary outcome. Secondary outcomes included psychological, physical, and biological functioning. DATA SYNTHESIS: An overall effect size of 0.177 (95% CI=0.256-0.094) indicated that patients receiving psychosocial interventions reported significantly lower pain than patients in control conditions (combined p=.01). Meta-analyses also supported the efficacy of psychosocial interventions for the secondary outcomes. CONCLUSIONS: These findings indicate that psychosocial interventions may have significant effects on pain and other outcomes in arthritis patients. Ample evidence for the additional benefit of such interventions over and above that of standard medical care was found.     

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies’ quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.     

Catastrophizing,locus of control,pain, and disability in chinese chronic low back pain patients

Abstract

The present study examined the associations of locus of control (LOC) and catastrophizing with pain intensity and disability in Chinese chronic low back pain (CLBP) patients. In the study, 56 respondents (21 men and 35 women) with a mean age of 36.98 years (SD= 12.22) completed measures assessing locus of control, catastrophizing tendency, pain intensity, disability, and psychological distress. Results showed that after partialling out the effects of gender, duration of pain, and psychological distress, internal LOC significantly explained the variance of disability. For pain intensity, only catastrophizing accounted for a large portion of the variance. Limitations of the study and suggestions for future work were discussed.     

Adjustment to chronic low back pain--the relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control

The present study investigated the relative extent to which patients' adjustment to chronic low back pain (CLBP) was influenced by their fear-avoidance beliefs, their tendency to catastrophize, and their appraisals of control. Eighty-three CLBP patients completed a series of self-report measures before participating in a physical therapist-led intervention. Hierarchical multiple regression analyses revealed that patients' perceptions of their ability to decrease pain explained a small, but statistically significant, proportion of the variance in pain intensity. In addition, patients' levels of catastrophizing, as well as their fear-avoidance beliefs about both work and physical activity, were independently associated with levels of disability. Interestingly, however, when exploring the relative predictive utility of these three psychological factors, it became evident that fear-avoidance beliefs about physical activity (FABs-PA) were the only significant predictor of patients' disability. Specifically, those patients who exhibited higher levels of FABs-PA tended to report greater levels of disability, even after adjusting for age, sex and pain intensity.     

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.     

Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Cognitive-Behavioral and Pharmacological Interventions for Premenstrual Syndrome or Premenstrual Dysphoric Disorder: A Meta-Analysis

The current meta-analysis investigates the efficacy of psychotherapeutic interventions and psychopharmacotherapy for premenstrual syndrome (PMS) and premenstrual dysphoric disorder. Based on a multiple-phase literature search, controlled trials were selected according to a priori defined inclusion criteria. Data were extracted on the basis of a standardized coding scheme. The standardized weighted mean difference (random effects model) was used as effect size index. Dependent on outcome, 22 included studies obtained small to medium effect sizes for cognitive-behavioral interventions (range: d (+)?=?0.24-0.70) and for serotonergic antidepressants (range: d (+)?=?0.29-0.58), at post-assessment. Follow-ups were performed only in studies of cognitive-behavioral interventions (range: d (+)?=?0.46-0.74). There was no evidence of a publication bias. For both cognitive-behavioral interventions and serotonergic antidepressants, efficacy in treatment of PMS was found to not be satisfactory. Future research should possibly focus more on a combination of both approaches.     

Older adults’ perceptions of ageing and their health and functioning: a systematic review of observational studies

Many older people perceive ageing negatively, describing it in terms of poor or declining health and functioning. These perceptions may be related to older adults’ health. The aim of this review was to synthesise existing research on the relationship between older adults’ perceptions of ageing and their health and functioning. A systematic search was conducted of five electronic databases (ASSIA, CINAHL, IBSS, MEDLINE and PsycINFO). Citations within identified reports were also searched. Observational studies were included if they included perceptions of ageing and health-related measures involving participants aged 60 years and older. Study selection, data extraction and quality appraisal were conducted using predefined criteria. Twenty-eight reports met the criteria for inclusion. Older adults’ perceptions of ageing were assessed with a variety of measures. Perceptions were related to health and functioning across seven health domains: memory and cognitive performance, physical and physiological performance, medical conditions and outcomes, disability, care-seeking, self-rated health, quality of life and death. How ageing is perceived by older adults is related to their health and functioning in multiple domains. However, higher quality and longitudinal studies are needed to further investigate this relationship.     

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children,Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients’ specific needs.     

La gestion des émotions et ses déficits,chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping

The goal of this review is to synthesize the data of scientific literature on emotional management and its deficits in chronic pain. We used terms referenced in databases and MesH terms (of the United States National Library of Medicine) to perform a literature search in a powerful online search engine (EBSCOhost research databases). Four hundred and forty-nine papers, taken from international reviews and published of 1994 (because it is in the middle of the 1990s that this theme begins to be handle) to the end of January, 2015, are identified by a total 5 electronic databases with predefined keywords about emotions and chronic pain. Forty-six of which met the inclusion criteria, according to their title, their summary and their complete text. The findings suggest that some emotional management strategies and its deficits can maintain a vicious circle of negative emotional states with physiological and psychopathological consequences. Several studies show that alexithymia, emotional ambivalence and emotional suppression have a deleterious impact on pain, emotional distress (depression, anxiety) and disability. In spite of some contradictions concerning the nature of this effect (sensory or affective pain intensity or even duration of pain), it seems that alexithymia is a major variable implied in chronic pain. Inversely, experiential acceptance has a beneficial effect on psychological distress (depression, anxiety and stress). Emotional disclosure (of stressful or traumatic events) can decrease pain intensity but not disability and mental health. Likewise, emotional expression in daily life seems beneficial, but when the expression of the positive and negative feelings are distinguished, emotional expression of negative feelings increases pain, disability and distress. The whole of these findings emphasize the need to further research about emotional management in chronic non-cancer pain. It is necessary to identify and control the source of potential bias. Some hypotheses have been proposed to explain these findings. In the future, it would be interesting to use a multifactorial approach to investigate the interactions between various processes of emotional management in chronic pain patients.     

Effects of psychological interventions on competitive anxiety in sport: A meta-analysis

ObjectivesThis study reviewed the effects of psychological interventions on competitive anxiety in sport.DesignMeta-analysis and systematic review.MethodPsycINFO, PsycARTICLES, SPORTDiscus, Web of Science, ProQuest, and Sage databases were searched for experimental studies that fulfilled the inclusion criteria. Risk of bias was assessed using the 12 criteria Cochrane Review Book Group tool. Hedge's g and 95% confidence intervals (CIs) were calculated and pooled using a random effects model employing the Hartung-Knapp-Sidik-Jonkman (HKSJ) method.ResultsThe search strategy identified 37 studies which fulfilled the inclusion criteria. The meta-analysis was conducted on 34 studies after removal of outliers. The results showed an overall small to medium-sized effect for psychological interventions on competitive anxiety in athletes (g = −0.42; 95% CI, −0.58 to −0.25). Subsequent subgroup analyses showed that this finding was robust regardless of experimental design, anxiety measure, anxiety type, gender, country, sport, intervention component, intervention delivery method, and intervention duration. The results indicated that the effects might be greater for athletes of higher levels of competition as compared to those from lower levels of competition. Separate meta-analyses also suggested that there were medium to large-sized effects for cognitive anxiety (g = −0.54) and self-confidence (g = 0.55) intensity, and a small to medium-sized effect for somatic anxiety (g = −0.36) intensity.ConclusionThe findings from this review study provide a robust evidence base for the use of psychological interventions to help reduce competitive anxiety in athletes. Future studies need to investigate how psychological interventions might affect the directional interpretation of anxiety symptoms.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

Meta-analysis of cognitive-behavioral interventions on HIV-positive persons' mental health and immune functioning.

OBJECTIVE: To evaluate the efficacy of cognitive-behavioral interventions (CBIs) for improving the mental health and immune functioning of people living with HIV (PLWH). DESIGN: Comprehensive searches of electronic databases from 1988 to 2005, hand searches of journals, reference lists of articles, and contacts with researchers. Meta-analytic approaches were used in synthesizing findings. MAIN OUTCOME MEASURES: Intervention effects on symptoms of depression, anxiety, and anger, stress, and CD4 cell counts were assessed. RESULTS: Data from 15 controlled trials were analyzed. Significant intervention effects were observed for improving symptoms of depression (d = 0.33), anxiety (d = 0.30), anger (d = 1.00), and stress (d = 0.43). There is limited evidence suggesting intervention effects on CD4 cell counts (d = 0.08). The aggregated effect size estimates for depression and anxiety were statistically significant in trials that provided stress management skills training and had more than 10 intervention sessions. CONCLUSION: CBIs are efficacious in improving various psychological states of PLWH. Future research should examine the relationship among interventions, psychological states, medication adherence, and immune functions, and identify other relevant factors associated with intervention effects.     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

A contextual approach on sex-related biases in pain judgements: the moderator effects of evidence of pathology and patients' distress cues on nurses' judgements of chronic low-back pain

Although women report feeling more pain than men, their pain is often underdiagnosed and undertreated. By proposing a gender-based theoretical conceptualisation, we argue that such sex-related biases may be enhanced or suppressed by contextual variables pertaining to the clinical situation, the perceiver or the patient. Consequently, we aimed to explore the moderator role of two clinically relevant variables in a chronic low-back pain (CLBP) scenario: diagnostic evidence of pathology (EP) and pain behaviours conveying distress. One-hundred and twenty-six female nurses (M?=?35.33, SD?=?7.64) participated in an experimental between-subjects design, 2 (patient's sex)?×?2 (EP: present vs. absent)?×?2 (pain behaviours: with vs. without distress). Independent variables were operationalised by vignettes depicting a patient with CLBP. Nurses judged the patient's pain on several dimensions: (1) credibility; (2) disability; (3) severity of the clinical situation; (4) psychological attributions and (5) willingness to offer support. Main findings showed that judgements of women's pain were influenced by EP, while judgements of men's pain were not. Moreover, nurses showed biases against men, but only in the presence of EP. The influence of distress cues was less consistent. Theoretical and practical implications are drawn.     

Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial

Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash-associated disorders were recruited from a patient organization and randomized to either a treatment or a wait-list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10-session protocol emphasizing values-based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7-month follow-up. The authors discuss implications of these findings and offer suggestions for further research in this area.     

Quality of Well-Being Scale and Chronic Low Back Pain

Outcome measures that assess quality of life for use in health policy decisions need to be investigated in chronic pain patients. In the present study, the validity of the Quality of Well-Being Scale (QWB) was evaluated on 67 adult chronic low back pain (CLBP) patients who were enrolled in a 12-week multidisciplinary pain treatment program. Participants completed the QWB, a battery of pain measures, a behavioral observation task, and a medical exam. The findings indicated that CLBP patients have a low level of functioning or quality of life (M = .567, SD = .08) compared with persons with life-threatening diseases. The QWB score was significantly correlated with observational measures of pain behavior and pain-related coping strategies. Multivariate analysis indicated that interference in daily activities, distorted ambulation, affective distress, pain duration, and guarding were the most significant predictors of quality of well-being (multiple R = .84, p < .0001). Patients with medically incongruent physical signs had significantly lower QWB scores than patients with congruent signs. Overall, the data supported the validity of the QWB in a sample of CLBP patients.     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

OBJECTIVE: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. METHOD: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. RESULTS: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. CONCLUSION: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy.