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.     

Emotional experiences during engagement in intrinsically and extrinsically motivated tasks

Previous theories of intrinsic motivation have traditionally ignored the experiential or subjective aspects of engagement in intrinsically and extrinsically motivated tasks. Part of the reason for the lack of research in this area was our ignorance of which emotions to study. Data are presented here from two studies designed to produce the first systematic evidence of changes in basic emotional states during task engagement. Our findings suggest that intrinsic and extrinsic tasks can be differentiated according to the emotional changes subjects retrospectively report about their engagement with these tasks, and point the way to future research incorporating emotion as an important variable to consider.The first author was supported in part by a Minority Fellowship administered by the American Psychological Association under a Clinical Training Grant from the National Institute of Mental Health (5 T01 MH13833), and by a Regents Fellowship from the University of California, Berkeley.     

Religion,Type A behavior,and health

In a study of air traffic controllers, religious differences are found in the way Type A behavior is associated with several health status indicators. Associations between the Jenkins Activity Survey (JAS) and physical illness incidence, health-promotive behavior, diastolic and systolic blood pressure, subjective distress and impulse control problems, and alcohol consumption are examined by religious attendance, religious affiliation, and change in affiliation. Findings confirm that Type A does not vary significantly by religion. However, there are several significant findings between Type A and various health indicators. Type A is associated with illness incidence, overall and more strongly in several religion, subgroups. Type A and alcohol consumption are related positively in Protestants and converts, and negatively in churchgoing Catholics. Type A is related to impulse control problems in churchgoing Protestants and to subjective distress in churchgoing Catholics. Finally, in individuals with weak or no religious ties, Type A is associated with lower blood pressure. This last finding suggests that in some people (for example, the irreligious or unchurched), the coronary-prone behavior pattern may have cardiovascular effects which are salutary in at least one respect.The authors wish to thank Dr. Kyriakos S. Markides and Laura A. Ray for their assistance with this study. Address requests for reprints to Dr. Levin at the Institute of Gerontology, 300 North Ingalls, Ann Arbor, MI 48109.